Polarities of Experiences: Relatedness and Self-definition in Personality Development, Psychopathology and the Therapeutic Process

401 Pages·2008·25.63 MB·English

Polarities of
Experience
RELATEDNESS AND
SELF-DEFINITION IN
PERSONALITY
DEVELOPMENT,
PSYCHOPATHOLOGY,
AND THE
THERAPEUTIC PROCESS
Sidney J. Blatt
FOREWORD BY PETER FONAGY
A M E R I C A N P S Y C H O L O G I C A L A S S O C I A T I O N
W A S H I N G T O N , D C
Copyright © 2008 by the American Psychological Association. All rights reserved. Except
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Who made it all possible
CONTENTS
Foreword ix
Peter Fonagy
Preface xv
Introduction 3
I. Relatedness and Self-Definition: A Fundamental Polarity
of Experience 13
Chapter 1. Fundamental Dimensions in Personality and
Social Theory 15
I. Personality Development , 41
Chapter 2. Developmental Antecedents of Relatedness
and Self-Definition 43
Chapter 3. Relatedness and Self-Definition in Personality
Development 71
Chapter 4. Dialectical Development of Interpersonal
Relatednes and Self-Definition 99
III. Personality Organization and Psychopathology 131
Chapter 5. Two Primary Configurations of Personality
Organization 133
Chapter 6. Two Primary Configurations of
Psychopathology 165
vn
IV. The Therapeutic Proces 201
Chapter 7. Relatedness and Self-Definition and
Therapeutic Change 203
Chapter 8. Relatedness and Self-Definition in the
Therapeutic Proces 243
Epilogue 285
References 297
Author Index 373
Subject Index 387
About the Author 403
vizi CONTENTS
FOREWORD
PETER FONAGY
This book should carry a health warning: "This book could seriously
damage your preconceptions!" Every decade or so clinical psychology pro-
duces a book that leads to a paradigm shift in the field. Intellectual seismic
activity makes cracks appear in existing edifices, prompting rapid rebuilding
of theories and calls for a realignment of ideas. Aaron Beck's (1976) book
drawing attention to the power of human cognition had this effect, as did
John Bowlby's (1969) focus on the long-term impact of separation, a decade
before. Marsha Linehan's contributions in the 1990s changed the way many
people think about personality disorders (Linehan, 1993). In the 1980s, think-
ing about trauma (van der Kolk, 1987) and particularly the possibility of
childhood sexual abuse, reoriented psychologists' views toward their work. I
believe Sidney Blatt's Polarities of Experience might well generate a similar
shift in perspective.
Over the past 3 decades, Blatt, with a number of eminent colleagues,
has identified an important opposition running through personality develop-
ment. The dialectic of relatedness and self-definition is fundamental to per-
sonality theory. The leap forward is represented by the recognition that re-
latedness and self-definition are not two independent processes. Blatt makes
the nontrivial and eye-opening claim that personality development through-
out the seven ages of man, from the mewling infant to the "last scene of all
that ends this strange eventful history, is second childishness and mere
oblivion, sans teeth, sans eyes, sans taste, sans everything" (As You Like It,
2.7) occurs as part of a complex set of dialectic transactions between two
developmental forces that are curiously interdependent. A mature sense of
self that is differentiated and integrated cannot develop without satisfying
interpersonal relationships. It is equally self-evident that mature, reciprocal,
interpersonal relationships cannot exist in the absence of a coherent sense of
identity and relatively clear self-definition. How these interact along the
IX
line of an individual's progress through life defines the person. This is the first
comprehensive integrated model of personality development and could pro-
vide the foundation for the developmental psychopathology of the future.
With extraordinary scholarship, Blatt first traces the historical roots of
this model in psychoanalysis, personality psychology, and evolutionary biol-
ogy. The chapters that follow validate the model in three domains: personal-
ity development, normal and abnormal personality organization, and psy-
chotherapy. In each domain the book usefully summarizes the major
contributions, both empirical and theoretical, that Blatt and others made.
The number and gravity of these contributions are remarkable in their own
right. But the most remarkable feature of this book is the coherence it brings
to these very disparate literatures. The reader making the journey across these
domains will have the satisfying experience of encountering a full and com-
prehensive narrative of individual differences and their origins, distortions,
and treatment. Suddenly, it all starts to make sense!
