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TMatch: Matching Clients to Therapist
Based on Anaclitic and Introjective Dimensions

Short Restatement of Matching Recommendations

The recommendation for introjective clients was that they should be matched with therapists who are less direct, and who practice therapy that tends to be less time limited. Anaclitic clients should be matched to therapists who are more direct and openly friendly.

Client Assessments

Blatt, Shahar, and Zuroff (2002, p 320) suggest four ways of assessing anaclitic and introjective types of depression. The shortest method is the Dysfunctional Attitudes Scale (DAS), which was designed by Arlene Weissman to measure cognitive distortions, especially those related to depression (Weissman, 2000, p. 263). According to Blatt et al., factor analysis of the DAS has identified two principal factors. Need for approval corresponds to the anaclitic style, and perfectionism corresponds to the introjective style. Although the DAS was designed for use with depression, it was hoped it would still work for TMatch, since Blatt et. al recommend it for measuring their two personality traits, and since these two personality traits show themselves in psychopathology.

By comparing factor analysis by different research groups, I shortened the shortest existing version of the DAS, which was 40 questions, to just 11 questions. Questions 1-5 below assess need for approval, which was taken as the measurement of anaclitic style. Questions 6-11 assess perfectionism, which was taken as the measurement of introjective style. The DAS is is normally answered on a Likert scale with 7 choices. This was reduced to 5 choices for TMatch.

  1. My value as a person depends greatly on what others think of me.
  2. What other people think about me is very important.
  3. If others dislike you, you cannot be happy.
  4. I do not need the approval of other people in order to be happy.
  5. I cannot be happy unless most people I know admire me.
  6. If I do not do as well as other people, it means I am an inferior human being.
  7. If I fail at my work, then I am a failure as a person.
  8. If I do not do well all the time, people will not respect me.
  9. If I am to be a worthwhile person, I must be truly outstanding in at least one major respect.
  10. People will probably think less of me if I make a mistake.
  11. People who have good ideas are more worthy than those who do not.

Therapist Assessment: Directiveness

Therapist directiveness was assessed with five questions:

  1. How much direction or control do you usually exert over what your clients discuss during therapy?
  2. How directive are you with clients during therapy?
  3. In general, how confrontational is your therapy?
  4. How often do you give specific advice to clients?
  5. To what degree is your usual method of therapy structured?

Therapist Assessment: Openness and Friendliness

Therapist openness and friendliness was assessed with the following questions:

  1. What level of intimacy usually occurs during your therapy?
  2. Place yourself on the following scales: (choices were on seven-point scales)
    1. I tend to be cooperative vs. I tend to be competitive
    2. I tend to be hard-headed and tough-minded vs. I tend to be compassionate and tender-minded
    3. I tend to be argumentative vs. I tend to be conciliatory

Therapist Assessment: Long-Term Emphasis of Therapy

The assessment for long-term emphasis of therapy was made with a combination of two questions relating to therapy complexity, one question directly related to therapy depth, and a section of direct questions asking therapist about their preference for length of therapy. The questions about complexity were added because it was assumed that complex therapy would require more time.


Future Use of Anaclitic and Introjective Dimensions for Client-Therapist Matching

Results of Study: Client Assessment

The reduction of the Dysfunctional Attitude Scale (DAS) created for TMatch had five questions to assess Need for Approval, purported to correspond to the anaclitic style, and five questions to assess Perfectionism, purported to correspond to the introjective style. Although these traits are supposed to be competing, where one or the other predominates in people, it did not appear that the questionnaire elicited this separation. To the contrary, the questions that evaluated Need for Approval and those that evaluated Perfectionism were completely separate, and the answers to these questions seem to be independent of each other. That is, there does not appear to be any reason why a person high in Perfectionism would therefore be relatively lower in Need for Approval, and vice versa. In fact, in the study, the client who was highest on Need for Approval was also highest on Perfectionism. In addition, these traits are supposed to be evident only in clients with pathology, which makes these criteria less useful for matching in general.

