Cognitive-Humanistic Psychodynamics: Sidney Blatt’s Theoretical-Philosophical Legacy

Blatt’s Life and Work

We are aware of at least three published summaries of Blatt’s biography. The first is a chapter written by John Auerbach, Kenneth Levy, and Carrie Schaffer to introduce the festschrift they edited in his honor (2005a,b). The second is an autobiographical piece published by Blatt (2006) in the Journal of Personality Assessment, as part of a series featuring invited biographies of eminent assessment psychologists. The third, most recent, is Patrick Luyten’s eulogy, written in 2015. We strongly encourage readers to look at two other resources: an interview with Blatt conducted by Lilly Dimitrovsky, published as part of a special issue in honor of Blatt in the Israel Journal of Psychiatry (Dimitrovsky 2007; Shahar, Zohar, and Apter 2007), and his New York Times obituary (May 18, 2014).

Blatt did not have an easy upbringing. He was born in Philadelphia in 1928, just a year before onset of the Great Depression, which had a profound impact on so many families. Like others, his parents struggled financially. His father, having lost his own mother when he was only five and now under considerable stress to support his family, was very critical of young Sid (Blatt 2006). As a child, Blatt was hospitalized for several weeks after contracting scarlet fever, and he had to cope with residual orthopedic difficulties. In retrospect, many years after childhood, he realized that he was struggling also with an undiagnosed auditory dyslexia and color blindness. Despite all this, Blatt depicts his childhood and adolescence in positive terms: his parents were happy together, he felt special priority in his mother’s regard, felt privileged financially despite the family’s economic hardship, had many close friends, and was intellectually stimulated. Indeed, his fascination with ideas and books grew steadily well into Blatt’s college years at Penn State.

Early on, even as an undergraduate, Blatt knew he was interested in becoming a psychoanalyst. Yet because becoming an analyst then required a medical degree, and because he wanted to please his mother, he enrolled in a premedical curriculum as a physics and chemistry major. It was then, during a laboratory chemistry task, that he discovered he was color blind. He then made the formative decision of changing his major to psychology. It was also in college that he met Ethel, the love of his life, whom he married and with whom he had three children.

Upon completing college, Blatt applied to graduate training in clinical psychology at Penn State. Rejected twice, he appealed both times and was eventually accepted, though only on a terminal master’s track. It was during his master’s studies that he discovered two clinical resources that availed him throughout his career: the Rorschach Inkblot Test and Carl Rogers’s psychotherapeutic technique of reflection (i.e., clarification of feelings). However, Blatt paid dearly for his vocal enthusiasm regarding these clinical resources, perhaps because—as he himself admits—he was “a somewhat provocative student” (Blatt 2006, p. 4). George Guthrie, his assessment teacher and an MMPI fan, disapproved of Blatt’s interest in the Rorschach. Similarly, William Snyder, his psychotherapy teacher and an early student of Carl Rogers, disliked Blatt’s arguing that reflection strongly resembles psychoanalytic clarification. Blatt master’s thesis, completed with Snyder, focused on recognition and recall processes in psychotic inpatients. The work (Blatt 1959), which was designated an honors thesis, was published in the highly prestigious Archives of General Psychiatry, predecessor to JAMA Psychiatry.

After completing his master’s, Sid and Ethel moved to Chicago, where he took a position as counselor at the Jewish Vocational Service. It is there Sid got his first taste of clinical experience, as he attempted to advise former patients of the Chicago State Hospital as they assumed their first real jobs. A couple of years later, Sid decided to pursue doctoral studies in psychology at the University of Chicago. He made the decision over his parents’ objections and despite the couple’s dire financial circumstances, but he had Ethel’s steadfast support. His dissertation advisor was Morris I. Stein, a creativity expert. Blatt (2006) found his year in the Ph.D. psychology program at Chicago “an intellectual paradise” (p. 6). He learned psychology and assessment from the best of minds (e.g., William Stevenson, the developer of Q methodology, and Samuel Beck, a leading Rorschach expert). He also discovered David Rapaport’s work on thought organization and pathology. His research dissertation focused on problem-solving processes of chemistry Ph.D. students and their link to the students’ creativity (Blatt and Stein 1959). His clinical internship with Carl Rogers strongly impacted his therapeutic identity and capacities. Studying with Rogers, he found he had been right all along: the provocative statement he had made at Penn State, that the difference between psychoanalytic interpretation and Rogerian/humanistic clarification might indeed be quite small, was confirmed.

