Working with Grief, Depression, and Masochism

Therapists struggle to help patients for whom situational stresses interact with personality patterns in complicated combinations of grief, mourning, and depressive and masochistic dynamics. Because neither “Depressive Personality Disorder” nor “Self-Defeating Personality Disorder” is found in the DSM or ICD, official taxonomies offer little clinical help in distinguishing between various painful self-states and framing therapy accordingly. Dr. McWilliams will differentiate conceptually between depression and mourning, between anaclitic and introjective depression, between relational self-sabotage and “moral masochism” (Reik, 1941), and between depressive and self-defeating personality patterns. She will give clinical examples, including a case in some depth, that illustrate treatment implications of the different presentations of sadness, despair, and malignant self-regard.