1. Depressive and Self-Defeating Personalities
Nancy McWilliams, PhD, ABPP
Rutgers Graduate School of Applied & Professional Psychology

2. Depressive personality does not equate with depressive illness
It is a more chronic, low-grade tendency toward feeling guilty or inadequate, feelings that go with cognitions explaining painful life experiences in terms of personal malfeasance or failure. One can have a depressive personality and never have had a significant depressive episode.

3. In fact . . .
It appears to be the most common personality type among psychotherapists (Hyde, 2009)

4. Depression versus normal grief:
In normal grief states:
There is a clear loss or rejection.
The world seems bad or empty.
The painful feelings come in waves; between the waves there is normal mood.
In depressive episodes:
The precipitant may be unclear.
The self seems bad or empty.
The painful feelings are chronic and unremitting.
There is no sense of a capacity to improve one’s mood (cf. Seligman’s “learned helplessness”)

5. Depressive and self-defeating personality disorders are not in the DSM or the ICD taxonomies
The decision not to include them, despite evidence that depressive-masochistic personality (Kernberg, 1984) is the most common kind of personality disorder, resulted from political rather than scientific factors.
The Psychodynamic Diagnostic Manual, which tries to reflect both accrued clinical experience and research, does have a category for depressive personality styles and disorders, with hypomanic and self-defeating variants.

6. Diagnosis for clinical purposes
Dimensional rather than categorical
Inferential rather than reified
Contextual rather than isolated
Integrated rather than artificially “co-morbid”

7. Depressive/masochistic affect
Psychological pain
Distress and a sense of grief without a clear object
Guilt and/or shame
Self-hatred (Fairbairn’s “moral defense”)
At the level of brain activity, activation of Jaak Panksepp’s PANIC (separation/attachment) system

8. Depressive and Masochistic Cognition
“When I experience a rejection, loss, or disappointment, I conclude it is because there is something wrong with me.
Early childhood experience that sets the stage for depressive psychology may include the inference, “Mother is gone. It must be my fault. I was bad or insufficient in some way.”
In masochistic psychology (especially the relational subtype), the inference is more like, “Mother is gone. It must be my fault. I was bad or insufficient in some way. But maybe if I keep demonstrating how hurt or needy I am, she will return.” Thus, attachment is predicated on suffering (cf. Martha Stark’s “relentless hope”)

9. Depressive and Masochistic Defenses
Introjection
Turning against the self
Idealization of others
Identification with the aggressor
In masochism, acting out and “victim entitlement”

10. Two subjective experiences of depressive psychology (Blatt, 2008)
Anaclitic (self-in relationship)
Introjective (self-definition)
Shame
Sense of being empty of anything valuable.
Relationship itself is therapeutic and reduces symptoms quickly.
Danger of losing gains at the end of a therapy.
Guilt
Sense of being full of badness, evil.
Therapy takes longer and must include focus on cognitions about one’s “faults.”
Improvement may continue after the end of treatment.

11. Transference in depressive patients
They attach quickly and may convey a sense of trust and hope.
They tend to idealize the therapist, but not in an empty way: they appreciate good qualities in the therapist that are real.
They are alert for criticism and rejection from the therapist.
They try to please, and they try not to “bother” the therapist.
They are frightened of any negative feelings or attitudes toward the therapist.

12. Countertransferences to depressive individuals
They are likeable and evoke natural sympathy.
The introjective type may be perfectionistic and be admirable as a result.
Both types may induce warmth and genuine concern, though the self-hatred of the introjective patient can become tedious, as can the passive dependency of the anaclitic patient.
Both depressive types may eventually evoke a sense of futility that mirrors the patient’s despair.
It is sometimes easy to enjoy the patient’s idealization and not notice opportunities to explore his or her negative experiences of the therapist.

13. Treatment implications for people with depressive psychologies
Because of their tendency to attach easily, they work well in therapy.
Anaclitically depressive patients may be helped by normalizing conversations about their sensitivity to attachment and separation. They may need either significantly long treatments, so that they can internalize the therapist’s attitude, or, when in shorter therapies, specific psychoeducation about separation.
Introjectively depressive patients need confrontation of their underlying automatic cognitions.
“Supporting the ego” versus “attacking the superego.”
Both need to become comfortable with critical and hostile feelings toward the therapist; otherwise, they will end treatment thinking they were lucky to go to such a wonderful person – without experiencing improvement in their own self-acceptance.

14. Self-defeating (masochistic) patients: Subtypes
Introjective self-defeating patients have been called “moral masochists” or Millon’s (1995) “aggrieved pattern” of personality
Anaclitic self-defeating patients have been called dependent or narcissistic- masochistic patients (Cooper, 1988)
There is a more paranoid version of masochism that Nydes (1965) called the “paranoid-masochistic character
Importance of appreciating the difference between normal altruism or surrender and masochistic submission (comparable to differences between grief and depression)

15. “Normal Masochism” (Adaptive Altruism)
Like all psychopathology, self-defeating patterns are extreme versions of normality.
Altruistic self-sacrifice is evolutionarily important to the survival of the human species. Parenting mammals will put the welfare of their children ahead of their individual welfare; we are biologically equipped for such sacrifices.
C. G. Jung: Masochism as a perversion of the normal need to worship or venerate
Helena Deutsch: Masochism as a normal and inevitable part of mothering
Emmanual Ghent: Masochistic submission as a perversion of the normal need to surrender to something larger than the self

16. Unconscious motives behind self-defeating behavior (Reik, 1941)
Provocation (“Let’s get the suffering over with”)
Appeasement (“I’m already suffering, so please don’t hurt me”)
Exhibitionism (“Pay attention! I’m in pain!”)
Deflection of guilt (“Look what you made me do!)

