Blatt S J
Department of Psychiatry, Yale University, New Haven, CT 06519.
J Am Psychoanal Assoc. 1992;40(3):691-724. doi: 10.1177/000306519204000303.
Analyses of the data from the Menninger Psychotherapy Research Project (MPRP) have consistently indicated little difference in the therapeutic outcome between patients seen in psychoanalysis and those seen in psychotherapy. Reanalysis of the data from the MPRP, utilizing a distinction between two broad configurations of psychopathology (Blatt, 1974, 1990a; Blatt and Shichman, 1983), however, indicates that patients whose pathology focuses primarily on disruptions of interpersonal relatedness and who use primarily avoidant defenses (anaclitic patients), and patients whose pathology focuses primarily on issues of self-definition, autonomy, and selfworth and who use primarily counteractive defenses (introjective patients) differ in their responsiveness to psychotherapy and psycho-analysis. Based on recently developed procedures for systematically evaluating the quality of object representation on the Rorschach, reanalysis of the Menninger data reveals that anaclitic patients have significantly greater positive change in psychotherapy, while introjective patients have significantly greater positive change in psychoanalysis. These statistically significant patient-by-treatment interactions are discussed in terms of their clinical implications as well as the importance of differentiating among types of patients in studies of therapeutic outcome and of therapeutic process.
对门宁格心理治疗研究项目（MPRP）数据的分析一直表明，接受精神分析治疗的患者与接受心理治疗的患者在治疗结果上差异不大。然而，利用精神病理学的两种广泛构型之间的区别（布拉特，1974年，1990年a；布拉特和希克曼，1983年）对MPRP数据进行重新分析后发现，病理主要集中在人际关联中断且主要采用回避防御机制的患者（依恋型患者），以及病理主要集中在自我定义、自主性和自我价值问题且主要采用对抗防御机制的患者（内摄型患者），在对心理治疗和精神分析的反应上存在差异。基于最近开发的系统评估罗夏测验中客体表征质量的程序，对门宁格数据的重新分析显示，依恋型患者在心理治疗中具有显著更大的积极变化，而内摄型患者在精神分析中具有显著更大的积极变化。这些具有统计学意义的患者与治疗方式的交互作用将从其临床意义以及在治疗结果和治疗过程研究中区分不同类型患者的重要性方面进行讨论。