Results of Study: Therapist Assessment of Directiveness

Although there was a tendency for therapists to answer toward the middle on this assessment, there was a useful variety in their answers. If most therapists really do fall in the middle range of directiveness, the questions could be expanded to draw out more subtle differences.

Results of Study: Therapist Assessment of Openness and Friendliness

This questions in this assessment did not work well. Almost all therapists saw themselves as having a great deal of intimacy in their therapy, as being very cooperative, compassionate and tender-minded, and as being conciliatory. If one could believe therapists' self-assessments, they all seem to be open and friendly. Perhaps the problem is that the questions all had one side that might have a negative connotation. For example, what therapist wants to be seen as being competitive rather than cooperative?

Results of Study: Therapist Assessment of Long-Term Emphasis of Therapy

This assessment seemed to work well. Of course it could be improved and validated through a more thorough study, but at this stage of development, it did differentiate therapists on the dimensions of emphasis on preference for therapy length and depth.

Results of Study: Matching Success

Despite the problems with the assessments, there was some indication that this matching criterion has potential to be useful.

Improvements in Client Assessment Needed for Future Success

A possible solution for the client assessment would be to increase the assessment to include all the questions from the DAS relating to the Need for Approval Scales and the Perfectionism Scales. However, the DAS measures these traits for depressed clients. That is, these traits are considered two different types of depression (Blatt, Shahar, and Zuroff, 2002). This is confirmed by the description of this scale by its creator (Weissman, 2000, p. 263), who states that its purpose is to identify cognitive distortions "that may underlie or cause depression." All other instruments suggested by Blatt, Shahar, and Zuroff are also for measuring these traits in the context of differentiating types of depression. However, Blatt et al.'s description of the Sociotropy-Autonomy Scale (SAS) and the Personal Style Inventory (PSI) seem to imply that these scales are less dependent on the assumption of depression. Both of these instruments should be examined for the possibility of using them to retry this matching criterion with more complete and appropriate client assessment.

Improvements in Therapist Assessment Needed for Future Success

The therapist assessments of directiveness and long-term-emphasis are probably adequate to be used without major changes. The therapist assessment of openness and friendliness needs to be improved to give a wider range of answers. The questions making up this assessment need to be rewritten so that neither of the choices for these questions has negative connotations.

General Conclusion

Although this criterion could be useful for matching, its relatively limited usefulness compared to other matching criteria, such as those from Prescriptive Psychotherapy, might mean that it should be deleted from TMatch. The main problem is that clients would have to be assessed for anaclitic and introjective dimensions just for this one matching criterion. To give accurate results, this assessment would take a fair amount of time and space in TMatch, and could not be used for any other aspect of matching. This is not the case for the therapist assessments, which can be used for several different criteria. If a short valid method can be found for accurate client assessments, then this matching criterion would be worth exploring further. Of course, it would be worth exploring this matching criterion by itself in a study, to determine its effectiveness.


For more information, or to give feedback, email Kenneth Frankel, Ph.D.

References

Beck, A. T., Brown, G., Steer, R. A., & Weissman, A. N. (1991). Factor analysis of the dysfunctional attitude scale in a clinical population. Psychological Assessment, 3 (3), 478-483.

Blatt, S. J., Shahar, G., & Zuroff, D. C. (2001). Anaclitic (sociotropic) and introjective (autonomous) dimensions. Psychotherapy, 30(4), 449-454.

Blatt, S. J., Shahar, G., & Zuroff, D. C. (2002). Anaclitic/sociotropic and introjective/autonomous dimensions. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions and responsiveness to patients (pp. 315-333). New York: Oxford University Press.

Cane, D. B., Olinger, L. J., Gotlib, I. H., & Kuiper, N. A. (1986). Factor structure of the dysfunctional attitude scale in a student population. Journal of Clinical Psychology, 42 (2), 307-320.

Weissman, A. (2000). Dysfunctional attitude scale (DAS). In J. Fischer and K. Corcoran (Eds.), Measures for clinical practice: Volume 2. Adults (3rd ed.) (pp. 263-266). New York: Free Press.