Again at a crossroads professionally and financially, Blatt decided to pursue postdoctoral training instead of taking a full-time job. His postdoc was taken at the joint program of the University of Illinois Medical Center and Michael Reese Hospital in Chicago. There Blatt deepened his study of the Rorschach and of Rapaport’s psychoanalytic writings, and continued his problem-solving research. In fact, he was able to integrate his interests in the Rorschach and in problem solving (Blatt, Allison, and Feirstein 1969). Following his postdoctoral fellowship, he received several offers for academic and clinical positions, including one for an assistant professorship in Yale’s department of psychology. He was to remain at Yale for the rest of his career.

Although Blatt described his early years in the department of psychology with enthusiasm, he was actually drawn more strongly to the department of psychiatry, which at the time had a strong psychoanalytic orientation. He learned from Theodore Lidz, Norman Cameron, Albert Solnit, Samuel Ritvo, Seymour Lustman, Fritz Redlich, Stephen Fleck, and Roy Schafer, and continued his research on cognitive processes, psychopathology, and clinical assessment (see Allison, Blatt, and Zimet 1968). Concurrently, Blatt applied—and was accepted—for full psychoanalytic training at the Western New England Psychoanalytic Institute, an undertaking that today might be considered unwise given the time-consuming nature of analytic training and the demands on a Yale assistant professor. Yet Blatt managed to acquit himself well in both capacities. Even while gravitating toward a full-time position in the department of psychiatry, he maintained his position in the psychology department. Collecting data at the Yale Psychiatric Institute, he continued to work and publish on the cognitive and psychodynamic underpinnings of psychopathology, particularly psychosis, work still cited today (see, e.g., Shahar et al. 2004).

In the early 1970s, a quantum leap occurred in Blatt’s thinking and writing. He published what for him was the most important article of his career, known at Yale as “the 1974 paper.” In it, Blatt described two analytic cases with a diagnosis of depression, one conforming to “an anaclitic depression” centering on object loss and loneliness, and the other to “introjective depression” centering on separateness, self-definition, and achievement. Blatt continued for decades to develop the anaclitic-introjective distinction in theory, research, and clinical practice. He collaborated with many well-known researchers and students in elaborating and sharpening this distinction, most recently with Patrick Luyten (Blatt and Luyten 2009; Luyten and Blatt 2011, 2013). Undoubtedly it is the anaclitic-introjective distinction that made him famous in psychology, psychiatry, and psychoanalysis. Yet that 1974 paper also included the precursors of his other important contribution: his formulation of a cognitive-developmental and psychoanalytic theory of mental representations of self, others, and relationships (object relations). This theory, too, was put to an empirical test and has yielded an impressive body of research, also inspiring clinical assessment and practice (see Auerbach and Diamond, this issue), as well as the study of modern art (Blatt and Blatt 1984).

Throughout his career, Blatt continued to combine theory, empirical research, and practice. “I am primarily a clinician and a theoretician,” he told one of us (GS). In his autobiographical article, he states, “It is important for me to stress that I view myself as fundamentally a clinician, and much of my research and theoretical formulations derive directly from my clinical experience” (Blatt 2006, p. 10). Though this accurately describes Blatt’s modus operandi, it should not be forgotten that Blatt was extraordinarily gifted as a quantitative researcher. Much as he made sense of Rorschach protocols and psychotherapy process notes, he was able to uncover quantitative patterns in data—and extensively published on them—decades before he productively explored the data through the lens of new questions. The most well-known data sets Blatt shaped with his theoretical and quantitative skills were the Menninger Psychoptherapy Research Project (Blatt 1992; Wallerstein 1986), the Yale-Riggs Project (Blatt and Ford 1994), and—of course—the Treatment of Depression Collaborative Research Program, funded by the National Institute of Mental Health. Further attesting Blatt’s quantitative skills is his development, with colleagues, of two extensively used and studied personality measures: the Depressive Experiences Questionnaire (Blatt, D’Afflitti, and Quinlan 1976), the premier instrument for assessing anaclitic and introjective tendencies, and the Object Relations Inventory (Blatt, Auerbach, and Aryan 1998; Blatt, Auerbach, and Levy 1997; Blatt et al. 1979; Diamond and Blatt 1994; Diamond et al. 1990), an investigator-based projective procedure for assessing the quality of object relations, predicated on an integration of Piaget’s cognitive-developmental theory and object relations theory.

