(Sidney J. Blatt) Polarities of Experiences Relat (Zlibraryexau2g3p.onion)

Polarities of
Experience
RELATEDNESS AND
SELF-DEFINITION IN
PERSONALITY
DEVELOPMENT,
PSYCHOPATHOLOGY,
AND THE
THERAPEUTIC PROCESS
Sidney J. Blatt
FOREWORD BY PETER FONAGY
AMERICAN PSYCHOLOGICAL ASSOCIATION

WAS H I N G T O N , DC
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Library of Congress Cataloging-in-Publication Data
Blatt, Sidney]. (SidneyJules), 1928-

Polarities of experience : relatedness and self-definition in personality development,
psychopathology, and the therapeutic process / Sidney J. Blatt. — 1st ed.
p. cm.
Includes bibliographical references and index.
ISBN-13: 978-1-4338-0314-7
ISBN-10: 1-4338-0314-3
1. Personality. 2. Mental representation. 3. Relatedness (Psychology). 4. Psychotherapy.
5. Developmental psychology. I. Title.
BF 698.B53 2008
155.2'5—dc22 2007033129
British Library Cataloguing-in-Publication Data
A CIP record is available from the British Library.
Printed in the United States of America

First Edition
To Ethel
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
II. 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
Relatedness 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 Process 201
Chapter 7. Relatedness and Self-Definition and
Therapeutic Change 203
Chapter 8. Relatedness and Self-Definition in the
Therapeutic Process 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
PREFACE
Extensive clinical experience in the late 1960s (1965-1970) with two

patients, both experiencing intense depression, altered my professional ca-
reer in profound ways. In my therapeutic work with these patients, I became
aware that depression can be organized around two different primary foci—
around interpersonal experiences of loss, abandonment, and feeling unloved;
or around a lack of self-worth in feelings of failure, worthlessness, and guilt. I
also discovered that these depressive experiences are usually expressed in
differences in the thematic content and structural organization of represen-
tations (cognitive-affective schemas) of self and others. These two discoveries—
the differentiation of two types of depressive experiences (anaclitic and
introjective) and the importance of representations of self and other in psy-
chological organization—became central issues in my theoretical formula-
tions and empirical investigations. This volume presents my explorations in
these two areas over the past 30 years.
Colleagues and I developed methods for systematically assessing the
thematic content and structural organization of representations of self and
others and considered how these representations evolve in normal psycho-
logical development, how they can be impaired in various forms of psycho-
pathology, and how they can change in the therapeutic process.
Other colleagues and I realized that the differentiation of the two foci
of depression had, in fact, identified two fundamental processes central to
psychological development—the development of interpersonal relatedness
and of self-definition or an identity—and we explored how these two funda-
mental developmental processes evolve over the life cycle and how varia-
tions in these developmental processes result in two broad configurations of
personality organization that experience and engage life very differently. Other
colleagues and I explored how severe disruptions of these developmental pro-
cesses can result in psychopathology that appears to cluster in two primary
xv
configurations. And a final group of colleagues and I attempted to evaluate
the validity of these theoretical formulations by differentiating patients whose
psychopathology was in one or the other of these two configurations of psy-
chopathology and investigating the extent and nature of their therapeutic
change.
This volume integrates more than 30 years of exploration into the de-
velopmental, clinical, and theoretical implications of these discoveries, ef-
forts conducted in collaboration with remarkably gifted colleagues and friends:
John S. Auerbach, Beatrice Beebe, Rebecca S. Behrends, William H. Berman,
Susan A. Bers, Avi Besser, Rachel B. Blass, Colin Bondi, Barry Cook, Carol
Cornell, Diana Diamond, Eva Eshkol, Ruth Feldman, Irit Felsen, Richard Q.
Ford, Shan Guisinger, Ilan Harpaz-Rotem, Lance L. Hawley, Patrick Luyten,
Kenneth N. Levy, Roslyn M. Meyer, Paul A. Pilkonis, Donald M. Quinlan,
Moon-Ho Ringo Ho, Charles A. Sanislow, Carrie E. Schaffer, Golan Shahar,
Shula Shichman, David Stayner, Steven J. Wein, and David C. Zuroff. I am
deeply grateful to them for the excitement of discovery that we shared in
these explorations. Their contributions are a vital part of this book.
In addition, several of these colleagues—John S. Auerbach, Rachel B.
Blass, Patrick Luyten, and David C. Zuroff—gave very generously of their
time, reading extensive portions of the manuscript, providing many con-
structive and creative suggestions for which I am deeply grateful. Nancy Free-
man and Beatrice Beebe provided extensive consultation on chapter 2, for
which I am also deeply grateful. I am also grateful to Joan Cricca for her
detailed and careful editorial assistance in this work. And as always, the sup-
port and wise counsel of my wife Ethel contributed in important ways to
these efforts.
Xvi PREFACE
Polarities of
Experience
INTRODUCTION
Every person throughout life confronts two fundamental psychological

developmental challenges: (a) to establish and maintain reciprocal, mean-
ingful, and personally satisfying interpersonal relationships and (b) to estab-
lish and maintain a coherent, realistic, differentiated, integrated, essentially
positive sense of self. This volume demonstrates that the articulation of these
two most fundamental of psychological dimensions—the development of
interpersonal relatedness and of self-definition—provides a comprehensive
theoretical matrix that facilitates the integration of concepts of personality
development, personality organization, psychopathology, and mechanisms
of therapeutic change into a unified model. The articulation of these two
fundamental developmental processes provides a coherent theoretical struc-
ture for integrating a wide range of theories of personality development into
a unifying comprehensive model that identifies conceptual links among
(a) processes of personality development, (b) normal variations in personal-
ity organization and personality style, (c) more extensive developmental de-
viations that are expressed in various forms of psychopathology, and (d) the
processes of personality development that can occur in the psychotherapeu-
tic process.
Psychological development, from infancy to senescence, occurs in a
synergistic dialectical transaction between these two fundamental develop-
mental processes—between the development of meaningful interpersonal
relationships and the formation of a coherent and integrated self-definition.
Development in the sense of the self leads to increasingly mature levels of
interpersonal relatedness that, in turn, facilitate further differentiation and
integration in the development of the self. Normal psychological develop-
ment occurs through a hierarchical series of dialectical transactions at differ-
ent developmental levels of interpersonal relatedness and of self-definition.
Effective psychological functioning involves an integration of mature levels
of interpersonal relatedness and self-definition, and individuals throughout
life struggle to achieve a balance between these two fundamental life com-
mitments. Within the normal range, however, individuals usually tend to
place a somewhat greater emphasis on one or the other of these two dimen-
sions. Extensive research (see summary in Blatt, 2004) documents important
differences between individuals who, although seeking to balance and inte-
grate these two fundamental life goals, tend to place a somewhat greater
emphasis and value either on issues of interpersonal relatedness (an anaclitic
personality organization) or on issues of self-definition (an introjective per-
sonality organization). Extensive research indicates that individuals with one
of these two different personality styles are vulnerable to different types of
stressful life events and cope with these stressful life events in different ways.
This differential vulnerability has important etiological implications.
Biological predispositions and markedly disruptive experiences—both
early and later in life—can profoundly interrupt this normal dialectical de-
velopmental process, resulting in a defensive exaggerated emphasis on one of
these two developmental dimensions at the expense of the other. The more
extensive this deviation from normal developmental processes, the greater
the exaggerated emphasis on one developmental line at the expense of the
other, the greater the possibility of psychopathology. Thus, many forms of
psychopathology can be understood as disruptions in the integration of the
two fundamental dimensions of relatedness and self-definition that are cen-
tral in personality development and personality organization.
Exaggerated and distorted preoccupation with establishing and main-
taining satisfying interpersonal relations, to the neglect of the development
of the self, defines, at different developmental levels, the psychopathologies
of the anaclitic or relatedness configuration of psychopathology—from un-
differentiated schizophrenia and abandonment depression to borderline, de-
pendent (or infantile), and histrionic personality disorders. These disorders
within the anaclitic configuration are interrelated. At varying developmen-
tal levels, from less to more organized, the psychopathologies in this configu-
ration share a basic preoccupation with intense struggles to establish and
maintain satisfying interpersonal relations that range from desires for merger,
symbiosis, and a loss of boundaries, to feelings of closeness, trust, coopera-
tion, mutuality, and intimacy. Psychopathologies within the anaclitic con-
figuration share a basic preoccupation with sensuous issues such as closeness
4 POLARITIES OF EXPERIENCE
and intimacy and use predominantly avoidant defenses such as denial, re-
pression, and displacement in an effort to maintain interpersonal ties. These
patients have a greater investment in affective bonding and thus a greater
capacity for developing meaningful interpersonal relations. Because of the
exaggerated and distorted emphasis on interpersonal relatedness, however,
the development of the self is neglected and is defined primarily in terms of
the quality of interpersonal experiences, and thus these individuals are very
vulnerable to experiences of loneliness and abandonment.
In contrast, exaggerated and distorted preoccupation with establishing
and maintaining definition of the self at the expense of establishing mean-
ingful interpersonal relations defines the psychopathologies of the introjective
or self-definitional configuration—paranoid schizophrenia and the paranoid,
obsessive-compulsive, self-critical depressive, and narcissistic personality
disorders. These disorders, at different developmental levels within this con-
figuration, are interrelated in their struggle to establish and maintain a sense
of self-definition to the neglect of developing interpersonal relations. The
primary preoccupation with self-definition in these disorders distorts the qual-
ity of interpersonal experiences, and these individuals are very vulnerable to
feelings of failure, criticism, and guilt. Psychopathologies in the introjective
configuration share a basic focus on assertiveness and aggression that is
expressed in concerns about separation, autonomy, independence, self-
definition, self-control, and self-worth. These individuals tend to use coun-
teractive rather than avoidant defenses including isolation, doing and undo-
ing, intellectualization, reaction formation, introjection, identification with
the aggressor, and overcompensation in efforts to preserve a consolidated
sense of self. Cognitive processes in the introjective configuration are more
fully developed with a greater potential for the development of logical thought.
From this perspective, various forms of psychopathology are no longer
separate diseases that derive from presumed but often undocumented bio-
logical disturbances, as implied in the Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994).
Rather, many forms of psychopathology can now be understood as distorted,
exaggerated, one-sided preoccupations, at different developmental levels, with
normal developmental issues of interpersonal relatedness or self-definition.
The distinction between anaclitic and introjective disorders derives prima-
rily from psychodynamic considerations including differences in instinctual
focus (libidinal vs. aggressive), types of defensive organization (avoidant vs.
counteractive), and predominant character style (e.g., emphasis on an ob-
ject vs. a self-orientation, and on affects vs. cognition).
In contrast to the DSM-IV with its many limitations including (a) a
lack of a cohesive unifying theory, (b) forced demarcation between the nor-
mal and the pathological through establishing arbitrarily defined threshold
values (see also T. A. Brown & Barlow, 2005; Widiger & Trull, 2007), (c) a
lack of a dimension of the intensity of the disturbance (T. A. Brown & Barlow,
INTRODUCTION 5
2005), (d) excessive concern with manifest symptoms and signs to achieve
acceptable levels of reliability, (e) high degree of overlap or comorbidity among
presumed distinct disorders, (f) failure to consider possible relations among
various disorders and their links with variations in normal personality devel-
opment, and (g) failure to consider issues of etiology and therapeutic inter-
vention (Blatt & Levy, 1998; Luyten, 2006; Luyten & Blatt, 2007), the theo-
retical model proposed in this volume regards various forms of psychopathology
in the anaclitic and introjective configurations of psychopathology as inter-
related forms of maladaptation that occur in response to serious disruptions
of the normal integrative, dialectical development of interpersonal related-
ness and self-definition. Psychopathology emerges as individuals, at varying
developmental levels, become preoccupied in a distorted one-sided effort to
establish and maintain either some level of interpersonal relatedness at the
expense of the development of self-definition or some sense of self-definition
at the expense of interpersonal relatedness.
In these formulations, continuity is maintained among the processes of
normal psychological development, variations in normal character style or
personality organization, and different forms of psychological disturbance.
On the basis of these distinctions, many forms of psychopathology, including
the Axis I and Axis II disorders of DSM-IV, can now be clustered into two
primary configurations, each configuration containing several levels of orga-
nization that can range from more primitive to more integrated, but still
distorted, attempts to establish and maintain meaningful interpersonal rela-
tions or a consolidated sense of self. These various levels of psychopathology
within the anaclitic and the introjective configurations also define lines along
which patients can progress or regress. An individual's difficulties can be
identified as predominantly in one or the other configuration, at a particular
developmental level, with a differential potential to regress or progress to
other developmental levels within that configuration. Thus, various forms of
psychopathology are not isolated, independent diseases but interrelated modes
of adaptation (more precisely maladaptation), organized at different devel-
opmental levels within two basic configurations, predominantly preoccupied
with issues of either interpersonal relations or self-definition. In addition to
specifying the structural relations among different forms of psychopathology,
the identification of the two primary configurations of psychopathology fa-
cilitates an appreciation of the motivational structure underlying more symp-
tomatic expressions of psychological disturbance including substance abuse
(e.g., Blatt, Rounsaville, Eyre, & Wilber, 1984; Lidz, Lidz, & Rubenstein,
1976), conduct disorder (e.g., Blatt, 1991b, 2004; Blatt & Shichman, 1981),
and posttraumatic stress disorder (e.g., Gargurevich, 2006; Southwick, Yehuda,
& Giller, 1995), thereby providing a coherent theoretical matrix for under-
standing the frequent problem of comorbidity that occurs with the current
diagnostic schema of DSM-IV.
POLARITIES OF EXPERIENCE
I first recognized the importance of these two fundamental develop-
mental dimensions of relatedness and self-definition in clinical experience
with two patients with depression in psychoanalytic treatment (Blatt, 1974,
1998, 2004). I discovered two fundamentally different types of depressive
experience: one focused on interpersonal concerns about feeling unloved,
unwanted, and uncared for (anaclitic depressive experiences) and the other
focused on issues of self-worth involving feelings of failure, worthlessness,
and guilt (introjective depressive experiences). Subsequent empirical research
(e.g., Blatt, D'Afflitti, &Quinlan, 1976; Blatt, Quinlan, Chevron, McDonald,
&. Zuroff, 1982) confirmed the validity of these clinical observations about
the nature of depressive experiences, as did the subsequent formulations of
other investigators (e.g., Arieti & Bemporad, 1978,1980; A. T. Beck, 1983).
Although pleased with the discovery of an inherent structure to the nature
of depressive experiences, 1 felt uneasy with these original formulations be-
cause they implied that the depressive experiences of women were usually at
a less mature developmental level, focused on interpersonal issues at a de-
pendent level, than were the depressive experiences of men, which usually
involved issues of self-worth that seemed to be at a developmentally more
advanced level. I was troubled by this implicit untenable gender bias and
thus sought a more comprehensive formulation in which the psychological
experiences of both women and men, although often different in many ways,
could range from primitive to more mature. On the basis of this assumption,
Shula Shichman and I (Blatt & Shichman, 1983) and later Rachel Blass and
I (Blatt & Blass, 1990, 1996) conceptualized personality development as in-
volving two fundamental developmental lines, which I initially described as
anaclitic and introjective and later as relational and self-definitional. We
discovered that this formulation enabled us to expand Erik Erikson's epige-
netic psychosocial developmental model and to illustrate that psychological
development, from infancy to senescence, progresses through a complex dia-
lectical transaction of these two fundamental developmental lines: the de-
velopment of interpersonal relatedness and self-definition. We (Blatt &
Shichman, 1983) also realized that this formulation of a fundamental polar-
ity of experience in personality development provided a way of specifying
the relationships among many forms of psychopathology that integrated a
remarkably wide range of psychopathology into a single comprehensive model
of anaclitic and introjective configurations of psychopathology—a model in
which the same fundamental psychological dimensions are involved in per-
sonality development, in normal variations of personality organization, and
in various forms of psychopathology.
The validity of the anaclitic-introjective diagnostic distinction in un-
derstanding a wide range of psychopathology has been demonstrated by ex-
tensive empirical research on depression and personality disorders. Studies
using the Depressive Experiences Questionnaire (DEQ; Blatt et al., 1976;
INTRODUCTION
Blatt, D'Afflitti, & Quinlan, 1979) and the Sociotropy-Autonomy Scale
(SAS; A. T. Beck, Epstein, Harrison, & Emery, 1983) to assess the anaclitic-
introjective dimensions have identified two types of depression: a dependent
or sociotropic form of depression focused on interpersonal loss and feelings of
abandonment (anaclitic depression) and a self-critical perfectionistic or au-
tonomous form of depression focused on issues of self-worth (introjective
depression). Extensive research (see summaries in Blatt, 2004; Blatt & Zuroff,
1992) documents the validity of this distinction and has identified early as
well as current life experiences that contribute to the emergence of these two
types of depression, the personality and clinical characteristics associated
with these two types of depression, and their differential response to various
types of therapeutic intervention. Systematic empirical investigation of out-
patients and inpatients with personality disorder, with the DEQ or SAS, also
supports the validity of the anaclitic-introjective distinction. These studies
have found that the various personality disorders in Axis II of DSM-IV are
organized in two primary configurations: one around issues of relatedness and
the other around issues of self-definition (K. N. Levy et al., 1995; Morse,
Robins, & Gittes-Fox, 2002; Ouimette, Klein, Anderson, Riso, & Lizardi,
1994). Dependent, histrionic, and borderline personality disorders (anaclitic
disorders) had statistically significantly greater preoccupation with issues of
relatedness than with issues of self-definition. Conversely, individuals with
paranoid, schizoid, schizotypic, antisocial, narcissistic, avoidant, obsessive-
compulsive, and self-defeating personality disorders (introjective disorders)
had significantly greater preoccupation with issues of self-definition than with
issues of relatedness.
Other clinical-theoretical formulations from this perspective suggested
the differentiation of two types of borderline personality disorders (Blatt &
Auerbach, 1988): an anaclitic, dependent type such as the one described in
the DSM and an introjective, self-critical, paranoid type. Thus, it was not
surprising that Ouimette and colleagues (1994) found that patients with bor-
derline personality disorder were the only group of patients with personality
disorder with elevated concerns regarding issues of both relatedness and self-
definition. These findings confirm the need to differentiate between more
affectively labile, intensely dependent borderline patients, those meeting the
DSM-IV diagnosis of borderline personality disorder (an anaclitic borderline
personality disorder), from overideational, thought-disordered, more para-
noid borderline patients (an introjective borderline personality disorder).
Patients with anaclitic borderline personality disorders focus on concerns
regarding abandonment and rejection and often make impulsive suicidal ges-
tures; patients with introjective borderline personality disorders, in contrast,
have central concerns with self-definition and self-worth, are vulnerable to
criticism and censure, and can be at risk for serious suicide attempts.
This distinction between anaclitic and introjective forms of personal-
ity organization and psychopathology also enabled investigators to system-
atically introduce patient characteristics into psychotherapy research—into
investigations of therapeutic process and outcome (e.g., Blatt, 1992; Blatt,
Besser, & Ford, 2007; Blatt & Ford, 1994; Blatt & Shahar, 2004B; Blatt &
Zuroff, 2005; Vermote, 2005). Empirical findings demonstrate that these two
groups of patients, both outpatients and inpatients, experience the therapeu-
tic process differently, in both brief and long-term intensive treatment. Judges
in several studies reliably differentiated between anaclitic and introjective
patients on the basis of intake evaluations, and this distinction was used to
investigate the differential response of these two groups of patients to brief,
as well as to long-term, intensive outpatient and inpatient treatments. Re-
sults of these studies indicated that anaclitic and introjective patients re-
spond differentially to different types of psychotherapeutic intervention in
long-term intensive treatment of seriously disturbed patients (Blatt, 1992;
Blatt & Shahar, 2004b; Vermote, 2005) and express their therapeutic gains
in divergent ways—that they change in dimensions most salient to their ba-
sic personality organization (Blatt, Besser, & Ford, 2007; Blatt & Ford, 1994;
Blatt, Ford, Berman, Cook, & Meyer, 1988). Research findings also suggest
that these two groups of patients may be differentially responsive to different
aspects of the therapeutic process. Anaclitic patients appear to respond pri-
marily to the supportive interpersonal or relational dimensions whereas
introjective patients appear to respond primarily to the interpretive or ex-
plorative aspects of the treatment process (Blatt & Shahar, 2004b; Vermote,
2005). And these differences in therapeutic response are apparent in changes
in the content and structural cognitive organization of their mental repre-
sentations (e.g., Blatt, Brenneis, Schimek, & Click, 1976b; Blatt, Wein, Chev-
ron, & Quinlan, 1979; see also Blatt, Stayner, Auerbach, & Behrends, 1996).
Colleagues and I (Colin Bondi, Lance L. Hawley, Paul A. Pilkonis,
Donald M. Quinlan, Moon-Ho Ringo Ho, Charles A. Sanislow, Golan
Shahar, and David C. Zuroff) also introduced the anaclitic-introjective dis-
tinction into further analyses of data that had been gathered as part of the
remarkably comprehensive and extensive study of brief outpatient treatment
of major depressive disorders—the National Institute of Mental Health-
sponsored Treatment of Depression Collaborative Research Program
(TDCRP) that compared two forms of manual-directed psychotherapy (cog-
nitive behavior therapy and interpersonal therapy) with medication (imi-
pramine) and a double-blind placebo. Though introjective patients did rela-
tively well in long-term intensive treatment, pretreatment introjective
personality characteristics (self-critical perfectionism) significantly impeded
therapeutic progress in all of the various forms of brief treatment for major
depression evaluated in the TDCRP. We also discovered some of the mecha-
nisms through which introjective personality dimensions impede therapeu-
tic response in brief treatment (see summary in Blatt & Zuroff, 2005). In
sum, the results of studies of brief as well as long-term intensive treatment
document the validity of the anaclitic-introjective distinction and its value
INTRODUCTION 9
in studying patient-treatment and patient-outcome interactions (e.g., Beutler,
1991; Cronbach, 1953).
Parallel to these empirical investigations of the role of anaclitic and
introjective dimensions in studies of depression, personality disorders, and
the treatment process, I also pursued the broad theoretical implications of
the anaclitic-introjective distinction with other talented and gifted colleagues,
including John S. Auerbach, Beatrice Beebe, Rebecca S. Behrends, Avi Besser,
Rachel B. Blass, Carol E. Cornell, Eva Eshkol, Ruth Feldman, Richard Q.
Ford, Shan Guisinger, Kenneth N. Levy, Patrick Luyten, Golan Shahar, and
Carrie E. Schaffer, and began to realize that my formulations about these
fundamental developmental dimensions of interpersonal relatedness and self-
definition were congruent with a very wide range of theoretical formulations
in personality development, personality theory, developmental psychopathol-
ogy, anthropology, and sociological theory. As I commented to Shan Guisinger
during our collaboration in the early 1990s, I felt as if I had a theoretical tiger
by the tail. As I explored the theoretical literature, I realized that the distinc-
tion between relatedness and self-definition appeared almost everywhere. For
many years I tried to integrate this enormous literature, but eventually real-
ized that this was an impossible task; the distinction was ubiquitous through-
out a vast literature—in cultural history; in personality, developmental, and
social psychology; in philosophy; and in political and social thought. Thus,
in the opening chapters of this volume I cover only a very limited range of
this vast literature, enough to give the reader some sense of the centrality of
these concepts across a variety of disciplines, before I turn to the primary
purpose of this book: to communicate the value of these formulations about
the development of interpersonal relatedness and self-definition for under-
standing personality development, personality organization, psychopathol-
ogy, and the therapeutic process.
Thus this volume is organized into four primary parts addressing per-
sonality development, personality organization, psychopathology, and the
therapeutic process. The first part (chap. 1) briefly demonstrates the central-
ity of interpersonal relatedness and self-definition as a fundamental polarity
of human experience. The second part (chaps. 2, 3, and 4) addresses the
development of these two fundamental dimensions from infancy through
adulthood. Chapter 2 discusses the process of engagement and disengage-
ment, of attachment and separation, of gratifying involvement and experi-
enced incompatibility that contribute to the formation of prerepresentational
structures of self and of significant others in infancy that provide the basis for
subsequent development. Chapter 3 discusses the development of the capac-
ity for interpersonal relatedness and self-definition as central issues in a wide
range of personality theories from psychodynamic to empirically derived for-
mulations. Chapter 4 proposes a dialectical developmental model through
which these two fundamental capacities develop throughout life in a hierar-
chical series of synergistic transactions. The third part (chaps. 5 and 6) pro-
poses a theoretical model of personality organization and psychopathology
in which normal variations in emphasis on interpersonal relatedness or self-
definition define two broad types of personality organization: anaclitic and
introjective (chap. 5). Chapter 6 identifies two primary configurations of
psychopathology that involve extreme developmental deviations that em-
phasize one of these two fundamental dimensions at the neglect of the devel-
opment of the other. Anaclitic psychopathologies have an exaggerated and
distorted preoccupation with issues of interpersonal relatedness, and
introjective psychopathologies have an exaggerated and distorted preoccu-
pation with issues of self-definition. Thus, these formulations propose a uni-
fying model of psychopathology that identifies basic commonalities among
many forms of psychopathology that cluster in two primary configurations
and that have continuities with normal variations in personality organiza-
tion. The fourth part (chaps. 7 and 8) considers the implications of these
formulations of personality organization and psychopathology for the thera-
peutic process. Chapter 7 presents findings from several extensive investiga-
tions of therapeutic change that demonstrate the validity of the anaclitic-
introjective distinction in the study of therapeutic change in long-term,
intensive, psychodynamically oriented treatment as well as in brief, behav-
iorally oriented, manual-directed treatments. Chapter 8 discusses the pro-
cesses of therapeutic change and proposes that psychotherapeutic change
involves the fundamental mechanisms of psychological development—
experiences of gratifying involvement and experienced incompatibility lead-
ing to the formation of representations of self and significant others—that
were discussed in the second part as essential processes in normal personality
development.
INTRODUCTION 11
RELATEDNESS AND
I
SELF-DEFINITION:
A FUNDAMENTAL
POLARITY OF EXPERIENCE
This initial part identifies two fundamental psychological dimensions

of human experiences—interpersonal relatedness and self-definition—and
places them into a broad cultural context. Chapter 1 demonstrates the cen-
trality of these two dimensions in a remarkably wide range of personality
theories, from classic and neoclassic psychoanalytic theories to views on per-
sonality organization derived from empirical research investigations, as well
as social and evolutionary theory.
FUNDAMENTAL DIMENSIONS IN
1
PERSONALITY AND SOCIAL THEORY
Establishing meaningful, mutually satisfying, reciprocal interpersonal

relationships and establishing a differentiated, integrated, realistic, essen-
tially positive sense of self (an identity) are two of the most fundamental
processes in personality development. The terms interpersonal relatedness and
self-definition identify these two primary complex developmental processes,
each of which has a number of different aspects. Aspects in the development
of interpersonal relatedness include, at different developmental levels, expe-
riences of merger, dependency, submission, cooperation, participation, be-
longing, communion, affiliation, union, intimacy, love, sexuality, mutuality,
reciprocity, and intersubjectivity. Aspects in the development of self-
definition, at different developmental levels, include experiences of sepa-
rateness, isolation, autonomy, control, possession, power, dominance, initia-
This chapter incorporates material from the following sources: (a) Continuity and Change in Art: The
Development of Modes of Representation, by S. J. Blatt, in collaboration with E. S. Blatt, 1984, Hillsdale,
NJ: Erlbaum. Copyright 1984 by Erlbaum. Adapted with permission; (b) "Dialectics of Individuality
and Interpersonal Relatedness: An Evolutionary Perspective," by S. Guisinger and S. J. Blatt, 1994,
American Psychologist, 49, pp. 104-111. Copyright 1994 by the American Psychological Association;
and (c) "Developmental Lines, Schemas, and Archetypes," by S. Guisinger and S. J. Blatt, 1995,
American Psychologist, 50, pp. 176-177. Copyright 1995 by the American Psychological Association.
15
tive, industry, achievement, agency, individuality, identity, and integrity. In
this chapter, I briefly review the emergence of aspects of these two funda-
mental psychological developmental processes of relatedness and self-defini-
tion in Western social organization and thought. I also consider how these
two fundamental developmental processes, or polarities of experience, pro-
vide a comprehensive theoretical structure for integrating a wide range of
theories of personality organization, from psychoanalytic to more empirical
perspectives, and for understanding behavior and psychological phenomena
in a variety of social contexts.
HISTORICAL DEVELOPMENT OF SELF-DEFINITION AND

INTERPERSONAL RELATEDNESS IN WESTERN CIVILIZATION
The development of individuality or self-definition and of interpersonal

relatedness and a sense of community in social organization and thought in
Western civilization is complex and multidimensional, and many volumes
have been and will continue to be written about the cultural development of
these two fundamental foci of human existence (Bakan, 1966). The goal of
this brief historical introduction is to provide a cultural context illustrating
the centrality of these two fundamental psychological dimensions and how
they provide a coherent unified theoretical structure that facilitates the inte-
gration of observations about personality development, variations in normal
personality functioning or character formation, concepts of psychopathol-
ogy, and processes of therapeutic change.
Self-Definition (Individualism)
An emphasis on self-definition or individualism has been predominant

in Western culture. Contemporary Western industrialized society stresses the
development of different aspects of individuality (autonomy, independence,
achievement, and identity) as essential components of psychological matu-
rity. Psychological theories have traditionally given much greater importance
to the development of individuality or self-definition than to interpersonal
relatedness as the primary feature of the mature individual.
In a historical consideration of the two fundamental human motives
(intimacy and power or relatedness and self-definition), McAdams (1985a)
traced these themes to antiquity, referencing Empedocles's (c. 440 BCE) dis-
cussions of love and strife, and union and division, as two primary principles
of the cosmos.
Self-identity or individuality is a complex concept that has engendered
considerable philosophical speculation (e.g., Descartes, Nietzsche, Kant) and
is also a fundamental issue in contemporary personality theory and social
psychological research. Morris (1972), Baumeister (1987), Lukes (1973), and
especially Charles Taylor (1989) provided comprehensive reviews of the his-
torical and philosophical development of the emergence of the concept of
self (or individuality) in Western culture. The self or individuality is essen-
tially a modem concept, deriving only partly from the ancient Greece polis
with its emphasis on human dignity. Emphasis on individualism in Western
civilization began with the emergence of participatory societies in Periclean
Athens and later in 2nd-century Rome when individualism for privileged
members of society was bounded by social obligation. Although one's indi-
viduality in ancient Greece was derived from and determined by external
factors such as fate and the gods, man was viewed as having an independent
capacity for thought, reflection, and action.
Despite Augustine's 4th-century effort to write the first known intro-
spective autobiography (C. Taylor, 1989), the medieval period was marked
by a general lack of interest in the individual and the self. The initial empha-
sis on individuality and the dignity of man that began to emerge in ancient
Greece and Rome was lost in medieval times when the individual was con-
sidered insignificant in God's conception of the universe. Individual lives
were considered of little consequence with respect to God's plans and schemes.
Life was preordained, determined by inheritance and social station, and one
had few options or alternatives. Individuality and personal freedom, which
were natural and taken for granted in ancient Greece and Rome, at least for
a segment of society, were suppressed during the Middle Ages. The politi-
cally free man of ancient Greece was redefined in early Christianity as a man
who is free as a consequence of his belief in Christ. Despite this emerging
emphasis on freedom in early Christianity, medieval and very early Renais-
sance theology denied the possibility of free choice. Major Christian theolo-
gians such as John Calvin believed in predestination.
As a consequence of this suppression of individuality, autobiographic
writing was infrequent in the Middle Ages (Weintraub, 1978) and artists
generally did not sign their work (Kris & Kurz, 1979). They would begin to
do so again only in the late 13th century when the concept of the individual
began to emerge once again in Europe in the transition of social organization
from the Middle Ages to the Renaissance. A transformed emphasis on indi-
viduals began to reemerge in the 13th century with Thomas Aquinas noting
that man had free will and therefore was blameworthy for his sins. Apprecia-
tion of the uniqueness of talented and meritworthy individuals emerged fur-
ther with the mercantile emphasis in 14th-century Italy and later in 16th-
century Holland, as well as in Elizabethan England. Thus, an emphasis on
individuality and the dignity of man began to reemerge in the early Renais-
sance, initially seen as achieved through faith and later seen as achieved
through work and talent. An individual's role in Renaissance society was no
longer determined solely by divine inheritance; talented and meritworthy
individuals were given increasing recognition. One's fate and role in society
were no longer preordained by God, but one could, with God's favor, win
FUNDAMENTAL DIMENSIONS 17
recognition on the basis of talent and accomplishments. The themes of indi-
viduality, freedom, and independence that reemerged during the Renaissance
and the Baroque Era could be characterized by the saying "The Lord helps
those who help themselves" (Doi, 1973). Doi pointed out that this emphasis
on individual freedom also has antecedents in Christian theology (pp. 92-
93). Paul spoke of freedom through Christ versus the slavery of sin, and St.
Augustine and Martin Luther stressed the freedom of a Christian.
In the 14th century, Petrarch (see Bishop, 1961) emphasized the im-
portance of introspection and reflection, but he also stressed the congruence
of insight and understanding with social ideals as the way to achieve personal
fulfillment. Introspective awareness of the separateness of individuals, as well
as an appreciation of unity within each life, according to Petrarch, was essen-
tial for self-knowledge. A number of commentaries and treatises in the 14th
and 15th centuries began to extol the dignity of man (e.g., Manetti's The
Dignity and Excellence of Man and della Mirandola's Oration on the Dignity of
Man). The emergence of the belief that individuals could succeed through
individual talent and merit as part of the emergence of a mercantile bour-
geoisie in Renaissance Italy, Holland, and England was crucial in the rebirth
of an emphasis on the individual and of individualism that was to dominate
Western thought over the following centuries.
The importance of the individual in Renaissance theology and philoso-
phy was also expressed in Renaissance art and science. The efforts of Renais-
sance artists to go beyond the intuitive perspective that had been established
in Greco-Roman painting resulted in the discovery of the central vanishing
point for the representation of recession in depth and for establishing inte-
grated and coherent compositions. Linear perspective is based on the posi-
tion of the observer as a stable and consistent reference point, unique and
differentiated from the perspective of others. Alberti's discovery (1435/1956)
of the vanishing point in art facilitated the representation of systematic re-
cession in depth in integrated and coherent compositions.
The paradigmatic change in Renaissance art was coincident with dis-
coveries in natural philosophy and science about the position of Earth in the
solar system—with an equally paradigmatic shift from a geocentric to a he-
liocentric conception of the universe, and the possibility of infinity in
nature. The development of linear (quantitative) perspective in art, similar
to the Copemican revolutionary reformulation in the 16th century of the
organization of the planetary system and Descartes's development of a spatial
coordinate system in the 17th century, involved an evolving conception of
space as homogenous, isotropic, and infinite, with the individual as the cen-
tral reference point (Butterfield, 1957; Koyre, 1957; Panofsky, 1927, 1960/
1972). Although some authors discuss the Copernican revolution as a blow
to the self-esteem of the individual in no longer being located at the center
of the universe and of God's attention, Lovejoy (1936) offered an alternative
interpretation, noting that the center of the world in medieval thought was
J8 POLARITIES OF EXPERIENCE
not a position of honor; rather, it was the bottom of creation to which "dregs
and baser elements sank. The actual center, indeed was Hell" (pp. 101-102).
Copernicus's reformulation of the solar system elevated the Earth by placing
it among, and equal to, the planets, raising the Earth from a lowly position to
an integral part of the celestial system around the sun (Koyre, 1957), thereby
transforming individuals' self-image and their relation to nature (Lovejoy,
1936). Thus, Copemicus's formulations were part of an elevation in the Re-
naissance of the role of the individual in nature. And it may be no coinci-
dence that Descartes, the inventor of coordinate geometry built around a
central reference point, was also preoccupied metaphysically with exactly
the same issue—the dignity of the individual. The relationship of Descartes's
invention of the geometric coordinate system (1637) with his developing
self-reflective awareness is nicely expressed by his metaphysical pronounce-
ment, "I think, therefore I am." Descartes, in Discourse on Methods and
Medications (1968a), discussed his search for a fixed, immovable
"Archimedean point," his hope to discover the one thing that is certain
and indubitable. And Descartes went on, of course, to establish his own
existence as that certain and indubitable reference point. Thus in Renais-
sance and Baroque art, science, and philosophy, the individual was viewed
as a constant and stable reference point for organizing experiences and for
understanding nature, including the importance of personal experiences
(e.g., meaning, emotion, and feeling) as important sources of knowledge
(Blatt & Blatt, 1984).
From the Renaissance to the Enlightenment (1400-1800) individual-
ity and individual development became increasingly important. Autobio-
graphic writing began to appear, as did portraits of individuals. A public
and a private self were differentiated. This distinction was in turn accom-
panied by self-consciousness, self-awareness, and the possibility of self-dis-
covery, as well as by the recognition of inner intentions and self-deception
and the deception of others (E. Auerbach, 1946/1953; Trilling, 1971). The
inner nature of the self could be expressed in feelings of sincerity or experi-
ences of emptiness (Trilling, 1971). Self-discovery became the personaliza-
tion of Christian piety; meditation on the life and passion of Christ, as well
as an increased use of the confessional, led to greater emphasis on personal
responsibility.
The emergence of this emphasis on individualism in Western civiliza-
tion over the following centuries was extraordinary. Maybury-Lewis (1992)
argued that the emphasis on the dignity and rights of the individual, and the
severing of traditional supportive and constraining obligations to kin and
community, was the sociological equivalent of splitting the atom. Individu-
alism, according to Maybury-Lewis (1992), unleashed a level of creativity
that resulted in extraordinary technical advances. Although the sources of
these developments are complicated and involve interaction among many
social, religious, political, and economic factors, individualism had emerged
as a major social and personal force by at least the late medieval period and
early Renaissance (Baumeister, 1987; Blatt, 1983,1994a, 1994b; Blatt&Blatt,
1984; Lukes, 1973; Morris, 1972) and has remained an essential characteris-
tic of Western society ever since. By the 18th century, Western philosophi-
cal and psychological views of human nature had become increasingly indi-
vidualistic. Individualism became most fully developed across a wide segment
of the population in the United States, especially with the advent of capital-
ism and the Industrial Revolution.
Maddi (1980) believed that the emphasis on the centrality of the power
motive in contemporary personality development derived from Nietzsche
who, in the late 19th century, articulated the will to power as an ethical,
religious, and psychological imperative that inspired men to passion, pride,
revenge, anger, adventure, war, destruction, and knowledge. Nietzsche's hero,
the ubermensch, is the incarnation of the will to power, someone who views
things, people, and ideas as objects of conquest. The prototype for Nietzsche
was the governing aristocrat, the ruthless tyrant, who at the same time was a
man of high culture with a passion for the arts and the pursuit of knowledge.
Although Nietzsche (in Thus Spake Zarathustra, 1896) clearly preferred war-
riors over servants, he highly valued the artist because he considered artistic
creation the highest expression of the will to power. In addition to consider-
ing the various antecedents of the desire for power (separateness, autonomy,
mastery, expansion, and conquest), Maddi (1980) also discussed the ante-
cedents of the motive for affiliation.
With the Enlightenment and the ascent of science, individuality and
personal freedom became secular concepts (cf. Jefferson, Hobbes, Locke,
Voltaire, Rousseau). The Romantic period of the late 18th and early 19th
centuries increasingly emphasized secular forms of fulfillment, thus creating
the possibility of conflicts between the individual and society. This conflict
became increasingly acute in the Victorian era (1830-1900) as society be-
came increasingly differentiated and provided people with a bewildering range
of choices and potential roles (Parsons, 1968; cited in Gordon & Gergen,
1968). Darwin's (1859) concept of the survival of the fittest and Sigmund
Freud's (1900/1953) view that the infant develops through frustration and
the delay of gratification are deeply rooted in the individualistic theories of
Adam Smith, Malthus, and others. Individuals increasingly recognized that
potential conflicts existed between self and society, as well as between public
and private versions of the self.
Hogan (1975) summarized four primary views of individualism that have
dominated more recent Western thought. Although these four individualis-
tic psychologies differ in a number of respects, they all minimize the impor-
tance of social and interpersonal aspects in psychological functioning:
• Romantic individualism, associated with Rousseau, emphasizes
that people are naturally good, are interested in mastery, and
tend to develop in a healthy, mature, and moral fashion if not
corrupted by society. Psychologists whose theories are conso-
nant with these assumptions include G. Stanley Hall, John
Dewey, Carl Rogers, and Jean Piaget.
• Egoistic individualism, associated with Hobbes's rationalism and
Nietzsche's romanticism, is often the basis of conservative po-
litical philosophies. People are seen as fundamentally selfish,
egocentric, and aggressive—tendencies that must be suppressed
by society. Sociability and altruism have to be learned
(Hardman, 1981). S. Freud (e.g., 1930/1961), in part, main-
tained this perspective.
• Ideological individualism views the social hierarchy as coming
between people and the truth; institutions must always be evalu-
ated in terms of an individual's vision of the truth (e.g., Jefferson,
Locke, Voltaire). Commitment to academic and scholarly tra-
ditions and faith in one's own perceptions and values can be
expressed in a willingness to challenge existing authority.
Kohlberg's (1963; Kohlberg & Kramer, 1969) theory of moral
development is an example of ideological individualism.
• Alienated individualism holds that the intellectual begins with
a responsibility to repudiate society; intellectuals cannot help
but be alienated because they realize social institutions are
ephemeral and are artificial constructions that are essentially
invalid. Existential and phenomenological psychologists such
as Perls (1947), May (1958), and Laing (1967) argue that to
the degree individuals identify with their social roles, they are
inauthentic.
With the development of psychoanalysis at the beginning of the 20th
century, the interest in individualism as a philosophical and cultural concept
was extended to an interest in the individual's development of a sense of self.
William James (1890/1958) wrote extensively about the self that he viewed
simultaneously as both subject and object, an I and a me, which has stability
over time and across contexts. This stability creates a consistency of behav-
ior and the capacity to adapt in a variety of changing conditions. As dis-
cussed more fully in chapter 3 (this volume), the development of the self
involves processing experiences, establishing personal meaning, and appre-
ciating the subjectivity of events (Blatt, 1983; Blatt & Bers, 1993). Although
these various philosophical positions, or indigenous psychologies, reach dif-
ferent conclusions about basic human nature, they all have a fundamental
egocentric or individualistic bias. The individual is not viewed as an integral
part of his or her social world; belonging to a group is not seen as providing
the individual with a sense of purpose and direction. Rather, society is viewed
as either corrupting or limiting the individual's basically asocial nature.
The importance of individual freedom, free will, and autonomy, how-
ever, has also been challenged ever since the Renaissance by the implica-
tions of several major paradigmatic shifts including Darwinian evolution,
Marxian material determinism, and Freudian unconscious motivation, all of
which recognized the limitations of human freedom and individual self-
determination. Thus, the late 19th and early 20th centuries were also a time
of increased awareness of individuals' dependence on society and the recog-
nition that identity or self-definition, as a structural aspect of personality, is
established through the internalization of social objects. As Parsons (1951)
stressed, the individual internalizes both a role relation and the collectivity.
Thus, social relationships both determine identity and limit autonomy. These
challenges to autonomy and independence engendered an increasing em-
phasis on knowledge as a way of promoting greater autonomy within a social
framework.
In the late 20th and early 21st centuries, the emphasis has been on the
need to find ways of accommodating the social reality by clearly defining
one's ideals and values, and by seeking experiences that are considered nec-
essary for personal fulfillment (Blatt, 1999a). Social forces create opportuni-
ties in a complex culture in which individuals make choices and decisions
that demand initiative as well as self-evaluation and self-criticism. Thus in-
dividualistic qualities such as free will, autonomy, choice, initiative, and per-
sonal responsibility are now viewed as responses to environmental limita-
tions as well as to environmental opportunities, and are associated with
psychological well-being and maturity. Although freedom of will is influ-
enced by favorable social and economic conditions, it is also determined by a
capacity for thought and imagination (Easterbrook, 1978). Psychological
maturity and well-being are associated with self-determination, the ability to
resist external influences, and the ability to experience freely one's own per-
ceptions, feelings, and needs and to respond to them (Gruen, 1986). The
experience of individuality, the sense of self as a free agent capable of initiat-
ing activity, is an expression of an integration and harmony with one's feel-
ings, needs, perceptions, and understanding of life. Thus, Gordon and Gergen
(1968) defined the self as organized around a set of aspirations toward major
life goals. The task is to be able to coordinate personal goals and aspirations
with social restrictions as well as opportunities.
Interpersonal Relatedness or Communion
Alexis de Tocqueville, in the mid-19th century, in Democracy in America