17. Masochistic Clinical Presentations
The “Isn’t it terrible?!” presentation, in which the patient attempts to enlist you in lamenting a context of victimization that is taken as a fact of life
Indications of the patient’s pleasure in frustrating efforts to help, like the slight smile in reporting, “That medicine didn’t work either . . .”
Emphasis on the role of others in wounding the person and recruitment of the therapist to feelings that the patient deserves special compensations for a difficult history (“victim entitlement”)

18. Countertransferences to self-defeating patients
Initially, deep compassion for the person, based on the patient’s having been realistically victimized
Also, early in treatment, masochistic feelings (expressed in behaviors such as reducing the fee, seeing the patient at inconvenient times, being available by telephone at all hours)
Usually later in treatment, irritable, sadistic feelings, including hostility, exasperation, lack of compassion.

19. Treatment implications for self-defeating patients
Don’t exemplify masochism
Don’t be too sympathetic (it can reinforce the schema that attachment is based on the patient’s suffering)
Don’t take on the patient’s anxiety (masochistic patients off-load it on the therapist, and they need it to motivate change)
Confront the underlying fantasy that if the therapist really understands the patient’s pain, psychological progress will happen without the patient’s personal effort.
These therapeutic stances tend to evoke anger in the patient, which is important to welcome and work through as a corrective to the person’s internal conviction that only the suffering self is welcome to others. Important to be accepted with one’s darker, more aggressive side.

20. Thank you!

21. Schizoid Psychologies
Nancy McWilliams, PhD, ABPP
Rutgers Graduate School of Applied & Professional Psychology

22. Not the DSM Version of Schizoid
The term “schizoid,” as it has been used in psychoanalytic clinical writing, does not imply schizophrenia, nor does it imply indifference to closeness. It refers to a central conflict around closeness versus distance.
Schizoid individuals are introverted and sensitive and often have rich inner lives. In the extroverted cultures of contemporary Western societies, schizoid people are often misunderstood and seen as pathological.

23. In fact . . .
A schizoid temperament is the second most common personality type in therapists, and is especially common, it would seem, in psycho- analysts: “Psychoanalysis is a profession by schizoids for schizoids” (attributed to Guntrip)
The role of therapist allows one to get very close to another person, but without being too exposed for one’s own comfort.
Schizoid people are often attuned to dynamics that are unconscious in other people (this differentiates them from those on the autistic spectrum).

24. Why not just call them introverts?
Because this term lacks the connotation of a rich inner life and the dynamisms and internal splits that were captured originally by the term “schizoid.”
On the Myers-Briggs inventory, they tend to score as INFJ (introverted, intuitive, feeling, judging), a group that is very small and sometimes called “the seers” or “the mystics” or “the confidants.”

25. The Schisms in Schizoid People
Overt Presentation
Covert Phenomenon
Detached
Self-sufficient
Absent-minded
Non-reactive
Blunted affect
Non-sexual and ascetic
Gentle, tentative
Longing to be close
Emotionally needy
Acutely vigilant
Highly reactive
Intense affect
Sexually preoccupied
Fantasies of world destruction

26. Distinctive Characteristics
Creativity/originality
Unconventionality/indifference to how others may see them
Deliberate eccentricity

27. Relational Patterns
“Come close, for I am alone, but stay away, for I fear intrusion” (Robbins, 1988)
The schizoid person “can neither be in a relationship with another person nor out of it, without risking the loss of both his object and himself” (Guntrip, 1969)
Schopenhauer’s Porcupines

28. Affects
Schizoid people may appear to be indifferent to emotion, but privately, they are frequently trying to manage intense feelings that threaten to overwhelm them.
Most common feelings in this struggle are fear, anger and hatred, shame, sadness, and longing.

29. Defenses Withdrawal – either physically or into the mind Dissociation
They notably lack distorting defenses such as repression and reaction formation

30. Problematic cognitions
Love is more dangerous than hatred.
Attachment hurts the other person and the self.

31. Problematic cognitions
Love is more dangerous than hatred.
Attachment hurts the other person and the self.

32. Experiential contributions
“Cumulative trauma” (Khan, 1963)
“Toxic nourishment” (Eigen, 1973)
“Impingement” (Winnicott)
Parental difficulty accepting normal dependency, whether because of depression, intrusiveness, or lack of “fit” between caregivers and child (Escalona, 1968)
Microtrauma and dissociation (Howell, 2005)
Lack of validating messages because of the relative rarity of this temperament

33. Transferences in schizoid patients
Resistance to attachment
Pain because of exposure (“It hurts too much to talk”)
Expectation of lack of understanding and intrusiveness from the therapist
Great sensitivity to any therapeutic mistake
Pleasure in, and gratitude for, authenticity

34. Countertransference with schizoid patients
Pleasure in the patient’s imagination, psychological talent, and honesty
Feelings of painful disconnection and some difficulties with silent periods
Fear of hurting the patient
Guilt over hurting the patient
Moments of symbiotic bliss

35. Treatment Implications
Be aware of how schizoid people appreciate the clear boundaries of psychotherapy and react well to standard therapies.
Be open to the patient’s sense of reality, even if it feels strange.
Do not probe or quiz or make the patient feel like a “case.”
Be willing to be seen as more “real” than may be wise with other patients.
Be willing to talk about transitional objects and topics.
Encourage the patient to take the growing capacity for pleasure in relationship beyond the therapeutic relationship.

36. And perhaps most important . . .
Psychotherapy with individuals with schizoid psychologies is not really about “making the unconscious conscious” (psychoanalytic) or “changing the patient’s irrational thoughts” (cognitive).
It is instead about allowing the patient to elaborate his or her personality fully in an atmosphere of emotional safety.

37. Thank you!