Over the years, particularly during the last two decades of his life, Blatt achieved national and international recognition for his diverse contributions to psychology, psychiatry, and psychoanalysis. This recognition came in the form of various festschrifts, keynote talks, and highly prestigious competitive awards. ¹ But as much as these awards meant to him, and they meant a lot, he took far greater pride and gratification in the relationships that evolved around his work; “the central issue for me,” he once wrote, “has not been my contributions in these various endeavors but the relationships that have evolved in these efforts” (Blatt 2006, p. 12). Everyone who has known Sid would have a hard time doubting the sincerity of this statement.

Cognitive Themes In Blatt’s Life and Work

In his autobiographical article, Blatt (2006) attests to spending a lot of time at museums in his teens, and to a particular fascination with Rodin: “The Thinker in particular was an important icon for me, and for many years, I had a picture of me as a young adolescent sitting on the base of the statue in a pose duplicating the posture of the statue” (p. 3).

This personal account is easily—inescapably, it could be argued—linked to Blatt’s stressing (in conversation with GS) that he had left Rogers because he wanted to think. Indeed, Blatt’s fascination with cognition and thought processes is apparent throughout his life and work. At a very early academic age—during his graduate school years—Blatt’s research focused on problem solving, perception, and other thought processes. One of his biggest psychoanalytic idols, second only to Freud himself, was David Rapaport, one of the seminal thinkers in psychoanalytic ego psychology, arguably the most cognitively oriented school of psychoanalytic thought.

Blatt’s first publications were in the field of problem solving, and his subsequent publications focused on cognitive-aptitude tests such as the WAIS, or on cognitive-representational aspects of the Rorschach. Interestingly, Blatt considered the Rorschach an assessment procedure (rather than a “test”), one that extracts representations of the world, including the world of people and relationships:

Research in developmental, social, and cognitive psychology has increasingly indicated the importance of investigating cognitive schema. Cognitive structures have been studied in a number of different ways—as schemas . . . plans . . . prototypes . . . and, more generally, as the tendency and capacity to construct meaning. We now recognize that an essential part of human functioning involves the establishment and creation of meaning—in what has been called a “constructivist” approach. . . . These contemporary approaches emphasize how individuals develop cognitive structures (schemas, plans, expectations, or scripts) that organize and shape their experiences. Cognitive structures or meaning systems have both content and structure—they are appraisal systems that influence the experiencing of events and the processing of information. But these cognitive schemas are more than memory structures or forms of information processing. Rather, they are relatively stable and enduring psychological structures that emerge during the life cycle and determine the full range of human experiences and guide and direct all human behavior and experience. Given this new emphasis on cognitive processes, it is important to recognize that psychology is now no longer just a science of behavior; it has become a science of the construction of meaning. The emphasis on cognitive structures and meaning systems in psychology is consistent with the contemporary emphasis in a number of other disciplines on structuralism and semiotics as basic philosophic and conceptual models. This emerging emphasis in psychology not only provides links between psychology and other disciplines; I believe it provides a new basis for integrating clinical psychology within the mainstream of psychological science [Blatt 1990, pp. 398–399].

And with respect to the Rorschach:

Our task now is to articulate theoretical models that will enable us to assess systematically the underlying cognitive schemas and representational structures that are expressed in responses to the Rorschach. But in order to approach the Rorschach as an experimental method for assessing cognitive or representational processes, we need theoretical models of personality development and functioning that go beyond manifest behavior and identify instead more basic psychological structures. We need concepts of psychopathology that are more than descriptive lists and taxonomies of manifest symptoms; we need theories of psychopathology that specify underlying morphological cognitive structures that differentiate among various forms of psychological disturbances. . . . We need personality theories that appreciate how different levels of psychological functioning emerge throughout the life cycle and how this understanding of normal development identifies various principles of structural organization that can account for similarities and differences across a wide range of manifest behavior. Although there is much to be done and a long way to go, it is important to recognize that a most important revolution has occurred in psychological science and that we are at the threshold of a new era in personality assessment, one that holds the potentiality for beginning to appreciate more fully the fascinating complexities of the human condition [Blatt 1990, p. 404].

Merely a year later, one of Blatt’s seminal articles, “A Cognitive Morphology of Psychopathology” (1991), was published. In this paper, Blatt contrasts “descriptive psychiatry” with a model of psychopathology that centers on cognitive schemas and accounts for the entire spectrum of psychiatric disorders, ranging from psychosis, to personality disorders, and to the “neuroses.” This article combines Blatt’s two most important contributions—a cognitive-psychoanalytic theory of psychopathology, and the anaclitic-introjective distinction, which itself is built on a nuanced understanding of how anaclitics and introjectives represent others, relationships, and the world at large, and how these individuals think about problems and issues (Blatt 1995, 2004, 2008; Blatt and Zuroff 1992).

