Within the field of clinical psychology, contributors who are both psychoanalysts and leading empirical researchers are exceedingly and increasingly rare. Yet one figure who made extensive contributions as an analytic clinician, as a researcher, and as a theoretician was Sidney J. Blatt (1928-2014). In addition to being trained as a psychoanalyst, he conducted extensive research on personality development, psychological assessment, psychopathology, and psychotherapeutic outcomes. In contemporary times, psychology is a field divided into specialties and subspecialties, but in a career spanning more than five decades, Blatt made contributions to multiple subdisciplines within psychology, crossing boundaries between specialty areas as if those boundaries were simply not there at all. Chief of the Psychology Section in the Department of Psychiatry at the Yale University School of Medicine, he authored or coauthored more than 250 articles and 18 books and monographs. A wide-ranging intellect, he made contributions not only in psychology but also in art history, with a particular focus on the role of spatial representation in art (Blatt & Blatt, 1984). He is perhaps best known for his two-configurations model, according to which personality forms along two developmental lines, relatedness and self-definition (e.g., Blatt, 1974, 1995b, 2008; Blatt & Blass, 1990; Blatt & Levy, 2003; Blatt & Luyten, 2011; Blatt & Shichman, 1983; Luyten & Blatt, 2013). In formulating this model, as in all of his contributions, he remained committed to the proposition that it is not only possible but also essential to investigate psychoanalytically derived hypotheses through rigorous empirical science.
As his earliest major theoretical statement (Blatt, 1974) indicates, Blatt started his career highly influenced by psychoanalytic ego psychology (e.g., Freud, 1965; Jacobson, 1964; Mahler, 1968; Rapaport, 1951) and cognitive developmental psychology (e.g., Piaget, 1954, 1962; Werner, 1957), and he ended it, as his later statements (e.g., Auerbach & Blatt, 2001; Blatt, 1995b, 2008; Blatt & Levy, 2003; Blatt & Luyten, 2011; Diamond & Blatt, 1994; Luyten & Blatt, 2013) demonstrate, as a relational thinker influenced by research on attachment theory, (e.g., Bowlby, 1988; Main, 1991; Main, Kaplan, & Cassidy, 1985) and mother-infant dyadic interaction (e.g., Beebe & Lachmann, 2002), as well as by concepts from relational psychoanalysis, intersubjectivity theory, and mentalization theory (e.g., Aron, 1996; Benjamin, 1995; Fonagy, Gergely, Jurist, & Target, 2002; Mitchell, 1988). Blatt was also a master clinician. Trained as a psychoanalyst at the Western New England Institute for Psychoanalysis (WNEIP), and therefore interested in the unconscious dimensions of the human mind, he never forgot his early training with Carl Rogers and Rogers’s focus on understanding the therapeutic encounter from the patient’s point of view (Blatt, 2013). About Rogers’s influence, he wrote:
I seek to view patients not from an external perspective from which I would make judgments about the nature of their pathology, the quality of their relationships, or their life more generally. Rather, I seek to be sensitive to patients’ struggles and try to capture conscious and unconscious aspects of their experiences, and to place these experiences into words that patients could hear and use effectively in their internal dialogue or exploration. (Blatt, 2013, p. 141)
Blatt therefore taught generations of student therapists how to start with the patient’s experience and move to what was just on the edge of the patient’s awareness, to just beyond what the patient could see.
This personal and intellectual biography will focus on Blatt’s main contributions: i) the two-configurations model of personality organization (Blatt, 1995b, 2008; Blatt & Blass, 1990; Blatt & Shichman, 1983; Luyten & Blatt, 2013); ii) the cognitive morphology or representational level of psychological development (Blatt, 1991, 1995b; Blatt, Auerbach, & Levy, 1997); and iii) internalization of caregiver-infant relationships as the chief means by which psychological development occurs (Auerbach & Diamond, in press; Behrends & Blatt, 1985; Blatt, Auerbach, & Behrends, 2008; Blatt & Behrends, 1987). Also discussed will be the influence of these ideas on Blatt’s psychotherapy research. But before turning to these intellectual contributions to the field, I will begin with an account of Blatt’s personal life story, not only to give a sense of the person behind the intellectual contributions but also to explain how his particular life story gave rise to the ideas that were to guide his thinking across so many decades.
