The Person in Recovery From Acute and Severe Psychosis: The Role of Dependency, Self-Criticism, and Efficacy Golan Shahar, PhD Yale University Peter Trower, PhD, Zaffer Iqbal, PhD, and Max Birchwood, FBPsS University of Birmingham Larry Davidson, PhD Yale University Paul Chadwick, PhD University of Southampton The role of 3 personality dimensions (i.e., dependency, self-criticism, and efficacy) in recovery from an acute and severe psychosis was examined. Conceptualizing psychosis as involving difficulties in establishing psychological boundaries, the authors hypothesized that dependency has a greater disruptive effect on recovery than self-criticism. Results of a reanalysis of longitu- dinal data (N  76) of people with schizophrenia spectrum disorders during recovery from acute psychosis were consistent with this hypothesis: Dependency predicted depressive and negative symptoms, and, under low efficacy, perceived loss of independence and insight into the presence of the illness. These findings elucidate the central role of interpersonal relatedness as a foundation for self-definition in recovery from psychosis. “I’m nobody ‘til somebody loves me. That’s the way I look at it.” —Man with schizophrenia speaking with interviewer Findings regarding the heterogeneity of outcome in psychosis (Davidson, 2004; Davidson & McGlas- han, 1997; Eggers & Bunk, 1997; McGlashan, 1988) have led several groups of investigators to focus on personal variables that might explain variability in the age and mode of onset, symptom profile and course, and treatment response in severe psychopa- thology. A focus on personal resilience in particular has been consistent with the emergence of the mental health consumer movement (Chamberlin, 1990; Dee- gan, 1988, 1992, 2000; Frese, 1998, 2000; Frese & Davis, 1997), in which people who have recovered to a significant degree from severe mental illness have become advocates and spokespeople for a more humanizing approach to psychiatric under- standing and practice (e.g., Davidson et al., 2001). Recognition that many people are able to show sig- nificant improvements in various life domains over time has resulted in increased clinical investigation of personality and other psychosocial factors in psy- chotic illness in general and schizophrenia in partic- ular (Hulbert, Jackson, & McGorry, 1996; Strauss, 1989). Inspired by these trends, we sought to examine the role of dependency and self-criticism in recovery from a psychotic episode in people with schizophre- nia spectrum disorders. These two dimensions, ini- tially proposed by Blatt (1974, 1998; Blatt, Shahar, & Zuroff, 2001; Blatt & Shichman, 1983; Blatt & Zuroff, 1992), reflect two primary configurations of personality that correspond to two fundamental de- velopmental trajectories: the development of inter- personal relatedness and self-definition. Interpersonal relatedness pertains to the need to establish and main- tain close, nurturing, and supportive interpersonal relationships, whereas self-definition pertains to the need to establish and maintain a stable, realistic, and essentially positive sense of self as an effective social agent. Healthy development entails the ability to co- ordinate the synergistic, interactive development of these two fundamental processes (Blatt & Blass, Golan Shahar, PhD, Departments of Psychiatry and Psy- chology, Yale University; Peter Trower, PhD, Zaffer Iqbal, PhD, and Max Birchwood, FBPsS, Department of Psychol- ogy, University of Birmingham, Birmingham, United King- dom; Larry Davidson, PhD, Department of Psychiatry, School of Medicine, Yale University; Paul Chadwick, PhD, Department of Psychology, University of Southampton, Southampton, United Kingdom. The analyses reported here were conducted with the support of a grant from the International Psychoanalytic Association. We thank Sidney J. Blatt for his helpful com- ments on drafts of this article. For reprints and correspondence: Golan Shahar, PhD, Department of Psychiatry, Yale University, 205 Whitney Avenue, New Haven, CT 06511. E-mail: golan.shahar@yale.edu American Journal of Orthopsychiatry Copyright 2004 by the Educational Publishing Foundation 2004, Vol. 74, No. 4, 480 – 488 0002-9432/04/$12.00 DOI: 10.1037/0002-9432.74.4.480 480