Blatt The Humanist

The impact of his training with Carl Rogers on Blatt’s work is well known. In his interview with Lilly Dimitrovsky (2007), Blatt spoke directly to Rogers’s influence on his thinking. Asked which theoretical models influenced him the most, he had this to say:

Freud’s case reports, his descriptions of the functioning and subtleties of the mind, but also my personal experiences with Carl Rogers and his emphasis on taking the perspective of the other, the unconditional positive regard for my patient as well as the importance of empathy which later became congruent with my involvement in an object relations perspective. One needs to be aware of drive derivatives for understanding patients, but it is vitally important to appreciate that we evolve and live in an interpersonal matrix. Insights and interpretations have therapeutic power, but only in the context of an understanding, empathic relationship. The therapeutic relationship is vital. It is augmented and enriched by the sensitivity and understanding that is communicated in sensitive and thoughtful interpretations. So I try to combine the empathic, person centered approach I learned from Carl Rogers with Freud’s knowledge, insight and understanding of psychodynamic development. I try to integrate Freud’s intellectual power with Rogers’ humanistic quality in my work as a therapist [p. 310].

Blatt’s response to Dimitrovsky’s question reveals three central tenets. The first is the quintessential role of expressing warmth and benevolence toward patients (what Rogers calls “unconditional positive regard”), a sentiment without which, according to Blatt, even the wisest interpretation would fall on deaf ears. The second humanistic tenet is empathy: to provide an interpretation, one needs to understand the patient from within, and in his/her totality, or gestalt (see, e.g., Bugental 1964; Shahar and Schiller 2016a,b). The third humanistic tenet, superimposed on the others, is that nurturing therapeutic relationships are in themselves curative. The last several decades in the development of psychoanalytic theory are more clearly in line with these tenets (see, e.g., Stolorow and Atwood 2002), but when Blatt received his clinical training they were far less recognized.

Taken together, these three tenets present a profoundly humanistic depiction of the person—humanistic in the sense that this depiction is optimistic, predicated on people’s ability to develop, grow, and actualize themselves even in the face of serious obstacles. Given this view of the person, our opening epigraph makes perfect sense. Blatt was convinced that therapists—rather than offering themselves to be internalized by patients—are in fact freeing adaptive structures already existing within them. To put it differently, health is predicated within us, or, to paraphrase the great phenomenologist Merleau-Ponty, “We are condemned to resilience.” ²

It was Nietzsche (1886) who alleged that every philosophy is ultimately a confession. One can only marvel at the poignancy of this statement when it comes to Blatt himself. Out of the economically disadvantaged streets of Philadelphia, confronted with health issues, a complex relationship with his father, and color blindness and dyslexia burdening a formidable mind, Blatt showed a tenacity and determination that delivered him, every step of the way, through rejections, failures, and risky decisions, to the very self-actualization that Carl Rogers (1963) and Abraham Maslow (1968) have seen as epitomizing the human spirit.

In his autobiographical article (Blatt 2006), Blatt alludes to this tenacity:

As I think about my personal and professional development, I gain deep respect for the complexities of human development and the impossibility of prediction. I have come to view development not as a linear natural unfolding or a process of defining and working toward specified goals but rather as a series of decisions at crucial nodal points throughout life that involve recognizing alternatives and opportunities and having the capacity and courage to take risks at these choice points. Decisions at these primary inflection (tipping) points determine one’s personal development. Thus, development is an interactive process between personal qualities and environmental events, and only retrospectively can one construct the factors that influenced and determined development. Development occurs in an open, complex, and often unpredictable context, and many of the factors that contribute to development can be appreciated only retrospectively [p. 1].

In keeping with his interest in adaptation across the lifespan, Blatt saw development as a lifelong process of learning. His developmental model was not, however, a reductively progressive one, for he understood that often an individual’s apparent regression is an adaptation to current environmental pressures and contexts. He understood that every individual cycles between more or less developmentally adaptive compromises and that flexibility and openness to change, even instability, is perhaps the greatest hallmark of maturity (see Mayes 1999). While he was especially wary of reductionistic efforts to translate complex psychological processes into the language of neuroscience, he was nonetheless appreciative of the emerging science of epigenetics and how experience shapes genetic expression that in turn contributes to an individual’s range of adaptability in a given context (see Mayes 2003).