Sidney J. Blatt: a biography in brief
We begin Blatt’s biography by noting that there is little, if anything, in his family background that would allow us to predict that he would eventually have a long, distinguished academic career in which he contributed to theory and research in personality development, personality assessment, psychoanalysis, and psychotherapy. The oldest of three children, he was born October 15, 1928, to Harry and Fannie Blatt. Raised in modest circumstances and the only member of his sibling group to obtain higher education, he grew up in a Jewish family in South Philadelphia, where his father owned a sweet shop and where his family lived in the apartment upstairs. Still this description does not fully capture the nature of Sid’s background. According to Blatt (Auerbach, Levy, & Schaffer, 2005a), his father was the third child born to Blatt’s paternal grandmother, but this woman died, perhaps in childbirth, when Blatt’s father was just three or four years old. Blatt’s grandfather then married a woman who had three children of her own by a previous marriage, and the new marriage in turn produced three more children. In consequence, Blatt’s father was raised in circumstances marked by maternal loss and economic poverty. He was forced, as the eldest son, to leave school after the sixth grade to help support his family, with its numerous half-siblings and stepsiblings, although Blatt recalled him as an intelligent man who worked hard, running his store seven days a week, 16 hours a day, and who read widely in the left-wing press.
Blatt found one memory of his father to be particularly important. Every year Blatt would accompany his father to the cemetery where Blatt’s paternal grandmother was buried, and there he would hold his father’s hand and attempt to console him as his father wept over the grave. Another youthful memory dates to age 13, when Blatt accompanied his mother on a painful two-hour bus trip to New Jersey as she responded to an urgent phone call informing her that her father had just suffered a heart attack. He tried to comfort his mother during the trip while she, correctly anticipating her father’s death, grieved his loss. Regarding these childhood memories, Blatt later found it no surprise that he eventually was to become interested in studying depressive experiences that focus on separation and loss. Another formative experience occurred when, at age 9, he became disillusioned with his father for failing to support him in some minor but symbolically important matter. Blatt decided to run away from home. He defiantly packed his bags and left the house, but within a few blocks he realized that he could not remember what his mother looked like; he ran home in a panic. This terrifying memory may be one of the roots of his lifelong interest in the stability of mental representation of the important people in one’s life, as well as in the stability of relatedness more generally.
Blatt’s interest in psychoanalysis began in high school with his reading of Freud’s (1963) Introductory Lectures on Psycho-Analysis. He was fascinated by Freud’s descriptions of unconscious processes. Then, as a psychology major at Penn State, Sid extended his earlier interest in psychoanalysis to an emerging interest in projective testing. When taking a group Rorschach in one of his classes that was being given to demonstrate how misguided the procedure was, he was instead intrigued by how much his responses revealed about himself. It was between his sophomore and junior years of college that he was introduced, by one of his fraternity brothers, to Ethel Shames. He and Ethel married on February 1, 1951, and were eventually to have three children, Susan Schwab Goettsche, Judith Blatt Casey, and David Blatt. Blatt always believed that, without Ethel by his side, his professional accomplishments would have been impossible.
In 1950, Blatt entered the graduate program in psychology at Penn State and worked under William Snyder, a student of Carl Rogers. In 1952, he completed his master’s degree and received honors for his thesis, a paper that was later published in Archives of General Psychiatry (Blatt, 1959). In 1954, he entered the Ph.D. program in psychology at the University of Chicago and found the U of C an intellectual paradise where he maintained an ever-increasing list of must read books and articles (Auerbach et al., 2005a, p. 5). He completed his predoctoral internship, in 1955 and 1956, under the supervision of Carl Rogers, whom he still described 60 years later, even after his analytic training, as a profound influence on his psychotherapeutic approach (Blatt, 2013). From Rogers, he learned the crucial importance of empathy – of understanding how his patients experienced the world and of framing his therapeutic interventions from the patient’s standpoint. He also worked as a research assistant for Morris I. Stein, who had been a student of Henry Murray’s at Harvard and who served as the chair of Blatt’s dissertation, completed in 1957 and published shortly thereafter (Blatt & Stein, 1959). Additionally, Blatt had the opportunity there to take testing courses from Samuel Beck. Blatt’s recollection was that Beck’s knowledge of the Rorschach was in fact brilliant but that Beck often could not articulate the rationale for his conclusions and, when challenged about them, would eventually appeal simply to his clinical experience. These appeals to clinical experience left Blatt distinctly unsatisfied because, as a beginner, he could not learn how to arrive at the same inferences himself. Thus, the other major influence on Blatt’s thought proved to be not one of his personal teachers but David Rapaport (1951), whose ideas gave him a deeper theoretical understanding of the workings of the mind, a way of linking motivation and cognition.
