Therapist and Patient Mental Representations: The Early Therapy Relationship in Long-Term Psychodynamic Psychotherapy

Blatt and Zurhoff (2005) have studied psychotherapy outcome and argue that the therapeutic relationship is one of the most influential factors promoting client change. Many clinicians and researchers agree and have focused on several aspects of the therapy relationship that foster client growth, notably the working alliance (Bordin 1979; Crits-Christoph and Connolly Gibbons 2003; Greenson 1967; Zetzel 1958, 1966), transference (Graff and Luborsky 1977; Gelso, Hill, and Kivlighan 1991), countertransference (Multon, Patton, and Kivlighan 1996; Gelso and Hayes 1998, 2002), and the real relationship (Couch 1999; Gelso 2002; Gelso and Hayes 1998; Gelso et al. 2005; Marmarosh et al. in press).

Blatt and colleagues (Blatt 1974; Blatt and Felsen 1993; Blatt and Shahar 2004) argue that psychotherapy research should also address how different patients benefit from the therapy relationship based on their varying ability to engage in treatment. They contend that patients' mental representations before treatment are integral to understanding long-term psychodynamic therapy. To address this issue, Blatt and his colleagues introduced a distinction between two broad categories of personality organization—anaclitic and introjective. Blatt and Shahar (2004) studied these two personality types in patients and found that patients who are anaclitic, who desire interpersonal relatedness and experience anxious attachment styles, benefit most from a form of analytic treatment that focuses on relational issues and supports their need for closeness. Patients with an introjective style, who tend to focus on self-worth and self-definition, and experience an avoidant attachment style, benefit most from analytic treatment focused on interpretation. Blatt observed a distinction between patients who turn away from relationships and those who seek merger to cope with deficits in the self.

Like Blatt (2001), Banai, Mikulincer, and Shaver (2005) applied Kohut's concept of selfobject hunger and avoidanc