(1835/2000), introduced the term individualism to describe a process of being
consumed with the private pursuit of happiness and ignoring the social struc-
ture of society. He was concerned that "the habits of the heart," the concerns
about the communal good, not be lost in the preoccupation with the private
self. Although individuality is considered essential in contemporary West-
ern society (Sampson, 1985, 1988), it is important to note that ancient as
well as less technological societies have had relatively little concept of the
individual as an isolated and atomistic self (Baumeister, 1987; Morris, 1972;
Tuan, 1982); rather, issues of community and interpersonal relationships have
been of primary concern. Collectivism or communalism, predominant in
Eastern cultures, emphasizes intimate and harmonious relationships with oth-
ers and participation in the social order and social process. In contrast to self-
definitional ideologies that value individual autonomy and well-being, com-
munal ideologies value group cohesion and interpersonal relations.
Non-Western cultures are often more communal and less individualis-
tic than are Western cultures. In contrast to the tension between individual
autonomy and connectedness with others in individualistic cultures, the self
in collectivist cultures is considered primarily in relation to others (Geertz,
1973; Guisinger & Blatt, 1994,1995). Individuals in communal societies are
more self-effacing than self-enhancing (e.g., Heine & Lehman, 1995; Kashima
&Triandis, 1986; Markus & Kitayama, 1991; Shikanai, 1978; Takata, 1987).
Investigators (e.g., Doi, 1986; Kojima, 1984), for example, noted that in Japa-
nese culture the self cannot be defined outside of its interpersonal relation-
ships. The qualities of autonomy, independence, control, and achievement,
regarded as positive developments in Western cultures (Kagitcibasi, 1990),
are often achieved at the expense of interpersonal relatedness (e.g., Geertz,
1973; Gergen, 1985,1991; Gergen & Gergen, 1988; Gilligan, 1982; Guisinger
& Blatt, 1994; Kagitcibasi, 1990; Moscovici, 1984; Sampson, 1985; Shweder
& Bourne, 1984; M. B. Smith, 1994). The relative lack of relatedness (e.g.,
Bellah, Madsen, Sullivan, Swindler, &Tipton, 1985; Doi, 1986) in Western
cultures has often led to further exaggeration of individualism (Hsu, 1983;
Kagitcibasi, 1990), sometimes to the point of pathology (e.g., Draguns,
1990).
Challenges to the individualistic view of human development have come
primarily from feminist and object relations theorists, anthropologists study-
ing tribal cultures, members of minority groups, and non-Western psycholo-
gists. Many cultures, other than Western society, conceptualize the person as
an integral part of his or her relationships. In these cultures, the boundary
between self and nonself is less sharply drawn, and relationships with others
are included within the definition of self. In traditional Asian cultures, for
example, the self is defined within the structure of relationships with society
and nature (Doi, 1973; Ho, 1993; Kim & Berry, 1993; Kojima, 1984). The
Chewong of Malaysia, for example, do not distinguish sharply between the
individual and his or her context (Howell, 1981); for the Maori, a person's
life is determined by a strong social focus (P. B. Smith & Bond, 1988; P. B.
Smith &. Schwartz, 1997); and individuals in Islamic, Confucian, and Hindu
cultures are embedded in a series of social relationships and obligations (Choi,
Kim, & Choi, 1993; Harre, 1981; Ho, 1993). Many non-Western societies
historically have been primarily more sociocentric than egocentric (see re-
views by Heelas & Lock, 1981; Kim & Berry, 1993), emphasizing related-
ness, sometimes at the expense of an independent, autonomous self. Rather
than focusing on self-definition, including maintaining an independence from
others, these societies focus on forming connections with others.
In Western culture these qualities of relatedness and self-definition are
often associated with sex-role stereotypes. Bakan (1966) cited Lombrosa
(1923), who noted that women are usually altercentric (i.e., others are at the
center of their emotional life) and function primarily in an expressive com-
munal social structure. Men, in contrast, are usually egocentric (i.e., the
self is at the center of their emotional life) and function primarily in an
instrumental-agentic social structure. Janet Spence (1984) made a similar
point in noting that masculinity is associated with agency and femininity is
associated with communion (see also Gilligan, 1982; Horney, 1945, 1950;
Miller, 1976/1986).
In light of the proclivity of females to emphasize relatedness and males
to emphasize individuality (e.g., Chevron, Quinlan, & Blatt, 1978; Diehl,
Owen, Si Youngblade, 2004; Golding & Singer, 1983; Moskowitz, Suh, &
Desaulniers, 1994), it would be interesting, following the suggestion of T. W.
Smith, O'Keefe, and Jenkins (1988), to evaluate gender-congruent individu-
als (relatedness-focused females and self-definitional-focused males) and
gender-incongruent individuals (relationally focused males and self-defini-
tional-focused females) in diverse cultures to study how different types of
individuals adapt within both types of cultures (collectivistic and individual-
istic) and how some individuals are able to achieve a reasonable balance of
both relatedness and self-definition in different cultural contexts. Sandra Bern
(1975) conceptualized the integration of qualities conventionally associated
with femininity (relatedness) and masculinity (self-definition) as defining a
well-functioning psychological state that she termed androgyny. Well-
functioning societies should facilitate a balanced integration of individual-
ism and communalism, of self-definition and relatedness, not only in very
well-functioning individuals but within the total society as well (e.g., Etzioni,
1990,1995; Kymlicka, 1989; C. Taylor, 1985,1989). These observations and
formulations suggest that the issues of relatedness and self-definition have
important implications for understanding normative and nonnormative per-
sonality development and organization in a variety of cultures.
RELATEDNESS AND SELF-DEFINITION IN

PERSONALITY THEORY
Personality development throughout the life cycle, from infancy to se-

nescence, evolves through the dynamic transaction of two fundamental de-
velopmental processes: (a) a relational developmental line that leads to in-
creasingly mature, mutually satisfying, reciprocal interpersonal relationships
and (b) a self-definitional developmental line that leads to a consolidated,
realistic, essentially positive, differentiated, and integrated self-identity. These
two developmental lines normally evolve through a complex hierarchical
series of dialectical synergistic transactions. An increasingly differentiated,
integrated, and mature sense of self emerges from satisfying interpersonal
relationships and, conversely, continued development toward increasingly
mature, satisfying, reciprocal interpersonal relationships is contingent on the
development of a more differentiated and integrated self-definition and iden-
tity. Meaningful and satisfying relationships contribute to the evolving con-
cept of self, and a new sense of self leads, in turn, to more mature levels of
interpersonal relatedness. Thus, as is discussed in more detail in chapter 4
(this volume), the transaction of these two developmental processes is fun-
damental to personality development throughout life (Blatt, 1974, 1991a,
1995a; Blatt & Blass, 1990, 1996; Blatt & Shichman, 1983). This formula-
tion of personality development as evolving through the complex dialectical
transaction of interpersonal relatedness and self-definition is consistent with
a surprisingly wide range of personality theories, from classic psychoanalytic
conceptualizations to more contemporary empirically derived formulations
that emphasize the importance of issues of self-definition (e.g., agency) and
interpersonal relatedness (e.g., communion) in personality organization.
Psychodynamic Theory
Classic psychoanalytic theory as well as many subsequent revisions and

elaborations of this theory have emphasized the fundamental polarity of re-
latedness and self-definition.
Classic Psychoanalytic Theory

Many of Sigmund Freud's theoretical formulations were based on this
fundamental polarity—the polarity of attachment and individuation, or in-
terpersonal relatedness and self-definition. S. Freud, throughout the full range
of his work, conceptualized human existence in terms of the fundamental
polarity of primary attachment and individuation. He observed, for example,
in Civilisation and Its Discontents that "the development of the individual
seems ... to be a product of the interaction between two urges, the urge
toward happiness, which we usually call 'egoistic', and the urge toward union
with others in the community, which we call 'altruistic'" (1930/1961, p. 140).
S. Freud (1930/1961) also noted that the struggle between the urge toward
egoism (personal happiness) and the urge toward union with others in the
community (altruism) occurs in every individual, and so the "two processes of
individual and of cultural development . . . stand in hostile opposition to
each other and mutually dispute the ground" (p. 141).
The fundamental polarity of relatedness and self-definition is also ex-
pressed in S. Freud's oft-quoted statement that the two major tasks in life are
"to love and to work" (cited in Erikson, 1950, p. 265) and in S. Freud's (1914/
1957f, 1926/1959c) distinctions between object and ego (or narcissistic) li-
bido (investment in others or in the self), as well as between libidinal (sexual)
instincts in the service of attachment and aggressive instincts necessary for
autonomy, mastery, and self-definition. S. Freud (1914/1957f, 1926/1959c)
also differentiated two types of object choice: an anaclitic choice based on
the mother who feeds or the father who protects, or both, and a narcissistic
choice based on who one is, was, or wants to be. An anaclitic choice involves
developing affectionate, need-satisfying relationships, whereas a narcissistic
choice involves the use of others to enhance the self.
S. Freud (1930/1961) also extended this polarity of relatedness and self-
definition (attachment and individuation) in personality development to
concepts of psychopathology by distinguishing between two fundamental
forms of anxiety. One source of anxiety derives from the intemalization of
superego (moral) authority and involves feelings of guilt and fears of punish-
ment that are related to ego instincts (issues of self-assertion and mastery)
that S. Freud viewed as opposing the progress of civilization. The second
source of anxiety—social anxiety—involves the fear of loss of love and con-
tact with others. S. Freud (1914/1957f, 1926/1959c) further linked these two
primary dimensions of relatedness and self-definition (or attachment and
individuation) to concepts of psychopathology in his differentiation of four
primary dangers or traumas: relational dangers involving feelings of helpless-
ness associated with (a) the loss of the mother or (b) the loss of her love, and
self-definitional dangers involving (c) a loss of superego approval and (d) the
fear of punishment because of assumed transgressions of omission or commis-
sion. S. Freud (1905/1963b, 1926/1959c) viewed the sense of helplessness
that derives from separation from a loved object as particularly related to
aspects of feminine development. S. Freud (1914/1957f, 1923/1959a, 19261
1959c) viewed the loss of superego approval and the threat of punishment
expressed in self-reproach and feelings of guilt as more characteristic of mas-
culine development. Hartmann, Kris, and Loewenstein (1949) suggested that
the fear of loss of the primary love object and her love (i.e., mother) is re-
lated to conflicts involving affectional (libidinal) strivings and that the loss
of superego approval and the threat of punishment (often from the father)
are related to conflicts involving aggressive strivings and the struggle for in-
dividuation and identity. Impressed with the extent to which this fundamen-
tal polarity pervaded Freud's wide-ranging contributions, Loewald (1962)
noted that
these various modes of separation and union . . . [identify a] polarity
inherent in individual existence of individuation and "primary narcissis-
tic union"—a polarity that Freud attempted to conceptualize by various
approaches and that he recognized and insisted upon from beginning to
end [in]... his dualistic conception of instincts, of human nature, and of
life itself, (p. 490)
Loewald (1962) also noted that this duality or polarity of individuation and
primary union underlies the significance of separation and internalization as
basic mechanisms in psychological development (see also Behrends & Blatt,
1985; Blatt & Behrends, 1987). These processes of internalization are con-
sidered in more detail in chapters 4 and 8 (this volume).
Karl Abraham (1949) also discussed the consequences of the type of
early attachment for the development of a capacity for love and for libidinal
(sexual) development more generally. He viewed attachment to a caregiver
(an anaclitic object choice) as providing the basis for establishing mature
intimate relationships in adulthood. Abraham (1949) viewed narcissistic
object choices that lead to identification and self-definition as also necessary
for mature adult relationships. Anaclitic and narcissistic object choices be-
come increasingly differentiated and refined with development and are the
basis for establishing two fundamental developmental processes: relatedness
and self-definition. Development throughout life occurs in repeated shifts in
investment in self and in others that result in a continual discovery of new
objects (or new aspects of others) and in revisions or new definitions of the
self. Thus, interpersonal relationships and self-discovery are integral aspects
of psychological development; new dimensions in the definition of the self
and new levels of interpersonal relatedness occur repeatedly with every new
developmental phase (Tausk, 1919/1948). Melanie Klein (1952) noted that
the development of both object relations and self-definition depends on the
degree to which the individual is able to achieve and maintain an optimal
balance between projection and introjection, between the discovery of others
and the discovery of the self. Satisfactory development, according to M. Klein
(1952), requires the taming of destructive impulses and the establishment of
an internal presence of a differentiated and integrated loving object.
Neopsychoanalytic Theorists
Other psychoanalytic theorists after S. Freud have articulated similar
distinctions and made them central to their formulations. Alfred Adler (1951),
for example, emphasized the difference between social interest and a preoc-
cupation with self-perfection. Adler (1933/1964) viewed striving for superi-
ority and perfection, through mastery of one's biological, physical, and social
environments, as the most fundamental human drive. He further asserted
that this drive, along with striving to establish some form of community, is
"the ultimate fulfillment of evolution" (Adler, 1933/1964, pp. 34-35). The
striving for superiority, self-expansion, growth, and competence was, for Adler,
the expression of an inherent aggressive drive. In his view, neurosis was the
consequence of a distorted overemphasis on self-enhancement in the ab-
sence of sufficient social interest. Adler also viewed pampering (overprotec-
tion, overindulgence, and overdomination) and rejection as leading to feel-
ings of inadequacy, selfishness, and a lack of independence. Thus, he implicitly
argued for a balance between an investment in self-interest and in the com-
munity. Otto Rank (1929) also discussed the juxtaposition of self- and other-
directedness and their relationship to creative and adaptive personality styles.
Rank (1929, 1945) viewed the dialectic of union and separateness as central
to personality development. Union with another person, persons, or human-
ity in general enables one to discover and affirm one's likeness with others
and to achieve a sense of security, whereas experiences of separation enable
one to discover and affirm one's identity and uniqueness as well as the unique-
ness of others (A. Schmitt, 1973). Heinz Kohut (1966) discussed two strands
of narcissism, one involving an idealized parental image and the other a gran-
diose self.1
The formulations of the psychoanalytic object relational and interper-
sonal theorists are also based on the distinction between relatedness and self-
definition. Karen Horney (1945,1950) discussed contemporary Western cul-
ture as containing inherent contradictions between competition and success
versus brotherly love and humility. Individuals seek to resolve these contra-
dictions by either moving toward, moving against, or moving away from in-
terpersonal relationships. H. S. Sullivan (1953) thought that individuals could
be best understood by considering their needs for both tenderness and power.
John Bowlby (1969, 1973, 1988a, 1988b), from ethological and object rela-
tions perspectives, explored attachment and separation as the emotional sub-
strates of personality development. Michael Balint (1959), from a psycho-
analytic object relations perspective, discussed the centrality of these two
fundamental tendencies—attachment and separation, and relatedness and
self-definition—in his formulations of a striving toward clinging and con-
nectedness (an ocnophilic tendency) and a striving toward free-moving activ-
ity and self-sufficiency (a philobatic tendency). Shor and Sanville (1978), on
the basis of Balint's formulations, discussed psychological development as a
process involving a fundamental oscillation between "necessary connected-
ness and an inevitable separateness" (p. 121) or between "autonomy and
intimacy" (p. 121) that occurs as "a dialectical spiral or helix which inter-
weaves the[se] two dimensions of development" (p. 121).
Nonpsychoanalytic Personality Theorists
A wide range of nonpsychoanalytic personality theorists (e.g., Angyal,
1951; Bakan, 1966; L. S. Benjamin, 1974; Deci &Ryan, 1985,1991; Helgeson,
1994; Helgeson & Fritz, 1999; T. Leary, 1957; Markus & Oyserman, 1989;
McAdams, 1985a, 1989; McClelland, 1986; R. W. White, 1959; Wiggins,
'Wink (1991), in an empirical investigation of a number of well-established measures of narcissism,

identified two primary orthogonal factors in the study of narcissism: (a) vulnerability—sensitivity
associated with introversion, defensiveness, anxiety, and vulnerability to life's traumas and
(b) grandiose-exhibitionism associated with a power orientation, extroversion, independence,
self-assurance, assertiveness, forcefulness, need to be admired, and aggression. Both types of narcissism
share key narcissistic themes such as conceit and arrogance and a tendency to be concerned about
satisfying one's own needs and disregarding others.
1991, 1997), from very different theoretical perspectives and at times using
different terms, also discussed interpersonal relatedness and self-definition as
two central personality dimensions. Angyal (1941, 1951) discussed surrender
and autonomy as two basic personality dispositions. Surrender, for Angyal
(1951), is the desire to seek a home, to become part of something greater
than oneself, to accept things as they are, and to promote a sense of together-
ness, whereas autonomy represents a
striving basically to assert and to expand . . . self-determination, (to
be) an autonomous being, a self-governing entity that asserts itself ac-
tively instead of reacting passively. . . . This tendency . . . expresses
itself in spontaneity, self-assertiveness, striving for freedom and for
mastery, (pp. 131-132)
Bakan (1966), similar to Angyal, viewed communion and agency as two fun-
damental personality dimensions. Agency and communion "characterize two
fundamental modalities in the existence of living forms, agency for the exist-
ence of an organism as an individual, and communion for the participation
of the individual in some larger organism of which the individual is a part"
(Bakan, 1966, pp. 14-15). Communion, for Bakan (1966), is a loss of self and
self-consciousness in a merging and blending with others and the world. It
involves feeling a part of and participating in a social structure, being at one
with and feeling in contact or union with others, and experiencing a sense of
openness, cooperation, love, and eros. Agency, in contrast, defines a pressure
toward individuation that Bakan believed permeates all living matter. Agency
involves feelings of being a separate individual and feeling comfortable with
isolation, alienation, and aloneness. The predominant themes in agency are
self-protection, self-assertion, self-expansion, and an urge to master the en-
vironment and make it one's own. In a similar way, Markus and colleagues
(e.g., Josephs, Markus, &Tafarodi, 1992; Markus & Kitayama, 1991; Markus
& Oyserman, 1989) discussed the self as consisting of two clusters: an inde-
pendent and an interdependent self-construal.
Bakan's communion, Angyal's surrender, and the interdependent self-
construal of Markus and colleagues define a fundamental desire for union in
which the person seeks to merge or join with other people and with the
inanimate environment to achieve a greater sense of participation and be-
longing as well as a greater sense of synthesis within oneself. Communion
and surrender refer to a stable dimension of personality organization directed
toward interdependent relationships with others. Baumeister and Leary (1995)
discussed this relatedness dimension as a need to belong in which themes of
dependency, mutuality, and unity define a basic dimension in life.
By contrast, Bakan's agency, Angyal's autonomy, and the independent
self-construal of Markus and colleagues define a basic striving toward indi-
viduation—a seeking of separation from others and from an attachment to
the physical environment—as well as a fuller differentiation within oneself.
Agency and autonomy both refer to a stable dimension of functioning that
emphasizes separation, individuation, control, self-definition, and autono-
mous achievement—the striving for uniqueness and the expression of one's
own capacities and self-interests (H. S. Friedman & Booth-Kewley, 1987).
Communion (or surrender)—with its emphasis on connectedness, at-
tachment, and a movement toward a sense of belongingness to and sharing
with others (another person, group, or society)—serves as a counterforce to
experiences of loneliness and alienation that can occur in agency and au-
tonomy. And, conversely, uniqueness and self-definition serve as a
counterforce to experiences of a loss of individuality that can occur in sur-
render and communion (Bakan, 1966). A similar distinction has been noted
by Mills and Clark (1982) in their discussion of communal and exchange
relationships, by Deutsch (1982) in his differentiation of cooperative and
competitive interdependence, and by Slavin and Kriegman (1992) in their
contrast of mutualistic and individualistic needs. A wide range of more em-
pirically oriented personality investigators, from a variety of theoretical per-
spectives, have also systematically studied two similar dimensions they re-
garded as central constructs in personality organization, such as the motivation
for affiliation (or intimacy; e.g., McAdams, 1980) and the motivation for
achievement (e.g., McClelland, 1980, 1986; McClelland, Atkinson, Clark,
& Lowell, 1953) or power (McAdams, 1980; Winter, 1973). In a series of
studies of life narratives, McAdams (1985a, 1985b), for example, found ex-
tensive evidence for themes of intimacy (e.g., feeling close, warm, and in
communication with others) and themes of power (e.g., feeling strong and
having a significant impact on the environment) as two dominant clusters or
central themes in personality organization. These two central motivational
clusters—power and achievement, and intimacy and love—express the is-
sues of self-definition and relatedness.
Power and achievement motivation emphasizes the active assertion
of self over and against the environment; intimacy and love motivation
emphasizes desires through which individuals relate to others in warm, close,
and supportive ways (McAdams, 1993). Individuals high on intimacy (or
relatedness) motivation speak frequently of close, reciprocal, harmonious
interpersonal interactions and of participating in social groups, and they
express a "recurrent preference or readiness for experiences of warmth, close-
ness and communicative exchange" (McAdams, 1985a, p. 76). These indi-
viduals often portray themselves as a helper, lover, counselor, caregiver,
and friend. In contrast, people high on power (or self-definitional) motiva-
tion speak frequently of self-protection, self-assertion, and self-expansion;
they separate themselves from a context and express needs for mastery,
achievement, movement, force, and action. McAdams (1985a) defined this
power motive as "a recurrent preference or readiness for experiences of hav-
ing impact and feeling strong and potent vis-a-vis the environment"
(p. 84). Individuals high on the power motive often speak of themselves
as a traveler, master, father, authority, or sage. McAdams (1985a) discus-
sed extensively the interplay between intimacy and power in personality
organization.
Relatedness and self-definition are central constructs in a number of
other personality theories, especially Deci and Ryan's formulations of self-
determination theory (SDT; e.g., Deci & Ryan, 1985, 1991, 1992; Ryan,
1995; Ryan & Deci, ZOOOa, ZOOOb), which addresses three basic needs—
autonomy, relatedness, and competence—as the antecedents of autonomous
self-regulation and psychological well-being and growth (e.g., Ryan & Deci,
ZOOOb). Deci and Ryan discussed the need for interpersonal relatedness, for
connectedness and belongingness with others, from object relations (e.g.,
Winnicott, 1958) and attachment (e.g., Bowlby, 1969) perspectives, as well as
the need for autonomy and self-initiated action rather than being controlled
by forces external to the self (Ryan, 1993), from phenomenological (e.g.,
deCharms, 1968) and ego psychological (e.g., D. Shapiro, 1989) perspectives.
Deci and Ryan's formulations of the need for competence are based on R. W.
White's (1959) conceptualization of efficacy motivation as an inherent hu-
man drive for mastery. They viewed these three basic needs—autonomy, relat-
edness, and competence—as interrelated, each supporting and facilitating the
others (Ryan, Sheldon, Kasser, & Deci, 1996). Interference with the expres-
sion of these needs results in impairments in psychological well-being (e.g.,
Kasser & Ryan, 1996; H. T. Reis, Sheldon, Gable, Roscoe, & Ryan, 2000;
Ryan & Deci, 2000b; Sheldon & Kasser, 1998) and in establishing autono-
mously regulated behavior (e.g., Connell, Spencer, & Aber, 1994; Grolnick
& Ryan, 1989; Ryan & Deci, ZOOOa, ZOOOb; Ryan, Stiller, & Lynch, 1994).
Ryan and Deci (e.g., Ryan, 1995; Ryan & Deci, ZOOOa, ZOOOb) also
distinguished between intrinsic and extrinsic motivation—between engage-
ment in behavior that is intrinsically satisfying and engagement in behavior
for external reasons including reward, avoidance of punishment, or the in-
strumental value of the activity. They (e.g., Ryan & Deci, ZOOOa, ZOOOb)
further differentiated levels of adaptiveness within extrinsic motivation—
from regulatory processes that are externally determined to those that are
more self-regulated, autonomous, or internalized. On the basis of their defi-
nition of internalization as "the processes by which individuals acquire beliefs,
attitudes, or behavioral regulation from an external source and progressively
transform those controlled motivations into personal attributes, values or
regulatory styles" (Grolnick, Deci, & Ryan, 1997, p. 139), they noted that
more fully internalized extrinsic motivations can be as adaptive as intrinsic
motivations. Autonomous motivations—that is, intrinsic and well-internalized
extrinsic motivations—are facilitated and enhanced by feelings of related-
ness, autonomy, and competence. Relatedness to significant others to whom
one feels connected is particularly important for autonomous extrinsic moti-
vation because it supports the internalization process. Alienation from sig-
nificant others can limit or interfere with internalization.
SDT is directed toward specifying the conditions that facilitate and
motivate human growth and well-being (Ryan & Deci, ZOOOa, ZOOOb) and
adaptive and maladaptive behavior, and the conditions that give rise to these
motives. Deci and Ryan viewed experiences of interpersonal relatedness and
self'definition as fundamental in these developmental processes (Shahar,
Henrich, Blatt, Ryan, & Little, 2003).
Other personality theories that emphasize the importance of aspects of
interpersonal relatedness and self-definition include Uri Foa's (1961) early
discussion of the polarity of status and love and Hogan's (1982) contrast of
status with popularity. Gilligan (1982) demonstrated that moral develop-
ment involves a dimension of interpersonal responsibility and concern as
well as the more frequently emphasized dimension of individual rights or
justice (Kohlberg, 1963; Kohlberg & Kramer, 1969). The interpersonal di-
mensions of moral development are more characteristic of female develop-
ment compared with the more masculine emphasis on rights and justice.
Maddi (1980), in a "bipolar" conception of personality, discussed the impor-
tance of a fundamental balance of relatedness and self-definition for psycho-
logical well-being. McClelland (e.g., 1980; McClelland & Steele, 1973) in
extensive empirical investigations of personality development, distinguished
four levels of power: (a) a more primitive form gained through dependence
on, or vicarious association with, powerful figures (e.g., father, authorities,
God); (b) a self-disciplined, assertive form of power that emerges in efforts to
contain and control oneself; (c) a sense of power deriving from a will to
dominate, control, and influence others; and (d) a form of power derived
from an adherence to the rules, regulations, and laws of society. The last
form, according to McClelland, is the most mature form of power, partly
because it integrates themes of power and self-assertion with a concern for
the well-being of others.
Wiggins (1991, 1997), an empirically oriented personality investigator
whose ideas derive partly from general philosophical principles (e.g.,
Confucius) and from various linguistic analyses (e.g., Benafeld & Carson,
1985; R. Brown, 1965; G. M. White, 1980), viewed self-definition and relat-
edness as the fundamental conceptual coordinates for the measurement of
interpersonal behavior and for developing a trait language for describing per-
sonality functioning. Wiggins noted that the "meta-concepts of agency and
communion" provide the bases for the circumplex and five-factor models of
personality that have been used extensively in the current conceptualization
and measurement of interpersonal acts, traits, affects, problems, and person-
ality disorders. Although Wiggins (1991) noted that agency and commun-
ion may not by themselves capture the broad spectrum of individual differ-
ences that characterize human transactions, he concluded that these two
dimensions are central to the study of interpersonal behavior. A wide range
of personality research, including the contributions of Wiggins, has been
based on these two basic dimensions. This body of work includes research
deriving from the circumplex model (Carson, 1969; T. Leary, 1957) as well
as Lorna Benjamin's (e.g., 1974, 1993) Structural Analysis of Social Behav-
ior and Leonard Horowitz's (1979, 2004) Inventory of Interpersonal Prob-
lems. These various approaches to the study of personality organization and
functioning are constructed around two major orthogonal axes: (a) domi-
nance-submission and (b) affiliation-isolation or, in other words, self-defi-
nition and relatedness, or agency and communion (Wiggins, 1982).
Other theorists, on the basis of empirical research or clinical observa-
tions, link the issues of relatedness and self-definition to more universal forces
active in nature. In more poetic terms, Martin Buber (1978) discussed the
development of I and You: how "Man becomes an I through a You .. . [how]
bonds are broken and [the] I confronts its detached self for a moment like a
You—and then it takes possession of itself and hence forth into relations in
full consciousness" (p. 80). Spiegel and Spiegel (1978) discussed the impor-
tance of these two fundamental dimensions of relatedness and self-definition
and drew parallels between these two personality dimensions and two funda-
mental forces in nature—fusion and fission as well as integration and differ-
entiation. But the importance of these two dimensions of relatedness and
self-definition in understanding psychological development extends far be-
yond personality theory. Sociological and evolutionary theory and research
have also highlighted the centrality of these two dimensions in understand-
ing psychological experiences in various cultural contexts.
RELATEDNESS AND SELF-DEFINITION IN SOCIAL

AND EVOLUTIONARY THEORY
The two fundamental dimensions of relatedness and self-definition have
also been useful in distinguishing two basic social processes. Paul Gilbert
(1989, 1992) and Christopher Boehm (1999) discussed two social systems: a
competitive system based on hierarchies or rankings and a cooperative sys-
tem. The competitive system fosters relationships organized around domi-
nance and submission (Boehm, 1996; de Waal, 1982, 1989, 2005), whereas
the cooperative system fosters egalitarian relationships (Bryne & Whitten,
1988; de Waal, 1982, 1989, 2005; Goodall, 1986). The competitive or hier-
archical system was the primary form of social organization in nomadic for-
aging groups (Tomasello, 1999, 2003), but the shift from a hunting and gath-
ering to an agrarian economy involving the domestication of plants and
animals led to a more cooperative form of social organization (Boehm, 1996)
in which men and women had a distinctive but equally valued contribution
(Cortina & Liotti, 2007). This more cooperative social system was estab-
lished through the sharing of prosocial values and altruistic motives (Fodor,
1994; Sober & Wilson, 1998) and was sustained through social sanctions
(e.g., shame, humiliation, and ridicule; Boehm, 1996). As Cortina and Liotti
(2007) noted, this social organization based on the internalization of social
norms and shared values and attitudes had adaptive significance (Sober &
Wilson, 1998) and was facilitated further by the development of language
(Stem, 2004; Tomasello, 1999, 2003).
Ferdinand Tonnies (1887/1957), from a sociological perspective, dis-
tinguished between two primary social modalities—Gemeinscha/t (commu-
nal society) and Gesellschaft (associational society)—participating in the so-
cial universe and in kinship groups as well as in productivity in industry and
commerce. Talcott Parsons (1951) contrasted an expressive and an instru-
mental orientation in various societies. The primary focus in the expressive
orientation is on "the organization of the 'flow' of gratifications (and of course
the warding off of threatened deprivations)" (p. 49) and on "the harmony or
solidity of the group, the relations internally of the members to each other
and their 'emotional' states of tension or lack of it in their roles in the group"
(pp. 59-60). The instrumental orientation, in contrast, involves "the attain-
ment of a goal anticipated for the future" and "given the goal, the evaluative
selection gives primacy to cognitive considerations; that is, knowledge of the
conditions necessary to attain the goal over immediate cathectic interests
defined as interests" and "placing priority for the goal over the immediately
available opportunities for gratification that might interfere with the attain-
ment of the goal" (p. 49). Ruth Benedict (1934/1946) distinguished between
less structured societies that emphasize feelings and activity and more struc-
tured societies that value reason, ceremony, and ritual. Well-being in an
individualistic society is defined by a sense of separateness and independence,
personal control, self-assertion, and achievement.
Harry Triandis (e.g., 1989, 1994, 1995, 2001) and colleagues used the
constructs of relatedness and self-definition (collectivism and individualism)
as fundamental coordinates of social organization in an extensive series of
investigations comparing a wide range of cultural traditions. Triandis (1990)
viewed the dimensions of collectivism and individualism as "perhaps the most
important dimensions of cultural differences in social behavior, across the
diverse cultures of the world" (p. 44) that are expressed in unique ways within
each culture. Kagitcibasi (1990) distinguished between collectivist and indi-
vidualist social groups as "cultures of relatedness and separateness" (p. 142).
A culture of relatedness involves family and interpersonal relationships char-
acterized by dependent and interdependent relationships with loose inter-
personal boundaries. A culture of separateness involves independent inter-
personal relationships with well-defined personal boundaries (Kagitcibasi,
1997). Collectivist cultures are characterized by concerns with interpersonal
relationships; people are interdependent and the society is organized around
small groups such as the family. People enjoy participating in groups and
compromise is the predominant form of conflict resolution. Child rearing
emphasizes security, conformity, and dependability (Triandis, 2001). Indi-
viduals in collectivist cultures pursue goals that benefit the group; they are
concerned about the effects of their actions on others, sharing resources with
group members, how they are perceived by others, and establishing congru-
ence between their own personal goals and those of the group. They feel
involved in the contributions of others and share in the lives of other group
members (Hui & Triandis, 1986).
In contrast, individualistic or separateness cultures are characterized by
independent interpersonal relationships between separate individuals with
well-defined personal boundaries. Child rearing emphasizes independence,
exploration, and personal creativity and accomplishments (Triandis, 2001).
Individuals are independent, concerned about their autonomy and accom-
plishments. People pursue personal goals usually without reference to the
goals of the collectives within the culture (e.g., family, work groups, or the
community). Individualistic themes stress separation, self-reliance, personal
dignity, autonomy, privacy, and competition (e.g., Lukes, 1973). Conflict
resolution usually involves confrontational judgments around right and wrong.
Investment in family integrity usually defines collectivist cultures, whereas
detachment from groups (including the family) usually defines individualist
cultures.
Triandis and colleagues noted that individualism and collectivism ex-
ist at the cultural level as well as at the individual level. At the individual
level, Triandis and colleagues (e.g., Triandis, Leung, Villarela, & Clark, 1985)
called these dimensions idiocentrism and ailocentrism. Individual differences
in collectivism (ailocentrism) within cultures are best defined by the degree
of interdependency and sociability; differences in individualism within cul-
tures (idiocentrism) are best defined by the degree of self-reliance (Triandis
et al., 1986). In a similar fashion, in discussions of evolutionary psychology,
David Buss (e.g., 1987, 1991) noted the importance of two primary dimen-
sions: (a) formation of reciprocal alliances and (b) negotiation of status. Re-
search investigations of differences between collectivistic and individualistic
cultures have revealed differences in self-concept, interpersonal relationships,
and emotional and cognitive development (Crystal, Watanabe, Weinfurt, &
Wu, 1998; Markus & Kitayama, 1991; Oyserman, Coon, & Kemmelmeier,
2002), in infant attachment styles (Grossmann & Grossmann, 1990; van
IJzendoom & Sagi, 1999), and in children's representation of their mother
and father (Priel, Besser, Waniel, Yonas-Segal, & Kuperminc, 2007). Troy
and Sroufe (1987) demonstrated that securely attached children at age 5
establish relationships based on equality and cooperation, avoidantly attached
children gravitate toward relationships characterized by dominance and con-
trol, and resistantly attached children become submissive and victimized
(Cortina &. Liotti, 2007).
Some research indicates, however, that the distinction between collec-
tivistic and individualistic cultures need not necessarily be considered as a
dichotomy. Kagitcibasi (1997) proposed an alternative model in which col-
lectivism and individualism are considered as independent rather than di-
chotomous variables, and various cultures may share similarities and differ-
ences on these dimensions. Green, Deschamps, and Paez (2005) stressed that
in future cross-cultural research, a typological approach based on various com-
binations of individualistic and collectivist dimensions would be valuable.
These constructs of relatedness (e.g., intimacy, caring, altruism) and
self-definition (e.g., autonomy, power, and achievement) have been useful
not only in studying human personality development and social organization
in different cultures but also in studying the social organization of primates.
Chance (1980, 1984), for example, discussed infrahuman primate social be-
havior in terms of agonic and hedonic modes. In the hedonic mode, primates
gather together as a group, making body contact, slapping and hugging
each other, from which activity each member gathers confidence. . . .
[Hedonic behavior] rewards experience, especially in social relations, and
maintains through frequent body contact a fluctuating, predominantly
low arousal. (Chance, 1980, p. 89)
Chance (1980) further stated that

a pattern of social attention underlies and is the mechanism for social
cohesion.... The ... existence of the hedonic mode, and ... its separa-
tion from the agonic, is the single most important discovery arising from
the recognition that a pattern of social attention exists and can be as-
sessed between members of a primate group, (p. 109)
The integral aspect of social or hedonic relationships is based on construc-

tive relationships. In the hedonic mode, reciprocal respect facilitates explor-
atory and integrative faculties.
The other [agonic] component of personality... is restrictive of explora-
tion and reciprocal communication and arises from denial of love in in-
fancy and from hostile integration in the social relations of later life,
which the agonic state helps to define. . . . Agonic social relations de-
velop out of negative referent relationships; and hedonic social relations
develop out of positive referent relationships. This is the foundation,
moreover, on which human sociability, as well as mental structure is
based. (Chance, 1980, p. 109)
Chance (1976, 1984) considered the implications of his observations
of primates' social organization for human behavior. He noted that agonic
social cohesion is focused on the possibility of conflict and attack, whereas
hedonic cohesion is based on an excitement of interest and attraction that
Chance consideted part of psychological health and cteativity. Moller (1990)
related these two modes of social behavior (agonic and hedonic) to high
versus low levels of arousal, respectively, and with negative and positive af-
fect (Chance, 1980; Davidson, 1985; Fox & Davidson, 1983; Tucker, 1981)
as well as to differences in the activation of the limbic system and the neo-
cortex. Behaviors of the interpersonal motivational system, such as careseeking
and caregiving, sexual behavior, and cooperation (e.g., smiles, separation
calls, clinging, and stroking), are linked to the affect states of the limbic
system, whereas the search for novelty, exploration, and the construction of
meaning (coherence and integration) are linked to the neocortex (e.g.,
Lapidus & Schmolling, 1975).
In evolutionary biology, human nature has most often been depicted as
essentially selfish and individualistic, characterized by Darwinian concepts
of natural selection and survival of the fittest. Anthropologists note that the
industrialized world is unique in its emphasis on separateness, independence,
and individual distinctiveness. Darwin's (1859) theory of evolution and natu-
ral selection provided major scientific support for this egocentric view of
human nature. Darwin's highly individualistic theory of natural selection
had a major impact on the scientists of the time, S. Freud included (Sulloway,
1979), and continues to be influential in behavioral sciences and economics,
especially in capitalist political theory. Fundamental to Darwin's formula-
tions is the assumption that naturally selected heritable traits confer an ad-
vantage on an individual. Differential survival and reproduction over many
generations result in an increasing prevalence of these traits. An important
assumption of this theory is that the mechanism of natural selection neces-
sarily operates at the individual level and inevitably selects for self-interest.
Individuals who behave selfishly are more likely to thrive and have more
offspring. Thus, Darwinian theory was taken to imply that all animals, in-
cluding humans, were exclusively motivated by self-interest. Biology seemed
to support the view that people are naturally egoistic and that evolutionary
processes support behaviors that benefit the individual.
Developments in evolutionary biology, however, have demonstrated
that altruism and cooperative behavior create a selective advantage in closely
related kin groups (e.g., de Waal, 2005; W. D. Hamilton, 1964; Trivers, 1971;
E. O. Wilson, 1975). As Cronin (1992) noted, altruism can be highly adap-
tive, especially from a gene-centered view of evolution, which posits that
genes, rather than individuals, struggle for survival. Mathematical modeling
and computer simulation have demonstrated that if interactions between
individuals are not random, if individuals do not treat all others alike, then
individuals can recognize kin and tend to behave differently with them. Al-
truism can then be selective as long as there is some genetic basis for the
particular social behavior (W. D. Hamilton, 1964). Investigators in evolu-
tionary biology argued that this process of kin selection (involving reciprocal
altruism and social selection) leads to traits that facilitate cooperation and
communalism (W. D. Hamilton, 1964; Simon, 1990; Trivers, 1971; E. O.
Wilson, 1975). Naturalistic observation of animal species demonstrates the
importance of prosocial behaviors: cooperation and altruism (hedonic activ-
ity). These observations posed a problem for evolutionary theorists because
the original formulation of natural selection cannot account for the evolu-
tion of prosocial behaviors (Michod, 1982). Although Darwin (1859) and
others described altruistic behavior in animals, more recent careful field work
and sophisticated mathematical models (e.g., Simon, 1990) have proposed
selective mechanisms for cooperative and altruistic behaviors (Guisinger &
Blatt, 1994).
Thus, contemporary evolutionary biologists no longer agree that selec-
tion takes place only at the level of the individual. According to Gould (1992),
selection operates simultaneously at several levels, including genes, organ-
isms, local populations, and species. If selection occurs at these various lev-
els, then altruism may have a selective evolutionary advantage over
egocentricism. Parental care, for example, is an expression of behavior oper-
ating according to the principles of kin selection. If parental care provides
benefits for children, then those parents who leave more and better func-
tioning descendants as a result of their caretaking will contribute more genes
to the next generation. The mechanisms of kin selection for cooperative
behavior toward relatives are thought to operate in a similar fashion. The
genetic consequences of care for offspring and siblings, for example, are actu-
ally similar because half of the gene pool, on average, is shared by siblings.
Individuals who help two siblings (or four cousins, aunts, or uncles) to repro-
duce more effectively may contribute more fully to the gene pool than indi-
viduals who do not. This form of altruistic selection for complex social be-
haviors depends on a genetic relatedness among members of a social group
(Guisinger & Blatt, 1994).
Field biologists have also observed seemingly altruistic and cooperative
behavior (Michod, 1982) and empathy (de Waal, 2005) even among unre-
lated members of social groups (Michod, 1982); unrelated vampire bats, for
example, will regurgitate a blood meal for a starving cave mate (Wilkinson,
1988). Trivers (1971) proposed a model of reciprocal altruism to account for
these observations, assuming that individuals will remember being helped
and will help in turn when needed. Axelrod and Hamilton (1981), modeling
evolutionary strategies using the prisoner's dilemma game, concluded that
when the probability of two individuals meeting each other again is suffi-
ciently high, cooperation based on reciprocity can provide evolutionary sta-
bility in a population without genetic relatedness. Selection that favors re-
ciprocal altruism requires that individuals must live together in stable social
groups, must be able to recognize each other, and must remember the past
behavior of each other. Thus, it is likely that the evolution of cooperative
behavior has occurred in primate and human history, given primates' and
humans' capacity for symbolic functioning—for identifying and remember-
ing individuals involved in reciprocal sharing. Anthropologists (e.g., Ho, 1993;
Kim & Berry, 1993; Maybury-Lewis, 1992), for example, have documented
elaborate exchange systems in non-Western and tribal societies in which
people are bonded to each other by a network of obligations (Guisinger &
Blatt, 1994). Most non-Western cultures have a sociocentric view that mini-
mizes self-other distinctions and facilitates participation in the social pro-
cess (Geertz, 1979; Heelas & Lock, 1981; Kim & Berry, 1993).
Thus, altruism has emerged as an important issue in the consideration
of human behavior both individually and collectively. Among humans, even
strangers are often the recipients of cooperation and concern. Simon (1990)
developed a model of bounded rationality to describe altruism that does not
depend on reciprocity or the rational return of concern and investment. Simon
postulated that it is impossible in a complex social world to calculate return
rationally, and thus individuals have an innate receptivity to learn social
skills and proper behavior (human docility). When individuals are insensitive
to the needs of others and unmoved by guilt and shame (are undersocialized),
others tend to avoid them. Thus, selfish individuals have decreased fitness
because society frowns on them, and they will not increase as rapidly in the
population as do more altruistic individuals as long as the cost of altruism is
compensated for by social benefits.
Chance (1976), citing Pearce and Newton (1963), considered the role
of conflicts in the agonic and hedonic modes in disruptions of psychological
functioning. Pearce and Newton (1963) used the distinction of agonic and
hedonic, as applied in the context of the social organization of primates, to
consider the ontogeny of human relations and to develop an interpersonally
oriented personality theory in which an individual's personality is determined
primarily by the quality of his or her interpersonal relationships, real or imag-
ined, past or present:
The integral personality arises from facilitating and encouraging the ex-
plorative and integrative faculty . . . through relations with others . . .
based on validation, tenderness, cherishing, and respect on a reciprocal
basis.... [a] constellation of mental, behavioral, and emotional charac-
teristics of the hedonic mode. (Chance, 1976, p. 330)
In the agonic mode, the self-system is composed of strategies to defend