After a postdoctoral fellowship at the University of Illinois Medical School and at Michael Reese Hospital’s Psychiatric and Psychosomatic Institute, then headed by Roy Grinker, Sr., Blatt joined the Department of Psychology at Yale University as an assistant professor in 1960. He was also accepted for analytic training at WNEIP. Blatt hoped that, at this institute, he would have a chance to work directly with Rapaport, whose intellectual contributions he had come to admire enormously, but Rapaport died suddenly on December 14, 1960. Although crestfallen at the loss of this opportunity, Blatt had already established a relationship with Roy Schafer, his Yale faculty colleague. From Schafer, who had collaborated with Rapaport and with Merton Gill on their magnum opus Diagnostic Psychological Testing (Rapaport, Gill, & Schafer, 1945, 1946), he learned in greater depth the subtleties of Rapaport’s thinking. In July 1963, Blatt became chief of the psychiatry department’s Psychology Section, the position he held until his retirement in 2012.
From 1965 through 1968, Blatt was also director of psychology at the newly established Connecticut Mental Health Center in the Department of Psychiatry at Yale University School of Medicine. Meanwhile, he continued his analytic training at WNEIP. His analyst, William Pious, was considered a maverick within the institute, and this reputation appealed to Blatt, whose life history thus far had shown him to have a rebellious spirit and who, as a psychologist in an institute of the American Psychoanalytic Association, an organization at the time quite hostile to nonmedical analysts, felt himself to be a bit of an outsider. In 1972, he completed his analytic training.
After that, Blatt earned numerous professional honors. In 1973 and again in 1977 and in 1982, he was a visiting fellow at the Hampstead Child Therapy Clinic in London, England. His third stay there coincided, sadly, with the death of Anna Freud. In 1977, he was a visiting fellow at the Tavistock Centre, also in London, and therefore had contact with John Bowlby, whose work Blatt greatly admired. From 1978 through 1989, he was a senior research associate at the Austen Riggs Center, and from this involvement came a book (Blatt & Ford, 1994) on the process of change in long-term inpatient treatment. In 1988 and 1989, he was Sigmund Freud Professor at the Hebrew University of Jerusalem. At the Hebrew University of Jerusalem, he was also director of the Sigmund Freud Center for Psychoanalytic Study and Research, Ayala and Sam Zacks Professor of Art History, and a Fulbright Senior Research Fellow. He was from 1984 to 1986 the president of the Society for Personality Assessment (SPA), and in 1989, he was awarded the SPA’s Bruno Klopfer Award for Distinguished Contributions to Personality Assessment. In 2016, that organization honored him again, this time with its Marguerite R. Hertz Memorial Award, also given for distinguished lifetime contributions to personality assessment. Other honors given to him included the Distinguished Scientific Awards of Divisions 12 (Clinical Psychology) and 39 (Psychoanalysis) of the American Psychological Association, the Appalachian Psychoanalytic Society’s Hans Strupp Award for Psychoanalytic Scholarship, the Canadian Psychological Association’s Otto Weininger Memorial Award for Psychoanalytic or Psychodynamic Achievement in Psychology, and the Mary S. Sigourney Award for the Advancement of Psychoanalysis. Over the years, he also served as a visiting professor at the following institutions: Ben Gurion University of the Negev in Beer Sheva, Israel; Nova Southeastern University in Fort Lauderdale, Florida; the Menninger Foundation in Topeka, Kansas; University College London in England; the Catholic University of Leuven in Belgium, the George Washington University in Washington, District of Columbia; and Bar Ilan University in Ramat Gan, Israel. Into his mid-80s, Blatt remained not only a renowned but also a productive, generative, and creative theorist and scientist, influential, even in a biological and cognitive-behavioral age, as a psychoanalytic psychologist. In his 50 years at Yale University, he was also a beloved teacher and mentor, and because of his enthusiasm for ideas, his work eventually became the subject of a Festschrift, Relatedness, Self-Definition, and Mental Representation: Essays in Honor of Sidney J. Blatt (Auerbach, Levy, & Schaffer, 2005b).
