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Factors Contributing to Sustained Therapeutic Gain in Outpatient Treatments of Depression

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Book cover Handbook of Evidence-Based Psychodynamic Psychotherapy

Part of the book series: Current Clinical Psychiatry ((CCPSY))

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Abstract

It is vital for the mental health disciplines, in this era of public and scientific demands to identify empirically supported treatments (ESTs), to differentiate themselves from other types of health-care providers, to define more precisely the uniqueness of the disorders with which we work, and to identify the central features of the treatments we provide and the dimensions that contribute to constructive and sustained therapeutic change.

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Notes

  1. 1.

    The clinical management (CM) component was designed to manage the medications and to “provide a generally supportive atmosphere and to enable the psychiatrist to assess the patient’s status.” “The manual and training … include guidelines for providing support and encouragement to the patient and giving direct advice when necessary. This CM component thus approximates a ‘minimal supportive therapy’ condition” [88].

  2. 2.

    Several studies of brief cognitive and pharmacological treatment of depression provide further support for the influence of the patients’ personality styles on therapeutic outcome. Peselow, Robins, Sanfilipo, Block, and Fieve [107], investigating the response to pharmacotherapy among 217 depressed outpatients, found that patients with high autonomous–low sociotropic profile on the SAS (introjective patients) responded better to antidepressants than patients who had a high sociotropic–low autonomous profile (anaclitic patients). According to Peselow and colleagues (1992), these findings support Beck’s [15] contention that the autonomous form of depression includes endogenomorphic characteristics. Rector, Bagby, Segal, Joffe, and Levitt [108], investigating depressed outpatients treated with either cognitive therapy (N = 51) or pharmacotherapy (N = 58), found that DEQ self-criticism did not influence the response to medication but did predict poorer response to cognitive therapy. Zettle and colleagues [109, 110] compared the responses of sociotropic and autonomous (anaclitic and introjective) depressed outpatients to individual and group cognitive therapy for depression and found that sociotropic patients had greater therapeutic response in group therapy, while autonomous patients had greater therapeutic response to individual therapy.

  3. 3.

    Similarily, Cox, Walker, Enns, and Karpinski [111] found that changes in level of self-critical perfectionism/autonomy were significantly related to outcome in brief group CBT of patients with generalized social phobia. The extent of change of self-critical perfectionism predicted therapeutic outcome.

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Authors and Affiliations

  1. Department of Psychiatry and Psychology, Yale University, 300 George Street, Suite 901, New Haven, CT, 06511, USA

    Sidney J. Blatt, David C. Zuroff & Lance Hawley

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  1. Sidney J. Blatt
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  2. David C. Zuroff
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  3. Lance Hawley
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Correspondence to Sidney J. Blatt .

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  1. Psychotherapy Research Program, Massachusetts General Hospital, Boston, MA, 02114, USA

    Raymond A. Levy (Clinical Director) & J. Stuart Ablon (Director) (Clinical Director) &  (Director)

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Blatt, S.J., Zuroff, D.C., Hawley, L. (2009). Factors Contributing to Sustained Therapeutic Gain in Outpatient Treatments of Depression. In: Levy, R.A., Ablon, J.S. (eds) Handbook of Evidence-Based Psychodynamic Psychotherapy. Current Clinical Psychiatry. Humana Press. https://doi.org/10.1007/978-1-59745-444-5_12

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