oneself from disaster that derive from the threat to the child of separation
from the caregiver. The danger in an agonic mode, therefore, is to be in the
power of others (Chance, 1976). Pearce and Newton (1963) viewed the ago-
nic mode as restrictive of exploration and reciprocal communication—a re-
striction that creates hostile social relations later in life. Thus, Chance (1976),
similar to Pearce and Newton (1963), viewed psychological disturbances as
arising primarily from an agonic self-system that is not integrated with he-
donic dimensions. This pathology can derive from any period in the life his-
tory in which the individual's experiences are hostile to or deny personal
relationships (Chance, 1976; Pearce & Newton, 1963). The role of imbal-
ances between the hedonic and agonic modes, or between a balanced in-
volvement in interpersonal relatedness and self-definition, in personality
organization and psychopathology is considered in detail in chapters 5 and 6
(this volume).
Recovery from pathology, according to Chance (1976), depends on
having current loving experiences. Thus, Chance (1976,1980,1984) viewed
hedonic and agonic modes as two essentially separate behavioral systems and
called for the study of the extent to which people are capable of operating in
each mode and how culture influences an individual's participation in each
mode—how industrial, economic, and political institutions engender and
promote either agonic relations between people or hedonic well-being.
Chance (1980) also stressed that intimacy and assertiveness can be inte-
grated in a full and meaningful expression, and that these two modes can
develop and function interactively without losing their separate definition
(Moller, 1990, 2000). Thus, the basic issues of individual autonomy and pre-
rogatives as well as interest in the collective or the social group (self-definition
and relatedness, or agency and communion) facilitated Chance's understand-
ing of the development of individuality and the capacity to participate in the
social order in particular social systems.
SUMMARY
From a variety of perspectives and in a wide range of disciplines, the

fundamental polarity of relatedness and self-definition provides the building
blocks with which major social forces are formed and expressed both within
individuals and within society. Overall, in this volume I consider the impli-
cations of this fundamental polarity of experience in understanding psycho-
logical development, the nature of psychopathology, and the processes of psy-
chological growth in the therapeutic process. In subsequent chapters 1 consider
these two fundamental dimensions in providing a coherent and comprehen-
sive framework for understanding personality development (see chaps. 2, 3,
and 4, this volume) and how they facilitate fuller understanding of variations
in normal personality organization or character style (see chap. 5, this volume)
as well as a structure for understanding serious developmental disruptions of
these fundamental processes that are expressed in various forms of psychopa-
thology (see chap. 6, this volume). In the closing chapters (chaps. 7 and 8, this
volume) I consider the implications of the synergistic dialectical interaction
of relatedness and self-definition in personality development for understand-
ing the nature of the psychotherapeutic process and the factors that can lead
to psychological growth within the therapeutic relationship.
2
DEVELOPMENTAL ANTECEDENTS OF
RELATEDNESS AND SELF-DEFINITION
Martin Buber (1978) poetically described prenatal life as "a pure natu-
ral association, a flowing toward each other, a bodily reciprocity" (p. 76). He
noted that the child detaches from this "undifferentiated not yet formed pri-
mal world" (p. 76) to
This chapter incorporates material from (a) "Self-Representation in Severe Psychopathology: The
Role of Reflexive Self-Awareness," by ]. S. Auerbach and S. ]. Blatt, 1996, Psychoanalytic Psychology,
13, pp. 297-341. Copyright 1996 by the American Psychological Association; (b) "Internalization
and Psychological Development Throughout the Life Cycle," by R. S. Behrends and S. J. Blatt, 1985,
Psychoanalytic Study of the Child, 40, pp. 11-39. Copyright 1985 by Yale University Press. Adapted
with permission; (c) "Interpersonal Relatedness and Self-Definition: Two Personality Configurations
and Their Implications for Psychopathology and Psychotherapy," by S. ]. Blatt, 1990, in ]. L. Singer
(Ed.), Repression and Dissociation: Implications for Personality Theory, Psychopathology & Health (pp.
299-335). Chicago: University of Chicago Press. Copyright 1990 by University of Chicago Press.
Adapted with permission; (d) "Precursors of Relatedness and Self-Definition in Mother-Infant
Interaction," by R. Feldman and S. J. Blatt, 1996, in J. Masling and R. F. Bornstein (Eds.),
Psychoanalytic Perspectives on Developmental Psychology (pp. 1-42). Washington, DC: American
Psychological Association. Copyright 1996 by the American Psychological Association; (e)
"Attachment Theory and Psychoanalysis: Further Differentiation Within Insecure Attachment
Patterns," by K. N. Levy and S. J. Blatt, 1999, Psychoanalytic Inquiry, 19, 541-575. Copyright 1999
Analytic Press. Adapted with permission; and (f) "Interpersonal Relationships and the Experience of
Perceived Efficacy," by C. E. Schaffer and S. ]. Blatt, 1990, in R. J. Sternberg and ]. Kolligian, Jr.
(Eds.), Competency Considered (pp. 229-245). New Haven, CT: Yale University Press. Copyright 1990
Yale University Press. Adapted with permission.
43
enter a personal l i f e . . . . From the glowing darkness of the chaos, he has
stepped into the cool and light of creation without immediately possess-
ing it ... to make it a reality for himself; he joins his world by seeing,
listening, feeling, forming. It is in an encounter that the creation reveals
its formhood.... Nothing is a component of experiences or reveals itself
except through the reciprocal force of confrontation [italics added]." (p. 77)
Early theoretical formulations of the contributions of the caring rela-
tionship to psychological development viewed the child as the passive re-
cipient of parental care. Psychoanalytic theory, for example, recognized the
importance of the mother-infant relationship but initially conceptualized
this relationship as mother providing the infant with relief from experiences
of disequilibrium and tension. This relationship was described in terms of the
satisfaction of primitive drive states, the reduction of physiological tension,
and the provision of protection (S.Freud, 1900/1953,1911/1951,1915/1957d,
1920/1957a). As Slavin and Kriegman (1992) noted, for example, classic
psychoanalytic theory focused on drive and conflicts and on the "deep divi-
sions and tensions within the self that are ... concomitants to an adaptation
to a conflictual relational world." Object relations theorists, in contrast, viewed
human nature as "primarily organized around motives and capacities for con-
ducting social relationships in the service of optimal, authentic self-develop-
ment" (Slavin & Kriegman, 1992, p. 70). Influenced by infant research, more
recent psychoanalytic formulations have stressed the infant as an active par-
ticipant in the mother-infant relationship. The British object relations theo-
rists (e.g., Winnicott, Guntrip, Balint, Fairbairn, Klein, Khan), for example,
regard the infant as primarily object seeking, and view the psychological as-
pects of the infant's active participation in this interpersonal relatedness as
crucial to the infant's development of self-definition (e.g., Bowlby, 1958,
1969, 1979; Guntrip, 1971; Sutherland, 1980). In addition, experimental
findings with animals (e.g., Harlow, 1958) and human infants, including
observation of infants in institutions (e.g., Provence & Lipton, 1962; Spitz
& Wolf, 1946) and studies of the early relationship between neonate and
mother, stress that the mother provides much more than feeding; she also
provides warmth, tactile experiences, and a wide range of other stimulation
essential for the infant's development of self-organization and interpersonal
relatedness.
Sequences of engagement and disengagement in early experiences of
self and interactive regulation in mother-infant interaction are the origins
of psychological life (e.g., Beebe & Stern, 1977; Jaffe, Beebe, Feldstein, Crown,
& Jasnow, 2001) in the formation of presymbolic representations of self and
of others. Beebe and Lachmann (1992,1994,2002; Beebe, Lachman, & Jaffe,
1997a, 1997b) reviewed and integrated extensive developmental theory and
research that indicates that infant development, consistent with Buber's
(1978) emphasis on the "reciprocal force of confrontation" (p. 77), evolves
out of a fundamental process of engagement and disengagement, of related-
ness and interruptions of this relatedness and its subsequent repair, especially
at moments of heightened affectivity. These experiences of engagement and
disengagement provide the basis for the development of self-regulation and
interactive regulation and of presymbolic representations of self and signifi-
cant others during the 1st year (Beebe & Lachmann, 1994). The process of
engagement and disengagement in infancy is the fundamental prototype
for processes of psychological development throughout life. And the
presymbolic representations that emerge in infancy are the precursors of
symbolic representations of self and other that begin to develop in the 2nd
year of life. These symbolic representations of self and of others are orga-
nized around the development of two fundamental psychological tasks: the
development of interpersonal relatedness and the development of self-defi-
nition or of an identity.
Relying on extensive home observations of early parent-child interac-
tions, Sander (1975, 1984, 1987) delineated several phases of an integrative
process during early development—phases in the mother-infant interaction
that alternate between self- and interactive regulation and between disrup-
tions and repair (Gianino & Tronick, 1988), between separateness and to-
getherness. Sander noted that the presymbolic (procedural) precursors of the
representation of self and of interpersonal relatedness are expressed in the
establishment of basic regulation at 3 months, in the early expressions of
relatedness in coordinated interactions at 3 to 6 months, and in more fo-
cused self-expression in initiatory infant activity between 6 and 9 months.
This initiating activity enables the infant to engage in more complex inter-
personal dyadic emotional regulation from 9 to 12 months that lead to fuller
self-expression in autonomous action at 1 year and eventually to object and
self-constancy at 18 months (Sander, 1975, 1984, 1987, 1999). Sander's ob-
servations implicitly stress the importance of viewing development as an alter-
nating dialectical interactive process between experiences of self-definition
(i.e., basic regulation, initiatory infant activity, and autonomous action) and
experiences of interpersonal relatedness (i.e., coordinated interactions and
dyadic emotional regulation) that begins in infancy and continues as a cen-
tral developmental process throughout life. This dialectical interactive pro-
cess in later stages of the life cycle is discussed more fully in chapter 4 (this
volume).
The infant is born with innate basic capacities for self-regulation and
interactive regulation that are elaborated and extended in early face-to-face
interactions with the primary caregiver. The caregiver helps the infant to
establish regulatory rhythms (e.g., sleep-wakefulness and feeding sequences)
that are the basis for later development of adaptive capacities (e.g., Chappell
& Sander, 1979; Collis, 1979; Field, 1981; Kraemer, 1992; Kraemer, Ebert,
Schmidt, &McKinney, 1991;Papousek&Papousek, 1978,1979; Stern, 1977,
1985; Stern, Hofer, Haft, & Dore, 1985; Tronick, 1989; Tronick & Gianino,
1986; Waugh, 2002). The caregiver helps the infant establish an internal
DEVELOPMENTAL ANTECEDENTS 45
homeostatic balance that forms the basis for the development of later physi-
ological regulation, including affect arousal (e.g., Brazelton, 1984; Brazelton
& Als, 1979; Emde, Gaensbauer, & Harmon, 1976; Field, 1985, 1994,
Kraemer, 1992; Stern, 1985, 1988a; Waugh, 2002).
Predictable rhythmic oscillation of attention and nonattention in the
infant offers the opportunity for the mother to adapt the level of stimulus
input to the infant's capacity to process stimulation (Lester, Hoffman, &
Brazelton, 1985; H. R. Schaffer, 1977). Repetition of these patterns of stimu-
lation allows the infant to develop interpersonal expectations—the early
expression of analytic and analogic thinking (Stern & Gibbon, 1978). Rep-
etition, regulation, and rhythmicity, the guiding principles of face-to-face
interaction (Beebe & Lachmann, 1994), facilitate the formation of rudimen-
tary prerepresentational, cognitive-affective sensorimotor schemas (Piaget,
1937/1954), or representations of interpersonal interactions that have been
generalized (Stern, 1985). These emerging cognitive-affective schemas not
only facilitate information processing (e.g., attention, encoding, and retrieval)
but also contribute to the development of a sense of security and predictabil-
ity in relationships. Thus, the early mother-infant play patterns at 3 and 4
months advance development of self-definition as well as contribute to the
development of interpersonal relatedness.
Experiences of self- and interactive regulation contribute to the devel-
opment of interactional harmony (e.g., Papousek & Papousek, 1978, 1979;
Scholmerich, Fracasso, Lamb, & Broberg, 1995; Waugh, 2002) in which in-
fant and mother can experience interchanges of shared attention, under-
standing, positive affect, receptivity, accommodation, and attunement as well
as of disengagement and degrees of contingent and noncontingent respon-
siveness. Each partner constructs complex bidirectional perceptions and ex-
pectations of self and other in the dyadic experiences of harmony and dis-
cord (Waugh, 2002). These prerepresentational patterns of experience in
infancy provide the basis for the later development of symbolic representa-
tion of self and other and for the emergence throughout life of the two funda-
mental psychological developmental dimensions of interpersonal relatedness
and self-definition.
Emde (1984, 1988a, 1988b) discussed two basic developmental pro-
cesses in the emergence of the prerepresentational self: self-regulation and
social fittedness. Self-regulation involves initial expressions of the infant's
autonomous self (Connell, 1990); social fittedness develops in the security of
the mother-infant dyad and is later extended to social adaptability in rela-
tionships with peers, colleagues, and intimate partners (Baumeister & Leary,
1995). Stern (1985) distinguished between two developmental configura-
tions in the early experiences of infancy—self with other (interpersonal feel-
ings of intersubjectivtty, mutuality, and harmony) and self versus other (expe-
riences of self as a differentiated entity vis-a-vis the other)—and described
how these two fundamental configurations contribute to psychological de-
velopment. Self- and interactive regulation form the nuclei for the develop-
ment of the self and experiences of others.
On the basis of these observations, Feldman and Blatt (1996) exam-
ined aspects of the behavioral patterns of the mother, infant, and their dy-
adic interaction in infancy and found that dimensions of relatedness and
self-definition could be identified as distinct and independent factors in
mother-infant play in the infant's 1st year. Aspects of infant play behavior
(i.e., maternal attentiveness and the dyadic interaction between infant and
mother) appear to define independent developmental dimensions. Play pat-
terns of infant and mother are relatively stable and independent of each other
during the infant's 1st year, between the 3rd and 9th month. Infant alertness,
emotional expression, and focused attention (aspects of self-regulation), in
the early weeks and months of the infant's life, are organized around the
infant's emerging capacity for initiation (Hoffmann, 1994) and appear to
define one developmental line—the capacities of the infant to be separate,
autonomous, and alert. The other developmental line evolves out of recipro-
cal maternal and infant early attentiveness and the quality of their dyadic
interaction. This line eventually defines the infant's development of capaci-
ties for interpersonal relatedness.
Beebe and colleagues (e.g., Beebe & Lachmann, 1992) noted that the
investigation of self-regulation and of interactive regulation has essentially
proceeded relatively independently. Interactive regulation has been the pri-
mary focus of much of the research on social and cognitive development
(e.g., Cohn & Tronick, 1988; Jaffe, Beebe, Feldstein, Crown, & Jasnow, 2001;
Lewis 6k Feiring, 1989b; Stern, 1985; Tronick, 1989). Behavioral patterns in
dyadic interactions express both self-regulation and interactive regulation
(e.g., Overton, 1998). Beebe and colleagues stressed that it is essential to
investigate both forms of regulation, as well as their dialectical interaction
(Beebe, 2006; Beebe et al., 2007; Beebe & Lachmann, 2002; Gianino &
Tronick, 1988), because each person in the dyad both monitors the partner
and regulates his or her own inner state. Rather than focusing on one form of
regulation or on trying to locate the source of regulation in one partner or
the other (e.g., infant self-regulation or maternal sensitivity or attentive-
ness), Beebe et al. (2007) stressed the need to study the relative contribu-
tions of self- and interactive regulation in both partners. Like Sander (1977),
Beebe et al. (2007) defined self- and interactive regulation together.
Beebe et al. (2007) noted that most investigators agree that self-regula-
tion (often included in the more inclusive concept of emotional regulation)
is important, but there is little agreement on how self-regulation is accom-
plished (Fox, 1994; Thompson, 1994). Self-regulation is most generally viewed
as the activation or dampening of arousal, especially the capacity to contain
negative affect (Field, 1985, 1994; Kopp, 1989; Stifter, 2002). Beebe et al.
(2007) defined regulation more specifically as the predictability of behavior
over time (coordinated or contingent responses; Gottman, 1981; Tronick,
1989). They defined self-regulation as autocorrelation, the predictability of
behavior within an individual. Time series analysis (e.g., Cohn & Tronick,
1988; Gottman, 1981; Sackett, Holm, Crowley, & Henkins, 1979; Warner,
1992; J. Watson, 1985) facilitates the identification of ways in which the
action of each individual in the dyad is coordinated with (is contingent on)
the action of the other. Beebe et al. (2007) viewed this contingent coordina-
tion as an expression of interactive regulation.
Considerable evidence documents the relevance of early patterns of
interaction in the first few months of life for the formation of interpersonal
patterns of attachment and the beginning development of symbolic repre-
sentation in the 2nd year (e.g., Isabella & Belsky, 1991; Jaffe et al., 2001;
Leyendecker, Lamb, Fracasso, Scholmerich, & Larson, 1997; Malatesta,
1988). With the advent of symbolic capacities, aspects of the early mother-
infant interactions are represented in cognitive-affective structures (e.g.,
Stern, 1985) that become increasingly complex "working models" (e.g.,
Ainsworth, Blehar, Waters, & Wall, 1978; Bowlby, 1979; Stern, 1988b) or
representational configurations of self, other, and self-with-other (Stern,
1983, 1985). These representational configurations have thematic or ex-
plicit episodic as well as structural or implicit procedural dimensions (Blatt,
1974, 1995a; Blatt, Auerbach, & Levy, 1997).
EARLY DEVELOPMENT
The infant developmental research literature demonstrates that an ex-

traordinary array of social, perceptual, and cognitive capacities is available to
the infant at the beginning of life. Infants can detect contingencies from
birth and by 4 months of age are quite adept at discriminating aspects of
these contingencies (Bigelow, 1998; DeCasper & Carstens, 1980; Gergely,
2002; Haith, Hazan, & Goodman, 1988; Miller, 1984; L. Murray &
Trevarthen, 1986; Papousek & Papousek, 1979; Stern, 1971; Tarabusly,
Tessier, & Kappas, 1996; Watson, 1985). The infant is also born with a ca-
pacity for organization and capacities for self-regulation—to regulate, for
example, arousal and sleep-wakefulness. These early capacities enable the
infant to begin to engage and interact actively with the caregiver. The infant's
innate capacities, including threshold levels and the ability to detect regu-
larities and perceive contingencies, extend beyond fulfilling biological needs
and include play and exploration (Lichtenberg, 1989; Lichtenberg &
Schonbar, 1992), and facilitate the development of self- and interactive regu-
lation and an increasingly organized social relatedness. Experiences of self-
and interactive regulation provide the basis for the construction of both an
interpersonal and a personal or subjective world (Beebe, 1986; Beebe &
Lachmann, 1988; Demos, 1984,1986; Emde, 1981; Homer, 1985; Lachmann
& Beebe, 1989; Lichtenberg, 1983, 1989; Sander, 1984; Silverman, 1983;
Stern, 1977, 1985, 1988b).
The sense of self begins early in life, in the infant's innate capacities
and ability to engage in and disengage from social interactions through par-
ticipating in mutual gaze and the aversion of this gaze. The infant begins to
construct a presymbolic representational world of self and other in the first
half of the 1st year through experiences of engagement in cross-modality
correspondences and through experiences of disengagement. A sense of sepa-
rateness and autonomy that begins at about 4 months of age (Stern, 1985)
becomes readily apparent at about 12 months of age in the infant's capacity
to initiate separation from the mother by walking away, by being able to
begin to say no at about 15 months of age (e.g., Mahler, Pine, & Bergman,
1975; Spitz, 1957a), and by establishing control of large muscle systems (e.g.,
locomotion, elimination, and speech) in the 2nd year of life.
Dimensions of early mother-infant face-to-face play undergo major
transformations during the second half of the 1st year (Lamb, Morrison, &
Malkin, 1987). The early maternal eliciting and responding style, which pro-
vides the foundation for secure relatedness in the early weeks and months of
life through gaze synchrony, imitation, and elaboration of the infant's ex-
pressions, is transformed into reciprocal affective sharing (e.g., intersub-
jectivity; Trevarthen, 1980) or dyadic (interactive) emotional regulation
(Sander, 1975). This change in the quality of mother-infant interaction in
the latter half of the 1st year of life is part of a major leap in affective devel-
opment between 6 and 8 months, after which the infant becomes increas-
ingly able to transmit and share intentions and affects (Emde, 1984). The
infant's capacity for dyadic reciprocity, developed within the context of sen-
sitive and responsive maternal style, facilitates curiosity and exploration, as
well as affective sharing and the ability to engage in intense relatedness
(Feldman & Blatt, 1996).1
On the basis of an array of empirical studies of early infancy, Beebe,
Lachmann, and Jaffe (1997a, 1997b) proposed that presymbolic representa-
tions of self and significant others emerge from the expectations of charac-
teristic patterns of mother-infant engagement that involve self- and interac-
tive regulation. "Mother and infant respond to and influence each other on a
moment-to-moment basis. . .. Mutual influence is indicated by the fact that
each partner's behavior is, to some degree, predictable from the other's be-
havior" (Beebe & Lachmann, 1992, p. 140). Expected and characteristic
patterns of self- and interactive regulation are stored as early presymbolic
representations in the early months of life and have a major role in the emerg-
1
A lack of consistent maternal emotional availability may lead to a reduction in both interpersonal
relatedness and exploratory behavior. Intrusive or unavailable maternal style, particularly at about 9
months of age, when initiation and reciprocity emerge, has been associated with later insecure
attachment (Isabella & Belsky, 1991), increased dyadic asynchrony (Field, 1994), and diminished
exploratory behavior (Belsky, Goode, & Most, 1980; see also Jaffe et al., 2001).
ing representations of self and significant others in the 2nd and 3rd year of
life. Investigations (e.g., Belsky, Rovine, & Taylor, 1984; Feldman & Blatt,
1996; Jaffe et al., 2001; Lewis & Feiring, 1989a, 1989B; Leyendecker et al.,
1997; Malatesta, 1988) indicate that variations in early interactions predict
cognitive development and patterns of attachment in the first 2 years of life.
Jaffe et al. (2001) documented that coordinated interpersonal timing (CIT)
at 4 months predicted social development (attachment style) and cognitive
development (Bayley Scale) at 12 months. However, Jaffe et al. (2001) found
that both low and high levels of CIT predicted insecure attachment. High
degree of bidirectional coordination, interpreted as a state of vigilance and
wariness, predicted disorganized and resistant attachment. Low bidirectional
coordination predicted avoidant attachment. Secure attachment was pre-
dieted by midrange infant-mother coordination. Jaffe et al. (2001) suggested
that midrange coordination "leaves more space, more room for uncertainty,
initiative, and flexibility with the experience of correspondence and contin-
gency" (p. 107).2
In summary, infants' inborn capacities for organization, together with
the nature of the interaction with the caregiver, contribute to the patterns of
experiences of engagement and disengagement that lead to the infant's con-
struction of representations of self and significant others. Infants actively
contribute to the organization of their experiences of engagement and disen-
gagement and of self- and interactive regulation. These experiences form the
basis for infants' construction of representations of self and others in the
continuous processes of transformation that occur in the social interactions
of engagement and disengagement between infant and caregiver. The in-
fant-caregiver interpersonal environment constitutes a functional system
(Emde, 1994; Fogel, 1993; Fogel & Thelen, 1987; Thelen & Smith, 1994)
and the quality of these interactive experiences creates the foundation for
the affective tone of subsequent relationships (Pipp, 1990). The level of in-
tegration of this system is an index of the maturity and competence of the
infant's interaction with his or her environment.
Beginning in early infancy, psychological development emerges as a
transactional process between a continuously emerging individual and an
ever-changing environment. From the earliest moments of life, a dialectical
process exists between self-generated and interactive aspects of psychologi-
cal development. The self develops within, and is also constrained by, inter-
personal relationships. And self- and interactive regulation in experiences of
engagement and disengagement in infancy is the basis for the establishment
of the developmental processes of separateness and connectedness, of self-
definition, and of interpersonal relatedness. The experiences of engagement
2
This curvilinear relationship suggests the importance of examining nonlinear effects and using a
nonlinear systems approach in the study of interactional harmony and discord in mother-infant
interaction (Waugh, 2002).
and disengagement in which self and interactive regulations emerge in early
infancy also provide the prototypes for the fundamental experiences neces-
sary for the later development of cognitive-affective schema (or representa-
tions of self and significant others). And consistent with the demonstration
in many infant studies of the importance of processes of engagement and
disengagement in psychological development, Behrends and Blatt (1985)
proposed that experiences of gratifying involvement and experienced incom-
patibility are a fundamental mechanism of psychological development
throughout life.
Antecedents of Individuality
The infant's emerging capacities in the first few days and weeks of life
involve the very early ability to perceive and attend to various properties of
the environment. This ability in turn provides the basis for the later develop-
ment of higher cognitive functions such as comprehension and memory (e.g.,
Meltzoff, 1985,1990). The capacity for attention and self-regulation in early
infancy is a relatively stable quality (Beebe & Lachmann, 1994; Rutter &
Durkin, 1987) that predicts the development of cognitive capacities (e.g.,
M. H. Bomstein & Sigman, 1986; Feldman & Blatt, 1996; McCall & Carriger,
1993). Maternal regulation of stimulus intake (e.g., Gable & Isabella, 1992),
maternal scaffolding (Findji, 1993), and verbal stimulation (Belsky, Goode,
& Most, 1980) encourage exploratory behavior and facilitate cognitive de-
velopment. Sensitive and consistent maternal caregiving, in interaction with
the infant's emerging capacities, contributes to the emergence of the infant's
sense of self, including affect regulation and exploration (Bretherton, 1987;
Cassidy, 1994; Pipp & Harmon, 1987). These early interactive interpersonal
experiences are the foundation for the development of a differentiated, inte-
grated, and cohesive sense of self. Interpersonal experiences provide physi-
ological and psychological interactive regulating mechanisms that augment
the development of self-regulation. The infant's appropriation of aspects of
the maternal caring relationship, especially its regulating functions, augments
the infant's emerging capacity for self-regulation.
One of the important functions of the very early mother—infant rela-
tionship is the provision of physiological homeostasis. The interactive regu-
lation experienced with mother augments the infant's capacities for self-
regulation as well as a sense of control and feelings of safety. For example, 36-
hour-old infants can discriminate and imitate facial expressions of happi-
ness, sadness, and surprise (Field, Goldstein, Vega-Lahr, & Porter, 1986). In
light of the fact that autonomic arousal (heart rate and skin temperature)
can be altered by instructing trained subjects to display facial expressions
associated with particular affects (Ekman, Levenson, & Friesen, 1983), facial
mirroring probably produces parallel physiological states in the mother and
infant as documented by the research on mirror neurons (e.g., Gallese, 2003;
Gallese & Metzinger, 2003; Ramachandran & Oberman, 2006; Rizzolatti,
Fagiga, Gallese, &. Fogassi, 1996). Thus, alteration of the infant's physiologi-
cal state may occur in response to changes in the mother and vice versa. This
intuitive, empathic communication enables the infant, early in development,
to share the mother's physiological and psychological state. The absence,
loss, or impairment of this important regulatory relationship with the mother
leads to the disruption of physiological and psychological homeostasis in the
infant (Hofer, 1984) and contributes to experiences of helplessness and inef-
fectiveness, feelings often associated with depression (e.g., Abramson,
Seligman, & Teasdale, 1978; Blatt, 1974, 1998, 2004). Many of the unto-
ward effects of maternal separation and sensory deprivation (e.g., decreased
weight and body temperature, anxiety, changes in endocrine levels, sleep,
and disrupted cardiac patterns) may derive from a deregulation of homeo-
static functions normally provided by the mother-infant relationship (Hofer,
1984). Separation, deprivation, and loss can result in the "withdrawal of pat-
terns of sensorimotor stimulation that had been exerting an imperceptible
regulating action on the subjects' minds and on their internal biologic sys-
terns" (Hofer, 1987, p. 191). Hofer (1987) suggested that we are genetically
predisposed to establish relationships that provide reciprocal regulatory func-
tions. This physiological regulation provides an early sense of order, organi-
zation, harmony, and safety (Bach, 1985), later enhanced by psychological
and symbolic aspects of the relationship. This physiological regulation, be-
ginning in early infancy, reduces experiences of anxiety, helplessness, and
disorganization and enhances feelings of control over both internal states
and the external environment, thereby augmenting the developing sense of
self that was based on the infant's innate capacities (C. E. Schaffer & Blatt,
1990).
The mother's heartbeat, for example, provides an intrauterine, rhyth-
mically organized environment. The very early mother-infant relationship
establishes a fundamental sense of order. Thus, for example, mothers are more
likely to hold infants left of the midsternal line (i.e., closer to the heart) than
they are to hold a package there (Sperber & Weiland, 1973). Furthermore,
the mother's reliable empathic contingent responsiveness in same and cross-
modal correspondence to her infant's signals conveys an ordered rhythmicity
that replicates to some degree the predictable rhythmicity of the womb
(Behrends & Blatt, 1985). The mother's ability to establish order creates a
background of safety (Bowlby, 1988a; Sandier, 1960; H. S. Sullivan, 1953).
The steady and reliable caretaking interpersonal transaction of mother and
infant complements and extends the regulatory effects of physiological relat-
edness and the infant's innate capacities for self-regulation.
The caregiver's facilitation of physiological regulation also contributes
to the infant's feelings of organization, cohesiveness, and security. In addi-
tion to physiological regulation, sharing of affective experiences with mother
52 POLAR/TIES OF EXPERIENCE
directly influences the development of three aspects of a sense of self:
(a) experiences of order and organization that guard against helplessness,
(b) participation in a bidirectional relationship in which one's experiences
can be shared and have an influence on the behavior of others, and (c) the
facilitation of the infant's inherent capacities for self-regulation as the infant
is increasingly able to assume functions provided by the mother.
The early mother-infant relationship enables the infant to establish a
state of going on being, a sense of the continuity of existence. Through a
process of identification with her infant, the mother facilitates the infant's
resolution of disruptions in homeostasis that could interfere with experiences
of continuity and the emerging sense of self. Thus, the mother enables the
infant to experience a sense of separateness and to develop a sense of self in
the overall context of relatedness (Winnicott, 1957, 1958, 1971). The se-
cure relationship with the mother provides the child with a sense of being
(Erlich & Blatt, 1985) and an "assured stable selfhood" that becomes the
basis for "spontaneous, creative activity" (Guntrip, 1971, p. 120). It is impor-
tant to note, however, that the some infant research (e.g., Jaffe et al, 2001),
as discussed earlier, demonstrates that midrange contingent coordination pro-
vides the infant with the greatest opportunity to experience his or her own
acts as efficacious, thereby contributing further to the definition of a sense of
self. Contingent coordination that is too high or too low distorts these devel-
opmental processes.
The degree of contingent coordination is defined in the dyadic inter-
action of mother and infant, and mothers differ widely in the degree to
which they value interpersonal experiences and in their ability to appreci-
ate and share affective experiences and to establish constructive levels of
contingent coordination. And these qualities of the mother influence the
infant's development of self-definition and interpersonal relatedness (Beebe
et al., 2007; Kaminer, 1999). Kaminer (1999), for example, found that the
nature of the mother's response to her infant's agency, in her comments
during their face-to-face interaction, was associated with the mother's level
of dependency, as measured on the Depressive Experiences Questionnaire
(DEQ: Blatt, D'Afflitti, & Quinlan, 1976, 1979). Mothers with lower DEQ
dependency made achievement-agency comments to their infants when
the infant was looking at them. Mothers with higher levels of DEQ depen-
dency, however, made these types of comments when infants were looking
away from them. High dependent mothers acknowledge their infant's agency
usually when the infant is experienced as separate from them. Beebe et al.
(2007) found that mothers high on DEQ dependency have heightened fa-
cial and vocal coordination with their infants—an "attentional vigilance"
in which mother and infant are overly reactive to each others' affective
shifts. This attentional vigilance is associated with lower self-regulation in
the infant. High dependent mothers closely monitor their infants and their
infants closely monitor them. This dyadic symmetry of attentional and
emotional engagement of dependent mothers with their infants and their
infants' intense engagement with their mothers keeps the infants from hav-
ing room to grow (Bergman & Fahey, 1999), thereby creating difficulty
with individuation and affect regulation (Beebe et al., 2007). In contrast,
Beebe et al. also found that mothers high on DEQ self-criticism (mothers
preoccupied with issues of self-definition) had lower coordination with their
infant and tried to compensate for this disengagement with their infants by
becoming involved with their infant through touch, a more neutral form of
interactive modality. And these infants seem to separate from their self-
critical mothers by reducing vocal quality coordination (Beebe et al., 2007).
Thus, aspects of mother's personality organization clearly influence the
quality of the interaction between infant and mother and, it is interesting
to note, provoke similar reactions in the infant.
The nature of the engagement in interactive interpersonal experiences
in the mother-infant relationship will determine the quality of representa-
tions of self and of other, initially on a presymbolic level and eventually,
beginning in the 2nd year, will be enriched by symbolic (psychological) di-
mensions. To the extent that these early self- and interactive regulations
reliably meet the infant's needs, these early internalizations will give rise to a
sense of security based on the expectancy that homeostatic disruptions can
be corrected (Pipp & Harmon, 1987). The mother's ability to recognize the
meaning of her infant's gestures and to share in her infant's affective experi-
ences creates a trusting relationship in which the spontaneous expression of
feelings is associated with the experience of being able to communicate and
feel understood (C. E. Schaffer & Blatt, 1990).3 Relationships that provide
shared physiological and psychological regulation augment experiences of
self-regulation and enable the child to eventually assume additional regulat-
ing functions through appropriating aspects of the caring relationship.
Through internalization of aspects of emotionally significant relationships,
the infant gradually establishes new levels of organization that allow him or
her to assume caregiving functions that he or she previously depended on
others to provide, thereby enriching the child's sense of self as independent
and efficacious (Behrends & Blatt, 1985). Early internalizations occur ini-
'If the mother is relatively unable to acknowledge the infant's experiences and is unable to transform
his or her gestures into occasions of mutual and shared understanding, the child struggles to achieve a
compensatory sense of relatedness with the mother by negating some of his or her own feelings (Kohut
& Wolf, 1978). The child's lack of appreciation of feelings and the inability to reflect on affective
experiences limit the child's capacity to understand his or her own feelings and those of others and to
establish close and intimate relationships in which meaning is mutually created and shared. The child
avoids interpersonal interactions and struggles to establish and preserve a limited sense of selfhood,
but frequently the child feels an inexplicable lack of congruence between his or her experiences and
an understanding of the experiences of others. Without mutually shared reciprocal relationships, the
child retains experiences of having little or no effect on the world and thus continues to withdraw to
defend against a potentially unresponsive world that continues to negate his or her existence. In
contrast, psychological development is enhanced when the caregiver's vision of the child is congruent
with the infant's emerging capacities, rather than with the caregiver's desires (Khan, 1972).
tially around sensorimotor experiences of reestablishing homeostatic equi-
librium. Over time these internalizations become increasingly differentiated,
complex, and symbolic (Blatt, 1974).
Mother-infant face-to-face interaction is the infant's first participa-
tion in a social interchange (Stern, 1974). Erikson considered the first social
achievement to be the capacity to allow the mother to be out of sight be-
cause she has become "an inner certainty" as well as an external predictabil-
ity (1950, p. 221). This inner certainty and predictability, this sense of the
dependability of caregiving (Mahler, 1975), is an essential factor in the emer-
gence of secure attachment at 9 months (Ainsworth, 1969, 1982; Bowlby,
1969, 1979) and of object and self-constancy several months later. Thus, the
interactive sharing of affective experiences between caregiver and infant is
essential to the process of psychological differentiation and development. In
addition to establishing an emotional communion with the infant, the
caregiver must, at the same time, support the infant to stand outside of that
communion. The alternations between union and separation, engagement
and disengagement, gaze and aversion of gaze, contingent and noncontingent
responses (e.g., Gergley & Watson, 1996), and experiences of harmony and
discord between mother and infant (Waugh, 2002) are aspects of a hierar-
chically organized dialectical process between a series of alternating experi-
ences of gratifying involvement (e.g., communion) and experienced incom-
patibility (e.g., separation) that facilitates the infant's development in multiple
ways (Behrends & Blatt, 1985).
In the 2nd year of life, development of the self also involves the capac-
ity for self-reflexivity (the ability to maintain simultaneously both a subjec-
tive and an objective perspective on the self)—to make smooth transitions
between the experience of oneself as a center of initiative and a recipient of
impressions (Kohut, 1977), on the one hand, and an awareness of oneself as
an object among other objects, a self among other selves, an object in the
eyes of others on the other (seej. S. Auerbach, 1993; J. S. Auerbach & Blatt,
1996, 1997; Bach, 1985, 1994, 2006; Broucek, 1991). This differentiation,
originally made by William James (1890/1958), of I as knower and me as
known and acted on, provided the basis for much theoretical work on the
development of the self, initially in sociological theory (e.g., J. M. Baldwin,
1902; Cooley, 1922/1964; Mead, 1934/1962) and later in social psychology
and psychoanalysis (e.g., Aron, 1996; J. S. Auerbach, 1993; J. S. Auerbach 6k
Blatt, 1996, 1997; Bach, 1985, 1994; Blatt & Bers, 1993; Damon & Hart,
1988; Duval & Wicklund, 1972; Fast, 1998; Harter, 1999; Lewis 6k Brooks-
Gunn, 1979; Mann, 1991; Mead, 1934/1962; Merleau-Ponty, 1960/1964;
Modell, 1993; Piaget, 1926; Schafer, 1968). This capacity for reflexive self-
awareness begins to emerge between the ages of 18 and 24 months as, for
example, an ability to recognize oneself in the mirror (Lewis & Brooks-Gunn,
1979) or to comment on one's immediate actions and preferences through
brief self-descriptive utterances (Kagan, 1981) and culminates in the abstract,
systematic self-conceptions of adolescence and beyond (Damon & Hart,
1988). Baumeister (1998, 2000) noted that selfhood is defined by reflexive
awareness, interpersonal membership, and an executive function that en-
compasses volition, including the capacity for control, decision making, and
initiation. Coincident with the emergence of self-reflexivity in the 2nd year
of life is the emergence of a child's capacity to distinguish between pretend
(i.e., make-believe) and reality (Bretherton, 1989; Harris & Kavanaugh, 1993;
Leslie, 1987). Prior to the age of 4 or 5, however, the child has difficulty
grasping the distinction between appearance and reality—between how
things look and how they actually are (Flavell, Green, & Flavell, 1986)—
as well as understanding the difference between beliefs and physical reality
(Perner, Leekam, & Wimmer, 1987; Wimmer & Perner, 1983). Preschool
children have difficulty recognizing that their beliefs about the world are
dependent on their perceptions—that their beliefs may be incorrect and
may differ from those of others. They also have difficulty recognizing that
other people may have false beliefs and can lie and have secrets (Astington,
1993; Meares, 1993). Thus, although the child comes to understand the
separateness of his or her body in the 2nd year of life, he or she does not
come to understand that his or her mind is distinct from those of others
until sometime in the 5th or 6th year (Mayes & Cohen, 1996). The discov-
ery of the separateness of the body and later of the mind is a crucial step in
the development of self-reflexivity because the child can now appreciate that
his or her beliefs about the world can differ from those of others (J. S. Auerbach
&Blatt, 2001,2002).
This capacity for reflexive self-awareness and a concept of mind emerges
in interactions with others—from the reflected appraisals of others and from
how others see one (Cooley, 1922/1964; Mead, 1934/1962). Thus, one de-
velops a concept of self and of mind not through the solitary introspection
proposed by Descartes (163 7/1968a, 1641/1968b) but by seeing oneself through
the eyes of others (J. S. Auerbach & Blatt, 2002). From a psychoanalytic
perspective, the child's ability to understand the mind of another requires
first being treated by one's caregivers as having a mind, will, and feelings of
one's own (e.g., J. Benjamin, 1995; Fonagy, Gergely, Jurist, & Target, 2002;
Stern, 1985; Winnicott, 1971). To understand the mind of another, one must
first be regarded by caregivers as an independent subject. A child becomes an
independent subject who can experience being regarded as an object only by
first being regarded as independent by the caregiver (Fonagy et al., 2002;
Kaminer, 1999; Stern, 1985; Winnicott, 1971). The tension between subjec-
tive and objective views of the self—the developmental emergence of self-
reflexivity and the capacity for self-observation in early childhood—creates
developmental differentiations that are essential for further psychological
development of the self (i.e., among views of oneself as the person I am, the
person I would like to be, the person I think I should be, and the person I fear
I am or do not want to be).
This developing sense of self is consolidated when the child can recog-
nize that the caregiver also has an independent mind, will, and feelings. The
child's independence becomes real only when the child recognizes the inde-
pendence of the other and appreciates that the other also has beliefs and
desires. With the appreciation of one's own thoughts and feelings and those
of others, the child begins to realize that he or she is an integral part of a
complex, coordinated, transactional social system—a family—that involves
multiple relationships among all the participants in a psychological field.
The child becomes aware of aspects of the dyadic relationship he or she has
established with each parent separately as well as of participation in the tri-
adic family system. But some evidence (e.g., Fivaz-Depeursinge & Corboz-
Warnery, 1999) suggests that an awareness of triadic relationships occurs on
a presymbolic level as early as 3 months of age.
This shift from dyadic relationships to the child's awareness of partici-
pating in the triadic structure of the family was initially discussed in interper-
sonal terms in early psychoanalytic theory as the oedipal phase and in cogni-
tive terms in developmental theory as the development of operational
thinking—that is, the capacity for the coordination and transformation of
various dimensions through an awareness of operations including reversibility,
reciprocity, and conservation—beginning at 5 or 6 years of age (Blatt, 1983,
1995a). Both early cognitive-developmental theorists (e.g., Piaget, 1937/1954;
Werner, 1948) and psychoanalytic theorists (e.g., Schafer, 1968) observed
that the thinking of a child that age is no longer necessarily direct, immedi-
ate, and literal; instead, part properties and features of various objects, and
the interrelationships among them, can be varied, constructed, and recon-
structed in coordinated and complex ways. Early research by Feffer (1969,
1970), for example, demonstrated that an important aspect of the develop-
ment of operational thought is the development of the child's capacity to
recognize his or her own point of view as well as recognize the perspective of
others and, eventually, to appreciate that he or she is a unique person among
all others, with a personal perspective (Inhelder & Piaget, 1955; Laurendeau
& Pinard, 1962, 1970; Olson, 1970). Thus, reflective self-awareness (Olson,
1970; Schafer, 1968), the establishment of the self as a unique and stable
reference point, is considered an essential part of both the development of
operational thought and an appreciation of subjective aspects of experience—
the recognition of the importance of personal meaning, affective experience,
priorities, and values (Blatt, 1983).
Later, with the development of formal operational thought, the child
becomes aware not only of the independent experiences of himself or herself
and others but also of the independence of his or her thought processes from
the environment. He or she becomes aware that he or she is responsible for
his or her construction and understanding of reality. With this development
of full reflective self-awareness and appreciation of his or her own thought
processes as well as the viewpoints of others, the child develops a capacity for
social reciprocity by which he or she can maintain his or her own subjectiv-
ity while appreciating the subjectivity of others, differentiating these various
subjective perspectives from more objective dimensions of reality, eventu-
ally appreciating that a relativistic subjective dimension always exists in the
understanding or interpretation of nature (Blatt, 1983; Inhelder & Piaget,
1955; Piaget, 1926, 1937/1954).
Thus, the self becomes a stable reference point, experienced as a unique
object among many other objects. The child becomes aware of his or her
continuity with his past as well as his or her potential extension into the
future. With the development of the self as a unique and stable reference
point, a wide range of subjective experiences such as affects, emotions, val-
ues, and personal meanings become increasingly differentiated, integrated,
and symbolic. At each developmental stage, subjective aspects are increas-
ingly coordinated with aspects of the external objective world. At lower stages,
affects are part of sensorimotor activity and impel the individual toward ac-
tion and discharge. At higher stages, understanding of reality is integrated
with the recognition of personal meanings, affective experiences, priorities,
and values. Increased recognition and appreciation of one's own personal
reactions, feelings, and values is accompanied by an increased awareness of
the perspectives, feelings, and values of others. Thus, the development of the
self involves greater differentiation of affective nuances, as well as the capac-
ity to establish interpersonal relationships characterized by reciprocity and
mutuality. The establishment of a stable, constant, self-reflective awareness
of experiences and thoughts is a major developmental milestone according
to both contemporary psychoanalytic (e.g., Aron, 1996; J. S. Auerbach &
Blatt, 1996, 2001, 2002; Bach, 1985, 1994; Bettelheim, 1967; Blatt, 1983,
1999a; Federn, 1952; Fonagy, 1994; Fonagy et al., 2002; Jacobson, 1964;
Mahler, 1975; Schafer, 1968) and cognitive—developmental theory (e.g.,
Damon & Hart, 1988; Ferrari & Stemberg, 1998).
As M. W. Baldwin (2005) observed, a remarkable increase of research
over the past decade on the dynamics of interpersonal interactions (interper-
sonal cognition) from multiple theoretical perspectives (e.g., interpersonal,
attachment, symbolic interactionist, and psychodynamic) has emphasized
the interpersonal roots of identity formation and the importance of investi-
gating the representation of interpersonal relations. As noted earlier, the
development of mental representations (or cognitive-affective schema) of
self and others in mutual relatedness is the consequence of the intemaliza-
tions of aspects of gratifying experiences that have both physiological and
psychological dimensions. The processes of internalization stress the subject's
role as the transformer of experience (Schafer, 1968), and aspects of the ex-
perienced relationship, real or imagined by the subject, rather than aspects of
the objects themselves, are internalized (Loewald, 1960, 1970).
Fehr (2005) discussed the role of prototype cognitive structures in orga-
nizing interpersonal knowledge around affective (e.g., love, anger) and rela-
tional (e.g., commitment and intimacy) themes. On the basis of research by
Rosch (1973a, 1973b) and M. W. Baldwin (e.g., 1992), Fehr, like Stern (e.g.,
1985), noted that relational knowledge is stored in interpersonal schemas
(scripts or prototypes) that consist of three components: the representation
of self (self-schema), the representation of the relational partner (other
schema), and the interaction between self and other (interactive schema).
Fehr (2005) stressed that prototype theory (e.g., Rosch, 1973a, 1973b) can
specify structural (procedural or implicit) aspects of the internalized rela-
tional schemas or representations of interpersonal interactions that can supple-
ment the usual focus on content (episodic or explicit) aspects of relational
schemas. Prototype or schema theory can provide links between cognitive
science and clinical research and theory as well as research on interpersonal
interactions more generally. Blatt (1995a) and Scarvalone, Fox, and Safran
(2005) observed that the procedural dimensions from prototype and schema
theory can provide further understanding of the development of normal as
well as dysfunctional interpersonal patterns (see also Baccus & Horowitz,
2005). And M. J. Horowitz (1979, 1991; Baccus & Horowitz, 2005), Blatt
et al. (Blatt, Stayner, Auerbach, & Behrends, 1996), and Hermans (2005)
stressed that revisions in the content and structural organization of inter-
personal schemas or mental representation of self, other, and their interac-
tions are central to change in the psychotherapeutic process. The normal
development of the structural organization and content of mental represen-
tations of self and other and their role in various forms of psychopathology
and in the psychotherapeutic process are discussed more fully in chapter 8
(this volume).
Mental representations of constructive caring mother-infant relation-
ships facilitate establishing psychological and physiological equilibrium.
Mental representations of constructive relationships enable well-functioning
individuals to restore a sense of integration. When the usual sources of con-
structive environmental support and interpersonal stimulation are unavail-
able, access to mental representation of constructive relationships can serve
an important adaptive function. Illusions and hallucinations of significant
figures, for example, frequently occur as part of constructive grieving (Rees,
1975) and of dealing with sensory deprivation (Heron, 1961). Throughout
life, these representations allow individuals to experience temporary separa-
tions without the profoundly disruptive behavioral and physiological changes
that are frequently associated with early separation, sensory deprivation, or
bereavement (C. E. Schaffer & Blatt, 1990). Because several physiological
responses are specifically mediated by the mother-infant relationship, it seems
likely that mental representations may also specifically facilitate the regula-
tion of particular biological responses (Hofer, 1984).
Much of the early, presymbolic, procedurally organized aspects of rep-
resentations of mother-infant regulation remains implicit and out of aware-
ness, unavailable to symbolic processing. The extent to which one has access
to aspects of complex, multidimensional, presymbolic and symbolic repre-
sentations of significant caring relationships in the absence of the caregiver
is related to the capacity for psychological and physiological self-regulation.
Because the sense of self derives in part from the achievement of these forms
of regulation, the organizational complexity of mental representations of re-
lationships with significant others is an integral aspect of a more mature and
effective sense of self. Impairments in the capacity for object representation
may therefore be associated with psychological disturbance including a des-
perate need for close contact with others; without adequate levels of object
representation, a lack of proximal interactions may lead to feelings of depres-
sion, helplessness, and ineffectiveness (Blatt, 1974, 1998, 2004; Freud, 1917/
1957h; Klein, 1934/1948).
Different types of impairments in the structural procedural organiza-
tion of mental representations of self and significant others are associated
with different forms of psychopathology (Blatt, 1991a, 1995a). For example,
because of impairments in representation, individuals experiencing depres-
sion may struggle to maintain contact with other people who might satisfy
their needs. Depression can be precipitated by the lack of the opportunity to
maintain direct, physical, emotional contact with another or to win the love
of others through achievement (Blatt, 1974, 2004). Because of the failure to
establish adequate levels in the organization of representations, the sense of
well-being for people who are depressed depends on having someone else
actually fulfill their needs. The lack of the internalized capacity to provide
for oneself the satisfactions that initially derived from caring relationships
contributes to an impaired sense of self. Conversely, the capacity to establish
differentiated, articulated, and integrated representations of self and signifi-
cant others both expresses and contributes further to an effective sense of
self. These issues are discussed more fully in chapter 8 (this volume).
Antecedents of Interpersonal Relatedness
Investigations of early mother-infant face-to-face interaction (e.g.,