Sidney J. Blatt: intellectual contributions
The two-configurations model
Although Blatt’s earliest interests were in psychological testing and mental representation (e.g., Allison, Blatt, & Zimet, 1968), with an approach to these topics heavily influenced by the pioneering work of Rapaport et al. (1945-1946; see Auerbach, 1999), it was with his two-configurations approach to psychopathology, depression in particular, that his thinking truly became his own. It was his experiences with his two analytic training cases led him to formulate the anaclitic-introjective distinction (Blatt, 1974). Although each of these patients suffered from depression, one proved to be highly self-critical and guilt ridden, with much suicidal ideation, and the other was highly dependent, wanting nurturance and desperately seeking emotional contact. From these experiences, Blatt concluded that depression, as both an affect state and a clinical syndrome, was not a unitary phenomenon and that some depressed patients, whom he termed introjective because of their excessively harsh superego introjects, are focused mainly on self-criticism, guilt, failure, and a need for achievement, as in Freud’s (1957) classical description of such individuals, and that others, whom he termed anaclitic because of their dependence and need to lean on others for emotional support, are concerned mainly with loss, separation, abandonment, and a need for emotional contact (Spitz & Wolf, 1946). In short, Blatt derived the anaclitic-introjective distinction and eventually the two-configurations model from clinical experience, not from the theoretical speculation.
In his next major theoretical statements, therefore, Blatt expanded this classification to apply to other forms of psychopathology (Blatt & Shichman, 1983), as well as to normal personality development (Blatt & Blass, 1990). As he expanded the scope of this model, he also became interested in attachment theory, intersubjectivity theory, neurobiology, and evolutionary theory, primarily as a result of the influence of younger colleagues (see, e.g., Auerbach & Blatt, 2001; Blatt et al., 1997, 2008; Blatt & Levy, 2003; Blatt & Luyten, 2011; Diamond & Blatt, 1994, 1999a, 1999b; Levy, Blatt, & Shaver, 1998; Luyten & Blatt, 2013; Schaffer, 1993), and his terminology shifted from anaclitic and introjective to the more inclusive distinction between attachment or relatedness on the one hand and separateness or self-definition on the other (e.g., Blatt & Blass 1990), with his earlier terminology (anaclitic and introjective) increasingly being used to characterized pathological expressions of these two broader psychological issues. Thus, this tension between relatedness and self-definition was central to Blatt’s understanding of human life.
Blatt recognized that his theories needed grounding in empirical evidence. He and his colleagues therefore developed the Depressive Experiences Questionnaire (DEQ; Blatt, D’Afflitti, & Quinlan, 1976), a self-report scale that assesses the two types of depression, anaclitic (or dependent) and introjective (or self-critical). The measure has now been validated in numerous studies (see Blatt, 2004), and an adolescent version of the measure has also been constructed (Blatt, Schaffer, Bers, & Quinlan, 1992). The DEQ was also the first of several inventories now available to measure this divergence between relational and self-definitional forms of depression, Blatt’s terminology having shifted over time from anaclitic and introjective to relational and self-definitional so as to encompass broader psychological themes that are not limited to psychopathological expressions (see Blatt & Blass, 1990, 1992, 1996); others include the Dysfunctional Attitude Scale (Weissman & Beck, 1978), the Sociotropy-Autonomy Scale (Beck, Epstein, Harrison, & Emery, unpublished manuscript), and the Personal Style Inventory (Robins et al., 1994).