The reader should not be under any illusion that the chapters on early
influence are a rehashing of known phenomena with sensitivity, attunement,
and so forth facilitating the emergence of more effective adaptation. It is a
total reinterpretation of the accumulated literature, which is now placed into
a framework in which facilitating experiences can be seen as contributing
either to engagement or disengagement between the infant and the caregiver.
The beautifully summarized reconceptualization of this massive literature leads
to a dissipation of many contradictions and controversies, aligns
intersubjective and dyadic perspectives, and almost as a bonus brings the
neuroscientific and psychosocial frames of reference into dialogue. In Blatt's
framework, developmental impairments are conceptualized as occurring
through either minimal or excessive interpersonal contingent coordination.
Of course, as readers navigate Blatt's lucid description and careful analysis,
they may be tempted to claim the usual precognition ("of course, I have
always known this") but this is the normal response to any great discovery.
Although readers might have known that both neglect and overstimulation
are forms of adversity, before Blatt there was no framework through which
this contradictory set of findings could be comprehended.
Previous theories in the literature have pointed to the parallel develop-
ment of self-definition and relatedness, but none have advanced a satisfying
dialectic model. In Blatt's work self-definition and relatedness are central
because of an ongoing synergistic dialectic interaction in which moves for-
ward in one dimension reciprocally prime advances in the other dimension.
This concept of the self is new. It certainly extends Erikson's model, and has
something in common with George Klein's and Hans Loewald's ideas, but it
is fundamentally different from anything described in the literature to date.
The interdependence of a differentiated mature sense of self and satisfactory
interpersonal experience allows readers to see the life cycle as a complex
dialectical process.
X FOREWORD
Blatt's model overcomes the failures of previous attempts to bring a
dimensional perspective to the categorization of mental disorders based on
empirical studies of the covariance of symptomatology and personality fea-
tures. These atheoretical multivariate approaches mostly fail because they
neither link to conceptually grounded models of psychological disturbance
nor to intuitive models that clinicians hold in mind when thinking about
patients (e.g., Clark, 2005; Cuthbert, 2005; Krueger, Watson, & Barlow, 2005;
Widiger & Samuel, 2005). Blatt's model provides both. The factors that
emerge from multivariate analyses are also fundamental dimensions of per-
sonality development. The mechanism of causation is intuitive and yields
close matching to clinically valid categories. For example, readers may rec-
ognize that generating either too much or too little support for individuality
leads to developmental distortion and generates a configuration that includes
aggressive and intrusive attacks on the self. But Blatt's dialectical view repre-
sents pathology as compensatory exaggeration. It is the failure of balance of a
normal transactional developmental process. This transactional process is in
its turn inherently dialectical. Blatt's approach has immense elegance con-
ceptually at the same time as it has an element of intuitive obviousness,
making it extremely helpful clinically.
The approach that Blatt has taken is qualitatively different from previ-
ous approaches and deserves to be formalized with a label. He refers to it as a
dynamic structural developmental approach and it is truly the first genuinely
psychodynamic developmental psychopathology model to appear in the lit-
erature. It is an empirically rooted frame of reference, and a massive body of
research is summarized in various chapters of the book, making it one of the
best-supported models of personality to date. Clinicians have always under-
stood that the same problem, such as substance abuse, is a final common
pathway with several dynamic developmental origins. Being able to see that
subtypes of a disorder, for example, the choice of the drug of abuse, meaning-
fully connects to personality dimensions and opens a new door to a clinically
meaningful diagnostic classification system that captures psychosocial influ-
ences on etiology. Above all, the clinical meaningfulness of Blatt's model
opens vast vistas for diagnosis-based interventions, a holy grail that thus far
has completely eluded models of classification.
There is a wealth of clinically suggestive and possibly vital findings in
this book. They point to directions in which therapeutic interventions could
be modified with different subgroups of patients to optimize their efficacy.
What is impressive is just how deep Blatt's model is able to reach—not only
the structure of the treatment or principal modes of intervention but also
even the content of individual sessions are all shown to be lawfully associ-
ated with the model of structural personality organization that he proposes.
There is a clear sense that Blatt's approach reaches to the very essence of the
psychotherapeutic process, in the course of which maladaptive cognitive af-
fective schemas and representations are given up in the context of a helpful
FOREWORD yd
relationship with another person who is committed to guiding the patient to
achieve a better understanding of how his or her personality functions. There
is accumulating evidence that, at least in the treatment of severe personality
disorders, recovering the balance between the introjective and anaclitic, or
self-definitional and relational poles, maps on to symptomatic improvement
across time as well as in terms of final outcome.