Beebe, 2006; Beebe et al., 2007; Brazelton, Koslowski, & Main, 1974; Stern,
1977, 1985) usually regard the mother-infant relationship as a unified social
system. The interactions between caregiver and infant during this intense
social process are a primary area of investigation. Systemic concepts such as
mutuality (Symons & Moran, 1987), reciprocity (Belsky, Rovine, & Taylor,
1984), bidirectional influence (Cohn & Tronick, 1988), interpersonal tim-
ing (Feldstein et al., 1994; Jaffe et al., 2001), or synchrony (Isabella & Belsky,
1991) are major constructs in infant research. The relation between the level
of dyadic maternal responsiveness in infancy and the child's attachment se-
curity (Crockenberg & McCluskey, 1986; Isabella, 1993; P. B. Smith &
Pederson, 1988) and social adaptability during the toddler's years (Sroufe,
1979, 1983) suggests that these interactive constructs predict the emerging
capacity for interpersonal relatedness in early childhood. Secure attachment
takes place in the context of positive relatedness (e.g., Ainsworth et al., 1978;
Bowlby, 1969).
Specific maternal and infant play patterns, as well as the overall prin-
ciples that guide mother-infant face-to-face interaction, not only augment
the development of self-definition (as discussed previously) but also contrib-
ute to the development of the capacity for interpersonal relatedness. Typical
face-to-face play patterns, such as mutuality of gaze (Kaye & Fogel, 1980),
simultaneous vocalizations (Feldstein et al., 1994), maternal acknowledg-
ment of the infant's social communication (Mayes & Carter, 1990), and
imitation and variations of the infant's movement and vocalization (Field,
Goldstein, Vega-Lahr, & Porter, 1986), contribute to affective and interper-
sonal (Malatesta, 1988; Stem, 1985) as well as cognitive, linguistic, and so-
cial development (Jasnow & Feldstein, 1986; Stern & Gibbon, 1978). The
close second-by-second coordination between mother's and infant's affec-
tive states during face-to-face interaction organizes their interaction and aug-
ments the emergence of self-regulation and control as well as the develop-
ment of interpersonal synchrony and intersubjectivity (Cohn & Tronick,
1987, 1988; Lester, Hoffman, & Brazelton, 1985).
Stern (1985) demonstrated the importance of cross-modal correspon-
dence of the shape, timing, and intensity of the child's and mother's coordi-
nation for the development of a sense of communion and communication.
Correspondence across sensory modalities indicates that this affective match-
ing or attunement between infant and mother is more than simple imitation.
The intensity and duration of the child's voice, for example, may be matched
by features of the mother's body movement. When the mother matches the
intensity, timing, and shape of the infant's excitement, the child continues
to attend to the ongoing activity. When a mother is instructed to intention-
ally mismatch the child's affective expression, the child stops his or her ac-
tivity and facially expresses a need for clarification. Stem concluded that the
experience of sharing that derives from affect attunement helps the infant
realize that feeling can be shared with others. Stern proposed that feelings to
which the mother is unattuned are experienced in isolation by the infant and
do not contribute to the infant's development of affective sharing, to the
sense of self, or to the development of interpersonal relatedness. As discussed
earlier, Jaffe et al. (2001) noted that too close or too little mother-infant
contingent coordination each led to insecure attachment. Midrange coordi-
nation leads to secure attachment (Jaffe et al., 2001).
The experience of affect attunement with the mother enables the child
to learn that affective experiences can be shared and that one has the capac-
ity to influence one's interpersonal relationships. Moments of well-
coordinated and poorly coordinated mother-infant interactions normally al-
ternate, with poorly coordinated interactions occurring about 70% of the
time (Tronick & Gianino, 1986). Of these poorly attuned interactions, how-
ever, about 34% are spontaneously corrected. Infants more accustomed than
other infants to these naturally occurring reparations responded to mothers
who were intentionally unresponsive to their infants in the still-face experi-
ment by emitting a greater number of signals in a vigorous attempt to get
mother to respond. Tronick and Gianino (1986) concluded that infants who
normally experience relatively higher levels of natural reparations "had the
clearest representation of the interaction as reparable and of themselves as
effective" (p. 8). Infants who normally experienced fewer repairs after
misattunements turned away in sadness and distress in the still-face experi-
ment and seemed to feel ineffective in interpersonal reparation. Tronick and
Gianino concluded that these responses develop over time and become per-
vasive and generalized, self-sustaining, regulatory styles. Thus the findings by
Jaffe et al. (2001) suggest that mothers who too closely coordinate with their
infants may limit their infant's experiences of the reparation of disruptions
and their infant's psychological development. Similarly, a depressed mother's
slow response to her infant's needs interferes with the infant's experiencing
the contingencies between his or her gestures and mother's response (Bettes,
1988). This interference creates a dissociation between the child's gesture
and the mother's reaction, such that the mother's behavior is no longer ex-
perienced as a response. What is lost is not necessarily supplies from the
mother so much as the experience of oneself as a person-in-relationship with
an other (Bettes, 1988).
These studies suggest that the reciprocal process of mother-infant con-
tingent coordination augments infants' capacity to regulate both their own
internal emotional states and their relationships with the external world.
This augmentation of regulation emerges out of a mutually reciprocal dyadic
regulatory system in which the "caretaker responses serve as an external seg-
ment of the infant's regulatory capacities" (Tronick & Gianino, 1986, p. 7).
The infant participates by indicating an optimal level of stimulation to the
mother, and this optimal level is achieved through the joint effort of both
members of the dyad. The mimetic musculature of the face is relatively de-
veloped at birth and allows the newborn to express an optimal level of stimu-
lation (Tomkins, 1962). By 3 to 5 months of age, the gaze of the infant exerts
major control over the "level and amount of social stimulation" the mother
provides as she responds at the level of stimulation the infant finds optimal
(Stern, 1985, p. 21). Thus, the infant's behavior serves to both distance and
reinitiate contact with the mother.4 Mother's success at meeting the infant's
needs is therefore partly related to the infant's capacity to communicate these
needs to her. These contingent coordinations between mother and infant,
4
At a later age, motor coordination (i.e., walking away and returning) serves these same regulatory
functions.
when in the optimal range, contribute to bidirectional reciprocity between
mother and infant.
Distinct patterns of face-to-face interactions are differentially related
to interpersonal and exploratory modes of interaction. M. H. Bornstein (1989)
and M. H. Bornstein and Tamis-LeMonda (1990) distinguished two distinc-
tive prototypes of early interactive styles: (a) a social prototype, in which
mother and infant are directed toward each other, and (b) a didactic proto-
type, in which mother directs infant attention to the environment. These
two maternal interactive styles are stable between 2 and 5 months. The so-
cial maternal style is significantly related to the quality of the mother-infant
relationship. The didactic, exploratory, directing maternal style at 5 months
of age is significantly related to the complexity of the child's symbolic play at
13 months (Tamis-LeMonda & Bornstein, 1989). These two interactive pro-
totypes, social attention on one hand and attention to objects in the envi-
ronment on the other, are each accompanied by distinct facial, visual, vocal,
and gestural configurations and also by differing emotional expressions—by
joy and interest, respectively (Weinberg & Tronick, 1994). Thus, specific
aspects of early mother-infant interactions appear to relate uniquely to the
development of interpersonal relatedness and the child's independent en-
gagement with aspects of the environment—an early expression of self-
directed activity.
Feldman and Blatt (1996) found that the pattern of mother-infant in-
teraction is an independent factor that accounts for the largest percentage of
the variance of the play patterns of infant and mother at both 3 and 9 months
of age. Components of mother-infant interaction, however, have different
developmental trajectories. Maternal play patterns change from 3 to 9 months;
imitation and elaboration (attentiveness) decrease significantly while reci-
procity increases and constitutes a major portion of maternal responsiveness
at 9 months. Maternal responsiveness later in development (at 9 months),
coordinated with increases in infant-initiated activity (Hoffmann, 1994),
results in increased dyadic reciprocity and greater sharing of affective experi-
ences (Emde, 1984; Stern, 1985). These findings, consistent with theory and
other empirical findings, indicate that mother-infant mutuality develops
within a context of maternal acknowledgment and positive responsivity. Thus,
maternal responsiveness and reciprocity at 9 months appear to express the
emergence of an interpersonal-relatedness developmental line.
In particular, mother's imitation and elaboration at 3 months and dy-
adic reciprocity at both 3 and 9 months facilitate the infant's affective and
interpersonal development (Emde, 1984; Stern, 1985). Dyadic reciprocity,
however, is not associated with the infant's general attitudes in play (e.g.,
level of affect or visual attention), but is specifically related to mother's ac-
tive play patterns of acknowledgment, imitation, and elaboration. Because
the centrality of the mother-infant regulatory process augments self-regulation
in early infancy (Sander, 1984,1987), adequate interactive regulation at both
3 and 9 months appears to be essential for the infant's development of cogni-
tive capacities, especially verbal abilities (Akhtar, Dunham, & Dunham,
1991), and for the development of relatedness (Emde, 1988a, 1988b) and
affect regulation (Malatesta, 1988; see also Jaffe et al, 2001). Maternal re-
sponsiveness earlier in development (3 months) regulates the infant's level
of arousal and excitement in a highly stimulating interaction. Later in devel-
opment (at 9 months), interactive regulation, expressed now in dyadic reci-
procity, establishes an effective pattern of give-and-take play between mother
and infant that is significantly related to interpersonal and emotional devel-
opment at 2 years of age (Feldman & Blatt, 1996). These findings are consis-
tent with previous studies (e.g., Sroufe, 1979, 1983) that demonstrate a rela-
tionship between early attachment security and ratings of self-esteem and
interpersonal skills at 4 years of age.
Although these early expressions of relatedness and self-organization
appear to be independent, they also have a sequential relationship. Feldman
and Blatt (1996) found that early expressions of maternal relatedness were
significantly related to later infant attention and involvement, and early in-
fant behavior was significantly related to the nature of the later maternal
interactive style (see also van den Boom & Hoeksma, 1994). The quality of
mother-infant relatedness and responsiveness at 3 months appears to aug-
ment the emergence of self-definition, as measured by the infant's alertness,
focused interest, and initiatory play at 9 months. And initiation in the infant's
play at 3 months appears to be related to maternal attention, positive affect,
and sensitivity in her interaction with her infant at 9 months (Feldman &
Blatt, 1996). In accordance with systemic and transactional perspectives on
development (e.g., Sameroff & Fiese, 1991; Thelen, 1990), these findings
indicate that the two relatively independent developmental lines of related-
ness and self-definition also interact during the early months of infant's de-
velopment and that mother and infant reciprocally influence each other's
relational style. Maternal responsiveness influences the infant's participa-
tion in play, and a more active and socially involved infant attracts and main-
tains mother's involvement.5
Studying these same children again at 2 years of age, Feldman and Blatt
(1996) found that an infant's alertness, attention, and initiative in face-to-
face play at 3 months is associated primarily with cognitive development at 2
years, whereas the degree of maternal responsivity and reciprocity at 9 months
is related primarily to the infant's socioemotional functioning at age 2. In-
fant attention and exploratory orientation (Bernstein's didactic mode) are
correlated with the development of cognitive capacities, whereas mutuality
and reciprocity (Bernstein's social mode) appear to relate primarily to the
5
Chapter 4 of this volume extends this dialectic synergistic developmental process to consideration of
issues in later development in adolescence and adulthood.
quality of interpersonal attachment and socioemotional development (see
also Jaffeetal, 2001).
These analyses of mother-infant interaction in the first 2 years of life
(Feldman & Blatt, 1996) indicate the importance of differentiating, within
the context of mother-infant interactions, between play related to the infant's
development as separate and independent (Bernstein's didactic mode) and
play associated with the patterns of dyadic interaction (Bornstein's social
mode). These two dimensions of early mother-infant interactions appear to
have differential association with development into the toddler years and
beyond. The quality of infant activity in the first 3 months of life appears to
contribute primarily to the development of infant's cognitive skills and self-
assertion or self-definition. Infant alertness at 3 months is significantly re-
lated to the level of intelligence at 2 years, with this relationship possibly
reflecting the fact that an inborn capacity for focused attention is related to
both the efficiency of the early information-processing system and later mea-
sures of intelligence (M. H. Bornstein & Sigman, 1986). The infant's early
level of alertness at 3 months is integrated with the infant's initiation at 9
months—with involvement in both toy-directed and interpersonal interac-
tions—and this capacity for initiation appears to facilitate the infant's visual
IQ, including the development of exploratory visual-tactile skills (e.g., vi-
sual perception, cross-modal integration, and manipulative competence at
age 2 years).
The significance of infant attention at 3 months and capacity for ini-
tiation at 9 months in predicting intelligence at 2 years is consistent with
theory and research on the early development of the self discussed earlier.
Interactive regulation that organizes the infant's curiosity and the amplitude
and pace of the infant's stimulus intake during the first 6 months is impor-
tant in the infant's development of the self-regulation, attention organiza-
tion, and state control, qualities that are central to the early consolidation of
the self (Cassidy, 1994; Sander, 1975; Sroufe, 1990) and to the development
of cognitive capacities. The capacity of mother and infant to establish reci-
procity in the first 9 months of life, in contrast, appears to contribute prima-
rily to dimensions of the infant's socioemotional development. Thus, aspects
of behavior of both infant and mother in dyadic play at 3 and 9 months
appear to be early expressions or precursors of the two fundamental develop-
mental processes, relatedness and self-definition (Feldman & Blatt, 1996;
see also Jaffe et al., 2001). Cognitive and social development come out of the
same dyadic encounter but express different aspects of that encounter.
The quality of the mother-infant relationship and the child's social-
emotional development becomes increasingly important in the 2nd year of
life as the child begins the process of separation and individuation from
mother. A great deal of research has been conducted on the child's response
to separation from mother in the 2nd year of life (e.g., Ainsworth et al.,
1978), and these data indicate that a large percentage of children negotiate
this separation quite successfully. A child who can manage separation from
the mother is considered to be securely attached to the mother and to have a
mental representation of the mother as dependable and reliable and a posi-
tive representation of self as effective and lovable. It is this confidence in the
caretaking relationship that enables a majority of children (about 68%) to
be secure as they begin the lifelong process of separation and individuation
in the 2nd year of life. A securely attached toddler uses the caretaker as a
secure base from which to explore the world and to which to retreat at mo'
ments of distress or anxiety. A smaller proportion of children, about 32%,
are insecurely attached; they display considerable discomfort and sustained
disruption of their exploration and play during separation and reunion. Among
insecurely attached children, resistantly attached toddlers respond to separa-
tion with considerable and sustained distress and cling to mother on her
return. The child focuses attention on the caretaker, is reluctant to separate
and to explore the environment, and is very dependent on reunion.
Avoidantly attached infants, in contrast, do not protest at separation but
actively avoid engaging with the mother on her return. These infants appear
to explore their environment with seeming confidence both during separa-
tion and reunion, but physiological measures indicate the presence of dis-
tress that is masked by seemingly self-reliant, composed behavior (Sprangler,
Fremmer-Bombik, & Grossmann, 1996).6 A very small proportion of infants
(usually less than 8% of insecurely attached children) are classified as disor-
ganized-disoriented because they display a mixed and inconsistent pattern
of both clinging and avoidant behavior on the mother's return. The two
predominant insecure attachment styles (resistant and avoidant), however,
are well-stabilized patterns involving preoccupation with the relationship to
a significant other (resistant attachment) or an exaggerated, defensive defi-
ance (avoidant attachment), even as early as the 2nd year of life (Ainsworth
etal, 1978).7
These attachment patterns are relatively stable over time (Ainsworth,
1982; Bretherton, 1985), and they influence behavior in adolescence (e.g.,
Elicker, Englund, & Sroufe, 1992) and adulthood. Research on these early
attachment patterns suggests that the child establishes internal working
models or mental representations of the relationship of self and caretaking
other (Blatt, 1974,1991a, 1995a; Bowlby, 1969, 1973,1988b; Main, Kaplan,
& Cassidy, 1985). Infants seem to form prototypic schemas of the process of
interactive regulation in early, emotionally charged experiences of gratifica-
tion and frustration, of match, mismatch, and repair (e.g., Beebe & Lachmann,
6
See earlier discussion of the suggestions of Jaffe et at. (2001) that types of insecure attachment may be
related to exaggerations (excessive or minimal) of the degrees of CIT in early mother-infant
interaction.
7
See Shahar, Blatt, and Ford, 2003, discussed in chapter 7 (this volume), for a similar formulation
regarding two different defensive or adaptive styles in young adult inpatients who are seriously
disturbed and in intensive treatment.
1988; Behrends & Blatt, 1985; Blatt & Blass, 1990, 1996; Bretherton, 1987;
Kernberg, 1995; Loewald, 1960; Stern, 1985; Zeanah & Anders, 1987), and
these schemas or representations serve as heuristic guides that organize expe-
riences, modulate affect, and provide direction for subsequent behavior. These
schemas become enduring transformational psychological processes or tem-
plates that process and organize information and promote the assimilation of
new experiences into existing cognitive structures (Blatt & Lemer, 1983).
Longitudinal studies have demonstrated the influence of these infant
attachment styles on subsequent functioning. Securely attached toddlers are
cooperative, popular with peers, and highly resilient and resourceful as
preschoolers (e.g., Sroufe, 1983) and, at age 6, are relaxed and friendly and
converse with their parents in a free-flowing and easy manner (Main &
Cassidy, 1988). Resistantly attached infants are tense and impulsive as tod-
dlers, passive and helpless in preschool (e.g., Sroufe, 1983, 2005), and later
are insecure and hostile in interactions with their parents (Main & Cassidy,
1988). Avoidantly attached infants appear emotionally insulated, hostile,
and antisocial as preschoolers (e.g., Sroufe, 1983) and later tend to distance
themselves from their parents and ignore their parents' initiatives in conver-
sation (Main & Cassidy, 1988).
A number of studies (e.g., Elicker et al., 1992; Grossmann & Grossmann,
1991; Grossmann, Grossmann, & Waters, 2005; C. Hamilton, 1994; Waters,
Merrick, Trebous, Crowell, & Albersheim, 2000) report considerable corre-
spondence of the secure-insecure status, as assessed in infancy, in adoles-
cence, and even in adulthood (Bretherton, 1985), especially if there has been
no major disruptive life event (e.g., loss of a parent, parental divorce). In
addition, evidence indicates that the patterns of secure-insecure attachment
have cross-generational continuity. Caregiving behavior of mothers is con-
gruent with the reports by these mothers of the care they received as chil-
dren. Reports by pregnant women of their early childhood caring experi-
ences with their own mothers are congruent with the quality of the subsequent
care these women eventually provide their infants (Fonagy, Steele, & Steele,
1991; Main et al., 1985; Slade & Aber, 1992; Virtue, 1992). In addition,
these attachment patterns are related to important cognitive differences in
adults such as the degree of cohesion and consistency in narrative reports
that individuals construct in describing their early life experiences (Main,
1991; Main et al., 1985).
Cross-sectional investigations also support the importance of these dis-
tinctions in assessing attachment styles in adults (Hazan & Shaver, 1987,
1990a, 1994; Shaver & Hazan, 1987,1993; West, Sheldon, & Reiffer, 1987).
Main et al. (1985) identified three patterns of attachment in adults—secure,
enmeshed, and detached—that were similar to the differentiation of three
attachment patterns that Ainsworth found in infants. The differentiation of
these attachment patterns in adults by Main et al. (1985) was derived from
an interview assessment of adults' descriptions of their early memories of
attachment-related events. In contrast to Main's interest in adults' recollec-
tion of their early relationships with their parents, Kazan and Shaver (1987;
Shaver, Hazan, & Bradshaw, 1988) used the paradigm of patterns of child'
hood attachment to study attachment patterns in the romantic relationship
of adults. Shaver and colleagues (Brennan, Shaver, &Tobey, 1991; Hazan &
Shaver, 1987, 1990a; Shaver & Brennan, 1992) demonstrated that the three
attachment styles (secure, resistant, and avoidant) can be reliably differenti-
ated in adults and are related to a wide variety of processes and outcomes in
adult close relationships. The experiences of love in secure adults, for ex-
ample, are characterized by caring, intimacy, supportiveness, and understand-
ing. Experiences of love in resistant adults are characterized by emotional
instability and a preoccupation with physical attractiveness and the desire
for union, whereas in avoidant individuals these experiences are character-
ized by a fear of intimacy (Hazan & Shaver, 1987, 1990b). Securely attached
individuals report that they feel appreciated at work and enjoy contact with
their coworkers, whereas avoidant adults regard success at work as more im-
portant than relationships and prefer to work alone, feeling satisfied with
their work but not with their coworkers. Resistant individuals, in contrast,
prefer to work with others and enjoy the people with whom they work more
than the actual work itself. In sum, numerous studies have investigated these
three attachment patterns (secure, resistant, and avoidant) in adults and found
that these styles are significantly related to important differences in patterns
of interpersonal relations (e.g., satisfaction, breakups, commitment), patterns
of coping with stress, and the quality of interpersonal communication (Feeney
& Kirkpatrick, 1996; Hazan & Hutt, 1993; Mikulincer & Nachshon, 1991;
Simpson, Rholes, &Nelligan, 1992).
It is noteworthy that the two primary forms of insecure attachment
(resistant and avoidant) are organized respectively around preoccupations
with either relatedness or self-definition. In addition, research suggests that
several developmental levels can be identified within each of these two inse-
cure attachment styles (K. N. Levy & Blatt, 1999). Research by Bartholomew
(1990; Bartholomew & Horowitz, 1991) suggests that two types of avoidant
behavior can be distinguished: fearful avoidant and dismissive. Fearful avoid-
ance is characterized by a desire for relatedness that is inhibited because of
fears of the consequences of intimacy. Such individuals are low in self-
esteem, hesitant, shy, lonely, vulnerable, dependent, afraid of rejection, and
lacking in social confidence. Dismissive individuals, in contrast, are charac-
terized by a defensive denial of the need and desire for relatedness. These
individuals describe themselves as high in self-esteem, socially self-confident,
unemotional, independent, cynical, critical of and distant from others, and
more interested in achievement than in interpersonal relationships. Although
dismissively avoidant individuals rate themselves as high in self-esteem, their
peers often see them as hostile and socially autocratic. The representations
of significant others (i.e., mother and father) provided by dismissively avoidant
individuals are significantly less differentiated, integrated, and conceptually
less complex than are the representations provided by fearfully avoidant in-
dividuals (K. N. Levy, Blatt, & Shaver, 1998).
A similar distinction can be made within resistant attachment. Re-
search by West and Sheldon (e.g., 1988), derived from the formulations of
Bowlby, differentiated between compulsive careseeking and compulsive
caregiving. Findings by C. E. Schaffer (1993) demonstrated that individuals
with a pattern of compulsive careseeking use less mature and effective modes
of affect regulation than do individuals classified as compulsive caregivers.
Thus, the distinction between compulsive careseeking and compulsive
caregiving seems to identify two different levels within the resistant pattern
of insecure attachment. Furthermore, issues of interpersonal relatedness and
self-definition, at different developmental levels, seem to identify three pri-
mary attachment patterns in adults. Secure attachment in infants, adoles-
cents, and adults is characterized by constructive feelings about self and sig-
nificant others, whereas the two forms of maladaptive functioning (resistant
and avoidant) are characterized by a distorted preoccupation, respectively,
with others or a defensive protection of the self.
The distinction between two primary forms of insecure attachment is
consistent with the discussions in chapters 5 and 6 (this volume) of two
primary forms of personality organization and two primary configurations of
psychopathology.
SUMMARY
A wide range of developmental research, from early infancy to adult-

hood, provides evidence that relatedness and self-definition are two funda-
mental dimensions in psychological development. This research suggests that
the two dimensions normally develop through a synergistic dialectical inter-
action of facilitating experiences of engagement and disengagement between
infant and caregiver and contribute to internalization and the development
of representations (cognitive-affective schema) of self and significant oth-
ers. Developmental research (e.g., Jaffe et al., 2001) suggests that develop-
mental impairments can occur in this process of engagement and disengage-
ment, of attachment and separation, by interactions in which interpersonal
contingent coordination is either minimal or excessive. In subsequent chap-
ters I consider the implications of the dialectical synergistic process of the
two fundamental lines of interpersonal relatedness and self-definition in per-
sonality development in later childhood, adolescence, and adulthood (see
chaps. 3-5, this volume) as well as how distortions (either minimal or exces-
sive coordination) within this dialectical process of engagement and disen-
gagement are expressed in two primary configurations of psychopathology
(see chaps. 5 and 6, this volume). And in chapters 7 and 8 (this volume) I
consider engagement and disengagement as a central process in psychotherapy
that leads to changes in the thematic content and structural (procedural)
organization of representations of self and significant others, dimensions that
provide a way of systematically assessing the extent of therapeutic gain (see
chap. 7, this volume) and of gaining further understanding of mechanisms of
therapeutic change (see chap. 8, this volume) in adolescents and adults.
3
IN PERSONALITY DEVELOPMENT
Research on infant development discussed in chapter 2 (this volume)

indicates that interpersonal relatedness and self-definition are central pro-
cesses in personality development beginning very early in life. As noted in
chapter 1 (this volume), almost all personality theorists discuss the impor-
tance of both relatedness and self-definition. But most theorists place prior-
ity on one or the other of these two fundamental dimensions—either on
separation, individuation, and identity or on attachment and interpersonal
relatedness—as the central dynamic in psychological development. Thus,
most personality theories can be identified as either primarily separation or
relatedness theories. In this chapter I discuss separation and relatedness theo-
ries of personality development as well as the few theorists who emphasize
This chapter incorporates material from (a) "Attachment and Separateness: A Dialectic Model of the
Products and Processes of Psychological Development," by S. J. Blatt and R. B. Blass, 1990,
Psychoanalytic Study of the Child, 45, pp. 107-127. Copyright 1990 by Yale University Press. Adapted
with permission; (b) "Relatedness and Self Definition: A Dialectic Model of Personality
Development," by S. J. Blatt and R. Blass, 1996, in G. G. Noam and K. W. Fischer (Eds.), Development
and Vulnerabilities in Close Relationships (pp. 309-338). Hillsdale, NJ: Erlbaum. Copyright 1996 by
Erlbaum. Adapted with permission; and (c) "Dialectics of Individuality and Interpersonal Relatedness:
An Evolutionary Perspective," by S. Guisinger and S. ]. Blatt, 1994, American Psychologist, 49, pp.
104-111- Copyright 1994 by the American Psychological Association.
71
the parallel development of both these dimensions, and close with the pro-
posal that personality development in fact evolves through a lifelong dialec-
tical, mutually facilitating, synergistic interaction between these two funda-
mental developmental processes.
SEPARATION THEORIES OF PERSONALITY DEVELOPMENT
Influenced by the predominant emphasis on individuality in Western

culture, many personality theories view personality development as a process
of separation and individuation through which individuals strive toward dif-
ferentiation, autonomy, independence, achievement, and identity formation
to become separate and self-contained. Development is viewed as a process
through which innate capacities find optimal expression in attaining various
levels of self-definition and of personal functioning. Various terms are used
to identify these processes in the development of self-definition or individu-
alism, including separation-differentiation or individuation, and to identify vari-
ous components of this developmental process, including autonomy, indepen-
dence, self'reliance, responsibility, industry, achievement, and identity. In these
separation theories, emphasis is placed on experiences of the self as separate
and independent that can result in achievement and accomplishment
throughout life.
Within psychoanalytic thought, this emphasis on self-definition or in-
dividualism is best exemplified by the contributions of Sigmund Freud, as
well as by later theorists such as Mahler, Settlage, Anna Freud, and Bios,
who were primarily interested in processes of separation-individuation. Freud,
with his focus on masculine psychological development, emphasized separa-
tion, individuation, and independence. Mahler (1971) formulated the sepa-
ration-individuation process as a gradual distancing from the mother, a tran-
sition from the dependency of infancy to independent functioning: "One
could regard the entire life cycle as constituting a more or less successful
process of distancing from the introjection of the lost symbiotic mother"
(p. 130). Bios (1979), emphasizing the importance of separation throughout
development, contended that the process in infancy of "hatching from the
symbiotic membrane to become an individuated toddler (Mahler, 1963)"
becomes in adolescence "the shedding of family dependencies [and] the loos-
ening of infantile object ties . . . [which] render the constancy of self-esteem
and of mood increasingly independent from external sources" (pp. 142-143).
Settlage (1980) stressed aspects of separation as well: "The separation-indi-
viduation process results in the formation of the psychic structures or func-
tions underlying the sense of self and enabling a beginning capacity for self
regulation and for object relations across a new established psychic boundary
of separateness" (p. 527).
The emphasis on separation and individuation in these psychoanalytic
formulations of psychological development is consonant with Sigmund Freud's
emphasis on the centrality of ego maturation and with Anna Freud's (1965,
1974) description of individual development as a series of progressive moves
toward emotional and physical independence and self-reliance. Sigmund Freud
(1905/1963b), in fact, described adolescent development as involving "de-
tachment [italics added] from parental authority," which he viewed as one of
the "most significant, but also one of the most painful, psychical achieve-
ments of the pubertal period ... a process that alone makes possible the
opposition, which is so important for the progress of civilization, between
the new generation and the old" (p. 227). Freud also noted that the domi-
nance of infantile needs can really come to an end only when a child has
achieved a psychological detachment from its parents. Throughout his work,
S. Freud stressed the importance of separation in personal as well as societal
development: "Detaching himself from his family becomes a task that faces
every young person, and society often helps him in the solution of it by
means of puberty and initiation rites" (1930/1961, p. 103). Likewise, Kohut's
self psychology is basically a psychology of separation and individuation.
Relations with others are discussed primarily in terms of the self-object or
the "essential other" (Galatzer-Levy & Cohler, 1993) whose primary role is
to facilitate the development of the individual, but who is not appreciated as
an independent other in his or her own right (Blass & Blatt, 1992; Blatt,
1995c).
Although psychological development in these separation-focused theo-
ries occurs in relationships with significant others, the establishment and
maintenance of relationships are not viewed as central developmental goals.
Rather, disengagement from relationships is seen as enriching the self by
facilitating the development of autonomy, self-control, independence, and
achievement—the assumed hallmarks of psychological maturation. Devel-
opmental research and theory from this perspective usually focus primarily
on the processes of separation-individuation and the establishment of an
identity, or a self, that is separate, independent, and goal directed. Accord-
ing to Mahler (1974b), in
the normal individual the sociobiological utilization of the mother, of
the "outer half of the self (Spitz, 1965), and later on, the emotional
availability of the love object—the postsymbiotic partner—are the nec-
essary conditions for an intrapsychic separation-individuation process. This
is, in fact, synonymous with the second, the psychological birth experi-
ence: a rather slow and very gradual hatching out process [italics added] as
it were. (p. 151)
On the basis of the epigenetic psychosocial model of personality devel-

opment articulated by Erikson (1950), one can view individuality as devel-
oping along a relatively well delineated path, progressively involving au-
RELATEDNESS AND SELF-DEFINITION 73

tonotny, initiative, industry, and, eventually, the consolidation of identity.
Autonomy, a sense of freedom from the control of others and of being in
control of one's own body, mind, and activity, often develops initially in
reaction and opposition to another person. The emphasis is on separating
from another person and feeling in control of oneself. Individuality is subse-
quently expressed in a desire to initiate and assert one's power and capacities.
This initiated activity no longer necessarily occurs in opposition to another
person but increasingly becomes a proactive, intentional assertion of one's
emerging capacities. This initiation of power and capacities initially occurs
without clearly defined long-term goals; it is subsequently expressed in task-
oriented, goal-directed activity that Erikson described as industry. The pri-
mary focus in these three early phases in the development of self-definition
and individuality (autonomy, initiative, and industry) is on self-expression
and freedom and feeling efficient and effective in asserting oneself in specific
goal-directed activity.
Many nonpsychodynamic personality theorists also focus on one or more
of these developmentally earlier expressions of individuality (autonomy or
free will, initiative, and industry or achievement) as the primary goal of psy-
chological development, with relatively little acknowledgment of the im-
portance of participating in a social matrix. The development of these vari-
ous levels of individuality is discussed with little attention to interpersonal
concerns and feelings of affection and relatedness. In fact, relationships are
often viewed as impediments to the development of these individualistic
capacities.
Many discussions of individuality by separation theorists focus on the
importance of autonomy—of being free from constraint by others; of being
in control and having rights, prerogatives, and power (Gruen, 1986; Perloff,
1987; Spence, 1985); and of being able to express freely one's perceptions,
feelings, and needs. Socialization is often viewed as thwarting autonomy.
Autonomy, a predominant preoccupation in contemporary Western society,
is often expressed in concerns about privacy, personal property, and posses-
sions (Lukes, 1973; Slater, 1976), power, issues of dominance and submission
(Deutsch, 1949/1963), and free will and freedom of choice (e.g., Lukes, 1973;
Waterman, 1981, 1983). Although a capacity for autonomy is an important
developmental achievement (e.g., Erikson, 1950), an exaggerated emphasis
on autonomy without some appreciation of relatedness to others can result
in an argumentative, defiant, isolated individual who defensively struggles to
preserve his or her separation and prerogatives. Although a sense of autonomy
is necessary for effective functioning, an overemphasis on or preoccupation
with these issues can be a serious defensive distortion that is expressed in
intense egocentric preoccupation with one's rights, possessions, feelings, and
actions, with little regard for others.
Other separation theories stress the development of a capacity for self-
interest, self-reliance, and personal responsibility (e.g., Perloff, 1987; Spence,
1985). Self-reliance and responsibility depend on a freedom from constraint
achieved in the development of a capacity for autonomy. Janet Spence (1985)
noted that responsibility for one's own well-being and the emphasis on one's
direct relationship with one's maker, without the intervention of an inter-
mediary, is an extension of the essence of Protestantism. Spence viewed these
religious beliefs, combined with the philosophy of the Enlightenment, as
producing the emphasis on individuality that pervaded American society
beginning with the Declaration of Independence and the American Consti-
tution, which speak of individuals as independent entities with natural in-
alienable rights. Individual rights, as part of the American heritage, are basic
to the sense of self. In the early 19th century, de Tocqueville observed the
centrality of individualism to the American character. Emerson and Thoreau
emphasized the virtues of independence and self-reliance, and psychological
theorists, such as Kohlberg (1963) and Loevinger (1976), stressed that the
highest stage of individual development is the establishment of a sense of
morality that transcends acceptance of and conformity to conventional stan-
dards (Spence, 1985).
Spence (1985) noted that the emphasis on individualism has made
important contributions to social and political institutions and that indi-
vidualism (autonomy and self-expression) has contributed to industrial pro-
ductivity and scientific creativity. Individualism, especially achievement (in-
dustry in Erikson's terms), is part of the broad historical and social context of
American culture, which has its origins in the Protestant work ethic (Weber,
1930). This individualism involves an autonomous self, a self clearly demar-
cated from nonself, which pursues individual expression and resists pressures
toward conformity. Individualism is "the belief that each of us is an entity
separate from each other and from the group and as such is endowed with the
natural rights" (Spence, 1985, p. 1288). Autonomy and independence facili-
tate the attainment of the highest level of moral development, in which one
rises above adherence to conventional society's standards (e.g., Kohlberg,
1963; Kohlberg & Kramer, 1969).
Perloff (1987) viewed agency (initiative in Erikson's [1950] terms) and
self-interest as central issues in society that lead to improved social condi-
tions such as the humanitarian treatment of disadvantaged groups (e.g., ill
people, elderly people, and people with disabilities), especially when these
groups express self-interest and demand equality. Commitment to individual
self-interest, according to Perloff, produced a social system that results in the
greatest good for most of society. Self-interest, Perloff (1987, p. 7) argued, is
democratic because it involves freedom of choice, a respect for individual
rights, and an "embodiment of genuine liberalism." Perloff s views of indi-
vidualism, however, are more extreme than those of Spence. Although Perloff
(1987) attempted to integrate self-interest with social responsibility, he be-
lieved that social responsibility without self-interest is not a virtue because it
can often occur in individuals who

may neglect their appearance and self-development so that they are out
of work half the time and fail to attract friends because of their slovenly
demeanor and attire, b u t . . . [who] may ... never refuse bed and board to
a destitute acquaintance, always relinquish their seat on the bus for an
infirmed passenger, and neither cheat on their spouses nor on their in-
come tax. Such people are low on self-interest and high in personal re-
sponsibility (responsibility for others), (p. 8)
Perloff saw no natural relationship between social responsibility and self-

interest. Individuals have to learn to be independent and self-reliant; even
those who are poor, disabled, or elderly have to do what they can for them-
selves to preserve their self-esteem. Perloff (p. 10) concluded that "God helps
those who help themselves." For Perloff, personal responsibility is a distinctly
effective way to pursue one's self-interest: "Assuming responsibility for one's
own destiny . . . the precedence of self-support as opposed to ... a dysfunc-
tional and not infrequently harmful overemphasis on social support ... all
are manifestations of the loading of personal responsibility on the self-inter-
est factor" (p. 9). For Perloff, self-interest "is a dominant and effective force
underlying behavior." It is the basis for the "institutions . . . [we] build, . . .
they value . . . [we] cherish, and yes even of the ways (and conditions unto
which) people extend helping hands to others" (p. 10). Exaggerated self-
interest and initiative, as proposed by Perloff, without social concern and a
sense of relatedness to others, however, can violate the autonomy and pri-
vacy of others and lack any long-range purpose or goal. Initiative, like au-
tonomy, is an important developmental achievement, but an intense preoc-
cupation with self-interest, especially without concern for others, can
eventually be destructive to oneself as well as to others.
Other separation theorists (e.g., Spence, 1985; Tuan, 1982) focus on
the importance of work and achievement (industry, in Erikson's [1950] terms)
and the freedom to pursue careers suited to one's talents to express one's
individuality consistent with one's personal desires and talents. Work and
achievement, in contrast to self-expression and self-interest (industry, as com-
pared with autonomy and initiative), imply a fuller utilization of one's ca-
pacities and talents in more proactive, goal-directed, intentional, sustained
activity. Spence (1985), for example, discussed the United States as a success-
oriented society whose attitudes toward achievement can be traced back to
its Protestant heritage, with its emphasis on individualism and the work ethic.
Psychological theories of achievement motivation are rooted in this empha-
sis on individualism. The Protestant work ethic, the individual's direct rela-
tionship with God, and the assumption of responsibility for one's life derive
from the religious duty to engage in productive work and to be successful in
achievement as a glorification of God. Relinquishing pleasures for the vir-
tues of thrift, sobriety, and devotion to hard work is essential in this work
ethic. Achievement of worldly success does not necessarily result in personal
salvation, but it is an indication of God's grace. Success and achievement
should not result in luxury and excessive enjoyment of the fruits of one's
labor. Rather, the moral imperative is to work hard, to make something of
oneself, and to be materially successful, but to avoid indulgence in material
pleasure and possessions. One must be self-sacrificing, and this emphasis on
earning and saving provides the ethical basis for capitalism (Weber, 1930).
People are expected to work hard and take pride in their labor because
it is inherently satisfying, not just to obtain money, power, or prestige. But in
an inherently competitive society, one's success is often achieved at the ex-
pense of others. An individualistic society emphasizes competition rather
than cooperation and collaboration; it is important, as Spence (1985) noted,
to develop the desire to win and to enjoy competing against others. Block
(1973) and Block, von der Lippe, and Block (1973) discussed how American
children are encouraged to seek competitive situations and to try to win and
be the best. Competitiveness and achievement are integral parts of the indi-
viduality of American society and the expression of its Protestant work ethic.
Spence believed that commitment to individual productivity is essential for
the economic success of the nation. Work should be intrinsically meaningful
because it offers the opportunity for self-development and self-expression
(Yankelovich, 1981). But it is also important for the free enterprise system
that individuals spend and consume rather than save and conserve. Com-
pared with the individuality of the 19th century that was defined by what
one does or produces, individuality in the 20th century was often defined by
what individuals possess, consume, or buy. Self-indulgent preoccupation with
material well-being and overconsumption, however, can lead to a decline of
spiritual values and the work ethic, as well as a dwindling of natural resources
(Yankelovich, 1981).
Nevertheless, achievement motivation remains central in several psy-
chological theories, particularly those developed by H. A. Murray (1938)
and elaborated on by McClelland, Atkinson, Clark, and Lowell (1953).
Murray's definition of the achievement motive comes close to capturing the
traditional spirit of the work ethic (McClelland, 1961):
to do things rapidly and/or as well as possible ... to master, manipulate,
and organize physical objects, human beings or ideas ... to overcome
obstacles and obtain a high standard ... to excel one's self, to rival and
surpass others. (H. A. Murray, 1938, p. 164)
Achievement enables one to be autonomous and self-fulfilling and to de-

velop skills that permit effective functioning and mastery of the environ-
ment. But one of the major motives for the desire to achieve is the satisfac-
tion of personal wants and desires (Spence & Helmrich, 1978). Spence (1985)
pointed out that relatively little discussion has taken place about the origin
of achievement motives because many people assume achievement and com-
petition are "an inborn need to be competent and self-determining and to
exert mastery over their environment" (p. 1290; e.g., deCharms, 1968, 1992;