Representational theory and the cognitive morphology
Although Blatt is perhaps best known for his work on the two-configurations model, he developed his cognitive-representational understanding of personality and psychopathology in conjunction with his understanding of relatedness and self-definition. In 1974, he delineated a Piaget-influenced cognitive-affective model of personality development. He and his colleagues (Blatt, 1974; Blatt, Chevron, Quinlan, Schaffer, & Wein, unpublished material; Blatt, Wein, Chevron, & Quinlan, 1979) proposed that personality development proceeds from a sensorimotor-enactive stage, in which a person’s object relations are dominated by concerns with gratification and frustration, through a concrete perceptual stage, in which object relations are based on what the other looks like, an external iconic phase, in which object relations involve mainly what others do, an internal iconic phase, in which object relations involve mainly what others think and feel, and finally, a conceptual stage, in which all previous levels are integrated into a complex, coherent understanding of significant others. Blatt used this model in developing the Conceptual Level (CL) Scale for rating open-ended descriptions of parents and other significant figures. Later, he and his colleagues integrated ideas from the two-configurations model with concepts from his representational model of cognitive development and from intersubjectivity theory in constructing the Differentiation-Relatedness (D-R) Scale, a measure that rates significant-figure descriptions from a more relational perspective (Diamond, Blatt, Stayner, & Kaslow, unpublished material; Diamond et al., unpublished material; Diamond, Kaslow, Coonerty, & Blatt, 1990). The theoretical assumptions underlying these scales are that cognitive development and the development of object relations occur in parallel and that the emergence of psychopathology is closely linked to disturbances in the development of object relations and cognitive organization (Behrends & Blatt, 1985). For example, low levels of D-R are usually found in psychosis, intermediate levels in borderline states, and higher levels in neurotic conditions and psychological health. Gradually, therefore, Blatt articulated his cognitive morphology, a comprehensive, integrated model of personality development, psychopathology, and therapeutic change that connects psychological maturation to the level of an individual’s representation of significant interpersonal relationships (Blatt, 1991, 1995b; Blatt & Blass, 1990; Blatt & Levy, 2003; Blatt & Shichman, 1983; see also Auerbach et al., 2005a). Using a largely Piagetian and Eriksonian (Erikson, 1963) framework, Blatt (1991) proposed that object representation develops from boundary constancy (formation of self-other boundaries) in early infancy, through stages of libidinal or recognition constancy (formation of attachments) at 8 to 9 months, evocative constancy (ability to evoke a significant other’s presence in that person’s absence) at 18 to 24 months, self and object constancy (formation of stable concepts of self and others) at 30 to 36 months, concrete operations (representation of triadic relational configurations) at 5 to 6 years, formal operations (representation of abstract internal states) at 11 to 12 years, self-identity (synthesis and integration of individuality and intimacy) in late adolescence and early adulthood, and integrity in mature adulthood.
Later developments in cognitive psychology, developmental psychology, and interpersonal neurobiology eventually made some of the specifics of Blatt’s (1991) initial formulation of his cognitive morphology, with its essentially Piagetian architecture, obsolete. However, insofar as Blatt, as a scientist, always regarded his theories as subject to revision and was willing to modify them in response to new evidence, he worked with younger colleagues to modify his ideas in response to newer cognitive and developmental research pertaining to attachment, caregiver-infant interaction, intersubjectivity, and theory of mind (see, e.g., Auerbach & Blatt, 2001; Auerbach & Diamond, in press; Beebe & Lachmann, 2002; Blatt et al., 1997; Blatt & Levy, 2003; Blatt & Luyten, 2011; Diamond & Blatt, 1994, 1999a, 1999b; Luyten & Blatt, 2013). What remained, regardless of these theoretical modifications, was the basic insight that representational level with regard to object relations was crucial to an understanding of an individual’s overall psychological functioning. Always one to recognize the importance of being able to measuring his ideas, Blatt and colleagues developed the Concept of the Object Scale (COS; Blatt, Brenneis, Schimek, & Glick, 1976; Levy, Meehan, Auerbach, & Blatt, 2005) and the Boundary Disturbance Scale (Blatt & Lerner, 1983) to assess object representations on the Rorschach Inkblot Test (Rorschach, 1942) and the aforementioned CL and D-R scales to assess, respectively, structural and intersubjective aspects of descriptions of self and significant figures collected through the Object Relations Inventory, an open-ended interview procedure developed from Blatt et al.’s (1979) original paper-and-pencil parent-description task (Sugarman, personal communication, July 16, 2014; see also Huprich, Auerbach, Porcerelli, & Bupp, 2016; Priel, 2005).