Each chapter of this book represents a leap forward. Some chapters de-
scribe several significant leaps. Together, Blatt offers a new approach to un-
derstanding the person, rooted in clinical science, integrating domains and
clearly marking the way toward a better integrated and coherent future. This
book signals a paradigm shift. No mental health professional can ignore the
evidence amassed in these pages and the coherent picture of psychosocial
clinical work that emerges. The field of clinical psychology has patiently
waited for a model that ties together the threads of a focus on cognition with
an emphasis on relationships, the recognition of developmental trajectories,
and the failure of atheoretical approaches to classification of mental disor-
ders. Blatt has provided us with a conceptual platform from which the next
generation of psychologists can develop. In 10 years or so, I have no doubt
the next paradigm shift will come in our stepwise progress toward ever more
effective ways of helping people in need.
REFERENCES
Beck, A. (1976). Cognitive therapy and the emotional disorders. New York: Interna-
tional Universities Press/Meriden.
Bowlby, J. (1969). Attachment and Loss, Vol. I: Attachment. London: Hogarth Press
and the Institute of Psycho-Analysis.
Clark, L. A. (2005). Temperament as a unifying basis for personality and psychopa-
thology. Journal of Abnormal Psychology, 114, 505-521.
Cuthbert, B. N. (2005). Dimensional models of psychopathology: Research agenda
and clinical utility. Journal of Abnormal Psychology, 114, 565-569.
Dunn, V., & Goodyer, I. M. (2006). Longitudinal investigation into childhood- and
adolescence-onset depression: Psychiatric outcome in early adulthood. British
Journal of Psychiatry, 188, 216-222.
Girard, R. (2005). Violence and the sacred. London: Continuum International.
Kazdin, A. E., & Nock, M. K. (2003). Delineating mechanisms of change in child
and adolescent therapy: Methodological issues and research recommendations.
Journal of Child Psychology and Psychiatry ,44, 1116-1129.
Kim-Cohen, J., Caspi, A., Moffitt, T. E., Harrington, H.-L., Milne, B. J., & Poulton,
R. (2003). Prior juvenile diagnoses in adults with mental disorder: Develop-
mental follow-back of a prospective longitudinal cohort. Archives of General
Psychiatry, 60, 709-717.
xii FOREWORD
Krueger, R. F., Watson, D., & Barlow, D. H. (2005). Introduction to the special
section: Toward a dimensionally based taxonomy of psychopathology. Journal
of Abnormal Psychology, 114, 491^93.
Linehan, M. M. (1993). Cognitive-behavioural treatment of borderline personality disor-
der. New York: Guilford Press.
McClelland, D. C. (1986). Some reflections on the two psychologies of love. Journal
of Personality, 54, 334-353.
Moffitt, T. E., Caspi, A., Harrington, H., & Milne, B. J. (2002). Males on the life-
course-persistent and adolescence-limited antisocial pathways: Follow-up at age
26 years. Developmental Psychopathology, 14, 179-207.
Rosenfeld, H. (1964). On the psychopathology of narcissism: A clinical approach.
International Journal of Psycho-Analysis, 45, 332-337.
Ryan, R. M., & Deci, E. L. (2003). On assimilating identities to the self: A self-
determination theory perspective on internalization and integrity within cul-
tures. In M. R. Leary & J. P. Tangney (Eds.), Handbook of self and identity (pp.
253-272). New York: Guilford Press.
Shakespeare, W. (1968). As you like it (H. J. Oliver, Ed.). New York: Penguin Books.
van der Kolk, B. A. (1987). Psychological Trauma. Washington, DC: American Psy-
chiatric Press.
Widiger, T. A., & Samuel, D. B. (2005). Diagnostic categories or dimensions? A
question for the Diagnostic and Statistical Manual of Mental Disorders—Fifth
Edition. Journal of Abnormal Ps^cholog^, 114, 494-504.
Wiggins, J. S. (1991). Agency and communion as conceptual coordinates for the
understanding and measurement of interpersonal behavior. In W. W. Grove &
D. Cicchetti (Eds.), Thinking clearly about psychology, Vol. 2: Personality andpsy-
chotherapy (pp. 89-113). Minneapolis: University of Minnesota Press.
FOREWORD xiii