Deci, 1975; Deci & Ryan, 1985; Dweck & Wortman, 1982; Elliott & Dweck,
1988; R. W. White, 1959). Thus achievement is another expression of Dar-
winian evolutionary theory in which the desire to survive and to be domi-
nant is often assumed to be a biological given—an innate inherited charac-
teristic of the human species. Spence (1985), however, believed that although
the motivation for achievement is intrinsic in the U.S. individualistically
oriented culture, it cannot be assumed that the need for autonomy, initia-
tive, self-fulfillment, and achievement (industry) is innate.
Even though Spence emphasized the importance of achievement and
other individualistic qualities in psychological development, she also recog-
nized the distortions that may occur from an overemphasis of these qualities.
She stressed that Western individualism was originally not an invitation to
self-gratification but primarily an obligation to serve God. Individualism was
developed initially as a counterweight against the authoritarian demands of
church and state. Enlightenment philosophy emphasized the natural rights
of individuals, but these rights go hand-in-hand with responsibility. Spence
believed that a work ethic that has no further justification than work itself,
divorced from communal responsibility and other values, can be narrow, self-
serving, distorted, and destructive to self and others. Spence discussed many
instances of a malignant form of achievement and individualism. An exag-
gerated emphasis on achievement can be distorted in at least two ways: ei-
ther because it has become the primary vehicle for self-definition and iden-
tity or because it lacks a concern for the community and for others. A
commitment to work, achievement, and success can become selfish and self-
serving if it is not integrated with a commitment to a larger community—
whether family, society, or humankind. A striving for achievement marked
by competitiveness is usually less successful than is a less competitive achieve-
ment motivation (Spence, 1985; Spence & Helmrich, 1978; Spence,
Helmrich, & Stapp, 1975). Self-oriented motives such as desire for pay, rec-
ognition, and prestige can impede performance or result in an individual
being so driven to succeed that he or she is vulnerable to depression and to
cardiovascular disease (e.g., Blatt, Cornell, & Eshkol, 1993; Price, 1982).
Helgeson (e.g., 1994), in a discussion derived in part from Bakan (1966),
explained how a one-sided emphasis on agency or on communion, what she
called "unmitigated agency" and "unmitigated communion," respectively,
can lead to disruptions of physical health (see also Blatt et at, 1993). But it is
important to note that the observations by Spence (1985) and Spence et al.
(1975) about the destructiveness of an exaggerated emphasis on achieve-
ment are still basically made from an individualistic perspective because the
reason given for being less competitive and more concerned about others is
that such an attitude leads to greater success (productivity). This view places
little inherent and intrinsic value on social concerns—on concerns about
others in their own right. Spence believed that investigators have to evalu-
ate the role of individualism and achievement in society, especially whether
the emphasis on achievement and individuality is integrated with a concern
for society and for others. An integration of individualism with social con-
cerns can contribute to a politically stable, materially prosperous, democratic
nation with freedom and individual rights and opportunities.
M. Leary (2004) noted that being self-absorbed has many potential ben-
efits, but it can also create a host of potential problems including distorted
perceptions of self and of others, and "depression, anxiety, anger, and other
negative emotions" that emerge from excessive ruminations about the past
and potential problems in the future (pp. v-vi). An egocentric and egotistic
manner can disrupt effective self-evaluation and create a great deal of inter-
personal discord and conflict. Leary stated that despite the "glorification of
egoism in Western culture" (p. vi), the "natural human tendencies to be
egocentric, egotistical, and otherwise egotistic play a central role in ... prob-
lems at both personal and societal levels" (p. v). Thus, self-preoccupation
can be a source of considerable distress and despair. The potential destruc-
tiveness of self-critical perfectionism, for example, has been discussed exten-
sively in more recent research on depression (e.g., Blatt, 1995b, 2004; Dunkley,
Zuroff, & Blankstein, 2003; Flett & Hewitt, 2002) and is discussed further in
chapters 5 and 6 (this volume) as a major source of psychological disturbance
that can occur as a consequence of a distorted, one-sided preoccupation with
issues of self-definition to the neglect of issues of interpersonal relatedness.
As discussed in the epilogue, Wachtel (2005) extended these formulations
further in his consideration of various motivations for "greed."
As observed by Tuan (1982), individuality, with its emphasis on sepa-
ration, achievement, and the importance of cognitive activity, can result in
social fragmentation. As members of a society grow more individualistic and
withdraw into "fragmented spaces" (Tuan, 1982), the social system (groups
and the cohesive whole) begins to break down. Intense self-awareness can be
isolating and painful and lead to being immersed in an ineluctable subjectiv-
ity (Tuan, 1982) that ignores group cohesiveness and the availability of oth-
ers (Hardin, 1968). But as Tuan (1982) pointed out, individuals may try to
regroup and create cohesive wholes to regain a sense of unity and reactivate
an interest in public values. Thoughtful reflective individuals, for example,
can challenge the conventional laws and customs of the community that
bind people together. This critical examination of social values can threaten
traditional social cohesiveness; but it can also lead to a fuller sense of com-
munity in self-reflective individuals who begin to challenge unreflective quali-
ties of the community (see also Kohlberg, 1963). Thus egocentric individu-
alistic concerns, inherent in less mature forms of self-definition (autonomy,
initiative, industry), can eventually be integrated with social concerns and
feelings of relatedness, but this integration requires a more mature and con-
solidated sense of individuality in which the individual appreciates and val-
ues what he or she can contribute to society. This mature sense of individu-
ality evolves from the freedom to feel close to and be intimate with others

without having experiences and expressions of individuality impeded or in-
terfered with. Relatedness, without a clear sense of self, can result in an asym-
metrical dependence. Mature relatedness, a relatedness involving mutuality
and reciprocity, can occur only with a clear sense of oneself and an apprecia-
tion of what one has to offer to others and of the ways one can enrich the
experiences of others and how others can enhance one's own experiences.
In summary, in separation theories of psychological development, the
development of self-definition and individuality involves an emphasis on
autonomy and freedom, the capacity to be active and assertive in expressing
one's self-interests, and a commitment to goal-directed, intentional expres-
sions of one's personal talents and capacities. This emphasis on issues of au-
tonomy, initiative, and industry (or achievement) is an aspect of what Ed-
ward Sampson (1988) called self-contained individualism—an emphasis on
self-expression unintegrated with concerns about others, without a sense of
relatedness that extends beyond self-preoccupation. Self-contained individu-
alism emphasizes firm boundaries, a clear demarcation of self from nonself, a
sense of personal control and self-reliance (Perloff, 1987), and an exclusion-
ary concept of the self—"the belief that each of us is an entity separate from
each other and from the group" (Spence, 1985; p. 1288). Self-contained in-
dividualism describes qualities of individuality with relatively little recogni-
tion and appreciation of others and the social collective.
As discussed in chapter 1 (this volume), self-contained individualism
has been the predominant indigenous psychology in Western culture since
the Renaissance, but contemporary historians (e.g., Morris, 1972) and an-
thropologists now view this individualistic psychology as "peculiar" (Geertz,
1973, 1979), "eccentric" (Morris, 1972), and a "curse" (M. Leary, 2004).
Individualism that places exaggerated emphasis on agency and achievement
without concern for others can eventually be destructive to the individual
and society (e.g., Hogan, 1975; M. Leary, 2004). Preoccupation with achieve-
ment, for example, is often accompanied by an emphasis on the acquisition
of material possessions and conspicuous consumption (Yankelovich, 1981).
Critics have suggested that predominant individualistic values of Western
culture have led to a psychology of entitlement (Bell, 1970), a culture of
narcissism (Lasch, 1978), terrifying isolation (Conger, 1981; Tuan, 1982), a
long-standing and intense crisis of alienation (Bellah, Madsen, Sullivan,
Swindler, & Tipton, 1985; Borgmann, 1992; Yankelovich, 1981), a joyless
culture of consumption (Borgmann, 1992), violence (Hsu, 1983), and the
devaluation of women (Miller, 1986) and minorities (Lykes, 1983). Extreme
preoccupation with self-interests, with achievement and accomplishments,
can result in inflated vanity, intense envy, resentment, competition, loneli-
ness, and the feeling that one has to be calculating and manipulative to achieve
(Slater, 1976). Excessive industry can also interfere with spontaneity and
pleasure because one feels driven to achieve (e.g., a workaholic). Impersonal
experiences in a consumer society can minimize relationships with others
and lead to the view that all products are essentially disposable. Things exist
for their pragmatic utilitarian value with little sentimental attachment or
nostalgia. This emotional detachment can result in feelings of isolation, alien-
ation, loneliness, and even guilt (Slater, 1976).
Excessive ambitiousness can be a defense against feelings of inadequacy
and a fear of failure. Likewise, excessive assertiveness and intrusiveness can
defend against fears of passivity. Slater (1976) pointed out that in an indi-
vidualistic perspective, each contest can lead only to a new one and that
people caught up in the rat race are often deeply hungry for trusting relation-
ships with their colleagues. One study (Yankelovich, 1981) found that 70%
of Americans had few close friends and feel that this lack of relatedness cre-
ates a serious void in their lives. Thus, the emphasis on individualism in
Western society has left individuals alienated from others and prone to nar-
cissistic self-absorption, and has often left modern families isolated from a
community and from familial support systems (Conger, 1981). Ample evi-
dence now indicates that the emphasis on individuality is a one-sided view
of psychological development. As discussed in chapter 1 (this volume), al-
though evolutionary theory has long been cited to account for the develop-
ment of individuality and aggressive self-interest, contemporary evolution-
ary models also indicate the importance of the development of an altruistic,
cooperative, interpersonally related self. Individuality without a capacity for
interpersonal relatedness or a concern for the larger society is now viewed as
limited and potentially disruptive for both the individual and society.
From a social psychological perspective, Sampson (1988) contrasted
"self-contained individualism" with "ensembled individualism"—an individu-
ality that includes a sense of self defined in relation to others and the collec-
tive. Using constructs central to Heelas and Lock's (1981) articulation of
fundamental indigenous psychologies such as boundaries and the locus of
power and control (e.g., distinction between self-nonself and internal-
external), Sampson noted that ensembled individualism implies fluid bound-
aries, an external locus of control, and feelings of inclusiveness with others.
Sampson (1988) contrasted these two types of individuality (self-contained
and ensembled individualism) in terms of three basic issues—freedom,
achievement, and responsibility—and argued that these three values are
achieved only in ensembled individualism. A consideration of Sampson's
discussion of individuality based on Erikson's (1950) epigenetic stages of au-
tonomy, initiative, and industry can facilitate further differentiation of the
basic processes underlying the development of self-contained and ensembled
individualism. Sampson's themes of freedom and achievement are similar to
Erikson's themes of autonomy, initiative, and industry. Although freedom
and achievement (autonomy, initiative, and industry) are important devel-
opmental experiences, exaggerated emphasis on these dimensions without
regard for others and for society is characteristic of self-contained individual-
ism. Autonomy and initiative, in conjunction with responsibility, in con-

trast, is an essential characteristic of ensembled individualism—an individu-
ality defined, not in isolation, but in terms of a self-in-relation to others
(Sampson, 1988).
RELATEDNESS THEORIES OF PSYCHOLOGICAL DEVELOPMENT
Parallel to the separation personality theorists discussed earlier is a group

of relatedness personality theorists. This more recent emphasis on the cen-
trality of interpersonal relatedness in psychological development evolved from
research on attachment (e.g., Ainsworth, 1969; Bowlby, 1969; Harlow, 1958;
Main, Kaplan, & Cassidy, 1985), studies of prosocial behavior in infants and
young children (e.g., Eisenberg & Mussen, 1989; Hoffman, 1981), feminist
theory (e.g., Gilligan, 1982; Jordan, Kaplan, Miller, Stiver, & Surrey, 1991;
Miller, 1986), and investigations of role taking (e.g., Feffer, 1969,1970; Hogan,
1975) and interpersonal behavior (e.g., Baumeister & Leary, 1995). Various
terms are used to identify aspects of this process of the development of inter-
personal relatedness including dependency, cooperation, collaboration, affection,
mutuality, reciprocity, intimacy, and intersubjectivity. On the basis of ethnologi-
cal theory and studies of social behavior of primates and of young children
separated from their parents, Harlow (1958) and Bowlby (1969) postulated a
biological basis for the propensity to form strong emotional attachments from
earliest infancy through adulthood. This adaptation is necessary in species,
such as humans, in which the infant has a long postpartum period of depen-
dency. Studies of loneliness and social isolation have demonstrated a basic
need for interpersonal contact. Infants whose needs for food and shelter are
met but who are deprived of physical contact often fail to thrive and may
even die (Provence & Lipton, 1962; Robertson & Robertson, 1971; Spitz &
Wolf, 1946). Even in adults, loneliness is associated with depressed immuno-
competence (e.g., Blatt et al., 1993; Weiss, 1987), and individuals without
interpersonal support systems are more likely to be hospitalized with psychi-
atric disorders (Essock-Vitale & Fairbanks, 1979; Priel & Besser, 2000). The
quality of interpersonal relations is an important factor in reducing the im-
pact of stressful life events (e.g., G. W. Brown, Harris, & Copeland, 1977).
The research literature on prosocial behavior (e.g., Eisenberg & Mussen,
1989; Hoffman, 1981) indicates a powerful inborn drive to aid others in dis-
tress. Observations of infants show the emergence of rudimentary helping
behavior among the first activities of life. Day-old babies become distressed
when they hear another baby crying (Sagi & Hoffman, 1976), and high lev-
els of helping behavior have been noted in children between 9 months and 2
years of age (e.g., Stayton, Hogan, & Ainsworth, 1971; Zahn-Wexler, Radke-
Yarrow, Wagner, & Pyle, 1988). Almost as soon as young children are able
to engage in helping behavior, they have been observed to do so (Hoffman,
1981). These findings contrast with earlier formulations from psychoana-
lytic theory (e.g., S. Freud, 1923/1959a) and cognitive-developmental theory
(e.g., Piaget, 1964), as discussed in chapter 2 (this volume), that conscience
and concern for others (e.g., empathy) emerge at approximately the age of 6
years with the beginning of triadic operational thinking and interpersonal
relationships and with the increased capacity for impulse control and subli-
mation (e.g., Blatt, 1983; Feffer, 1970).
Additional evidence for the early development of interpersonal relat-
edness comes from children's compliance with social rules and roles. Hogan
(1975), noting that children age 3 1/2 to 5 years are mutually interactive and
reflectively concerned about others (Garvey & Hogan, 1973) and spontane-
ously use a wide variety of roles in their interactions with others, concluded
that children are genetically prepared to accept a wide variety of seemingly
arbitrary rules that govern social interaction, speech, dress, and dietary cus-
toms. M. Friedman (1985) posited a biological basis for the existence of emo-
tions, such as guilt, that arise when an individual has injured or failed to help
others. Friedman believed these emotions to be the result of natural selec-
tion for an altruistic motivation in humans (Guisinger & Blatt, 1994).
These early observations led theorists and investigators to challenge
the traditional emphasis on the development of the self and of identity over
the development of social relations. Within psychology, these critics have
come from attachment theory and research (e.g., Bowlby, 1969; Grossmann
& Grossmann, 1990; van IJzendoom & Sagi, 1999), psychoanalytic object
relations (e.g., Blatt & Shichman, 1983; Fairbairn, 1954; Guntrip, 1969;
Winnicott, 1957), feminist theory (e.g., Chodorow, 1978; Gilligan, 1982;
Jordan et al., 1991; Miller, 1986), cross-cultural theory and research (e.g.,
Doi, 1973; Kagitcibasi, 1997; Kojima, 1984; Markus & Kitayama, 1991;
Oyserman, Coon, & Kemmelmeier, 2002), and a relational emphasis in psy-
choanalytic theory (e.g., Aron, 1996; J. Benjamin, 1995; Mitchell, 1988).
Feminist theorists (e.g., Gilligan, 1982; Jordan et al., 1991; Miller, 1986), for
example, challenged the individualistic bias in traditional psychological theo-
ries and pointed out that most major developmental formulations (e.g., A.
Freud, S. Freud, Erikson, Piaget, & Kohlberg) had been based primarily on
male development. These individualistic formulations often neglect impor-
tant dimensions of personality development, especially those occurring in
females. Feminist theorists (e.g., Miller, Chodorow, Gilligan, Surrey) made
major contributions to a fuller understanding of psychological development
by calling attention to interpersonal relatedness as a central developmental
process and a fundamental motivational force in psychological development.
This call for the recognition of the importance of interpersonal relatedness
in psychological development is consistent with the extensive research and
theory of the past 3 or 4 decades, as discussed in chapter 2 (this volume; e.g.,
Beebe, 1986; Stern, 1985), that indicate that children actively seek social
interaction from birth, form patterns of interpersonal attachment (e.g.,
Ainsworth, 1969; Bowlby, 1978; Main et al., 1985), and develop a capacity

for mutuality and empathy (e.g., Stern, 1985) relatively early in life. Jordan
et al. (1991) and Gilligan, Rogers, and Tolman (1991) noted that a woman's
sense of self is usually organized around being able to attain and maintain
affiliation and relationships. This emphasis on the development of the ca-
pacity for interpersonal relatedness and on the development of a self-in-rela-
tion is a major departure from traditional emphasis on the centrality of the
development of identity formation based on experiences of autonomy and
achievement.
As Lykes (1983) pointed out, some members of the feminist movement
initially accepted the culture's predominant overvaluation of autonomy, ini-
tiative, and industry (achievement) and emphasized the importance of these
individualistic characteristics for women. Later feminist theorists, however,
emphasized a social individuality based on an understanding and apprecia-
tion of the "interaction of autonomous individuals in a co-acting network of
relationships embedded in an intricate system of social exchange and obliga-
tions" (Lykes, 1985, p. 362). Numerous feminist theorists (e.g., Chodorow,
1978, 1989; Miller, 1984, 1986; Noddings, 1984) discussed this social or
ensembled individualism (Sampson, 1988), or a self-in-relation, as an im-
portant alternative to the predominant contemporary emphasis on self-
contained individualism (Sampson, 1988) or autonomy and industry (Erikson,
1950), initiative (Perloff, 1987), achievement (e.g., Spence, 1985), and iden-
tity (Erikson, 1950). Although people from the less powerful and prestigious
segments of society usually emphasize social or ensembled individualism
(Lykes, 1983), it is important to note that as S. Freud (1930/1961) stated,
"the replacement of power of the individual by the power of the community
constitutes the decisive step in civilization" (p. 95). He also noted that "the
readiness for a universal love of mankind and the world represents the high-
est standpoint which man can reach" (p. 103). Ensembled individualism, as
defined by Sampson, involves feeling that one is part of a social order and
seeking to establish and sustain harmony with that society. This capacity for
harmony and intimacy is related to marital and job satisfaction (e.g., Antill,
1983; McAdams & Vaillant, 1982), greater happiness and life satisfaction in
women, and an absence of anxiety, physical illness, and substance abuse in
men (McAdams & Bryant, 1987).
Although Sampson's distinction between self-contained and ensembled
individualism differentiated two types of self-organization, it is important to
note that two very different levels of organization are conflated in Sampson's
definition of ensembled individualism. He described a more passive, less re-
flective sense of belonging (e.g., the infant's early relationship with mother)
in which one cannot or does not consider other options, and a more proac-
tive form of ensembled individualism based on a reflective and intentional
decision to adhere to, participate in, and contribute to the activities of a
social collective and the well-being of others. Although this second level of
relatedness may derive from the earlier and more primary experiences of be-
longing, this second form of ensembled individualism is more mature be-
cause it requires an established sense of one's individuality (a self-identity), a
differentiated appreciation of both what one can uniquely contribute to the
collective or to a relationship and how such participation can enrich one's
own experiences and those of others. Although this reflective form of
ensembled individualism emerges from and has continuity with the earlier,
more reflexive form of ensembled individualism that occurs in the mother-
infant matrix, the more reflective form of ensembled individualism is very
different because it is based, in part, on a clear sense of identity and purpose.
The more mature form of ensembled individualism is an expression of an
integration of individuality (identity) with a capacity for relatedness and a
concern for others. As is discussed in detail in chapter 4 (this volume), this
integration is the result of progress along the two fundamental developmen-
tal lines (relatedness and self-definition)—an integration that enables the
individual to participate in mature experiences of what Erikson considers to
be the expressions of adulthood—of intimacy, generativity, and integrity—
all expressions of a self in a relational context.
The feminist movement has been crucial in psychology's inclusion of
relational dimensions in its developmental theories of personality organiza-
tion with concepts such as ensembled individualism or a self-in-relation. But
it is noteworthy that feminist theorists (e.g., Gilligan, 1982, 1989b; Surrey,
1985), like Sampson, sometimes do not differentiate an earlier or less mature
form of relatedness, dependency, from more mature forms of relatedness that
involve mutuality, reciprocity, and a clear and well-articulated sense of self
defined in relation to others. Gilligan (1982) stressed the importance of a
self-in-relation in the lives of women and the need for society to acknowl-
edge the value and importance of an emphasis on interpersonal relationships
and social affiliation. But Gilligan, like some other feminist theorists, used
the term dependency to refer to all forms of interpersonal relatedness, includ-
ing a self-in-relation. As with individuality, it is important to distinguish
different levels within the broad spectrum of relatedness. Interpersonal relat-
edness can be expressed on several different levels, from enmeshment in the
mother-infant relationship, to a sense of a dependency on an other—what
Helgeson (1994) termed unmitigated communion—to an interest in and a will-
ingness to cooperate and share with an other, to a capacity for intimacy,
mutuality, and reciprocity (e.g., Blatt, Zohar, Quinlan, Luthar, & Hart, 1996;
Blatt, Zohar, Quinlan, Zuroff, & Mongrain, 1995; R. F. Bornstein, 1993a,
1993b, 1998; R. F. Bornstein & Cecero, 2000; Pincus &. Gurtman, 1995;
Pincus & Wilson, 2001; Rude & Bumham, 1995).
In contrast to the extensive literature on different levels of self-
definition and identity, the literature on different levels of interpersonal re-
latedness is relatively sparse. The development of attachment and related-
ness in infancy and early childhood has received increasing scrutiny by de-
velopmental investigators. Initially John Bowlby (1969, 1973, 1988b) drew

attention to the importance of attachment in personality development and
regarded the propensity to establish strong emotional attachments as a basic,
biologically based, fundamental motivational system that is active from the
earliest moments of infancy through adulthood and into senescence. The
vicissitudes of attachment throughout the life cycle are expressed in a perva-
sive and intense desire to form bonds, "sometimes in the care-seeking role
and sometimes in a caregiving one" (Bowlby, 1988a, p. 3). As Winnicott
(1958) noted, generalizing from extensive clinical experience, "The basis of
the capacity to be alone is the experience of being alone in the presence of
someone" (p. 36).
As discussed in chapter 2 (this volume), investigators have studied early
interactive regulation between mother and child as well as the various alter-
native responses of the young child to separation and loss. The child actively
seeks and relies on mother's care and nurturance, and this nurturance is most
effectively experienced in the coordination of the mother's caring patterns
and the infant's capacity to initiate and be responsive to such care (e.g.,
Beebe & Lachmann, 1988; Noddings, 1984; Stern, 1985). The mother-
infant caring relationship provides stimulation, warmth, and tactile and physi-
cal sensations (Hojat, 1987) that lead to a sense of trust (Erikson, 1950) and
to the child's responsiveness and receptivity to the mother's care and affec-
tion (Noddings, 1984). Although the child is clearly dependent on the mother,
the relationship is still interactive, with infant and mother responding to
each other's cues. Despite this active interaction between mother and child,
the relationship is essentially unequal, with the infant being dependent
on the other for care and attention. This level of relatedness can be called
dependency.
As the child moves out beyond the primary relationship with mother,
the child also establishes other relationships, first with father and siblings
and later with peers. The infant initially is capable of disengaging from con-
tact with the mother through aversion of gaze and later by becoming increas-
ingly mobile and capable of leaving the mother and of initiating activity.
Relationships are less unequal, unidirectional, or dependent. Play patterns
develop from parallel play to cooperative play (e.g., Whiteside, Busch, &
Homer, 1976), initially with caregivers and later with peers, with a begin-
ning capacity for sharing and reciprocity. Whereas these experiences have
their antecedents in the mother-infant interaction, these more mature types
of relationships can occur only with an increasing emerging sense of self that
allows these relationships to take on new qualities as the child participates
more actively in symmetrical, rather than asymmetrical, relationships. Par-
ticipation in social activities (Hojat, 1987), especially in play with peers,
enables the child to begin to identify with the caregiver in giving as well as
receiving care (Noddings, 1984), to identify with peers along a number of
dimensions including age and gender (Yankelovich, 1981), to begin to feel a
sense of equality with others and to become affiliated with them (Deutsch,
1982), to feel related and connected (Noddings, 1984), and to desire to par-
ticipate in social groups and establish an "exchange" relationship (M. S. Clark,
Powell, & Mills, 1986).
The role of interpersonal relatedness in psychological development
within psychoanalytic theory is complex and controversial. As noted earlier,
classic psychoanalytic formulations emphasized separation, individuation, and
the development of identity. Although, as discussed earlier in this chapter,
S. Freud viewed separation as the major dimension of psychological develop-
ment, he was also keenly aware of the importance of love and attachment.
For example, in a letter (1926/1959c) to Remain Holland, S. Freud wrote
that "our inborn instincts and the world around us being what they are, I
could not but regard love as no less essential for the survival of the human
race than such things as technology" (cited by Erikson, 1982, pp. 27-28). S.
Freud (1914/1957f) also noted that "we must begin to love in order not to fall
ill, and we are bound to fall ill if, in the consequence of frustration, we are
unable to love" (p. 85). S. Freud (1930/1961) also described a
way of life which makes love the centre of everything, which looks for all
satisfaction in loving and being loved. A psychical attitude of this sort
comes naturally enough to all of us; one of the forms in which love mani-
fests itself—sexual love—has given us our most intense experience of an
overwhelming sensation of pleasure and has thus furnished us with a
pattern for our search for happiness, (p. 82)
S. Freud (1930/1961) considered it essential to recognize "love as one of the

foundations of civilization" (p. 101). Egoism or self-preservation is impor-
tant but insufficient. S. Freud (1930/1961) noted that "one of the major
endeavours of civilization is to bring people together into larger unities"
(p. 103). One of the primary characteristics of civilization, according to Freud
(1930/1961), is the "manner in which relationships of men to one another,
their social relationships, are regulated—relationships which affect a person
as a neighbour, as a source of help, as another person's sexual object, as a
member of a family and of a State" (pp. 94-95). Furthermore, "Civilization
depends on relationships between a considerable number of individuals . . .
[and, therefore] aims at binding the members of a community together in a
libidinal way" (Freud, 1930/1961, p. 108).
More recent psychoanalytic formulations have focused on attachment
and relatedness to understand personality development primarily from the
perspective of the individual in interaction with others. In these relatedness
theories of personality development, the differentiation, integrity, and con-
tinuity of the self are established and maintained by the gestalt of past and
present interpersonal relationships. The individual is viewed as predominantly
seeking contact and relatedness; psychological development is defined pri-
marily not by what occurs within the individual per se but by the quality of
the interpersonal relationships that he or she establishes. The positive, clearly

demarcated, autonomous, and independent sense of self that emerges in the
course of development is viewed as a necessary by-product in the process of
development toward increasingly mature relationships. Dependence, care,
affection, intimacy, and reciprocity are considered the hallmarks of develop-
ment; the emphasis is on relationships with others, rather than on the devel-
opment of the self. The individual's perception of and experiences with oth-
ers are usually the topics of investigation (Blatt & Blass, 1990, 1996).
As noted earlier, proponents of relatedness (attachment) theories of
personality development among psychoanalysts are primarily British object
relations theorists (e.g., Balint, 1934/1952a, 1934/1952b; Fairbairn, 1952,
1963; Guntrip, 1969, 1971; Winnicott, 1958, 1971), who emphasized the
development of interpersonal relationships and themes of dependency, care,
affection, mutuality, reciprocity, and intimacy. The primary criterion of psy-
chological development is the maturation of interpersonal relationships.
Guntrip (1969, 1971), for example, noted that psychological development
in object relations theory is discussed in terms of the maturation of inter-
personal relatedness—"the emotional dynamics of the infant's growth in
experiencing himself as 'becoming a person' in meaningful relationships,
first with the mother, then the family, and finally with the ever enlarging
world outside" (1969, p. 243). Although Guntrip (1969) did not completely
neglect the development of the individual as a separate entity, his focus was
on attachment and relatedness:
Meaningful relationships are those which enable the infant to find him-
self as a person through experiencing his own significance for other people
and their significance for him, thus endowing his existence with those
values of human relationship which make life purposeful and worth liv-
ing." (p. 243)
This emphasis on the importance of interpersonal processes in personality

development and in the treatment process has been extensively enriched
and expanded by the development of relational and intersubjective approaches
in psychoanalysis (e.g., Aron, 1996; J. Benjamin, 1995; Mitchell, 1988;
Stolorow & Atwood, 1992; Stolorow, Brandchaft, & Atwood, 1987).
A number of nonpsychoanalytic theorists also emphasize the centrality
of interpersonal relations in personality development. Buber, Maslow, and
H. S. Sullivan all focus on reciprocal relatedness and perceived harmony in
personality development. They discussed an interest in openness, contact,
union and receptivity, a concern for the well-being of others, and a desire to
relate to others as a developmental goal in itself rather than a striving to
attain a relationship for some extrinsic reward. Maslow (1954, 1968), in ad-
dition to emphasizing self-esteem needs such as independence, achievement,
and competence, also discussed the importance for psychological develop-
ment of affiliation and the importance of "being in love"—the unconditional,
noninstrumental wish to merge with another and to experience a sense of
joy, pleasure, and mutual delight in egalitarian interpersonal exchange with
others. H. S. Sullivan's (1953) interpersonal theory, with its theoretical an-
tecedents partly in social psychology and social philosophy (e.g., J. M. Baldwin,
1902; Cooley, 1922/1964; Mead, 1934/1962), considered personality devel-
opment as the consequence of exchanges between the individual and signifi-
cant others on whom the person depends for satisfaction and security. And
H. S. Sullivan's contributions were central to the development of the rela-
tional and intersubjective approaches in psychoanalysis. For H. S. Sullivan,
personality development evolves through an increasing capacity for inter-
personal relatedness and mature interactions with significant others.
Intimate relationships are initially established in infancy in the shared
experience between parent and child. The experience of basic trust discussed
by Erikson (1950) is another manifestation of this very early developmental
phase that develops in the interpersonal context of affective sharing. As dis-
cussed in more detail in chapter 4, a next level of interpersonal relatedness,
according to H. S. Sullivan, occurs as the preschool child becomes increas-
ingly aware of his or her relationships with others and begins to accommo-
date the needs of others. The child's transition from primary involvement
with parents within the family to an involvement with peers occurs during
the early primary school years, from kindergarten through second grade (ages
5-8). The child begins to generalize the rudiments of compromise and coop-
eration, first learned in the triadic interpersonal matrix within the family, as
the child becomes acutely aware of his or her participation in the family
system and then subsequently in his or her relationship with peers (Selman
& Schultz, 1990). At first, this capacity for cooperation and accommodation
is expressed primarily with family members and then later with playmates.
About the age of 6, the child begins to develop the capacity to appreciate the
perspectives of others (Feffer, 1969, 1970; Piaget, 1945/1962) and that oth-
ers have an independent mind, feelings, and perceptions.
Later, during latency and preadolescence (approximately ages 8-12),
the capacity for cooperation with authority figures and peers is transformed
into a more mature capacity that H. S. Sullivan described as collaboration.
The primary interpersonal mechanism for the transition from cooperation to
collaboration, according to H. S. Sullivan, involves a shift from a general
participation with a number of equally valued peers to a close and special
friendship with a particular peer or chum. With the emergence of this
chumship, the satisfaction of the needs of the other becomes as important as
the satisfaction of one's own needs. H. S. Sullivan (1953), like Piaget, viewed
this development, what he called the "quiet miracle of preadolescence," as a
major developmental achievement and milestone in the child's growth to-
ward interpersonal maturity and of the capacity for mutuality and reciproc-
ity. The development of a chumship in early adolescence is an essential step
for the eventual development of the intimacy and reciprocity of a mature
sexual relationship. This development is essential not only for the develop-

ment of interpersonal maturity (H. S. Sullivan, 1940, 1953) but also for the
development of formal operational thought (Inhelder & Piaget, 1955; see
also Feffer, 1970).
H. S. Sullivan (1940, 1953) specified particular qualities of interpersonal
relatedness (e.g., emotional contagion, accommodation and cooperation, and
collaboration) as milestones in the development of interpersonal maturity, but
he also stressed that this developmental process has no particular end point,
ideal goal, or telos. Rather, interpersonal maturity is characterized by an open-
ended capacity for collaboration and reciprocity in a wide range of relation-
ships. H. S. Sullivan considered that this entire developmental progression
derives from the quality of the shared experiences with significant others—
from the satisfaction of biological needs in infancy to the satisfaction of more
symbolic or psychological needs later in development, from relationships that
are reflexive and reactive to those that are more reflective (Werner, 1948).
More mature levels of interpersonal relatedness require a communicative com-
petence that develops primarily during latency and the preadolescent period,
when the child begins to be able to see the perspective of the other (Blatt,
1983; Feffer, 1969, 1970; Inhelder & Piaget, 1955; Piaget, 1937/1954).
Communicative competence requires not only the capacity to be re-
flectively aware of one's own thoughts and feelings and to put them into
suitable language but also the ability to assume the role of the other to appre-
ciate how the other may be perceiving one's communication (e.g., see Fonagy
and colleagues' [e.g., 2002] discussions of the importance of the development
of mentalization and reflective functioning). Language becomes a tool for
the sharing of experiences. The sharing of bodily experiences in the emo-
tional contagion of infancy and in the shared action and play patterns of
early and mid childhood (ages 5-8) continues on a more symbolic and con-
ceptual level in preadolescence and beyond. Personal experiences are en-
riched and extended through a mutual sharing of experiences with an other
(Selman & Schultz, 1990).
The capacity and desire to participate in cooperative experiences of
sharing and collaborating eventually develop in adolescence into a capacity
and desire for intimacy. Feelings of intimacy can range from experiences of
"puppy love" or of an infatuation with an idealized other, who may or may
not return the admiration and affection, to affectionate relationships that
eventually become increasingly reciprocal in later adolescence and young
adulthood. Affectionate relationships contain the desire both to give as well
as to receive affection and concern (Hojat, 1987). In part, the desire to ini-
tiate giving to others is a consequence of identification with the caregiver
experienced in infancy and childhood.
Emphasis on interpersonal relatedness occurs with greater frequency in
women (Parsons, 1951), whereas emphasis on self-definition occurs with
greater frequency in men (S. Freud, 1896/1957c, 1930/1961). Western soci-
ety appears to place greater emphasis on capacity for relatedness for women—
for giving care, affection, and love (e.g., Chevron, Quinlan, & Blatt, 1978;
Golding & Singer, 1983)—and on self-definition for men. From an evolu-
tionary perspective, women bear and nurture the young and so are selected
for their capacity for relatedness, and men are selected for an instrumental
role by virtue of their interest in having many partners so as to have more
offspring. Parsons (1964), from a sociological view, noted that
the universal fact that woman are more intimately concerned with early
childcare than are men (with lactation playing a very fundamental part)
is the primary reason why the feminine role, in the family as well as
outside, tends to be more expressive in this sense than the masculine,
(p. 60)
Parsons (1951) noted that in a wide range of societies a relative emphasis on

instrumentalism is most often an essential part of the father role. Deviations
from a full integration of intimacy and autonomy, of affiliation and achieve-
ment, are often expressed in sex-role stereotypes of masculinity and feminin-
ity along the predominant tasks defined by cultural expectations. Women
and girls are often predominantly interested in establishing affective inter-
personal relatedness (e.g., Belenky, Clinchy, Goldberger, & Tarule, 1997;
Chodorow, 1978, 1989;Gilligan, 1982;Gutmann, 1967, 1992; Jordan etal,
1991; Jordan & Surrey, 1986), whereas men and boys are more often prima-
rily interested in establishing a consolidated self-concept.
In addition to cultural expectations and social role demands, differ-
ences in emphasis on individualism and relatedness in the experience of males
and females arise partly from different developmental psychological processes
(Chodorow, 1978; Gilligan, 1982; Miller, 1986). Both boys and girls begin
development with a primary and intense attachment to mother. A major
developmental task for the young boy is to maintain this attachment to
mother, but to seek another figure, usually father, as the object for identifica-
tion. Thus, the developmental challenge for the young boy, early in life, is to
maintain continuity with the mother as the object of affection but to shift
the object of identification from mother to father. This challenge results in
greater concern about separation, individuation, and identification for males.
In contrast, the normative developmental task for the young girl is to main-
tain mother as the object of identification, but to switch the object of affec-
tion from mother to father. Thus issues of attachment, caring, and related-
ness are usually of greater concern for females than for males (Blatt &
Shichman, 1983; Lidz, 1976). The developmental demand for girls to find an
alternative object for affection and for boys to find an alternative figure for
identification is central to their differential emphasis on relatedness and self-
definition in their respective courses of personality development.
The father is the alternative object who breaks the primary union with
the mother for both boys and girls (Loewald, 1960; Vergote & Tamayo, 1980),
but the father serves this function in different ways for the male and the

female child. Both girls and boys establish an intense unity with the mother
and, starting with the experience of separateness in the 2nd year of life, both
seek to achieve a separation from this basic enmeshment. Relatedness to
father provides the girl with the opportunity to establish, consolidate, and
sustain a separation from the union with mother. Boys, in contrast, establish
this separation from mother through an identification with father that en-
ables them to achieve, consolidate, and sustain a differentiation from her.
This identification with father in boys, initially at least, may include a dis-
tancing from mother by placing her in a somewhat diminished, and some-
times depreciated, role. Male chauvinism, including the depreciation of
women, may be partly an expression of an exaggerated identification with
the father as the young boy attempts to reinforce and consolidate his differ-
entiation from mother. So some men, consciously and unconsciously, seek to
perpetuate sex-role stereotypes in society that denigrate women. And some
women, consciously or unconsciously, may seek to placate and please men to
sustain their hard-won separation from the powerful and potentially regres-
sive enmeshment experienced in the primary union with mother.
Generally in normal personality development, women tend to be more
invested in interpersonal relationships, and men tend to be much more con-
cerned about issues of self-definition. Women, for example, show greater adreno-
cortical response to interpersonal stressors than they do to achievement stres-
sors, whereas men have greater adrenocortical response to achievement stressors
(Stroud, 1999). Interpersonal shyness is one of the most serious obstacles to
learning for girls, whereas assertiveness or aggression is the most serious ob-
stacle to learning for boys (Maccoby & Jacklin, 1974). These differences be-
tween males and females are supported by findings (e.g., Witkin, 1965; Witkin,
Dyk, Faterson, Goodenough, & Karp, 1962; Witkin & Goodenough, 1981)
about basic gender differences in cognitive style. Using the rod-and-frame and
embedded-figures tests, Witkin and colleagues found that field-dependent cog-
nitive style is consistent with the predominant interest that women have in
external issues such as interpersonal relationships and that the field-indepen-
dent cognitive style in men is consistent with their focus on internal issues
such as self-definition, assertion, and achievement. In addition, some research
findings (e.g., LoPiccolo & Blatt, 1972) suggested that men who have a more
feminine cognitive style (higher scores on a scale assessing interpersonal sensi-
tivity than on a scale assessing the acquisition of information), who are more
concerned about interpersonal relatedness than aspects of achievement and
self-definition, experience significantly greater conflict around issues of sexual
identity than do men with the reverse pattern.
1NTEGRAT1VE THEORIES OF PSYCHOLOGICAL DEVELOPMENT