Blatt saw internalization, specifically the internalization of aspects of early childhood relationships, as essential to the cognitive-developmental maturation that he regarded as central to personality development. His views were influenced by Piaget (1926, 1954, 1962), Werner (1957) and Rapaport’s (1951, 1967) ego psychology, and it was through two pivotal papers (Behrends & Blatt, 1985; Blatt & Behrends, 1987) on internalization that he moved toward a more experiential approach consistent with intersubjectivity theory (e.g., Auerbach & Blatt, 2001; Blatt et al., 2008; Blatt, Stayner, Auerbach, & Behrends, 1996; Diamond et al., 1990) and involving relationships as lived, rather than relationships as structured. Blatt had always been concerned with how action sequences become internalized first as trial action and then as thought, but in these two papers, he focused on the experiential aspects of the internalization process. He and Behrends proposed that internalization requires a dialectic between gratifying involvement with significant others on the one hand and, borrowing a term from Klein (1976), experienced incompatibilities in those same relationships on the other. Although in their papers they endeavored to maintain their ties to existing ego psychological theory, Blatt and Behrends proposed a theory of internalization that was essentially relational and experiential in its premises, especially if we substitute terms like attachment or relatedness for gratifying involvement and terms like individuation or self-definition or separateness for experienced incompatibility, as Blatt increasingly did in a series of papers written with Blass in the early 1990s (Blatt & Blass, 1990, 1992, 1996). His collaboration with Blass also reflected his move toward attachment theory, particularly through their expansion of the relational line of development. With the addition of an understanding of the inherently structuring role of early attachment relationships – of the early caregiver-infant microexchanges that are encoded in implicit or preverbal relational procedures well before the explicit memory system associated with language and with consciously recalled images or symbols is available (Beebe & Lachmann, 2002; Stern, 1985) – and of the role of intersubjectivity in structuring attachment relationships, Blatt’s theories about internalization achieved their mature form. He increasingly gravitated to the ideas of Bowlby (1982, 1988) regarding internal working models and of Stern (1985) regarding representations of interactions that have become generalized as the means through which individuals come to create psychological structure.
In the last 20 years of his career, Blatt applied his theoretical ideas concerning the two-configurations model, the cognitive morphology, and internalization to concrete questions like what changes in treatment and how. As regards his representational theories, Blatt and his colleagues found, in a sample of severely disturbed adolescents and young adults in long-term psychoanalytically oriented inpatient treatment, that changes in the structure and content of representations of self and significant others, in variables like C-L, D-R, and thematic content, were related to independent assessments of clinical improvement (Blatt et al., 1996; Blatt, Auerbach, & Aryan, 1998). Specifically, they found that more positive and better articulated representations of mother and therapist, along with the expression of negative feelings about father, paralleled improvements in global functioning. They also found that more differentiated representations of the therapist were crucial for allowing patients to find and describe in others their own positive qualities and then to reappropriate these psychological strengths in a more integrated manner.
Blatt also demonstrated that relationally oriented and self-definitionally oriented persons have differential responses to psychotherapy, responses deeply congruent with their respective underlying personality organizations. He thought such findings to be crucial in the validation of his two-configurations model (Blatt, 2004). Thus, in his reanalysis of Wallerstein’s (1986) Menninger Psychotherapy Research Project, Blatt (1992) found that self-critical (or introjective) patients responded better to psychoanalysis, with its greater interpersonal distance and its focus on internal associations, and that dependent (or anaclitic) patients responded better to psychotherapy, with the increased support provided by face-to-face interaction. Meanwhile, his study of therapeutic change in long-term inpatient treatment at Austen Riggs (Blatt & Ford, 1994) found that dependent patients changed most with regard to interpersonal functioning while self-critical patients, who tend to be ideational, rather than affective, in their orientation to the world, showed change primarily through improved cognitive functioning and decreased thought disorder. These studies showed that personality characteristics can crucially determine what kinds of therapeutic interventions prove to be effective.