An Advocate of The Psychodynamic Unconscious

Given that Blatt’s research and clinical training were both undertaken in the midst of the “cognitive revolution,” of which he was keenly aware (Blatt 1991), one might have expected he would end up as a leader of the cognitive-clinical school of thought. Alternatively, given his “Rogerian personality,” his early interest in humanistic psychotherapy, and the impact made on him by his training with Carl Rogers, one could have expected that he would become a leader in the humanistic-existential school of thought. Instead, however, Blatt elected to take the long and arduous route of psychoanalytic training while concurrently creating himself as a clinical scientist. He continued practicing psychoanalysis throughout his career, even after he had become widely known in professional circles and no longer had to practice. This choice to embrace clinical practice and understand the complexity of individual lives speaks to Blatt’s commitment—not only to psychoanalysis as a professional community—but also, perhaps principally, to the core idea underlying psychoanalysis as an intellectual enterprise: the psychodynamic unconscious.

What made Blatt so committed to this idea? In our opinion, the idea was deeply compatible with Blatt’s conviction that the human condition is not only nuanced, but is also complex, multifaceted, full of riddles to be solved, albeit slowly, and marred with apparent contradictions that must be sorted out very patiently. It is only by accepting and appreciating “the complexity of the human situation,” as Blatt was fond of saying, that one is able to better understand psychological phenomena and individual people. For Blatt, we would argue, adherence to the notion of the psychodynamic unconscious was a safeguard against cognitivism’s becoming reductionistic, and humanism’s turning into Pollyannaism.

For instance, Blatt was careful to highlight that mental representations of self and others—“object relations”—are “hot cognitions” rather than being purely informational processing structures: they are knowledge structures intimately linked to emotion and motivation, most of it unknown to the experiencing person (Blatt 1995). Indeed, Blatt and his colleagues emphasized the importance of reexperiencing—in the therapeutic relationship—the mental pain associated with maladaptive mental representations of self and others as a principal way of altering these maladaptive representations (Luyten, Blatt, and Fonagy 2013), and he and his colleagues also addressed the importance of changing structural/formal aspects of these representations, over and above awareness of their malevolent content (Blatt et al. 1996; Luyten, Blatt, and Fonagy 2013).

In numerous descriptions of the anaclitic and introjective personality styles, Blatt was careful to address irreducible components of these large personality styles in a way that is faithful to the psychoanalytic distinction between wishes, drives, ego states, defense mechanisms, and mental representations (Freud 1914, 1926; see Blatt 1998; Blatt and Zuroff 1992). His fascination with defensive processes—which epitomize the dynamic nature of the unconscious—is evident throughout his writing, and he has made noteworthy empirical contributions to the understanding of defenses, primarily in collaboration with Phoebe Cramer (Cramer, Blatt, and Ford 1998).

Blatt was convinced that psychopathology may “travel in time” within patients: that it may progress and regress in predictable ways based on an individual’s personality (Blatt 2008; Blatt and Shichman 1983; Blatt and Zuroff 1992; Shahar, Blatt, and Ford 2003). In that, he adhered not only to Freud’s emphasis on the continuity between normalcy and psychopathology (1901) but also, presumably, to Ernest Kris’s notion of regression in the service of the ego (1952). Blatt’s emphasis on the possibility of both regression and progression throughout both development and psychotherapy expresses the tension between his humanistic and psychoanalytic persuasions: people are potentially adaptive and resilient and may overcome difficulties. Concurrently, however, they may also fail and be destructive to self and others, and regress, owing to unresolved internal conflicts.

Conclusion

Throughout a decades-long, incredibly creative, productive, and pioneering career, Sidney Blatt has left to the field a legacy built on three pillars: (1) an appreciation of the cognitive nature of the human mind, particularly as manifested by the centrality of mental representations of self and others to human personality; (2) an unyielding belief in the individual’s capacity to grow, mature, adapt to normal and abnormal conditions, and actualize themselves; and (3) a sober understanding of the nuanced, multifaceted, complex, conflicted, at times contradictory, even tragic nature of the human situation. Together these pillars support an integrated, coherent intellectual monument.

Blatt was very much a “people person.” Consequently, if one were to attempt to project his legacy into the future and imagine what it might become, we should look to the people whose lives Blatt has impacted. Colleagues, students, patients—they are as numerous as they are diverse and vibrant. Proud to be included among them, we will do our best to advance his elucidation of the developing, thinking, experiencing, and interacting nature of human beings.