The recognition of the narrow emphasis on individuality and the ne-
glect, until recently, of the importance of interpersonal relations in Western
culture should not result in an overreaction to this distortion by diminishing
or neglecting the importance of the self in psychological development or
juxtaposing individuality with interpersonal relatedness as incompatible trends
in psychological development (cf. S. Freud, 1930/1961). Theories that em-
phasize only self-definition or only relatedness as the central process in psy-
chological development present a limited view of human existence. Indi-
viduality (or sense of self) and relatedness with others are both vital processes
in psychological development. Aspects of the self (e.g., autonomy, achieve-
ment, identity) develop within an interpersonal matrix, and conversely,
the full development of mature interpersonal relationships (from depen-
dency to cooperation, to mutuality, reciprocity, and intimacy) requires in-
dividuals to have achieved a reasonably consolidated sense of self-definition
and identity.
A number of theorists and investigators more recently have moved away
from giving priority in development to either issues of related or issues of
self-definition and now emphasize the simultaneous development of both a
sense of self and a deepening capacity for intimate reciprocal interpersonal
relationships—establishing a self-in-relation as a basic goal in psychological
development. Although many theories emphasize either separation and in-
dividuality (identity) or attachment and relatedness as the primary dimen-
sion in psychological development, or view these processes as developing
simultaneously in parallel, several theorists have stressed the integration of
these two dimensions as vitally important in personality development and
psychological well-being (e.g., Stewart & Malley, 1987). Normal personality
organization involves an integration of these two basic dimensions: the
development of the capacity for both interpersonal relatedness and self-
definition. Modell (1968), for example, stated, "With the painful acceptance
of the limitations of other persons and an acceptance of separateness, there is
established a capacity for a more mature form of loving, that is, a love rela-
tionship that can be maintained in the face of privation and ambivalence"
(p. 60). Laing (1967) noted that separateness and relatedness are essential
in the development of both women and men, Bowlby (1969, 1973) ad-
dressed the complementary development of connectedness and autonomy
(of attachment and separation), and Schafer (1968) discussed the impor-
tance of maintaining a balance between dependency and self-sufficiency
for the attainment of optimal personal development. Helgeson (1994), af-
ter an extensive review of research literature, concluded that a sense of both
agency (autonomy) and communion (relatedness) is essential for psycho-
logical well-being.
Bakan (1966) noted the importance of maintaining a dynamic tension
between agency and communion, and Angyal (1951) stressed that the major
task in life is to achieve a compromise and balance between these two forces,
between autonomy and surrender, so that both are represented fully in one's
experiences. Increased autonomy, mastery, and a capacity to govern one's

life and environment are best done not by force or violence but by an under-
standing and respect for laws and rules of the social matrix. In a similar way,
a loving relationship requires not only relinquishing one's autonomy and
agency to some degree but also retaining a capacity for mastery, resource-
fulness, and self-reliance, without which a relationship is in danger of dete-
riorating into helpless dependency, exploitation, and possessiveness. Both
Angyal and Bakan emphasized the need for differentiation as well as for
integration—for the emergence and the constructive integration of the po-
larities of communion and agency, surrender and autonomy, and relatedness
and self-definition.
In self-determination theory (e.g., Deci & Ryan, 1985, 1991; Ryan &
Deci, ZOOOa, 2000b), a research approach that emphasizes the role of related-
ness and self-definition (autonomy and competence) in personality develop-
ment, these three fundamental needs (relatedness, autonomy, and compe-
tence) are seen as mutually enhancing and as contributing to psychological
growth and well-being (Ryan, Sheldon, Kasser, & Deci, 1996), including the
establishment of autonomous regulation (e.g., Grolnick & Ryan, 1989; Ryan
& Deci, ZOOOa, 2000b; Ryan, Stiller, & Lynch, 1994). Research with adoles-
cents and young adults based on SDT (e.g., Avery & Ryan, 1988; Ryan,
1993; Ryan & Lynch, 1989) indicates the complex interrelationship between
the development of interpersonal relatedness, autonomy, and competence
and its particular importance in adolescent development. Kobassa and col-
leagues (Kobassa, 1982; Kobassa, Maddi, & Kahn, 1982) also discussed the
importance of a blend of communion and agency, of intimacy and power, as
central to the development of psychological well-being and hardiness.
McAdams (1982, 1985a) found that an integration of power and intimacy
motivation in Thematic Apperception Test stories is correlated with a ca-
pacity to portray constructive action scripts that are future oriented and high
on generativity. Power and intimacy are integrated by establishing a clear
agentic sense of self and by establishing intimate exchange with others. As
noted earlier, for McClelland, the most mature form of power is based on an
integration of autonomy and affiliation. A mature identity, according to
McAdams (1985a), is one based on a sense of "sameness and continuity which
provides unity and purpose" (p. 28). Such an identity requires individuation
and connectedness, an integration of identity formation and interdependence,
which establishes continuity with, as well as separation from, one's past and
one's current environment, and a sense of the future and the capacity to
establish new connections. Bern (1975) noted that a blend of feminine and
masculine qualities in an androgynous personality is probably most adaptive
and beneficial for psychological health. Helgeson (1994) concluded that an
overemphasis on one dimension (agency or communion) with an
underemphasis of the other dimension is negatively associated with a sense
of well-being.
Waterman (1981), consistent with the formulations of Maslow, Erikson,
Rotter, and Kohlberg, noted that among the ideals and objectives of indi-
vidualism is a search for one's true self (eudaemonism) that includes freedom
of choice, a lack of coercive constraints enforced by others, assumption of
personal responsibility, and respect for the integrity of others. Mature ex-
pressions of individualism involve interdependence because the ethical pur-
suit of self-interest can also provide benefits to others (Waterman, 1981).
Waterman argued that people are more trusting when they feel in control of
their lives, have high self-esteem, and feel cooperative. He believed that
people choose to be interdependent because they enjoy sharing experiences
and feel a psychological attachment to others. This sharing often yields greater
personal gratification than does being alone (Gordon & Gergen, 1968;
M. Taylor, 1982). Thus, Waterman (1981) viewed self-knowledge and self-
respect as directly related to the capacity to form successful friendship and
love relationships. The maintenance of a genuinely mutual, reciprocal rela-
tionship enhances feelings of self-respect. Waterman cited research evidence
indicating a positive relationship between identity and intimacy, between
self-actualization and helping behavior. Individualistic characteristics such
as internal locus of control, self-esteem, and principled moral reasoning are
associated with a willingness to work with and assist others. Thus, Waterman
argued against maintaining a dichotomy between individual and social in-
terests; he believed instead that they are compatible and, in fact, both are
essential for psychological well-being.
Identity, a period of integration and consolidation in Erikson's devel-
opmental theory, includes the universal search for a true self (Waterman,
1981)—not only self-awareness and self-reflectivity (what Baumeister, 1986,
called self-knowledge) but also a humanistic recognition and appreciation of
the integrity of others (Waterman, 1981). Identity is, in part, based on the
reflected appraisals of others or on the ability to take the role of the general-
ized other in evaluating himself or herself (Cooley, 1922/1964; Mead, 1934/
1962). Thus, identity is partly achieved in reference to social standards. Indi-
viduality and identity result from the intemalization of role relations—from
being part of a collectivity (Parsons, 1951). But self-identity also involves
self-discovery and recognition of one's fundamental intentions and values—
a capacity for self-reflectivity (Schafer, 1968). Thus, self-identity includes
intentionality, reflectivity, and the capacity for personal evaluation and criti-
cism. But this self-reflective evaluation and criticism implicitly involve so-
cial values and social norms. Identity, therefore, is not just a culmination of
the developmental line of individuality, but an integration of individuality
with social concerns—an integration of self-strivings with participation in
communal interests and values. In other words, as discussed in chapter 4
(this volume), identity is primarily an integrative stage that brings together
individuality and relatedness so that the self is also defined in relation to

others. Properly speaking, therefore, self-identity is or should be equivalent
to the ensembled individuality described by Sampson.
According to Erikson (1968), "Identity formation, finally, begins when
the usefulness of identification ends. It arises from the selective repudiation
and mutual assimilation of childhood identifications and their absorption in
a new configuration" (p. 159)—"a new unique Gestalt which is more than a
sum of its parts" (p. 158). He described identity as a stage of "integration of
the identity elements ascribed ... to the childhood stages; only that now a
larger unit, vague in its outline and yet immediate in its demands, replaces
the childhood milieu" of the family with the broader concerns of society
(p. 158). According to Erikson (1974),
A sense of identity means a sense of being at one with oneself as one
grows and develops; and it means at the same time, a sense of affinity
with a community's sense of being at one with its future as well as its
history—or mythology, (pp. 27-28)
A sense of identity implies that one experiences an over-all sameness
and continuity extending from the personal past (now internalized in
introjects and identifications) into a tangible future; and from the
community's past (now existing in traditions and institutions sustaining
a communal sense of identity) into foreseeable or imaginable realities of
work accomplishment and role satisfaction. (Erikson, 1954, p. 51)
The developmental stages of intimacy versus isolation and generativity
versus stagnation described by Erikson (1974) are integrated expressions of a
self-identity achieved in late adolescence that lead to a capacity for mutual-
ity and reciprocity in young adulthood (Gouldner, 1961)—to fuller expres-
sions of individuality with a sustained commitment to enduring values and
goals. The integration of individuality and relatedness in self-identity also
results in a capacity for intimacy in a mutual and reciprocal relationship with
another because one believes that one has something to offer and share with
the other—a sense of self-worth, pride, and competence that emerged during
the period of industry. One also begins to recognize one's needs and limita-
tions—what one has to offer to the other as well as the enrichment one can
gain from sharing and reciprocity. Likewise, genetattvity is not only a goal or
task-oriented expression of individuality, but is different from industry in
that it also involves concerns about extending beyond one's own self-interest
to the interest of others and about dedicating oneself to broader goals, values,
and principles. Thus, intimacy and generativity in Erikson's formulations—
the capacities, respectively, to form a unique, mutual, and reciprocal rela-
tionship with another and to dedicate oneself to long-term principles and
goals that extend beyond one's own self-interest—are expressions of the in-
tegration of earlier developmental levels of individuality and relatedness
that occurs with the formation of self-identity (Blatt & Blass, 1990, 1996).
But, as is discussed extensively in chapter 4 (this volume), the relation-
ship between self-definition and relatedness in normal personality develop-
ment goes well beyond a balanced simultaneous development, or even a gen-
eral integration of these two fundamental psychological dimensions in adult-
hood. Rather, normal personality development evolves from a dynamic ten-
sion and synergistic interaction between the two dimensions of relatedness
and self-definition at various stages of the developmental process, from in-
fancy through senescence. These two dimensions evolve developmentally in
a transactional dialectical manner, with higher levels of self-development
making possible higher levels of interpersonal relatedness and, conversely,
more mature levels of relatedness facilitating the further development of a
sense of self. Individuality and interpersonal relatedness develop throughout
the life cycle in an interrelated, transactional, dialectical manner (Blatt,
1990a, 1995a; Blatt & Blass, 1990, 1996; Blatt & Shichman, 1983; Bowen,
1978; Deci & Ryan, 1991; Kagitcibasi, 1990; Ryan, 1993). As discussed by
Shor and Sanville (1978), personality development oscillates between the
necessary connectedness and the inevitable separateness: "The pace and style
of oscillation and the transitions between these two axes will vary for each
person and map out his particular life history, his individual pattern of growth"
(p. 121). Personality development occurs "as a dialectical spiral or helix which
interweaves the two dimensions of development, intimacy and autonomy"
(p. 126). The capacity for adult intimacy and love is the product "of an in-
tense search to formulate one's individual identity and, once having formed
it, to risk to suspend concern with oneself while focusing on the qualities of a
potential mate" (p. 126). The elaboration of this dialectic synergistic devel-
opmental model is the focus of chapter 4 (this volume).
SUMMARY
Proponents of various theories of personality development have dis-

cussed the developmental processes of relatedness and self-definition in dif-
ferent ways, using different terminologies and different theoretical constructs.
Some theorists have focused primarily on the development of different as-
pects of self-definition and view the development of the capacity for inter-
personal relatedness as a derivative consequence of the development of self-
definition. However, other theorists emphasize the development of
interpersonal relatedness as the central dynamic in personality development
and view the development of self-definition as a derivative consequence of
the development of interpersonal relatedness. A few theorists emphasize the
parallel development of these two fundamental developmental processes. In
contrast to these three theoretical alternatives, chapter 4 (this volume) pre-
sents a fourth alternative: a dialectical developmental model in which the
development of self-definition and the development of interpersonal relat-
edness are both central to psychological development because they evolve in
an integrated, synergistic, dialectical interaction in which development in

one dimension reciprocally facilitates development in the other dimension.
The development of these two basic psychological dimensions occurs as a
synergistic, mutually facilitating, reciprocal process. This dialectical syner-
gistic development of the concept of the self and of the capacity to form
meaningful interpersonal relationships throughout life is illustrated by an
elaboration and extension of Erikson's (1950, 1974) epigenetic model ofpsy-
chosocial development.
DIALECTICAL DEVELOPMENT OF
INTERPERSONAL RELATEDNESS
AND SELF-DEFINITION
An elaboration and extension of Erikson's (1950) epigenetic psychoso-

cial model of psychological development provides an opportunity to articu-
late more fully the complex dialectical synergestic development of interper-
sonal relatedness and of self-definition and how these two fundamental
developmental sequences are eventually integrated in a "we" system (e.g., Emde,
1988a; G. S. Klein, 1976; Stem, 1985), a "self-in-relation" (e.g., Gilligan,
1989a; Surrey, 1985), or "ensembled individualism" (Sampson, 1985, 1988)
in mature integrated expressions of self-definition and interpersonal related-
This chapter incorporates material from (a) "Attachment and Separateness: A Dialectic Model of the
Products and Processes of Psychological Development," by S. ]. Blatt and R. B. Blass, 1990,
Psychoanalytic Study of the Child, 45, 107-127. Copyright 1990 by Yale University Press. Adapted with
permission; (b) "Relatedness and Self Definition: A Dialectic Model of Personality Development," by
S. ]. Blatt and R. Blass, 1996, in G. O. Noam and K. W. Fischer (Eds.), Development and Vulnerability
in Close Relationships (pp. 309-338). Hillsdale, NJ: Erlbaum. Copyright 1996 by Taylor & Francis.
Adapted with permission; (c) "Two Primary Configurations of Psychopathology," by S. J. Blatt and
S. Shichman, 1983, Psychoanalysis and Contemporary Thought, 6, pp. 187-254. Copyright 1983 by
International Universities Press. Adapted with permission; and (d) "Internalization and Psychological
Development Throughout the Life Cycle," R. S. Behrends and S. ]. Blatt, 1985, Psychoanalytic Study of
the Child, 40, pp. 11-39. Copyright 1985 by Yale University Press. Adapted with permission.
99
ness. These elaborations of Erikson's developmental model have important
implications for understanding the products (results) of psychological devel-
opment as well as the processes through which these developmental changes
are achieved.
THE PRODUCTS OF PSYCHOLOGICAL DEVELOPMENT
In a linear series of hierarchical epigenetic stages, Erikson (1950, 1959,

1964, 1968, 1977, 1982) described how processes of identification and so-
cialization enable the individual to progress from infantile dependency to
increasing individuation with a consolidated identity and a capacity for ma-
ture interpersonal relationships. Although Erikson stressed the importance
of social agents for the facilitation of psychological development, his empha-
sis was consistently on the antecedents and consequences of the attainment
of a self-identity. Statements by Erikson such as "True 'engagement' with
others is the result and the test of firm self delineation" (1968, p. 167) reflect
the special status that Erikson assigned to identity formation and its associ-
ated processes of separation and individuation (Blatt & Blass, 1990, 1996).
Although the term identity has been used somewhat differently by many
authors, identity for Erikson (1959) involves the definition of the individual
as a separate and autonomous agent. Relationships are not commonly em-
phasized in Erikson's concept of identity, which instead stresses the "integra-
tion of perceptions of oneself as separate and distinct from the other" (Mussen,
Conger, & Kagan, 1979, p. 495). The roles of attachment and interpersonal
relatedness are underplayed in Erikson because of his linear schematization
of psychological development and his emphasis on identity consolidation as
the central goal or result of normal development. The implication in much
of Erikson's writings is that he is primarily a separation theorist (see chap. 3,
this volume) who focuses on identity formation as the development of one-
self as separate and autonomous. Attachment and interpersonal relatedness
appear to play secondary roles in identity development, either facilitating or
serving as by-products of identify formation. Attachment and interpersonal
relationships provide intermediary links in the process of development to-
ward individuation. Mature relationships occur as a consequence of the at-
tainment of individuation (Blatt & Blass, 1990, 1996).
Erikson's overriding emphasis on individuation, apparently at times at
the neglect of noting the importance of the development of interpersonal
relatedness, has been discussed as a major limitation of his epigenetic model
(Blatt & Shichman, 1983; Carlson, 1972; Franz & White, 1985; Gilligan,
1982; Surrey, 1985). Although attachment (or relatedness) does not receive
sufficient consideration in Erikson's formulations, his model is not exclu-
sively an identity or separation theory of personality development. Attach-
ment is, in fact, embedded in his theoretical formulations. Segments of

Erikson's formulations call attention to the importance of issues of related-
ness. For example, in discussing identity formation in one of his later state-
ments, Erikson (1982) noted that
Epigenetically speaking, of course, nobody can quite "know" who he or
she "is" until promising partners in work and love have been encoun-
tered and tested. Yet, the basic patterns of identity must emerge from
(1) the selective affirmation and repudiation of an individual's child-
hood identifications; and (2) the way in which the social process of the
times identifies young individuals—at best recognizing them as persons
who had to become the way they are and who, being the way they are,
can be trusted, (p. 72)
Furthermore, Erikson (1982) stated the following:
In summary, the process of identity formation emerges as an evolving con-
figuration—a configuration that gradually integrates constitutional giv-
ens, idiosyncratic libidinal needs, favored capacities, significant identifi-
cations, effective defenses, successful sublimations, and consistent roles.
All these, however, can only emerge from a mutual adaptation of indi-
vidual potentials, technological world views, and religious or political
ideologies, (p. 74)
Although aspects of self-definition (i.e., autonomy, initiative, industry,
and identity) are central in Erikson's formulations, it is important to note
that processes of separation and differentiation also imply an ability to recog-
nize similarities, as well as differences, with others and the ability to see one-
self in relation to others. Thus, in considering Erikson's formulations, it would
be more accurate and productive to consider self-identity as emerging from
an ongoing dialectic between the self as separate and the self as experienced
in relationships with others. The articulation of two distinct but interactive
lines of psychological development—relatedness and self-definition—
provides the basis for modifying and expanding Erikson's psychosocial devel-
opmental model and for more fully identifying aspects of these two funda-
mental developmental lines as well as the processes that lead to their even-
tual integration. The modifications of Erikson's model discussed in the next
section facilitate the recognition of the role of interpersonal relatedness (or
attachment) in the development of identity and an appreciation of the con-
tinuous dialectical interaction between relatedness and separateness in per-
sonality development.
Erickson's Epigenetic Development Model Modified

Erikson's epigenetic stages of psychosocial development parallel the
classic psychoanalytic model of psychosexual development. Thus, Erikson
delineated a stage of trust-mistrust parallel to the oral phase of development,
a stage of autonomy-shame parallel to the anal phase, a stage of initiative-
DIALECTICAL DEVELOPMENT 101

guilt parallel to the phallic phase, and a stage of industry-inferiority as the
primary psychosocial issue of latency. Erikson curiously omitted defining a
psychosocial stage to parallel the oedipal phase.1 H. S. Sullivan's formula-
tions (e.g., 1953), as discussed in chapter 3 (this volume), identify an addi-
tional psychosocial developmental phase—cooperation versus alienation—
that occurs around the time of the emergence of operational (triadic) thinking
(i.e., Piaget, 1945/1962), the appreciation of triadic interpersonal relation-
ships (i.e., the oedipal family matrix), and the development of cooperative
peer play, at about 4 to 6 years of age. If one places a developmental phase of
cooperation versus alienation at the appropriate point in the developmental
sequence, between Erikson's phallic phase of initiative versus guilt and his
latency phase of industry versus inferiority (Blatt & Shichman, 1983),
Erikson's epigenetic formulations define more fully a relatedness (or an at-
tachment) dimension in psychological development. This revision of Erikson's
model also demonstrates more clearly the dialectical developmental transac-
tion between interpersonal relatedness and self-definition implicit in Erikson's
formulations.
In this more dialectical rendering of Erikson's ideas, one developmen-
tal line—self-definition or individuality—includes his stages of autonomy-
shame, initiative-guilt, industry-inferiority, identity-alienation, generativity-
stagnation, and integrity-despair. Thus, as noted in chapter 3 (this volume),
individuality or identity develop through the following sequence: (a) an early
sense of separation and autonomy from the control of another; (b) the capac-
ity to initiate activity, not just in opposition to the other but internally
determined—more proactive than reactive; and (c) industry in sustained,
goal-directed activity that has an inherent direction and purpose. The devel-
opmental achievements of these early phases in the emergence of individual-
ity (autonomy, initiative, and industry) provide important attributes and
qualities that contribute to the eventual attainment of self-identity.
The addition of an intermediate stage of cooperation and collaboration
versus alienation, on the basis of concepts derived from Sullivan, to the re-
latedness developmental line also defines a sequence in the development of
interpersonal relatedness that extends from (a) sharing of intense affective
experiences between mother and infant (e.g., Beebe & Lachmann, 1988;
Stern, 1985) with a concomitant sense of basic trust, through (b) a capacity
for cooperation and collaboration with family members and later with peers,
and eventually in a close friendship with a same-sex chum (H. S. Sullivan,
1940, 1953), to (c) the development of a mutual, reciprocal, enduring inti-
mate relationship. Thus, as noted in chapter 3 (this volume), the second
'Erikson may have omitted including an oedipal phase in his formulations because he may have based
his psychosocial epigenetic model on earlier psychoanalytic formulations that initially did not
distinguish between the phallic and oedipal phases (e.g., Three Essays on the Theory of Sexuality [Freud,
1905/1963b] and Inhibitions, Symptoms and Anxiety [Freud 1926/1959c]). 1 am grateful to John S.
Auerbach for calling this possibility to my attention.

developmental line, relatedness, includes stages of trust-mistrust, coopera-
tion and collaboration-alienation, and intimacy-isolation. This identifica-
tion of the three developmental levels of relatedness distinguishes, as dis-
cussed in chapter 3 (this volume), dependency at a lower developmental
level from a more mature reciprocal relatedness in which one gains pleasure
from giving and sharing, as well as receiving, care and affection. This articu-
lation of a relational developmental line in Erikson's formulations corrects
to some extent the deficiency noted by a number of theorists (e.g., Blatt &
Shichman, 1983; Carlson, 1972; Franz & White, 1985) that Erikson's model
tends to neglect the development of interpersonal attachment and the ob-
servations of feminist theorists (e.g., Chodorow, 1978; Gilligan, 1983; Miller,
1984, 1976/1986) that most theories of personality development fail to give
sufficient status to the development of interpersonal relatedness. The articu-
lation of a relational developmental line in Erikson's formulations is also
consistent with extensive research and theory that demonstrate the impor-
tance in personality development of processes of attachment (e.g., Ainsworth,
1969; Bowlby, 1969, 1973; Main, Kaplan, & Cassidy, 1985) and of separa-
tion-individuation (e.g., Mahler, Pine, & Bergman, 1975) and the develop-
ment of the capacity for mutuality, empathy, and intersubjectivity (e.g., Stern,
1985).
Although the contributions of feminist developmental theorists stress
the importance of including a relatedness line in theories of personality de-
velopment, some of these theorists (e.g., Gilligan, 1982,1989b; Surrey, 1985),
as noted in chapter 3, often used the term dependency to designate this entire
developmental sequence. The articulation of a relatedness developmental
line in Erikson's formulations suggests, however, that it would be more pre-
cise to view dependency as an early form of relatedness and to distinguish it
from more mature forms of relatedness in which the emergence of a well-
articulated sense of self as separate and effective enables one to participate
in mature, reciprocal, mutually satisfying relationships with others. As also
noted in the previous chapter, several research groups (e.g., Blatt, Zohar,
Quinlan, Luthar, & Hart, 1996; Blatt, Zohar, Quinlan, Zuroff, & Mongrain,
1995; R. F. Bornstein, 1998; R. F. Bornstein & Cecero, 2000; Pincus &
Gurtman, 1995; Pincus & Wilson, 2001; Rude & Bumham, 1995) have dem-
onstrated the importance of differentiating among various levels of interper-
sonal relatedness.
The articulation of a relatedness or attachment developmental line not
only broadens Erikson's model but also clearly demonstrates the dialectical
transaction between relatedness and self-definition implicit in Erikson's de-
velopmental model. Both interpersonal relatedness and individuality (attach-
ment and separation, or communion and agency) evolve through a complex
interactive developmental process. The evolving capacities for autonomy,
initiative, and industry in the self-definitional developmental line develop
in parallel with an evolving capacity for relatedness—to engage with and

trust another, to cooperate and collaborate in group activities (e.g., play), to
develop a close friendship with a same-sex chum, and to eventually experi-
ence and express feelings of mutuality, intimacy, and reciprocity in a mature
relationship. The development of these evolving capacities in these two de-
velopmental lines of individuality and relatedness is well coordinated in nor-
mal development. Although Erikson's (1950) epigenetic model of psychoso-
cial development is basically a linear developmental process toward identity
consolidation, it implicitly suggests that normal personality development
involves simultaneously and mutually facilitating dialectical interaction be-
tween the two primary developmental dimensions of interpersonal related-
ness and self-definition (Blatt, 1990a, 1995a, 2006; Blatt & Blass, 1990,1992,
1996; Blatt & Shichman, 1983).
As Figure 4.1 illustrates, relatedness and individuality both evolve
through a complex interactive developmental process. The evolving capaci-
ties for autonomy, initiative, and industry in the self-definitional (individu-
ality) developmental line progress in an alternating sequence with the stages
in the development of relational capacities. For example, one needs a sense
of basic trust to venture in opposition to the need-gratifying other in assert-
ing one's autonomy and independence, and later one needs a sense of au-
tonomy and initiative to establish cooperative and collaborative relation-
ships. In this revised or extended Eriksonian model, development begins with
a focus on interpersonal relatedness—specifically with the stage of trust ver-
sus mistrust—before proceeding to two early self-definitional stages, autonomy
versus shame and initiative versus guilt. These early expressions of self-
definition are then followed by the newly identified stage of interpersonal
relatedness, cooperation versus alienation, and then by two later stages of
self-definition, industry versus inferiority and identity versus role diffusion.
These more mature expressions of self-definition are followed by the more
advanced stage of interpersonal relatedness, intimacy versus isolation, before
development proceeds to two more mature stages of self-definition,
generativity versus stagnation and integrity versus despair (Blatt & Shichman,
1983). Although these two developmental lines interact throughout the life
cycle, they also develop relatively independently through the early develop-
mental years until adolescence, at which time the developmental task is to
integrate more mature expressions of these two developmental dimensions
into the comprehensive structure Erikson called "self-identity."
Examination of Erikson's terms denoting the first three stages of the
self-definition developmental line (autonomy, initiative, and industry), as
well as of the two later integrative stages of self-definition (identity and in-
tegrity), however, reveals that Erikson is actually describing the develop-
ment of two different aspects of the self: an expressive mode of self and self-
feeling. In his psychosocial formulations, Erikson articulated polar pairings
in the relatedness developmental line (e.g., trust-mistrust and intimacy-
J 04 POLARITIES OF EXPERIENCE
Interpersonal Relatedness Self-Definition
1. Trust-Mistrust
2. Autonomy-Shame
3. Initiative-Guilt
4. Cooperation-Alienation
5. Industry-Inferiority
6. Identity-Role Diffusion
7. Intimacy-Isolation
8. Generativity-Stagnation
9. Integrity-Despair
Figure 4.1. The dialectical interaction of interpersonal relatedness and self-

definition implicit in Erikson's psychosocial model. From Development and
Vulnerability in Close Relationships (pp. 309-338), by G. G. Noam and K. W.
Fischer (Eds.), 1996, Hillsdale, NJ: Erlbaum. Copyright 1996 by Taylor & Francis.
Reprinted with permission.
isolation), but pairings in the various stages of the self-definitional line are
based instead on psychosexual theory. Erikson contrasted (anal) autonomy
with shame; (phallic) initiative with guilt; and preadolescence (latency) in-
dustry with feelings of inferiority. These pairings are not polar opposites as
occurs in Erikson's juxtaposition of trust with mistrust in infancy or intimacy
with isolation in late adolescence. The opposite of autonomy is not shame
but a lack of autonomy—and the opposite of shame is pride. The opposite
of initiative is not guilt but a lack of initiative—and the opposite of guilt is
self-esteem. Finally, the opposite of industry is not inferiority but a lack of
industriousness—and the opposite of inferiority is confidence. Thus, on
one level in the self-definitional developmental line, Erikson articulates
behavioral expressions—autonomy, initiative, and industry—or expressive
modes of self. Each term denotes a behavioral activity that can be defined
as a continuum (e.g., autonomy can range from a low to a high degree of
autonomy). The expressive mode of self at each stage corresponds to what
Shapiro (1965) referred to as "a way of functioning, an attitude, and a frame
of mind" (p. 11). On the other level, Erikson articulated polarities of shame
and pride, guilt and self-esteem, and inferiority and confidence. These con-

cepts identify a bipolar continuum of self-feeling (e.g., from shame to pride)
that refers to the experience of the self in a broad sense (Blatt & Blass, 1990).2
In the later stages of the self-definition developmental line and inte-
grative stages of identity and integrity, however, the concepts denoting the
expressive mode of self and self-feelings begin to approximate polar oppo-
sites. Thus, identity versus role diffusion and integrity versus despair appear
to be expressions of the sense of self that integrate the behavioral dimension
of the expressive mode of self with self-feelings. This convergence of the two
aspects of self, expressive mode and self-feeling, is an indication of a funda-
mental change that has taken place in the developmental process, beginning
in adolescence, from a process of identification and internalization to a pro-
cess of integration. Although it is helpful to maintain the distinction be-
tween the two aspects of self (expressive mode and self-feeling) when dis-
cussing the early stages of the self-definition developmental line in
preadolescence, these two dimensions seem to converge beginning in adoles-
cence and this convergence continues in the later stages of development. In
contrast, the terms in the various stages of the relatedness developmental
line (i.e., trust-mistrust, cooperation-alienation, and intimacy-isolation)
remain polar opposites throughout psychological development.
All three components of psychological development—the quality of
the attachment relationships, the expressive mode of self, and self-feelings—
become stable attributes of the self as the individual matures toward more
complex levels of psychological development. This differentiation of these
three components of psychological development and the formulations of the
dialectical developmental process between relatedness and self-definition now
enable researchers to define more precisely what it is in the interaction with
significant others that is transformed through internalization into psycho-
logical structures. Internalizations in the relatedness developmental line are
based on the quality of the relationship between self and the object, expressed
in a sense of trust, cooperation, mutuality, and intimacy that emerge in in-
teraction with significant need-gratifying others. In the self-definition de-
velopmental line, various levels of self-feeling and the expressive mode of
self are internalized. These various capacities and feelings about the self that
are experienced within an interpersonal relationship gradually consolidate
to become integral aspects of the self. In contrast to self-feelings, the expres-
sive or behavioral mode of self can be defined from the perspective of both
the subject and the observer. In terms of the subject, the mode of self-
experience refers to the experience of self that prevails during the individual's
active expression—that is, the individual's attitudes toward such expression.
In terms of the observer, the expressive mode of self is both an external be-
havioral manifestation of the individual (e.g., autonomy or initiative) and
2
Erikson (e.g., 1959, p. 113) referred to self-feelings but he seemed to have assigned them a different
and much less prominent role in the developmental process.

the individual's capacity to express him- or herself in certain interpersonal
conditions (e.g., an ability to act freely and efficiently in the absence of a
guiding authoritative figure).
Psychological development can now be defined as a process in which
an individual, through interaction with significant others, internalizes as-
pects of the quality of relatedness, functional capacities in the expressive
mode of self, and conscious and unconscious attitudes and feelings about the
various expressions of self that are experienced in relationships with signifi-
cant others at different stages of development (Blatt & Blass, 1990, 1996).
As Figure 4.2 illustrates, consolidation and integration of these internaliza-
tions occur at each developmental phase and provide the basis for progres-
sion to the next developmental phase.
A brief description of the dialectical interaction between the two fun-
damental developmental lines illustrates the developmental process in this
extension of Erikson's model. Under relatively optimal conditions, the ini-
tial development of trust in the relatedness developmental line enables the
child to establish and extend the process of self-definition by asserting a de-
gree of autonomy and independence from significant need-gratifying others.
If this expression of autonomy is accompanied by feelings of pride rather
than shame, expressions of autonomy then become more proactive, rather
than reactive, as the child begins to initiate activity. The feelings of trust and
the experiences of autonomy and pride, together with biological-cognitive
maturation, prompt expressions of initiative in interactions with significant
others. Mother and father consciously and unconsciously communicate their
feelings about the child's various expressions of initiative as they did earlier
in response to the child's expressions of autonomy. Some expressions of ini-
tiative are responded to positively, others are neither supported nor encour-
aged, and still others meet with parents' active disapproval. The relative bal-
ance of these experiences, and the manner in which each parent's express
approval and disapproval of the child's self-expression (i.e., initiative) deter-
mine the quality of self-feelings (i.e., worthiness or self-esteem), are inter-
nalized by the child. Experiences that enhance the child's sense of self as a
separate and functional individual, with feelings of pride in his or her au-
tonomy and a sense of self-esteem in being able to initiate activity in his or
her own right, provide the child with the basis for establishing a new type of
relatedness with his or her parents. If the parents have been appropriately
responsive to the child's expressions of initiative (approving and supporting
some aspects and appropriately disapproving and setting limits on others),
then the child can begin to redefine his or her relatedness to both parents in
terms of various efforts at initiative with one or both of them. These initia-
tives directed toward each parent contribute to establishing a new sense of
relatedness in which the desire and capacity for sharing and cooperation gradu-
ally emerge, first with parents and later with peers.

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Feelings of pride and worthiness and expressions of a capacity for au-
tonomy and initiative on the self-definition developmental line, along with
experiences of trust and cooperation on the relatedness developmental line,
contribute to the emergence of a capacity for more proactive goal-directed
activity (industry). The expressive mode of self as industrious and the self-
feeling of confidence eventually lead to the formation of an identity on the
self-definitional developmental line as capable and functional, which, in
conjunction with the capacity for trusting a caregiver and for cooperating
with parents and peers on the relatedness developmental line, contributes to
the development of a sense of self in relation to others. Active expression of
new capacities attained at each developmental stage enables the individual
to enter into new forms of interaction with others. New forms of interaction
are the consequence of both the activity of the caring agent and the active
move of the individual toward the caregiver, a move in which the individual
strives for optimal levels of stimulation as well as for new opportunities for
the expression of recently discovered potentials.3 The new forms of interper-
sonal interaction created by the individual and his or her significant others
open up the possibility for new forms of self-expression and new aspects of
relationships that are then internalized in the formation of newly revised
psychological structures. This repeated developmental sequence, together with
biologically determined maturation, contributes to the progressive evolve-
ment of self-identity.
A marked change occurs in the nature of these developmental sequences
beginning in adolescence. Earlier in development, various aspects of the two
developmental lines of relatedness and self-definition are internalized pri-
marily as separate components, but beginning in adolescence various expres-
sive modes of self and self-feelings merge into a single continuum and be-
come integrated with the developmental achievements of the relatedness
line. This merging of the two developmental lines in late adolescence is con-
sistent with Erikson's (1968) description of the identity stage in adolescence
as one of an "integration of the identity elements" (p. 158) in a new gestalt of
self-identity. Thus, the successful outcome of the identity stage results in a self-
identity that integrates dimensions of both self-definition and relatedness—a
self-in-relation. Identity formation involves an integration and consolida-
tion of the internalizations of various aspects of self-definition (self-feelings
and modes of self-expression). But identity is not based only on experiences
of autonomy, initiative, and industry and on self-feelings of pride, self-es-
teem, and confidence; it also involves qualities of interpersonal relatedness
that have emerged in the earlier preadolescent developmental periods. Iden-
3
This view is consistent with findings by Beebe and Lachmann (e.g., 1988); Stern (1977, 1983), Emde
(1981), and others and formulations by Behrends and Blatt (1985) that stress the caring relationship
as a reciprocal process in which both members of the dyad initiate and direct the interaction, as
discussed in chapter 2 (this volume). The implications of these formulations for the therapeutic
process are discussed in chapter 8 (this volume).

tity as a self-in-relation to others is an integration of aspects of the self-defi-
nitional developmental line with earlier interpersonal experiences of trust
and cooperation. Thus, self-identity is a superordinate integration of inter-
nalizations, including the quality of the interpersonal relationships and the
feelings toward the self acquired in these relationships. These formulations
are consistent with the conclusions of M. W. Baldwin (e.g., 2005) about the
social construction and the interpersonal roots of identity formation.
The emergence of a new configuration, self-identity, is the consequence
of the integration of the two primary developmental lines. Although self-
identity is partly a stage in the development of self-definition, it is also a
cumulative integrative stage in which the sense of individuality that has
emerged from the development of autonomy, initiative, and industry is coor-
dinated with the capacity to cooperate and share with others. Self-identity
develops out of a synthesis and integration of individuality with relatedness—
that is, of the intemality and intentionality that develops as part of autonomy,
initiative, and industry with the capacity and desire to participate in rela-
tionships with an appreciation of what one has to contribute to, and gain
from, participating in a relationship or in a social collective. Thus, Erikson's
advanced stage of self-identity involves a synthesis and integration of more
mature aspects of the relatedness and self-definitional developmental lines
(Blatt & Blass, 1990, 1992, 1996).
This new gestalt reflects a shift in the mechanisms of psychological
development from intemalization and identification to integration (Blatt &
Blass, 1990, 1992, 1996). The formulation of a shift from intemalization and
identification to integration as the primary mechanism of psychological de-
velopment in late adolescence is consistent with Erikson's (1968) descrip-
tion of the identity stage in late adolescence as one of "the integration of the
identity elements ascribed ... to the childhood stages" (p. 158). As noted in
chapter 3 (this volume), Erikson (1968) discussed identity formation as a
new and unique organization that arises from the selective repudiation and
assimilation of aspects of childhood identifications.
The integration and consolidation of dimensions of self-definition and
relatedness in self-identity is also characterized by a marked increase in
self-awareness and self-reflectivity—what Baumeister (1986) called self-
knowledge—as well as in a recognition of and an appreciation for the integ-
rity of others (Waterman, 1981, 1983). Thus, one can now participate in a
collective or a relationship with an appreciation of what one can contribute
to others as well as value what one can gain from others without losing one's
individuality within the relationship or the collective. Furthermore, the ca-
pacity for intentionality and self-reflectivity in self-identity derives, at least
partly, from the appropriation of social values and norms. The attainment of
self-identity, therefore, involves not just development along the lines of in-
dividuality and relatedness but an integration of individuality with an iden-
tification with communal concerns and standards—in the formation of a

self-in-relation or a sense of we. A number of psychoanalytic theorists have
discussed the importance of the concept of the we. George S. Klein (1976)
was among the earliest psychoanalytic investigators to develop a detailed
conceptual framework that stressed the importance of an integration of ex-
periences of the self as separate with experiences of relatedness. As G. S.
Klein (1976) noted,
The terminology of subject and object has contributed to misleading
conceptualizations of selfhood and especially to obscuring its "we" as-
pect. The traditional view of man as becoming gradually aware of him-
self as "subject" confronting others as objects may be applicable morpho-
logically but it does not describe dynamic wholes, (pp. 178-179)
G. S. Klein (1976) described how individuals can experience deprivation in

relation either to feeling autonomous or to feeling needed by another. Needs
for autonomy may be manifested as ambition, competitiveness, or aggres-
sion. Affiliative needs "may be expressed through familial and societal bonds;
or the person may crave surrender to the higher entities of god and cosmos..
. . Affiliative needs can also be reflected in esprit de carps or clannishness, in
loyalty and devotion ... or in contagious mob behavior and group violence"
(p. 179). In summary, Klein noted that "Separateness and independence .. .
[and] cooperation and dependence . . . may be served by motives and emo-
tional commitments that run the gamut from constructiveness to destruc-
tiveness, good to evil" (p. 179). Klein's formulations imply that more adap-
tive and constructive expressions of both autonomy and affiliation can occur
when there is an integrated balance of needs for relatedness and for self-
definition.
George S. Klein (1976) was especially interested in the development and
maintenance of an identity as a basic principle of psychological development:
a sensibility for identity may be inborn, but the identity structure itself—
its contents—is not inborn; it is an artifact, a creation which emerges. . . .
Loss of identity is a specifically human danger; maintenance of identity
is a specifically human necessity, (p. 177)
G. S. Klein, like Erikson, was particularly interested in the development of
self-identity, which is "shaped according to the instrumentalities and socio-
cultural conditions of each period of life" (p. 177). He considered the mo-
tives and aims involved in establishing a sense of self-integration or identity
as central in developing a general psychological theory. Klein emphasized
two aspects of identity: (a) an autonomous distinction from others as a locus
of action and decision and (b) a "we-ness" that is a necessary part of the self
that transcends one's autonomous actions. The we is as important a part of
the self as the I. One must feel, G. S. Klein (1976) wrote,
both separate and a part of an entity beyond itself. . . . Identity must
always be defined as having aspects of both separateness and member-

ship in a more encompassing entity, and as developing functions that
reflect one's role in a relationship with a larger entity. . . . This [latter]
aspect of identity—'we-ness'—has its earliest prototype in the mother-
infant unit... .The infant Unwelt can be considered as a kind of prolon-
gation of the mother-child symbiosis; the mother "pole" is the surround-
ing total organism and the infant is an organic "part" within this totality.
The actions of the infant occur within this mother-child sphere. From
this symbiosis emerges a feeling of being part of a larger identity, (pp.
178-179)
This desire to be part of a larger unit serves as a "continuing presence and a

molding factor" (G. S. Klein, 1976, p. 179) in the development of the self.
Thus, G. S. Klein forcefully argued for the need in psychoanalysis to develop
a theory of the "wego" to parallel its theory of the ego and to include in its
developmental theory a concept of we that emerges from the dialectical in-
teraction between the development of a sense of self as separate and autono-
mous and a sense of self in relationships with others. G. S. Klein (1976)
viewed psychoanalysis and much of psychology as being predominantly con-
cerned with a concept of self as a separate, autonomous unit and as failing to
address the importance of the development of a sense of "belonging to" or of
"we-ness" (p. 179). G. S. Klein (1976), in part influenced by Erikson, stressed
the need for a sense of continuity, coherence, and integrity that derives from
an integration of affiliation and autonomy or relatedness and self-definition.
Other investigators, mainly from the field of infant research, also began
to elaborate important aspects of this dialectical developmental process of
separation and relatedness in the formation of the concept of we. Emde
(1988a), in discussing the work of Stern and others, considered the dialectic
between the sense of self and of the sense of relatedness as reflective of an
important theoretical development:
It is perhaps ironic that in our age, so preoccupied with narcissism and
self, we are beginning to see a different aspect of psychology, a "we" psy-
chology in addition to a "self psychology. I draw our attention to the
fact that this represents a profound change in our world view. (p. 36)
The profound change of which Emde spoke involves an expansion of concepts
of the self-system to include the we dimension. Emde discussed three dynamic
aspects of the self-system: the experience of self, the experience of the other
(e.g., attachment figure), and the experience of the self-with-other or we. The
development of a mature sense of we (a self-in-relation or ensembled individu-
alism) emerges from a complex transaction and integration of the two funda-
mental developmental lines of relatedness and self-definition.
Lichtenberg (1983), integrating empirical infant studies with psycho-
analytic theory, concluded that psychoanalysis may
overstate^] our separateness, our degree of independence from our ani-
mate and inanimate surroundings. Rather than simply eliminating the

interactional concept with an intrapsychic model, we need to retain a
view of the interactional context as an explanatory concept with consid-
erable validity throughout the life cycle, (p. 35)
Stern (1977, 1983, 1985, 1988b) systematically studied this interactional
context by examining the infant's capacity to create schemas not only of self
and of other but of self-with-other. Stern (1983) described three types of
relationships of self-with-other: self-other complementing, state sharing, and
state transforming. Although these relationships can be characterized by the
degree of attachment or separateness they imply, Stern was interested in how
they contribute to the structuralization of the self through the schematization
of interpersonal experiences. Thus Stern took the concept of relationship
beyond the meaning ascribed to it by separation theories that view self-other
relationship as a means toward the development of a sense of self as separate,
as well as beyond the meaning ascribed to the relationship by attachment
theories that consider the establishment of relationships as a developmental
goal. These relationships, according to Stern (1983),
are also the stuff that human connectedness, as well as normal intimacy
and basic trust, are made of at all points in development. The ability to
engage in them is among the most needed and healthy of capacities. The
point of view I am taking proposes to take the being-with experience (in
normally developing infants) beyond their primarily problematic role in
the differentiation of self and other and establish them as positive hu-
man capacities, the development of which is best understood against a
background of intact schemata of self and other, (pp. 80-81)
Erikson (1982) also discussed the development of the I and the we:
Freud put the self-observing "I" and the shared "we" into the exclusive
service of the study of the unconscious.... [A] more systematic study of
"I" and "we" would seem to be not only necessary for an understanding of
psychosocial phenomena, but also elemental for a truly comprehensive
psychoanalytic psychology. I am, of course, aware of the linguistic diffi-
culty of speaking of the "I" as we do of the ego or the self; and yet, it does take
a sense of "I" to be aware of a "myself or, indeed, of a series of myselves,
which all the variations of self-experience have in common . . . the con-
scious continuity of the "I" that experienced and can become aware of
them all. Thus, the "I," after all, is the ground for the simple verbal assur-
ance that each person is the center of awareness in a universe of communi-
cable experience, a center so numinous that it amounts to a sense of being
alive and, more, of being the vital condition of existence. At the same
time, only two or more persons who share a corresponding world image
and can bridge their languages may merge their "Is" into a "we." It could, of
course, be of great significance to sketch the developmental context in
which the pronouns—from "I" to "we" to "they"—take on their full mean-
ing in relation to the organ modes, the postural and sensory modalities,
and the space-time characteristics of world views, (pp. 87-88)