Stronger support for his model, however, was found in a series of reanalyses (e.g., Blatt, Quinlan, Pilkonis, & Shea, 1995; Shahar, Blatt, Zuroff, Krupnick, & Sotsky, 2004; Shahar, Blatt, Zuroff, & Pilkonis, 2003; Zuroff & Blatt, 2006; Zuroff, Blatt, Krupnick, & Sotsky, 2003; Zuroff, Shahar, Blatt, Kelly, & Leybman, 2016) of the NIMH Treatment of Depression Collaborative Research Program (TDCRP). Blatt and colleagues identified two factors in psychological functioning within the sample – perfectionism (a proxy for self-criticism) and need for approval (a proxy for dependence). They found that, regardless of the form of psychotherapy used (i.e., cognitive-behavioral, interpersonal, medication, and placebo), perfectionism had a negative effect on outcome in short-term treatment of depression, presumably because patients with high standards were unlikely to resolve their problems in just 15 or 20 sessions. These findings prompted Blatt (1995a) to argue that introjective or self-critical patients need long-term treatment to effect change. Thus, these research findings suggested not only that personality differences are important in response to psychotherapy but also that the short-term treatments that may be imposed on psychotherapy patients by managed care might have significant countertherapeutic effects on perfectionistic patients. In his re-analyses of the TDCRP, Blatt and colleagues also found, as have many psychotherapy researchers before him, that a positive therapeutic relationship, early in short-term treatment, predicted both symptom reduction and enhanced adaptive capacity, above and beyond patient characteristics and type of therapy. Thus, Blatt’s reanalyses of archival data produced evidence that confirmed his psychoanalytically informed predictions that therapeutic alliance and underlying personality dimensions, not manualized treatments, are the chief determinants of therapeutic outcome (Blatt & Zuroff, 2005; Blatt, Auerbach, Zuroff, & Shahar, 2006; Blatt, Zuroff, Hawley, & Auerbach, 2010), and this is one of his most important contributions.
In his long, distinguished career as a psychoanalytic clinician, researcher, and theorist, Sidney Blatt focused on three main ideas: i) the two-configurations model (i.e., the polarity between relatedness and self-definition) in normal functioning, psychopathology, and psychotherapeutic change; ii) the structure and development of cognitive-representational aspects of personality, as delineated in his cognitive morphology; and iii) the role of internalization in personality development and psychotherapeutic change. Although he is best known for his two-configurations model of personality and psychopathology, he made essential contributions to object relations theory and research, especially through his Rorschach measures, as well as through the ORI and the scales used to rate significant-figure descriptions collected via this method [CL, D-R, and the Assessment of Self (Blatt, Bers, & Schaffer, unpublished manual)]. He understood object relations, and personality functioning in general, as developing and growing through the internalization of basic caregiving or attachment relationships, whether in childhood or through the therapeutic process. Particularly remarkable about Blatt’s contributions, and a testament to the generativity and fertility of his mind, is that his views grew and changed throughout his five-decade career. Although he initially conceptualized human functioning, both normal and abnormal, through the lens of cognitive-developmental theory and ego psychology, his understanding of the personality, of psychopathology, and of psychotherapy moved in an increasingly relational and experiential direction, with growing emphasis on attachment and intersubjectivity, themes that are central to contemporary psychoanalytic discourse.
Beyond psychoanalysis, however, Blatt’s most important contribution to psychotherapy will likely be to have shown that anaclitic and introjective patients have differential responses to treatment that may have more influence on therapeutic outcome than the specific therapy or therapies to which they are assigned. Thus, the distinction between relatedness and self-definition that Blatt, inspired by psychoanalytic theory, began exploring some 40 years ago, has had relevance not only for psychopathology, personality theory, and psychoanalysis, as he originally theorized, but for short-term, nonpsychoanalytic approaches to therapy as well. In a field that remains divided by theoretical approach and that lacks the unified body of knowledge that characterizes physical sciences, it is no small accomplishment to have ideas that are relevant across theoretical boundaries. But this broad relevance is precisely the case in Blatt’s work, perhaps because he has always worked to translate complex psychoanalytic ideas into concepts useful to clinicians and researchers of all theoretical persuasions – in essence, because he has lived with the tension of simultaneously asking deep questions about what it means to be human and submitting his ideas to empirical test.