To understand the development of the sense of we, Erikson relied pri-
marily on S. Freud's (1921/1959B) formulations in Group Psychology and the
Analysis of the Ego of the individual's relationship to primal groups and to the
charismatic leader. Erikson (1982) stressed the importance of mutual rela-
tionships with others:
It must be remembered that children must continue to learn to use other

selected adults, be they grandparents or neighbors, doctors, or teachers,
for much-needed extraparental encounters. Thus, what is sometimes
monotonously referred to as the child patient's search for "object-
relations" (that is, for a fully deserving and responding recipient of one's
love) must come to include that clarified mutuality of involvement on which
the life of generations depends, (p. 100)
But Erikson (1982) acknowledged the limitations of his theory in articulat-

ing fully the development of the <we when he noted that "the overall theory
seemed to be working toward and yet stopping short of a systematic atten-
tion to the ego's role in the relationship of individuality and communality"
(pp. 15-16).
Identity in the Erikson model is followed by the stages of intimacy and
generativity. Self-identity, a sense of self as a separate and capable individual
who has positive feelings about oneself and positive and constructive rela-
tions with others, leads to mature expressions of generativity and intimacy.
But after the integration in identity formation, the relation between the two
developmental lines of relatedness and self-definition becomes more intri-
cate. The capacity for generativity reflects both self-definition and attach-
ment, and the capacity for intimacy is based on a loss of oneself within a
relationship as well as an ongoing awareness of one's unique contributions to
the relationship. The degree to which these elements of relatedness and self-
definition are expressed in these more mature stages of intimacy and
generativity depends not only on developments that take place in the later
stages of the two developmental lines but also to a large extent on the degree
of integration that occurred earlier in identity formation.
Erikson (1982) noted that "intimacy and generativity are obviously
closely related but intimacy must first provide an afftliative kind of ritualization"
(pp. 71-72). This specific sequence of intimacy preceding generativity in
Erikson's formulations is based to a large degree on the social norms preva-
lent at the time Erikson prepared his model. Generativity reflects the sepa-
rateness line of development with the emergence of self as a distinct entity
producing, giving, and creating. Intimacy, however, reflects the expression
of self-identity in the context of attachment. A focus on the adult matura-
tion of internal capacities leads to a reformulation of the developmental pro-
cess in which generativity and intimacy emerge concurrently following iden-
tity formation. This conceptualization provides a synthesis of various
approaches to adult development that does not place priority on either the

development of intimacy within relationships or the development of
generativity (Blatt & Blass, 1990, 1996).
Although generativity and intimacy can be assigned to the separate-
ness and relatedness developmental lines respectively, considerable variabil-
ity exists in the extent to which the capacity for generativity reflects sepa-
rateness or attachment and in the degree to which the capacity for intimacy
is based on a loss of oneself within the relationship or on an ongoing aware-
ness of one's unique contributions to the relationship. Although intimacy
connotes primarily issues of relatedness, it requires an appreciation of reci-
procity between self and other in an intimate relationship. And likewise, the
contributions associated with generativity are those that extend beyond self-
interest and contribute to the well-being of society or of others.
The synthesis of the two developmental lines of relatedness and self-
definition in an integrated self-identity in adolescence leads to more mature
expression of relatedness in intimate relationships characterized by mutual-
ity and reciprocity, as well as to fuller expressions of individuality in
generativity with sustained commitment to enduring values and goals. The
integration of individuality and relatedness in self-identity results in a capac-
ity to establish a mutual and reciprocal relationship with another because
one is now aware that he or she has something unique and special to offer
and share with the other. This awareness derives partly from a sense of self-
worth, pride, and competence that has previously emerged during the vari-
ous earlier stages of the individuality developmental line as well as from an
appreciation of the unique needs of the other. The capacity for intimacy also
derives from a growing recognition of one's own needs and limitations, not
only in what one wants from the other but also in the enrichment one can
gain from the other and the pleasures of sharing and of reciprocal interper-
sonal relationships. Likewise, generativity, as formulated by Erikson, also in-
volves a concern about extending beyond one's own self-interest and dedi-
cating oneself to broader goals, values, and principles, including contributing
to others and society. Thus, Erikson's stages of intimacy and generativity—
the capacity to form a mutual and reciprocal relationship with another and
to dedicate oneself to long-term principles and goals that extend beyond
one's self interest—are both expressions of an integration of earlier develop-
mental levels of individuality and relatedness that have been consolidated in
a mature self-identity, a self-in-relation (Gilligan, 1982,1989b; Surrey, 1985),
an ensembled individualism (Sampson, 1985, 1988), or a full sense of we.
A further and more complete synthesis in the development of related-
ness and individuality ultimately occurs once again later in the life cycle, in
the stage of integrity. Erikson's developmental process culminates in integ-
rity—a stage of "emotional integration" (Erikson, 1968, p. 139)—a new and
more encompassing integration of the two developmental lines based on the
gradual and natural convergence of intimacy and generativity. At midlife
and beyond, intimacy and generativity are integrated in what Erikson termed

integrity, which is an "emotional integration" and "coherence and whole-
ness" (Erikson, 1982, p. 65). Integrity, a new and more encompassing synthe-
sis, is based on both a gradual natural convergence of the two developmental
lines and the ongoing dialectic between mature expressions of self-definition
and relatedness. Experiences of integrity combine intimacy and generativity
with a sense of personal satisfaction in one's commitments and contributions
to communal values (Yankelovich, 1981), to individuals, and to social groups.
These contributions enable one to feel an integral part of the group
(M. Taylor, 1982) and that one's emotional ties to others are satisfying and
reciprocal. Thus, Erikson's advanced stage of integrity versus despair in later
adulthood derives from a further integration of mature expressions of the
relatedness and self-definitional developmental lines, a further synthesis of
individuality and relatedness that had been achieved earlier in the formation
of the self-identity (Blatt & Blass, 1990, 1996).
In addition to feeling that one's life has had value, purpose, and mean-
ing, integrity involves a sense of personal commitment to, and a personal
responsibility for, others and communal well-being. One identifies with so-
cial norms and societal values, and actively supports and participates in them.
As Hanna Arendt (cited in Yankelovich, 1981) noted, one wishes to join
with others in shaping tasks and sharing social meanings and values. Integ-
rity involves communal participation (M. S. Clark, Powell, & Mills, 1986)
and loyalty to a group, not as a source of personal power but as expressions of
economic, religious, and personal allegiances (Nisbet, 1966). One has a sense
of responsibility and purpose, and one assumes a plurality of functions and
loyalties, and accepts and appreciates the contributions of other members to
the collective. The intentional, self-reflective decision to participate in seg-
ments of society as a unique individual enables one to make particular con-
tributions to the collective and the well-being of others on the basis of an
appreciation of the unique talents and capacities that one has to contribute.
Although identity and integrity can be conceptualized as part of the
self-definitional line, these two advanced stages of psychological develop-
ment are also periods of integration and consolidation. Erikson's more ad-
vanced stages of identity versus role diffusion and integrity versus despair are
periods of integration of mature expressions of the relatedness and self-
definitional developmental lines. Thus, the process of integration in these
later two stages results in a new and more complete synthesis in more mature
expressions of both individuality and relatedness (Blatt & Blass, 1990,1996).
THE PROCESSES OF PSYCHOLOGICAL DEVELOPMENT
The articulation of the fundamental developmental lines of relatedness

and self-definition within Erikson's epigenetic developmental model has fa-
cilitated the identification of distinctions implicit within Erikson's formula-

tions that have important implications for understanding the processes of
psychological development (Blatt & Blass, 1990, 1996). The reformulations
and elaborations of Erikson's epigenetic psychosocial developmental model
enable the differentiation and fuller appreciation of the role of two basic
processes of psychological development—internalization and integration—
and their interplay throughout the life cycle.
Internalization
Internalization is a fundamental process through which psychological

development occurs throughout the life cycle. Although the concept of in-
ternalization is central to a number of theories of personality and cognitive
development, as well as to formulations about the nature of therapeutic ac-
tion, the term lacks clear and consistent definition, and its underlying mecha-
nisms have never been fully explicated. Although various authors in psycho-
analysis (e.g., Dorpat, 1974; Loewald, 1973; Meissner, 1979; Schafer, 1968)
and in cognitive, developmental, and social psychology (e.g., L. S. Benjamin,
1995; Deci & Ryan, 1985,1991; Piaget, 1945/1962) have discussed different
types of internalization, issues of relatedness and self-definition and of at-
tachment and separation appear to underlie the processes of internalization
that instigate psychological growth at all developmental levels. The three
levels or types of internalization frequently discussed in the literature (e.g.,
Loewald, 1962, 1973; Schafer, 1968)—incorporation, introjection, and
identification—identify three different developmental levels or degrees with
which aspects of an other are integrated into the functional characteristics of
the self. Incorporation describes those processes of internalization involving a
basic loss of differentiation between self and the other (e.g., a loss of bound-
aries that can occur in more disturbed psychological states, as discussed in more
detail in chap. 8, this volume). Introjection refers to a process in which some-
what differentiated aspects of the other are experienced as part of the self,
but primarily as a foreign presence that is not fully integrated into the self
(e.g., see the discussion [Blatt, 1974; 2004, p. 294] of George, a patient with
severe depression, who at one point in the treatment began to experience a
voice, not unlike that of his father, saying "Die boy die"). Identification de-
scribes a process through which well-differentiated and articulated aspects of
the other are fully integrated into the self and become functional properties
of the self that are coordinated with other aspects of the self (i.e., values).
Because internalization (e.g., Loewald, 1973; Schafer, 1968) or
interiorization (Piaget, 1945/1962) is central to many developmental theo-
ries, it is important to articulate the basic mechanisms of this crucial devel-
opmental process. The first major component of the internalization process
can be conceptualized as the establishment of a gratifying relationship that
has its fundamental antecedents in the good-enough mother-child relation-
ship (Mahler, 1963,1974a; Winnicott, 1953,1965). The mother-infant unity

is the prototype, at a particular developmental level, of the affective bond, or
gratifying involvement, necessary for internalization. Inevitable, progressive,
minute losses of aspects of this gratifying relationship, however, also appear
to be essential for internalization and for subsequent self-object differentia-
tion and individuation. Thus, a second major prerequisite for internalization
appears to be some disruption of the gratifying relationship. If these disrup-
tions are not too great and do not exceed the adaptive capacity of the child,
then the normal infant manages these losses in the mother-infant relation-
ship through processes of internalization (Behrends & Blatt, 1985). As dis-
cussed in chapter 2 (this volume), the subtleties of relational attunement
between caregiver and infant in patterns of affect regulation (Tronick, 1989,
1998) and in experiences of engagement and disengagement in the early
months of life (e.g., Beebe, 1986; Beebe & Lachmann, 1988; Beebe,
Lachmann, & Jaffe, 1997a; Stern, 1985; Tronick, 1989, 1998) and later ex-
periences of contingent and noncontingent response in mother-infant in-
teractions (e.g., Gergely & Watson, 1996) create a dialectical process of grati-
fication and frustration, of disruption and repair, of attachment and separation
(e.g., Bowlby, 1973) that are central to the processes of internalization and
to the development of representations of self and significant others. Thus,
internalization has been described as "a process whereby the child reaches
out to take back from the environment what has been removed from him in
an ever-increasing degree since his birth" (Loewald, 1962, p. 496). Similarly,
Tolpin (1971) linked each step in the separation-individuation process spe-
cifically to the process of internalization: "When a 'tolerable' phase appro-
priate loss of some discrete function that the object carried out for the child
is experienced . . . the psyche does not resign itself to the loss. . . . [I]t pre-
serves the function of the object by internalization" (p. 317).
In the mother's absence, the infant forms sensorimotor patterns based
on experiences with mother that eventually enable the child first to recog-
nize and later to recall qualities of the mother's activity that have become
associated with gratification, comfort, and stimulation. The caregiver repeat-
edly initiated ministrations in response to the infant's distress signals, and
repeated experiences of engagement and disengagement, of match and mis-
match, of contingent and noncontingent responses, of gratifying involve-
ment and experienced incompatibility, result in the child's construction of
schema of expectations of crucial aspects of attachment and separation in
the mother-infant interaction. These rudimentary prerepresentational schema
of caregiving experiences reflect the beginnings of psychological organiza-
tion and individuation as brought about through early forms of internaliza-
tion (Loewald, 1970, 1978). Thus, the development of cognitive-affective
schemas (or representations) of self and significant others is based on the
child's establishing a gratifying involvement and then experiencing a loss,
absence, or disruption of some gratifying aspects of that relationship. If these
disruptions occur at a time and pace that the child can tolerate, they can

serve as the precipitant for the child to establish and subsequently to revise
existing cognitive schemas to include those aspects of the need-gratifying
aspects of the relationship that have been lost or displaced. A highly stable
and predictable environment usually places little demand to revise estab-
lished cognitive schema but perturbations, as Piaget (e.g., 1937/1954) noted,
can be a driving force for revisions of cognitive-affective schemas. Children,
for example, often have a spurt in psychological growth after some change in
their environment such as a family vacation (Blatt, 1974). Perturbations can
be externally induced by changes in the relationship or in the environment,
or internally induced by the individual's recognition of developmentally in-
appropriate aspects of the relationship or of inadequacies in aspects of the
current cognitive-affective schemas. Thus, certain basic mechanisms under-
lie the process of internalization at every developmental level, and these
mechanisms instigate psychological growth throughout the life cycle
(Behrends & Blatt, 1985; Blatt & Behrends, 1987). Two components of the
internalization process are the establishment of a gratifying involvement and,
eventually, experiences of incompatibility with aspects of that gratifying
involvement.
On the basis of these developmental considerations, the first step in the
internalization process, at any level of psychological development, is the es-
tablishment of a gratifying involvement with another person. The term grati-
fying involvement is chosen to convey the assumption that a relationship that
meets certain fundamental needs creates an impetus to internalize the need-
gratifying functions of the relationship when these functions are disrupted.
Even though the needs of the individual, and the manner in which relation-
ships meet them, change in form and complexity with development, a grati-
fying involvement with another person appears to be an essential precondi-
tion for internalization at every developmental level.
Gratifying involvement refers to a relationship with a significant other
in which the individual's phase-appropriate psychological needs are met. A
gratifying involvement does not necessarily refer to a relationship that grati-
fies infantile needs, is a healthy one, or even occurs on a direct behavioral
level. Rather, gratifying involvement signifies that individuals, at each level
of psychological development, experience relationships in terms of certain
basic psychological needs. Thus, what constitutes a gratifying involvement
changes with maturation. In early infancy, for example, gratifying involve-
ment refers to the mother's responding sufficiently and appropriately (being
a "good enough mother") to the infant's needs. But gratifying involvement
also occurs in the context of relationships that not only offer closeness and
intimacy but also encourage individuation and autonomy by respecting dif-
ferences and tolerating disengagement as well as expressions of disagreement
and even anger. A gratifying involvement with others, at any level, enables
the person to function with a degree of coherence and integrity that would
not otherwise be possible. The establishment of a gratifying involvement is

an essential precondition for internalization, but it is only with the disrup-
tion of this involvement that internalization takes place (Behrends & Blatt,
1985).
The prototype of this second step in the internalization process is the
inevitable disruption of the mother-infant unity. These developmental cri-
ses can be conceptualized as experienced incompatibilities, a term borrowed from
George Klein (1976). Klein originally used this term to describe experiences
when the integrity of a person's identity or self-structure is threatened in
some fashion (i.e., by conflicting aims, developmental crises, traumas, or cir-
cumstances), provoking a sense of limitation or dissociation of the self. This
concept can be extended, however, to place more emphasis on disruptions
within a relational matrix in which a previously established relationship no
longer meets the needs of at least one of the participants. Experienced in-
compatibility can take many forms, including object loss, deprivation of func-
tion, intrapsychic conflict, conflict between one's own wishes and the de-
mands and limitations of the environment, and maturational change. The
concept of experienced incompatibility, because it is not restricted to object
loss alone, provides an expanded conceptualization of the various cleavages,
rifts, and discontinuities in interpersonal relations that can instigate the pro-
cess of internalization at any level (Behrends & Blatt, 1985).
Experienced incompatibility occurs when the relationship no longer meets
the needs of at least one of the participants. The individual, in an attempt to
preserve psychologically significant aspects of the relationship, gradually trans-
forms those functions that the relationship had previously provided into his
or her own enduring self-generative functions and characteristics. Psycho-
logically significant aspects of the relationship that are internalized include
feelings, attitudes, and behavioral expressions, both conscious and uncon-
scious, which are present in the gratifying involvement. Components of the
relationship that were not gratifying may also be internalized. Thus, for ex-
ample, hostile introjects—that is, conscious and unconscious destructive el-
ements in the relationship—may be internalized because they are intimately
tied to some aspect of the relationship that was gratifying (Behrends & Blatt,
1985).
An experienced incompatibility may occur either consciously or un-
consciously, symbolically or presymbolically. Experienced incompatibility can
come about for a variety of reasons including the possibility that the other
person either no longer wants to or is no longer able to gratify one's needs.
Incompatibility may occur when one of the individuals, in his or her own
right, feels ready to move the relationship to a more mature or less mature
level. If the disruption in the relationship is not too sudden or severe, then
the individual can preserve psychologically significant aspects of the previ-
ous gratifying involvement through internalization. And the internalization
results in changes in the content and structural organization of representa-
tions of the self and the significant other, and of their relationship. If the

disruption in the relationship is premature, then the individual may not be
prepared to internalize aspects of the relationship and thus may be forced to
resort to other, less successful, means of adaptation (i.e., the experience of
anxiety and the formation of symptoms or the development of some form of
pathological mourning) for the loss of gratifying involvement.
The view that experienced incompatibility in a gratifying involvement
leads to intemalization is consistent with S. Freud's (1938/1959d) concept of
superego formation, in which the threat of object loss precipitates recovery
or restitution through identification with, or intemalization of, the lost ob-
ject. S. Freud (1938/1959d) wrote,
A portion of the external world has, at least partially, been abandoned as

an object and has instead, by identification, been taken into the ego and
thus become an integral part of the internal world. This new psychical
agency continues to carry on the functions which have hitherto been
performed by people (the abandoned objects) in the external world,
(p. 205)
Conceptualizations of intemalization, however, have been extended beyond

superego formation to include all processes in which interactions in the en-
vironment are transformed into inner regulators and are taken on as charac-
teristics of the self (e.g., Hartmann, 1939/1958b; Loewald, 1962,1973; Schafer,
1968). Thus, intemalization of aspects of a significant interpersonal rela-
tionship is a primary basis for the development of psychological structures
and organization involving revisions and reorganizations of representations
of self and significant others.
Superego formation (the establishment of values and a moral code) is a
prototypic example of the process of intemalization leading to increased
separation-individuation. The child increasingly experiences new forms of
gratifying involvement (admiration, attraction) and experiences incompat-
ibility (rivalry, resentment, and even death wishes) in relation to each par-
ent within the family matrix, prompting the child to revise earlier schemas
and thereby develop new levels in the organization of cognitive-affective
schemas of self and of significant other and of their relationship. Through
the process of intemalization the child is able to establish a new and more
mature (more symbolic) level of gratifying involvement with each parent
based on identification. These internalizations occur in the context of the
child's beginning experiences of participating in a triadic family system in
contrast to the earlier experiences of dyadic interactions with each parent
separately. In these triadic (oedipal) interactions the child internalizes not
only aspects of earlier dyadic relationships with each parent but also aspects
of the triadic structure of the parental marital system in relation to him- or
herself (Laplanche & Pontalis, 1974) as well as aspects of the relationship of
the parents with each other. The internalizations achieved in this develop-
mental phase become increasingly refined and integrated through subsequent

experienced incompatibilities of gratifying involvements that occur as the
child matures through adolescence and beyond.
The individual, in an attempt to preserve psychologically significant
aspects of the relationship, gradually transforms those functions that the rela-
tionship had previously provided into his or her own enduring self-generative
functions and characteristics. Psychologically significant aspects of the rela-
tionship, gratifying elements, and the forms of experienced incompatibilities
as well as other distinguishing characteristics of the relationship, including
conscious and unconscious feelings and attitudes experienced in the responses
of significant others to aspects of the self that are expressed in the relation-
ship, are internalized. Gratifying as well as nongratifying components of the
relationship may be internalized. On the basis of these developmental con-
siderations, Behrends and Blatt (1985) defined internalization as "those pro-
cesses whereby individuals recover lost or disrupted regulatory, gratifying in-
teractions with others, which may have been either real or fantasized, by
appropriating those interactions, transforming them into their own, endur-
ing, self-generated functions and characteristics" (p. 22).
This view of the internalization process is consistent with intersubjective
views that children become independent subjects only if they are recognized
by a significant other as having a mind, will, and feelings of their own
(J. Benjamin, 1990, 1995; Fonagy, Gergely, Jurist, & Target, 2002; Ogden,
1994; Winnicott, 1971) beginning early in life, long before the infant has
intentionality, feelings of bodily cohesiveness, self-reflexivity, and symboliz-
ing capacities. And the child becomes an independent subject in recognizing
the independent subjectivity of his or her caregiver. Being regarded as inde-
pendent subject enables the child to appreciate another's independent sub-
jectivity. This mutual recognition of each other's mental states by caregiver
and child, of their feelings, thoughts, wishes, fears, and intentions, is the
psychological capacity necessary for intersubjective relatedness. The trans-
actional matrix from which this capacity emerges is a basis for the further
development of representations of self and significant others (J. S. Auerbach
& Blatt, 2002).
The establishment of a gratifying involvement and the subsequent ex-
perience of an incompatibility in the context of a psychologically significant
relationship constitute the fundamental underlying mechanisms of the in-
ternalization process, resulting in increased psychological differentiation and
individuation. Psychological growth occurs as these elemental steps are re-
peated, again and again, over the course of the entire life cycle, in a "hierar-
chical spirality" (Werner, 1948). At various levels of psychological develop-
ment, the mechanisms of this process remain the same even though they are
manifested in new forms and in new contexts and result in increasingly greater
psychological differentiation and higher levels of organization. The shift to
internal regulation occurs throughout life and, in fact, psychological devel-
opment is never fully complete. The internalization process, and the increased

psychological differentiation and capacity for relatedness that results from it,
is basic to all developmental periods and constitutes the essence of psycho-
logical growth throughout life. And this psychological development is ex-
pressed in increasingly differentiated, articulated, and integrated representa-
tions of self and significant others. New levels of internalization provide a
more diverse and complex psychological matrix that can serve as the sub-
strate for subsequent internalization and psychological growth.
As a consequence of internalization, various levels of constancy in the
development of the structural or procedural organization of the representa-
tion of self and others are achieved at different developmental levels, includ-
ing libidinal (affect), object and self-constancy, a sense of we or of a self-
in-relation, and the development of operational thought (e.g., Blatt, 1991a,
1995a; Fraiberg, 1969; A. Freud, 1965; Jacobson, 1964; Mahler, 1974a; Piaget,
1937/1954). The structural organization of representations of the other and
the self is revised and modified throughout development, enabling individu-
als to think of themselves and others in a more differentiated and integrated
fashion and to relate to others in more mature ways. The various levels of
constancy in the development of mental representation of self and others
provide a way of identifying the development of aspects of the prototypic
structures inherent in interpersonal knowledge (e.g., M. W. Baldwin, 1992;
Clyman, 1991; Fehr, 2005; Rosch, 1973a, 1973b)—prototypic structures that
are organized around affective and relational terms (e.g., trust, commitment,
and intimacy; Fehr, 2005), as discussed in chapter 2 (this volume). The iden-
tification of these points in the development of the organization of prototypic
structures in the representations or schemas of self and other, and their inter-
action, is discussed further in chapter 8 (this volume) in the consideration of
the revisions in mental representation that can take place in the psycho-
therapeutic process (see also Baccus & Horowitz, 2005; Blatt, Stayner,
Auerbach, & Behrends, 1996; Eklund & Nilsson, 1999; Hermans, 2005;
M. J. Horowitz, 1979,1991; Piper, Joyce, McCullum, Azim, & Ogrodniczuk,
2002; Scarvalone, Fox, & Safran, 2005).
Procedural aspects of representations (e.g., Kihlstrom & Cantor, 1984)
are the implicit aspects of the rules that influence organizational processes
and guide action sequences (Grigsby & Hartlaub, 1994; Squire & Cohen,
1984) of how to proceed and do things. These dimensions of knowing are
nonconscious and are powerful interactive "emotional schemes" (Bucci,
1997)—which Lyons-Ruth and her colleagues in the Process of Change Study
Group (e.g., 1998) called "implicit relational knowing"—that have impor-
tant affective and interpersonal as well as cognitive dimensions. Beebe and
Lachmann (2002) believed that these implicit dimensions are more perva-
sive and powerful organizers of behavior than are the explicit dimensions of
representations. Clyman (1991) noted that these implicit procedural dimen-
sions provide developmental continuity. Beebe and Lachmann (2002) stressed,
however, consistent with Bowlby (1973), Sander (1995), and Sameroff (1983),

that these implicit or procedural dimensions of representations can be trans-
formed by important developmental events. Beebe and Lachmann (2002)
cited research by Freeman (1987, 1991) and by Thelen and Smith (1994)
that suggests an interactive model in which representations are continually
revised by experiences and are in a "continually shifting process of emergent
organization" (Beebe & Lachmann, 2002, p. 229). Thelen (1998) and Thelen
and Smith (1994) argued that representations are context sensitive, which
allows for the possibility of change. And Beebe and Lachmann (2002) sug-
gested that interpersonal experiences of separation and reunion, disruptions
and their repair, and gratifying involvement and experienced incompatibil-
ity (Behrends & Blatt, 1985) may be part of the critical context that leads to
revisions of representations. As Beebe and Lachmann (2002) suggested, con-
sistent with formulations in this chapter and in chapter 8 (this volume),
these procedural dimensions of representation are relatively fixed and rigid
in psychopathology (Blatt, 1995a), whereas flexible response to contextual
changes (e.g., Thelen, 1998) is essential for development.
Because the substrate of intemalization is the relationship, changes in
representation that occur when one of the individuals achieves a higher level
of intemalization are likely to affect the other because they can be experi-
enced as an incompatibility within the relationship that may prompt new
internalizations for the other person as well. By implication, then, it is not
only the child who internalizes and revises the schemas of self and other, but
the caring parent does so as well—not just the patient who internalizes but
also the therapist. The inevitable changes, surprises, and disruptions that
accompany any significant relationship can create the conditions in which
internalizations are likely to occur for both individuals. These new levels of
intemalization can provide a richer and more complex psychological matrix
that can then serve as the new substrate for subsequent intemalization and
psychological growth. It is important to stress that these processes of inter-
nalization can occur on a psychological level involving subjective experi-
ences and the unique construction of meaning. Although experiences of grati-
fying involvement (relatedness) and of experienced incompatibility
(separation) are the crucial factors in development, it is not just the manifest
behavior or actual events that matter in psychological development but the
personal meaning that these events have for the individual matters as well.
Thus, with increased psychological development, internalizations can come
about from elements of gratifying involvement and experienced incompat-
ibility on a purely subjective level without overt observable activities or ex-
periences (Behrends & Blatt, 1985).
Understanding the processes of intemalization can enrich our appre-
ciation of the interaction between aspects of the relatedness developmental
line and two components of the self-definitional developmental line—
expressive behavioral mode of self and self-feelings—that was articulated in
the extension and elaboration of Erikson's psychosocial formulations discussed

earlier in this chapter. These three dimensions of psychological development
provide further understanding of the links between internalization and revi-
sions of the sense of self as well as interpersonal relatedness. Gratifying in-
volvement, an inherent component of the internalization process, occurs in
experiences of both relatedness and separateness. On the attachment line,
gratifying interactions involve a sense of relatedness (e.g., trust, cooperation,
or intimacy); gratifying involvement on the separateness (or self-definitional)
line is different and includes experiences of the object's reactions to the
individual's expressions of his or her emerging sense of self as separate, dis-
tinct, and functional. The individual internalizes his or her own experiences
in the expression of his or her functional (behavioral) capacities as well as
the conscious and unconscious reactions of significant others and their ac-
ceptance and rejection of various aspects of the individual's expressive modes
of self—of the individual's expressions of autonomy, initiative, and industry—
that occur in the relationship. Gratifying involvement in the self-definitional
developmental line is based on the object's conscious and unconscious atti-
tudes and feelings in response to the individual's phase-specific behavioral
expressions of self. Gratifying involvement is experienced in both the qual-
ity of the attachment relationship and the object's reactions to the individual's
emerging behavioral expressions of a sense of self. The acceptance of expres-
sions of autonomy, initiative, and industry and the sharing of experiences of
trust, cooperation, mutuality, and intimacy determine the extent to which
the relationship is experienced as gratifying. These formulations broaden the
concept of the "good enough mother" to include not only the mother as early
caregiver but all significant responses of caregivers to the individual's earliest
self and relatedness needs as well as to expressions of such needs throughout
life. It is the psychological context and the object's response to the child's
broad psychological needs for attachment and self-expression that are basic
to a sense of gratification. The acceptance of expressions of autonomy, ini-
tiative, and industry, as well as the sharing of trust, cooperation, mutuality,
and intimacy, determines the extent to which the relationship is experienced
as gratifying. Although the internalizations of the two aspects of the separa-
tion line (self-expression and self-feeling) are interrelated, they also have a
degree of independence: The self-feeling may influence the expressive mode
of self, but the expressive mode is not completely dependent on the self-
feeling. Nevertheless, internalization of these three aspects of psychological
development (attachment, self feeling, and expressive mode of self) provides
the basis for the formation and consolidation of self-identity (Blatt & Blass,
1990, 1996).
As noted earlier, Erikson (1968) indicated that the psychological pro-
cesses that occur with the establishment of identity involve more than inter-
nalization and identification: "The limited usefulness of the mechanism of
identification [emphasis added] becomes at once obvious if we consider the
fact that none of the identifications of childhood . . . could, if merely added

up, result in a functioning personality" (p. 158). [Identity] is "superordinated
to any single identification with individuals of the past: it includes all signifi-
cant identifications, but it also alters them in order to make a unique and a
reasonably coherent whole of them" (Erikson, 1959, pp. 112-113).
Thus, the synthesis in late adolescence of earlier identifications or in-
ternalizations is mediated through a second major developmental mecha-
nism: integration. This process of integration, beginning in adolescence, is
primarily a synthesis of the various self-feelings, modes of experience, and
the quality of interpersonal attachments that have been acquired in the ear-
lier stages rather than new internalizations derived from present relation-
ships (Blatt & Blass, 1990, 1996).
Integration
A marked change occurs in the developmental processes in adolescence

when various aspects of self-development—expressive modes of self and self-
feelings—and aspects of interpersonal relatedness merge and become inte-
grated in the formation of a self-identity. Identify formation, a sense of self-
in-relation to others, as noted earlier, derives from an integration of aspects
of the expressive modes of self-definition (i.e., autonomy, initiative, and in-
dustry) and self-feelings (i.e., pride, self-esteem, and confidence) with inter-
personal experiences of trust and cooperation with others. This new synthe-
sis in an identity formation of a self-in-relation is expressed in adulthood in
mature expressions of intimacy and generativity—in expressions of the ca-
pacity and desire to participate in relationships and social groups based on an
appreciation of what one has to contribute to others as well as gain from
participating in a relationship and collective. With the shift from processes
of identification and intemalization to the integration of experiences of re-
latedness and self-definition, as well as the consolidation and convergence of
the two developmental lines in identity formation in late adolescence, the
motivating forces in personality development become increasingly symbolic.
These more mature integrated expressions of self-definition and interper-
sonal relatedness become even more fully integrated in later adulthood, even-
tually leading to a sense of integrity.
Experiences of integrity in later adulthood derive from a further and
more comprehensive synthesis of the development of relatedness and indi-
viduality. As noted earlier, integrity is an "emotional integration" (Erikson,
1968, p. 139), a "coherence and wholeness" (Erikson, 1982, p. 65) that de-
rives from the gradual convergence and integration of experiences of inti-
macy and generativity—from a more complete synthesis of relatedness and
individuality in mature expressions of intimacy and generativity. Thus,
Erikson's stages of identity and integrity are periods of synthesis, integration,
and consolidation that result in a sense of personal satisfaction in a commit-
ment to contribute to individuals, social groups, and communal values.

The relative shift from identification and internalization to integra-
tion as the primary mechanism of psychological development in identity
formation and integrity marks a major change in the nature of the develop-
mental process from adolescence onward. Powerful innate biological forces
shape and influence interpersonal interactions in early development dur-
ing the more biologically driven oral, anal, phallic, oedipal, and latency
periods, as well as during adolescence, with the resurgence of sexuality.
Change in psychological development occurs during adolescence in the
self-definitional developmental line with the integration of the expressive
mode of self and of self-feelings. These two modes of the self-definition
developmental line become more integrated, internal, and conceptual be-
ginning in adolescence in the development of identity and integrity. In
preadolescent stages, by contrast, self-expression was more enactive and
behavioral. The shift inward in adolescence is reflected in the convergence
of expressive behavioral modes with self-feelings. A similar view was pro-
posed by Butler (1963) and Neugarten (1964) who called attention to a
decrease in ego energy (Neugarten, 1964) and a shift in ego style (Butler,
1963) and increased interiority of the personality (Neugarten, 1964) to
describe the change in focus to more internal psychological needs in the
second half of the life cycle. This increased reflectivity and general shift
from concrete behavioral experiences to more internal psychological expe-
riences is also consistent with Piaget's (1937/1954) observations that with
the development of formal operational thought in adolescence, the indi-
vidual can now deal with abstract internal dimensions such as values and
attitudes (Blatt & Blass, 1990, 1996).
Following adolescence the motivating forces become more psychologi-
cal and symbolic. Colarusso and Nemiroff (1981), for example, viewed de-
velopment in infancy and childhood as stimulated by the emergence of in-
tense needs and the appropriate gratification and frustration of these intense
needs. Adult development, in contrast, is stimulated more by psychological
awareness. Several research groups (e.g., Benedek, 1975; Binstock, 1973;
Colarusso & Nemiroff, 1981; Gutmann, 1992; Settlage, 1980) conceptual-
ized adult development as involving the emergence of new psychological
organization as well as a rearrangement and a "psychological reorganization"
(Benedek, 1975, p. 338) of structures that had developed prior to adoles-
cence. Gutmann (1987, 1992), in an extensive series of investigations of
older men and women in various cultures, noted a "postparental transition
toward androgyny," a "countersexual transition" to acquire "appetites, atti-
tudes and even behavior characteristic of the opposite sex.... Men discover
a ... vein of nurturance and aesthetic sensibility; women discover tough,
managerial, and competitive qualities" (Gutmann, 1992, p. 289). Construc-
tive transition at midlife and beyond is often expressed in a fuller integration
of features of both developmental lines—of capacities for self-definition and
interpersonal relatedness.
DIALECTICAL DEVELOPMENT ]27

Although integration comes to predominate over internalization and
identification as the primary mechanism of psychological development later
in the life cycle, a balance between internalization and integration is essen-
tial to normal development. Integration depends on the qualities of prior
internalizations (identifications) from the two fundamental developmental
lines—of aspects of self-definition and of increasingly mature relationships.
And conversely, internalization without integration would result in limited
psychological development. In preadolescence and adolescence, the lack of
integration would result in confusion that would become especially intense
in late adolescence when the developmental demand is for identity consoli-
dation (Blatt & Blass, 1990). Integration of various internalizations is vital
during this period. At adolescence and beyond, the major effect of deficient
integration would be the emergence of a sense of meaninglessness, fragmen-
tation, and a lack of purpose, partially expressed by despair, a term Erikson
used to describe the negative outcome of the stage of integrity. In contrast,
integration of essentially positive realistic elements that have been internal-
ized in the relatedness and self-definition developmental lines creates a psy-
chological context, in adolescence and beyond, that enables the individual
to develop coordinated and mature expressions of relatedness and self-
definition, and to cope effectively with the later vicissitudes of the life cycle
at midlife and throughout aging into senescence (Blatt & Blass, 1990, 1996).
SUMMARY
Reformulation of Erikson's epigenetic model of psychosocial develop-

ment provides an opportunity to articulate more fully the contributions that
the evolving capacities for interpersonal relatedness and self-definition make
to psychological development. Erikson's formulations also provide an oppor-
tunity to consider how aspects of these two fundamental developmental lines
are eventually integrated, beginning in late adolescence, in the development
of a self-identity—of the we system (Emde, 1981; G. S. Klein, 1976), a sense
of self-in-relation (e.g., Surrey, 1985), or ensembled individualism (e.g.,
Sampson, 1985,1988).
The basic theoretical model proposed in this chapter views personality
development as the result of a complex synergistic transaction of two funda-
mental developmental lines throughout the life cycle: (a) the development
of increasingly mature, reciprocal, and satisfying interpersonal relationships;
and (b) the development of a consolidated, realistic, essentially positive, in-
creasingly integrated self-definition or identity. These two developmental
lines normally evolve throughout the life cycle in a complex dialectical pro-
cess. The development of an increasingly differentiated, integrated, and ma-
ture sense of self is contingent on establishing satisfying interpersonal expe-
rience and, conversely, the development of increasingly mature and satisfying

interpersonal relationships depends on the development of more mature self-
definition and identity. In normal personality development, these two de-
velopmental processes evolve in an interactive, reciprocally balanced, mutu-
ally facilitating fashion from birth through senescence (Blatt & Blass, 1990,
1996; Blatt & Shichman, 1983). Furthermore, the articulation of the two
primary developmental lines of relatedness and self-definition highlights the
interactive role of gratifying involvement and experienced incompatibility
in facilitating the developmental processes of internalization (or identifica-
tion) and integration, each of which is the predominant developmental
mechanism in different phases of the developmental process.
Subsequent chapters demonstrate that the articulation of these two fun-
damental developmental dimensions of relatedness and self-definition con-
tribute not only to a fuller understanding of personality development but
also to an understanding of variations in normal character or personality
formation (see chap. 5, this volume), to an integrated conceptualization of
wide range of psychopathology in adults as exaggerated, distorted, one-sided
preoccupations with issues either of relatedness or of self-definition (see chap.
6, this volume), and to a fuller understanding of some of the mechanisms of
therapeutic action and therapeutic change that can occur in long-term in-
tensive as well as in brief treatment (see chaps. 7 and 8, this volume).

TWO PRIMARY CONFIGURATIONS OF
5
PERSONALITY ORGANIZATION
Mature personality organization involves the internalization and inte-

gration, over succeeding developmental levels from infancy to adulthood, of
mutually facilitating age-appropriate experiences of relatedness and self-
definition. But even within this balanced normal range, most individuals
place a somewhat greater emphasis on one or the other of these fundamental
dimensions—on issues of relatedness or self-definition. As S. Freud noted
(1930/1961), each individual struggles with these two dimensions because
they stand "in opposition to each other and mutually dispute the ground"
This chapter incorporates material from (a) "A Cognitive Morphology of Psychopathology," by S. J.
Blatt, 1991, Journal of Nervous and Mental Disease, 179, pp. 449-458. Copyright 1991 by Williams and
Wilkins. Adapted with permission; (b) "Representational Structures in Psychopathology," by S. J.
Blatt, 1995, in D. Cicchetti and S. Toth (Eds.), Rochester Symposium on Developmental Psychopathology:
Vol. 6. Emotion, Cognition, and Representation (pp. 1-33). Rochester, NY: University of Rochester
Press. Copyright 1995 by the University of Rochester Press. Adapted with permission; (c)
"Contributions of Psychoanalysis to the Understanding and Treatment of Depression," by S. ]. Blatt,
1998, Journal of the American Psychoanalytic Association, 46, pp. 723-752. Copyright 1998 by the
American Psychoanalytic Association. Adapted with permission; (d) Experiences of Depression:
Theoretical, Clinical, and Research Perspectives, by S. ]. Blatt, 2004, Washington, DC: American
Psychological Association. Copyright 2004 by the American Psychological Association; and (e) "Two
Primary Configurations of Psychopathology," by S. J. Blatt and S. Shichman, 1983, Psychoanalysis and
Contemporary Thought, 6, pp. 187-254. Copyright 1983 by International Universities Press. Adapted
with permission.
133
(p. 140). Within the normal range, this relative emphasis on one or the other
of these dimensions delineates two basic personality or character styles, each
with a particular experiential mode; preferred forms of cognition, defense,
and adaptation; different aspects of interpersonal relatedness; and specific
forms of object and self-representation (Blatt, 1990a; Blatt & Shichman,
1983). As Bakan noted (1966), individual differences in personality style
and motivational disposition are determined in part by which of these two
dimensions—interpersonal relatedness or self-definition (communion or
agency)—an individual gives priority (Maddi, 1980). S. Freud (1930/1961),
in fact, distinguished between "the man who is predominantly erotic" and
gives "first preference to his emotional relationships to other people ... [and]
the narcissistic man, who inclines to be self-sufficient . . . [and] seek[s] his
main satisfactions in his internal mental processes" (pp. 83-84).
VARIATIONS IN NORMAL PERSONALITY OR CHARACTER STYLE
Blatt (1974) and Blatt and Shichman (1983), linking the fundamental
polarity of relatedness and self-definition to personality organization, used
the term anaclitic for the personality organization predominantly focused on
interpersonal relatedness. The term anaclitic was taken by S. Freud (1905/
1963b, 1915/1957d) from the Greek anklitas—to rest or lean on—to charac-
terize interpersonal relationships that initially derive from the very early de-
pendency experienced in satisfying drives such as hunger with a love object
such as mother (Gove, 1966; Laplanche & Pontalis, 1974). The term
introjective designates the personality organization focused primarily on self-
definition. Introjection was a term used by S. Freud (1917/1957h) to describe
processes whereby values, patterns of culture, motives, and restraints are as-
similated into the self (e.g., made subjective), consciously and unconsciously,
as guiding personal principles through learning and socialization (Gove, 1966).
Spiegel and Spiegel (1978), influenced by Friedrich Nietzsche (1907), used
the terms Dionysian and Apollonian to distinguish two similar personality styles.
Extensive research in nonclinical settings, with the Depressive Experiences
Questionnaire (DEQ; Blatt, D'Afflitti, & Quinlan, 1976, 1979; see pp. 141-
154 for a detailed discussion of the DEQ) and similar scales such as the
Sociotropy-Autonomy Scale (SAS; A. T. Beck, 1983) that assess anaclitic
and introjective personality dimensions, has consistently found differences
between individuals with predominantly anaclitic personality features and
those with predominantly introjective personality qualities (see summary in
Blatt, 2004; Blatt & Zuroff, 1992).
Introjective (or Apollonian) Personality Organization

Introjective (Apollonian) individuals, individuals focused more on is-
sues of self-definition than on issues of interpersonal relatedness, are described

EXHIBIT 5.1
Introjective (Apollonian) Personality
Thought processes: Literal; critical; focused on overt behavior, manifest form, logic,
consistency, and causality.
Emphasis on linguistic (sequential) processes.
Cognitive focus: Analytic: Critical evaluation of details and separate elements.
Cognitive style: Field independent, sensitized, sharpens differences.
Object relations: Assertion, control, autonomy, power, prestige.
Instinctual focus: Aggression in service of self-definition.
Primary defenses: Counteractive (e.g., projection, reaction formation, intellectual-
ization, overcompensation).
Character style: Organized, critical, steady, responsible, reliable, unemotional,
cautious, methodical, with an emphasis on control and reason.
Dominated by issues of the head (Spiegel & Spiegel, 1978).
by Blatt and Shichman (1983) and Spiegel and Spiegel (1978) as literal and
critical in their thinking (see Exhibit 5.1). Overt behavior, manifest form,
logic, consistency, and causality are attended to rather than feelings and in-
terpersonal relationships. Research evidence (Szumotalska, 1992) indicates
that Apollonians think primarily in sequential and linguistic terms and em-
phasize analysis or the critical dissection of details and the juxtaposition and
comparison of part properties, rather than minimizing differences to achieve
integration and synthesis of the larger totality. These introjective or
Apollonian individuals tend to be sensitizers or sharpeners in their cognitive
style (e.g., R. W. Gardner, Holzman, Klein, Linton, & Spence, 1959; R. W.
Gardner, Jackson, & Messick, 1960), noting and emphasizing differences and
contradictions. They are predominantly field independent (Witkin, 1965;
Witkin, Dyk, Faterson, Goodenough, &.Karp, 1962): Their experiences and
decisions are determined primarily by internal appraisal rather than by envi-
ronmental events. Their basic instinctual focus is on aggression and self-
assertion with the goal of achieving autonomy, control, power, and prestige,
primarily in the service of differentiation and self-definition. They are ide-
ational in orientation, are judgmental and critical of self and of others, and
value control and reason over emotions. They are usually steady, responsible,
reliable, unemotional, highly organized individuals who use logic and reason
to plan for the future. They value their own ideas, use them as a primary
reference point, and seek to influence others to accept and conform to their
views. They tend to dominate interpersonal relationships, seek to be in con-
trol, and are often critical of the ideas of others. They are cautious and me-
thodical, comparing and contrasting alternatives and evaluating ideas and
situations piece by piece before arriving at a final decision and taking action.
Because they often pride themselves on being responsible, they are hesitant
about making commitments, but once these commitments are made, they
feel obligated to carry them out. Usually highly reliable and steadfast, they
tend to stick rigidly to a decision once it has been made, and are relatively
TWO PRIMARY CONFIGURATIONS OF PERSONALITY ORGANIZATION 135

uninfluenced by others. They seek to make sure that things are carried out
correctly and precisely (perfectly); they plan logically and systematically.
Spiegel and Spiegel (1978) succinctly summarized this personality style by
noting that Apollonian or introjective individuals are more organized and
influenced by the head than by the heart.
Extensive empirical investigation indicates that markedly introjective
(highly self-critical) individuals—that is, individuals in both clinical and
nonclinical samples with elevated scores on the Self-Criticism factor of the
DEQ—were more introverted (Mongrain, 1993); resentful, irritable, and criti-
cal of themselves and others (Zuroff, 1994); and isolated and distant from
others (Mongrain, Vettese, Shuster, & Kendal, 1998; Mongrain & Zuroff,
1994). Their interpersonal interactions are relatively unpleasant (Zuroff,
Stotland, Sweetman, Craig, & Koestner, 1995) and hostile (Mongrain et al.,
1998; Zuroff & Duncan, 1999). Although concerned about achievement,
possibly because of apprehensions about failure, they are less agentic (Zuroff,
Moskowitz, Wielgus, Powers, & Franko, 1983). As college students, these
more hostile individuals are more frequently rejected by their roommates
(Mongrain, Lubbers, & Struthers, 2004). They usually have a fearful, avoidant
attachment or interpersonal style (Blatt & Homann, 1992; K. N. Levy &
Blatt, 1999) and, as Mongrain et al. (2004) found, are usually located in the
hostile-submissive quadrant of the circumplex model of personality func-
tioning (Laforge & Suczek, 1995; Wiggins & Trapnell, 1996). Extensive re-
search on self-critical perfectionism, a personality dimension central in
introjective personality organization (e.g., Dunkley, Blankstein, Halsall,
Williams, & Winkworth, 2000; T. A. Powers, Zuroff, & Topciu, 2002), indi-
cates that these individuals have low self-esteem (e.g., Zuroff et al., 1983),
report depressive symptoms (e.g., Dunkley & Blankstein, 2000), are vulner-
able to substance abuse (specifically opiate addiction [Blatt, Rounsaville, Eyre,
& Wilbur, 1984]) and eating disorders (Bers, 1988; Lehman & Rodin, 1989;
Steiger, Gauvin, Jabalpurwala, Seguin, & Stotland, 1999; Steiger, Leung,
Puentes-Neuman, & Gottheil, 1992; Steiger, Puentes-Neuman, &. Leung,
1991), are excessively worried (Stober, 1998), have intense negative and less
positive affect (e.g., Dunkley, Zuroff, & Blankstein, 2003; Mongrain, 1998;
Zuroff, Moskowitz, & Cote, 1999; Zuroff et al., 1995), and tend to assume
blame (Dunkley, Zuroff, & Blankstein, 2003; Hewitt & Flett, 1991) and to
be ruminatively critical of themselves (Frost et al., 1997) and of others (Vettese
& Mongrain, 2001).
Zuroff (1994) and Dunkley, Blankstein, and Flett (1997) found that
Self-Critical Perfectionism is related to neuroticism and low agreeableness
on the NEO Five-Factor Inventory (Costa & McCrae, 1985) and to negative
and problematic interpersonal relationships (e.g., Mongrain, 1998; Mongrain,
Vettese, Shuster, & Kendal, 1998; Whiffen & Aube, 1999; Whiffen, Aube,
Thompson, & Campbell, 2000; Zuroff & Duncan, 1999). These individuals,
for example, are sensitive to concerns about ridicule and are formal, reserved,

distant, and cold (Alden & Bieling, 1996; Mongrain & Zuroff, 1994). They
avoid close intimate relationships and are dissatisfied, distrustful, and non-
self-disclosing in their relationships (e.g., Mongrain, 1998; Mongrain & Zuroff,
1995). They often try to manipulate others through flattery, craftiness, and
deception. They respond to stress with feelings of guilt, self-blame, and hope-
lessness, and they usually use maladaptive, non-problem-focused coping strat-
egies. Their self-critical attitudes derive from intrusive and punitive parent-
child relationships (see summaries of these research findings in Blatt, 2004;
Blatt & Homann, 1992).
Critical, judgmental, demanding, disapproving, and punitive parents
lead to negative representations of self and others (Blatt, 1995a; Blatt &
Homann, 1992; Frost, Lahart, & Rosenblate, 1991; Koestner, Zuroff, & Pow-
ers, 1991; Mongrain, 1998; Zuroff, Koestner, & Powers, 1994). Self-critical,
introjective individuals have unrealistic goals and stringent standards (Nietzel
& Harris, 1990), react strongly to any implications of their personal failure
and loss of control (Dunkley et al., 2003), and are very concerned about how
others react to their mistakes (e.g., Frost et al., 1997). They are easily pro-
voked to anger, which they direct toward others as well as themselves (Hewitt
& Flett, 1991), and they can be self-destructive and suicidal (e.g., Adkins &
Parker, 1966; A. T. Beck, 1983; Beutel et al., 2004; Blatt, 1974,1995a; Blatt,
Quinlan, Chevron, McDonald, & Zuroff, 1982; Fazaa, 2001; Fazaa & Page,
2003; Hewitt, Flett, & Weber, 1994; Hewitt, Newton, Flett, & Callander,
1997). Fazaa and Page (2003), controlling for level of depression, found that
suicide attempts in introjective, self-critical college students showed greater
intent to die and greater lethality than did such attempts in anaclitic stu-
dents. These suicide attempts in introjective college students were often in
response to an "intrapsychic stressor" (Fazaa & Page, 2003).
Self-critical individuals generate stressful life events involving rejec-
tion and confrontation (Beutel et al., 2004; Dunkley & Blankstein, 2000;
Dunkley, Blankstein, Halsall, Williams, & Winkworth, 2000; Priel & Shahar,
2000; Zuroff & Duncan, 1999); they do not elicit social support or turn to
others (Beutel et al., 2004; Enns et al., 2003; Mongrain, 1998; Priel & Shahar,
2000). Thus, their interpersonal relationships are characterized by pervasive
negative expectations (Mongrain, 1998) and feelings of isolation, shyness,
and a lack of self-esteem. They have impaired social skills (Campbell, Kwon,
Reff, & Williams, 2003; Flett, Hewitt, & DeRosa, 1996) that are expressed
in feelings of mistrust and a lack of intimacy (Zuroff & Fitzpatrick, 1995).
They have an avoidant attachment style (Blatt & Homann, 1992; K. N.
Levy & Blatt, 1999; K. N. Levy, Blatt, & Shaver, 1998; Zuroff & Fitzpatrick,
1995), use avoidant coping mechanisms (Dunkley et al., 2000, 2003), are
uncomfortable socially (Norton, Buhr, Cox, Norton, & Walker, 2000), and
perceive others as critical and unsupportive (Dunkley et al., 2000, 2003;
Mongrain, 1998; Mongrain, Vettese, Shuster, & Kendal, 1998). They can
spend considerable effort trying to compensate for their painful feelings of
TWO PRIMARY CONFIG URATIONS OF PERSONALITY ORGANIZATION 13 7

inadequacy by getting involved in activities to try to inflate their sense of
self-worth, but they do not usually feel agentic (Saragovi, Aube, Koestner, &
Zuroff, 2002) and often fail because they tend to overextend in efforts to
prove themselves.
Self-critical, socially isolated, introjective individuals (e.g., Alden &
Bieling, 1996) experience less pleasure in social interactions (Zuroff et al.,
1995), make fewer requests for social support, feel distant from their peers,
and experience others as less expressive and forthcoming. Self-critical women
were noted by observers as being less loving and more hostile toward their
boyfriends (e.g., Mongrain et al., 1998) and as being generally uncooperative
(Santor, Pringle, &. Israeli, 2000). They have fewer friends (Moskowitz &
Zuroff, 1991; Zuroff et al., 1995) and are less liked by peers (Zuroff et al.,
1983). These individuals tend to turn against others to avoid acknowledging
their own sense of failure (Zuroff et al., 1983). They are less likely to accept
suggestions from a friend, particularly when they feel the friend has done
better than they have done (Santor & Zuroff, 1997), and they are more likely
to be quarrelsome than agreeable. Self-critical, introjective women report
selecting their romantic partners primarily in terms of their partners' power
and achievement, rather than on the basis of their capacity for intimacy and
affection (Zuroff & de Lorimier, 1989; see also Luyten, 2002).
Introjective and anaclitic personality dimensions were both significantly
related to the occurrence of postpartum depression in women with high-risk
pregnancies, but in different directions. Introjective personality characteris-
tics were positively related to postpartum depression, whereas anaclitic per-
sonality characteristics not only were negatively related to the occurrence of
postpartum depression but also moderated (diminished) the impact of self-
criticism on postpartum depression (Priel & Besser, 2000).
Anaclitic (or Dionysian) Personality Organization
Anaclitic (or Dionysian) individuals who place relatively greater em-

phasis on interpersonal relatedness were described by Blatt and Shichman
(1983) and Spiegel and Spiegel (1978) as generally more figurative in their
thinking and usually focused on affect and visual image (see Exhibit 5.2).
Research (Szumotalska, 1992) indicates that their thinking is more simulta-
neous than sequential and that they emphasize reconciliation, synthesis, and
the integration of elements into a cohesive unity, rather than the critical
analysis of separate elements and details. In terms of cognitive style, these
anaclitic or Dionysian individuals tend to be levelers (e.g., R. W. Gardner et
al., 1959, 1960), minimizing differences and contradictions. They are prima-
rily field dependent (Witkin, 1965; Witkin, Dyk, Faterson, Goodenough, &L
Karp, 1962) and are very aware of and influenced by their environment.
They seek experiences of fusion and harmony in interpersonal relationships
and are interested in the reconciliation of contradictions and achieving a
] 38 POLARITIES OF EXPERIENCE
EXHIBIT 5.2
Anaclitic (Dionysian) Personality
Thought processes: Figurative and impressionistic, focused on feelings, interpersonal
relations, and affects.
Emphasis on visual (simultaneous) processes.
Cognitive focus: Synthetic: Reconciliation, integration, cohesion.
Cognitive style: Field dependent, leveling of differences.
Object relations: Maintain close, intimate relationships.
Instinctual focus: Sexuality in service of affection, intimacy, and relatedness.
Primary defenses: Avoidant (e.g., denial and repression).
Character style: Sensitive to interpersonal issues, distractible, intuitive, passive,
dependent, emotionally naive, trusting, living in present,
sensuous.
Dominated by issues of the heart (Spiegel & Spiegel, 1978).
sense of integration (Szumotalska, 1992). They focus on feelings and affects—

on the emotional implications of situations. Their thinking is primarily in-
tuitive and determined more by feelings and subjective reactions than by
facts, figures, and other manifest details. Their basic instinctual orientation
is affiliative and sensuous (libidinal) rather than aggressive, and they value
affectionate feelings and close intimate relationships. They are sensitive to
interpersonal issues and nuances and are more distractible, intuitive, passive,
dependent, emotionally naive, and trusting and focused more on feelings
than ideas. They are sensitive to tactile and kinesthetic experiences, and are
more action oriented. They tend to suspend critical judgment, live primarily
in the present, and value affiliation and interpersonal relationships. Their
focus is on personal experiences—on feelings, affect, and emotional reac-
tions. And as noted by Spiegel and Spiegel (1978), they are dominated by
the feelings of their heart rather than by their head.
Extensive empirical research indicates that anaclitic individuals—those
with elevated scores on the Dependency (Interpersonal) factor of the DEQ
or on the SAS—tend to be agreeable (Mongrain, 1993), oriented to inter-
personal relationships, and have more frequent, constructive, and supportive
interaction with others (Mongrain, 1998; Zuroff et al., 1995). Their relation-
ships are usually stable, secure, and harmonious (Mongrain, 1998; Mongrain
& Zuroff, 1989; Zuroff et al., 1999). These individuals are usually submissive
and placating (Santor & Zuroff, 1997) and thus, as college students, are more
fully accepted by their roommates (Mongrain et al., 2004). They have a posi-
tive orientation to others and attend to feelings and emotions (Dunkley et
al., 1997). Evidence (e.g., Dunkley et al., 1997; Priel & Besser, 1999, 2000,
2001) indicates that anaclitic personality qualities tend to have adaptive and
proactive features because they are associated with a positive orientation to
others and a seeking of social support. But this personality style also has mal-
adaptive features.
Anaclitic individuals usually have an anxious-preoccupied interper-
sonal attachment style (Blatt & Homann, 1992; K. N. Levy & Blatt, 1999;

Zuroff & Fitzpatrick, 1995) and in the circumplex model (Laforge & Suczek,
1995; Wiggins &Trapnell, 1996) are located in the friendly submissive quad-
rant (Mongrain et al., 2004). Anaclitic individuals have less cognitive differ-
entiation and more somatic preoccupations, feelings of helplessness, and anxi-
ety over separation, loss, and a lack of contact and support (Blatt et al., 1982).
They tend to be fearful, worried, and anxious because they feel unable to
cope with stress (Mongrain, 1993), and they have intense and chronic fears
of being abandoned (Luthar & Blatt, 1993). In terms of clinical symptoms,
anaclitic personality attributes (e.g., dependency) are associated with eat-
ing disorders and substance abuse, especially abuse of amphetamines and
alcohol (Lidz, Lidz, & Rubenstein, 1976), as well as with particular forms
of antisocial activity involving a search for nurturance (Blatt & Shichman,
1981). Anaclitic individuals tend to make suicide gestures designed to com-
municate their unhappiness but without serious intent to harm themselves
(Blatt et al., 1982; Fazaa, 2001; Fazaa & Page, 2003). Anaclitic, dependent
college students who make suicide attempts tend to try to ensure their sur-
vival by making less lethal attempts and doing so in ways that increase the
probability of their being discovered. These suicide attempts often follow
interpersonal life stressors and appear to be "a plea for help or nurturance"
(Fazaa & Page, 2003, p. 181). Initial evidence (Blatt, Besser, & Ford, 2007;
Shahar, Trower, Iqball, & Davidson, 2002) also suggests that in the psy-
chotic range, anaclitic issues may be more central to more disturbed pa-
tients (i.e., those with undifferentiated schizophrenia), whereas introjective
issues may be more central in more organized patients (i.e., those with para-
noid features).
Dan McAdams (e.g., 1985a, 1985b, 1990, 1993) proposed a taxonomy
similar to the anaclitic-introjective distinction on the basis of patterns of
thought and behavior he found personified in personal myths (imagos).
McAdams viewed these patterns as similar to archetypes (Jung, 1928), per-
sonifications (H. S. Sullivan, 1953), internalized objects (Fairbairn, 1952),
ego states (Berne, 1977) and possible selves (Markus & Nurius, 1986). On
the basis of the polarity of agency (self-definition) and communion (inter-
personal relatedness), McAdams noted that individuals have different scripts
and prototypes (e.g., Cantor & Mischel, 1979; Rosch, 1973a, 1973b).
McAdams described three personality types: (a) the sage, high on agency
and low on communion, who is controlling, judgmental, and distant; (b) the
caregiver, low on agency and high on communion, who is nurturant, altruis-
tic, and gentle; and (c) the peacemaker, high on both agency and commun-
ion, who is generative, prudent, and communicative. A similar but more
limited distinction was made much earlier by Jung (1928) between extro-
verted and introverted personality styles. Extroverts seek contact with others
and derive gratification and meaning from relationships, whereas introverts
give priority to their own thoughts and experiences and maintain a clear
sense of self-definition, identity, and uniqueness. Jung, as did Spiegel and

Spiegel (1978), McAdams (1985a, 1985b), Blatt (1974), and Blatt and
Shichman (1983), viewed these character types as independent of, but re-
lated to, concepts of psychopathology. Eysenck (1960), for example, extended
the Jungian topology to discuss neuroticism in terms of both the hysteric
(extroverted) and the obsessive (introverted) types. Research with the Myers-
Briggs Personality Inventory (e.g., McCaully, 1981; Myers, 1962) and the
Eysenck Neuroticism Scale (1960) provided some empirical support for the
differentiation of two basic character types, especially in relation to neurotic
psychopathology.
Differences in Defense Mechanisms
In a discussion of anaclitic and introjective personality or character

styles, Blatt and Shichman (1983) noted that distinct types of psychological
defenses or coping styles are integral to each of these two basic types of per-
sonality organization. Psychological defenses—cognitive—affective processes
through which individuals avoid recognizing and acknowledging conflict both
within themselves and with others—are central to personality or character
style (Shapiro, 1965). As such, defenses are not only methods of dealing with
internal or personal conflict but also processes used in adaptation more gen-
erally. In other words, people rely on the same basic cognitive-affective pro-
cesses and styles to cope with important situations, whether these situations
are relatively neutral and impersonal or difficult and conflict-laden interper-
sonal interactions. Psychological defenses are essential modes of adaptation
that express the individual's preferred cognitive style.
Defenses are often discussed as specific mechanisms (e.g., denial, re-
pression, isolation, projection, reversal, intellectualization, reaction forma-
tion, overcompensation), but they can also be classified more broadly, or
generically, as either avoidant and counteractive (Blatt & Shichman, 1983)
or as repressing and sensitizing (Byrne, Barry, & Nelson, 1963). Avoidant
defenses (e.g., withdrawal, denial, and repression), characteristic of anaclitic
individuals, are used to avoid recognizing and acknowledging conflict and
can function at different levels of effectiveness to reduce conflict and anxi-
ety in efforts to maintain interpersonal relatedness. Denial, for example, is
usually less effective and efficient than is repression. In contrast, counterac-
tive defenses (e.g., projection, reversal or undoing, intellectualization, reac-
tion formation, and overcompensation), characteristic of introjective indi-
viduals, are used not to avoid conflicts but rather, at different levels of
effectiveness, to transform the conflict into an alternative form that permits
partial, but disguised, expression of the problematic issues in efforts to pre-
serve an effective sense of self. Counteractive defenses transform a conflict
or an impulse, often involving anger and aggression, into its opposite. Intel-
lectualization and overcompensation are usually more effective and efficient
than are projection, reversal, and reaction formation.
TWO PRIMARY CONFIG URATIONS OF PERSONALITY ORGANIZATION 141

The classification of defenses by Byrne et al. (1963) into repression and
sensitization, or disengaged and engaged coping styles, parallels the avoidant
and counteractive distinction discussed by Blatt and Shichman (1983). The
extensive research of Byrne et al. (1963) on repression and sensitization thus
offers support for the validity of the distinction between these two primary
types of defenses (avoidant and counteractive) that are characteristic of the
anaclitic and introjective personality configurations. Repressers (individuals
who use avoidant defenses), according to Byrne, tend to be more concerned
with interpersonal relations and tend to maintain a positive and optimistic
outlook about themselves and others. Their undifferentiated, essentially posi-
tive self-descriptions are quite congruent with their stated ideals to maintain
peace and equanimity (Byrne et al., 1963; Shavit & Shouval, 1977). They
have a global cognitive approach (V. Hamilton, 1983) and try to avoid con-
tradiction and controversy—especially expressing their anger (O'Gorman &
Stair, 1977)—and to avoid perceiving interpersonal conflicts. Although re-
pressers try to avoid conflict and interpersonal difficulties (e.g., J. D. Davis &
Sloan, 1974; Rofe & Weller, 1981), their relationships can be conflicted
(Graziano, Brothen, & Berscheid, 1980) because they are usually less aware
of their own negative feelings and those of others that might be disruptive to
their interpersonal relationships. Thus, they try to avoid conflictual themes
and report few negative childhood experiences (P. J. Davis & Schwartz, 1987),
but their speech has more disruptions than does that of the other groups.
They are less aware of bodily sensations and feel less vulnerable to disease
(Dziokonski & Weber, 1977), and they report less fear, anxiety, and pain
during pregnancy (Rofe, Lewin, & Padeh, 1977). But they often seek health
care (Blatt et al., 1982; R. F. Bornstein, 1998) and tend to show a strong
placebo effect (Corveleyn, Luyten, & Blatt, 2005). Although they are less
consciously aware of contradictions and conflicts and of sexual and aggres-
sive impulses (Beutler, Johnson, Morris, & Neville, 1977; Byrne et al., 1963;
Rofe et al., 1977; Tempone & Lamb, 1967) and report low levels of anxiety
(J. P. Schmitt & Kurdek, 1984; Slough, Kleinknecht, & Thorndike, 1984;
P. F. Sullivan & Roberts, 1969), they are more responsive physiologically to
emotionally stressful situations (Epstein & Fenz, 1967; Hill & Gardner, 1976;
Scarpetti, 1973; Weinberger, Schwartz, & Davidson, 1979; M. D. White &
Wilkins, 1973). Thus, their subjective experiences and their physiological
responses can be markedly discordant.
Sensitizers (introjective individuals who use counteractive defenses),
in contrast, are preoccupied with issues of self-worth, self-control, and iden-
tity, and are overly critical of themselves and others. They have negative
views of themselves and others, and are more aware of contradiction and
conflict. They are ruminative, autonomous, independent, less influenced by
the judgment of others (Zanna & Aziza, 1976), introspective, and very self-
critical. Reporting more personal dissatisfaction, anxiety, and concerns about
illness, they are more aware of and able to report more aggressive and sexual

impulses and imagery, but they do not respond physiologically to an exces-
sive degree when confronted with stressful conditions.
Avoidant or repressive (Byrne et al, 1963) defenses (e.g., denial and
repression) are typical of the anaclitic personality style that emphasizes in-
terpersonal relatedness. Counteractive or sensitizing (Byrne et al., 1963) de-
fenses (e.g., projection, reversal and undoing, intellectualization, reaction
formation, and overcompensation) are typical of the introjective character
style that emphasizes self-definition and identity. As already noted, these
two defensive organizations (avoidant and counteractive) are also related to
the distinction between histrionic and obsessive personality styles (e.g.,
Eysenck, 1960; Shapiro, 1965). Although I discuss the relationship of these
two personality styles to different types of psychopathology in detail in chap-
ter 6 (this volume), it is important to note that the histrionic character style
(an anaclitic type of psychopathology) is characterized by excessive preoccu-
pation with interpersonal issues—about loving and wanting to be loved—of-
ten at the neglect of self-definition and identity. With repression as their pri-
mary defense, individuals with a histrionic personal style have diffuse,
impressionistic, global functioning and lower levels of cognitive complexity
(Starbird & Miller, 1976). Counteractive defenses are characteristic of the
obsessive personality style (an introjective type of psychopathology), which is
characterized by excessive preoccupations with self-definition, autonomy, con-
trol, and personal prerogatives and possessions. Individuals with obsessive-
compulsive disorder are deliberate, precise, and attentive to details, contradic-
tion, and conflict. They are sensitizers (Byrne et al., 1963), overideational, and
ruminative, and they try actively to control and manipulate the environment
through critical use of their intellectual processes. Thus, considerable research
findings support the validity of the distinction between the anaclitic and
introjective personality or character styles and their associated defenses.
Within each general character style, anaclitic and introjective, individu-
als can function at different developmental levels. Less well functioning ana-
clitic individuals tend to use lower level avoidant defenses (usually denial)
that are usually less effective. These individuals tend to have an insecure, pre-
occupied attachment style and are primarily careseekers. Better functioning
anaclitic individuals use higher level avoidant defenses (repression rather than
denial) that are usually more effective. And their preoccupied attachment style
is more likely to be expressed in concern for the well-being of others, in
caregiving rather than in careseeking relationships (C. E. Schaffer, 1993). Like-
wise, within the introjective character style, less well functioning introjective
individuals tend to use lower level counteractive defenses (projection and re-
action formation) that are less successful and efficient. These interpersonally
isolated, distant individuals usually have an avoidant attachment style that is
primarily dismissive rather than fearful avoidant. Better functioning introjective
individuals are likely to use more effective counteractive defenses (e.g., intel-
lectualization and overcompensation), and their avoidant attachment style is

likely to be the more adaptive fearful avoidant style than the less adaptive
dismissive style (K. N. Levy & Blatt, 1999; C. E. Schaffer, 1993).
Very well functioning individuals usually have an integrated blend of
qualities from both anaclitic and introjective personality styles and are likely
to use higher level anaclitic and introjective defensive styles (i.e., repression
and overcompensation, respectively) that can lead to the development of a
capacity for sublimation. Sublimation is an integration of higher level avoidant
(i.e., repression) and counteractive defenses (i.e., overcompensation) that
can result in well-modulated, socially appropriate, personally satisfying be-
havior. These individuals are also more likely to have patterns of secure at-
tachment. Thus, in normal development, the two dimensions of relatedness
and self-definition evolve in an integrated form, such that psychologically
mature individuals have developed an active commitment to interpersonal
relatedness and a viable and integrated sense of self. Although well-
functioning individuals have preferred modes of cognition, adaptation, and
defense (either anaclitic and avoidant or introjective and counteractive),
these modes are relatively flexible and responsive to environmental circum-
stance. Thus, well-functioning individuals are capable of establishing per-
sonally meaningful interpersonal relationships and have an essentially posi-
tive, consolidated, and integrated self-definition or identity.
Because most individuals, even within the normal range, place a some-
what greater emphasis on one or the other of the two basic concerns (relat-
edness or self-definition), even normal well-functioning personality styles
can usually be characterized as either anaclitic or introjective, depending on
which set of psychological issues (values) and modes of adaptation are pre-
dominant. Dynamic, structural, and experiential dimensions in the anaclitic
personality configuration are qualitatively different from these dimensions
in the introjective configuration, even in the normal range. Each configura-
tion involves a fundamentally different experiential focus and behavioral
orientation, with different types of gratification and with different modes of
cognition, defense, and adaptation. Each configuration has a different em-
phasis on the representation of the self or on others and a particular orienta-
tion toward interpersonal relationships and attitudes about the self. Exten-
sive research with nonclinical samples, summarized earlier, has demonstrated
the validity of these differences between anaclitic and introjective individu-
als in the normal (nonclinical) range (see extensive summaries in Blatt, 2004;
Blatt & Zuroff, 1992; Corveleyn et al., 2005; Luyten, 2002; Zuroff, Mongrain,
& Santor, 2004).
THE ASSESSMENT OF INTERPERSONAL

Research findings indicate that the DEQ can be used to assess these
two fundamental personality dimensions. The DEQ was developed on the

assumption that psychopathology is most effectively considered not as sepa-
rate diseases deriving from unspecified but as yet often undocumented bio-
logical disturbances (e.g., an unspecified chemical imbalance in depression)
but as disruptions of normal psychological development. Thus, the DEQ was
developed by reviewing clinical reports in the classic psychoanalytic litera-
ture on depression (e.g., Sigmund Freud's Mourning and Melancholia, 1917/
1957h; Edward Bibring's "The Mechanism of Depression," 1953; and Mabel
Blake Cohen and colleagues' "An Intensive Study of Twelve Cases of Manic
Depression Psychosis," 1954) and gleaning from these reports examples of
the everyday life experiences of depressed individuals and their families rather
than the symptoms of depression. Sixty-six items were eventually identified—
items that tapped issues such as a distorted or depreciated sense of self and
others, dependency, helplessness, egocentricity, fear of loss, ambivalence,
difficulty dealing with anger, self-blame, guilt, loss of autonomy, and distor-
tions of family relations. These items were not selected from any particular
theoretical position on depression; rather, they were selected because they
represented a wide range of experiences characteristic of the lives of depressed
individuals. These 66 items were initially administered to a large sample of
college students with the instructions to rate, on a 7-point scale, the degree
to which each item characterized their experiences. Principal components
factor analysis with varimax rotation indicated that the responses to this
questionnaire could be organized into three primary factors (Blatt, D'Afflitti,
& Quinlan, 1976): a Dependency factor containing items focused primarily
on interpersonal issues of loneliness and loss (e.g., "I often think about the
danger of losing someone who is close to me"); a Self-Criticism factor com-
posed of items focused on issues of self-definition and self-worth (e.g., "There
is considerable difference between how I am now and how I would like to
be"); and an Efficacy factor composed of items reflecting feelings of resil-
ience, competence, and personal strength (e.g., "I have many inner resources").
Thus in developing the DEQ for the study of the phenomenology of depres-
sion, Blatt, D'Afflitti, et al. (1976) serendipitously developed an empirical
method that reliably and systematically assesses two primary foci of experi-
ence: interpersonal (anaclitic) concerns of loss and loneliness and introjective
issues of self-worth, self-blame, and guilt.
A wide range of empirical studies over the past 3 decades has demon-
strated that the three factors of the DEQ are highly stable independent fac-
tors in clinical and nonclinical samples of both adolescents and adults in a
number of different cultures (e.g., Beutel et al., 2004; Campos, 2002; Frank,
Poorman, Van Egeren, & Field, 1997; Frank, Van Egeren, et al., 1997; Jae
Im, 1996; Luyten, 2002; Priel, Besser, & Shahar, 1998; Zuroff, Quinlan, &
Blatt, 1990). These studies consistently indicated that the 66 items of the
DEQ cluster into three primary factors. The first factor, Dependency, reflects
wishes to be cared for, loved, and protected and fears of being abandoned.
The second factor, Self-Criticism (or Self-Critical Perfectionism), taps pre-

occupation with issues of self-definition including achievement and feelings
of inferiority and guilt in the face of perceived failure to meet standards. The
third factor, Efficacy, represents personal resilience and inner strength (see
summaries in Blatt, 1998, 2004; Blatt & Zuroff, 1992; Corveleyn et al., 2005;
Luyten, 2002).1 In addition to the DEQ (Blatt, D'Afflitti, et al., 1976; Blatt,
Quinlan, Chevron, McDonald, & Zuroff, 1982), several other procedures to
assess these two personality dimensions were more recently developed. Aaron
Beck (1983) developed a similar assessment method, the SAS, and several
other investigators (e.g., Cane, Olinger, Gotlib, &Kuiper, 1986) found that
the Dysfunctional Attitudes Scale (DAS; Weissman & Beck, 1978) also as-
sesses these two dimensions:
• Feelings that derive from disruptions of interpersonal relations
including feelings of loss, abandonment, helplessness, and lone-
liness; wanting to be close to, related to, and dependent on
others; and being concerned about hurting or offending others
for fear of losing the dependent gratification that others can
provide.
• Experiences more internally focused on disruptions of self-
definition and self-esteem, and expressed in feeling guilty, empty,
hopeless, unsatisfied, insecure, ambivalent about oneself and oth-
ers, and lacking a sense of autonomy and self-worth; feeling hav-
ing failed to meet expectations and standards, pressured by re-
sponsibilities, and threatened by change; tending to assume
blame and responsibility; and being critical toward oneself.
In an attempt to develop a scale that might have improved psychomet-
ric properties, Robins and Luten (1991) combined elements from the DEQ
and the SAS to create the Personal Style Inventory (PSI; Robins, Bagby,
Rector, Lynch, & Kennedy, 1997). Research with all of these scales (e.g.,
DEQ, SAS, DAS, PSI) has resulted in an impressive extensive literature that
has led to a fuller understanding of some of the early and contemporary life
experiences that contribute to the occurrence of depression and of important
differences in the clinical expression and treatment of anaclitic (dependent)
and introjective (self-critical) individuals (e.g., Blatt, 1974, 1998, 2004; Blatt
& Homann, 1992; Blatt & Shahar, 2004a; Blatt & Zuroff, 1992, 2005; D. A.
Clark & Beck, 1999).
Developmental Levels of Interpersonal Relatedness and Self-Definition

Methods have been developed for differentiating several levels in the
development of self-definition and in the capacity for interpersonal related-
'See Blatt (2004) for a more extensive discussion of the development of the DEQ and research
findings using this assessment procedure. Copies of the DEQ and its scoring programs can be obtained
from S. J. Blatt (Sidney.Blatt@Yale.Edu) or David C. Zuroff (Zuroff@egopsych.McGill.edu).

ness. As I discussed in chapter 4 (this volume), interpersonal relatedness
evolves from feelings of trust in another person to a capacity for coopera-
tion and collaboration, and eventually to a capacity for sustained reciproc-
ity and intimacy. Likewise, self-definition or identity evolves from reactive
expressions of autonomy to proactive capacities for initiative and industry
(achievement), to a consolidated identity and the capacity for generativity,
and ultimately to feelings of integrity. As I also noted in chapter 4 (this
volume), these two developmental processes evolve in normal personality
development in an interactive, reciprocally balanced, mutually facilitating
fashion from birth through senescence (Blatt, 1990, 1995a; Blatt & Blass,
1990, 1992, 1996; Blatt & Shichman, 1983). If development does not pro-
ceed well, however, interpersonal relatedness can be characterized by feel-
ings of uncertainty about the dependability of others, alienation from oth-
ers, or loneliness and isolation. Likewise, disruptions in the development
of a sense of self can involve primitive fears of annihilation; concerns about
a loss of control; feelings of shame, guilt, and inferiority; and feeling a lack
of integration and integrity. Research findings indicate that the DEQ can
be used to assess some of these different levels of interpersonal relatedness
and of self-definition.
Research (Blatt, Zohar, Quinlan, Luthar, & Hart, 1996; Blatt, Zohar,
Quinlan, Zuroff, & Mongrain, 1995; Rude & Burnham, 1995) indicates that
the DEQ actually assesses two levels of interpersonal relatedness: (a) a mal-
adaptive desperate neediness in which one feels terrified about abandonment
and threatened by feelings of helplessness when alone and (b) a more adap-
tive, higher level of interpersonal relatedness in which one has meaningful
involvement with particular individuals and feels a sense of sadness and loss
if these relationships are disrupted (e.g., Blatt & Shahar, 2004a; Blatt, Zohar,
et al., 1995, 1996; Rude & Burnham, 1995). Other research with the DEQ
(Kuperminc, Blatt, & Leadbeater, 1997) has also empirically identified two
levels in the development of the self: (a) a maladaptive, reflective, rumina-
tive, self-critical, evaluative sense of self involving concerns about self-worth
including feelings of a loss of autonomy, initiative, and industry and feelings
of shame, guilt, and inferiority and (b) a more adaptive, proactive sense of
self involving feelings of efficacy, identity, integrity, and purpose (Blatt &
Shahar, 2004a).
Levels of Interpersonal Relatedness

Blatt, Zohar, et al. (1995, 1996) examined the items loading most
strongly on the Dependency (or Interpersonal) factor of the DEQ with the
hypothesis that this factor may contain two facets or subfactors: one that
assesses adaptive interpersonal relatedness and one that assesses a more mal-
adaptive dependence or neediness. Using small space analysis (a theory-driven
clustering procedure developed by the research methodologist Louis Guttman)
researchers identified two facets within the Dependency factor in both adults

and adolescents (Blatt, Zohar, et al, 1995,1996; Henrich, Blatt, Kuperminc,
Zohar, & Leadbeater, 2001; see also Rude & Burnham, 1995).
One facet, labeled dependence (or neediness), includes items expressing
feelings of helplessness, fears, and apprehension about separation and rejec-
tion, and intense and broad-ranging concerns about a general loss of contact
with others, unrelated to a particular relationship (e.g., "I become frightened
when I am alone")- These items reflect a desperate need for others but with
little differentiation or specification of any particular person or relationship.
The primary theme of these items is an intense fear of abandonment and
feelings of helplessness. The second facet, labeled relatedness, includes items
that assess feelings of loss, sadness, and loneliness in reaction to disruption of
relationships with a particular person (e.g., "I would feel like I'd be losing an
important part of myself if I lost a very close friend"). These feelings are not
undifferentiated and nonspecific; rather, they reflect concerns about the loss
of a special person to whom one feels attached. These items do not reflect
feelings of helplessness without this relationship, but rather feelings that this
particular relationship is valued and therefore loss is accompanied by feelings
of sadness and loss. Thus, the results of small space analyses with adolescents
and young adults indicated that the Dependency or Interpersonal factor of
the DEQ is composed of two sets of items that assess both adaptive and mal-
adaptive levels of interpersonal relatedness. Rude and Burnham (1995), us-
ing another statistical procedure, also identified these two levels of items in
the Dependency factor of the DEQ.
In future research on the clinical and nonclinical expression of ana-
clitic issues, it will be important to differentiate between these two levels of
interpersonal concerns—between developmentally earlier issues of a desper-
ate neediness and more mature or organized relatedness concerns (e.g., Blatt,
Zohar, et al., 1995, 1996; Rude & Burnham, 1995). Schulte and Mongrain
(2002), for example, found that Neediness, but not Relatedness (or Con-
nectedness), was significantly correlated with diagnoses and the presence of
prior clinical episodes of depression in an outpatient sample of young adults
(see also Cogswell, Alloy, & Spasojevic, 2006). As summarized by Zuroff et
al. (2004), lower level anaclitic concerns (e.g., neediness) are associated with
individuals who are highly insecure, who want to be cared for and protected
by others, and who are frightened of being abandoned and hurt, whereas
higher level anaclitic concerns (relatedness or connectedness) are associated
with people who are somewhat insecure but are capable of developing warm,
intimate relationships.
When the two facets of dependency (i.e., dependence or neediness, and
relatedness) were used to predict psychological well-being, two interesting
patterns emerged. First, the dependence or neediness facet had significantly
higher correlations with measures of depression whereas the relatedness facet
had significantly higher correlations with measures of psychological well-
being (Blatt, Zohar, et al., 1995, 1996; Henrich et al., 2001). Second, the

intercorrelations between the four DEQ factors and variables (i.e., Self-Criti-
cism, Efficacy, dependence or neediness, and relatedness or connectedness)
no longer reflect the orthogonality found among the three original DEQ fac-
tors (i.e., Dependency, Self-Criticism, and Efficacy). In specific terms, Self-
Criticism correlated positively with dependence or neediness and negatively
with relatedness (r = .19 and -.10; respectively; Blatt, Zohar, et al., 1996). In
other words, Self-Criticism, a maladaptive sense of self, correlated positively
with the maladaptive dimension of interpersonal relatedness (neediness) and
negatively with the adaptive dimension of interpersonal relations (related-
ness). In contrast, efficacy, an adaptive sense of self, correlated positively
with relatedness and negatively with dependence or neediness (r = .16 and -
.23; respectively; Blatt, Zohar, et al., 1996). Thus, two subscales within the
Dependency or Interpersonal factor of the DEQ assess different levels of in-
terpersonal relations that are differentially related to depressive symptoms
and a host of maladaptive and adaptive dimensions (Blatt, Zohar, et al., 1995,
1996; Nietzel & Harris, 1990; Priel & Shahar, 2000). Cogswell and Alloy
(2006), in a sample of college students, found that DEQ neediness, the less
mature level of interpersonal relatedness, was "significantly associated with
dimensions of dependent, borderline and histrionic personality disorders"
(anaclitic personality disorders) and was a better predictor of these dimen-
sions than was DEQ relatedness or connectedness (the more mature level of
interpersonal relatedness). The differentiation between these two levels of
anaclitic issues, between neediness and relatedness, may be an important
distinction in future investigations of the role of interpersonal processes in
psychological functioning.
Levels of Self-Definition
Differential correlations of the DEQ Self-Criticism and Efficacy factors
with the maladaptive and adaptive dimensions of interpersonal relationships
(i.e., neediness and relatedness, respectively) suggested that the Self-
Criticism and Efficacy factors of the DEQ assess different levels of self-con-
cept—a maladaptive view of the self assessed by the Self-Criticism factor
and an adaptive self-definition assessed by the Efficacy factor of the DEQ.
Extensive research documents the maladaptive aspects of self-criticism
(e.g., Blatt, 1974, 1995b, 2004; Blatt & Zuroff, 1992; Blatt, D'Afflitti, et al.,
1976; Blatt et al., 1982). As noted earlier, individuals with elevated scores
on DEQ Self-Criticism are sensitive to ridicule and are uncomfortable in
interpersonal relationships; they tend to be interpersonally isolated and in-
sensitive, formal, ambivalent, reserved, and distant, and they often try to
manipulate others through deception and flattery (e.g., Dunkley, Blankstein,
& Flett, 1997). They are prone to feelings of guilt, sadness, hopelessness, and
depression (e.g., Mongrain, 1998) and at times they can be seriously suicidal
(A. T. Beck, 1983; Blatt, 1974,1995b, 2004; Blatt et al., 1982; Enns, Cox, &
Inayatulla, 2003; Fazaa, 2001; Fazaa & Page, 2003; Shahar, 2001).These feel-

ings of self-criticism are relatively resistant to brief therapeutic interventions
(Blatt, Quinlan, et al., 1995), and several studies (e.g., Alden & Bieling,
1996; Zuroff & Fitzpatrick, 1995) have demonstrated the avoidant qualities
of individuals with elevated scores on the self-criticism factor of the DEQ.
In contrast to the extensive research on Self-Criticism (the maladap-
tive dimension of the self), research on the Efficacy factor of the DEQ (the
more adaptive dimension of the self) has been minimal. Investigators who
use the DEQ usually report findings with the Dependency and Self-Criticism
factors, mentioning only in passing that the Efficacy factor was not explored
in their study (cf. Priel & Shahar, 2000). If the Efficacy factor is mentioned,
it is usually done in a few lines, rarely with elaboration of its negative corre-
lation with depression (Blatt, D'Afflitti, et al., 1976; Blatt et al., 1982; D. F.
Klein, 1989). Even when Efficacy was found to be associated with higher
levels of functioning over time (D. F. Klein, 1989), it was still mentioned
only briefly.
Increased interest in the Efficacy factor of the DEQ emerged in a study
of risk and resilience in early adolescence (e.g., Leadbeater, Kuperminc, Blatt,
& Hertzog, 1999). The researchers evaluated a large and socioeconomically
diverse sample of early adolescents (230 girls and 230 boys) in an urban middle
school (sixth to eighth grade) once and then again 1 year later. Although
most of the reports from this research focused on Dependency and Self-
Criticism, some interesting findings were obtained with the Efficacy factor.
Whereas Self-Criticism was related to maladaptive indicators of social and
academic functioning, Efficacy was related to indicators of adaptation
(Kuperminc et al., 1997). These findings suggest that Self-Criticism taps ru-
minative, self-reflective preoccupations with past as well as current deficits
or deficiencies, whereas Efficacy assesses proactive feelings and behavior (posi-
tive self-attitudes). Self-Criticism, for example, predicted increases in inter-
nalizing and externalizing symptoms over a 1-year period, whereas Efficacy
predicted a reduction in these symptoms over the same period (Kuperminc,
Leadbeater, & Blatt, 2001). Further analyses of the data from the study of these
adolescent students (Shahar, Gallagher, Blatt, Kuperminc, & Leadbeater, 2004)
indicated that Efficacy moderates, or buffers, the adverse effects of Dependency
and Self-Criticism on depressive symptoms. Adolescents who had greater lev-
els of vulnerability, as reflected in elevated Dependency and Self-Criticism,
were even more prone to depression and impaired functioning, especially if
they also had reduced levels of personal resilience as reflected in lower Effi-
cacy. These longitudinal analyses indicated that Efficacy moderated the com-
bined effect of Dependency and Self-Criticism in the development of de-
pression. In particular, adolescents who had elevated levels of both
Dependency and Self-Criticism tended to be more depressed if they also had
low, rather than high, levels of Efficacy (see also Blatt et al., 1982).
Thus, the DEQ has become more than a measure of two sources of de-
pression; it has also become an effective research instrument for measuring

adaptive as well as maladaptive aspects of the two fundamental developmen-
tal processes—of both interpersonal relations and self-definition. The sig-
nificant correlations between maladaptive aspects of self-definition and in-
terpersonal relations (self-criticism and neediness, respectively) and between
adaptive aspects of self-definition and interpersonal relations (efficacy and
relatedness, respectively) also support the formulations (Blatt & Blass, 1990,
1996; Blatt & Shichman, 1983) of the parallel dialectical development of
self-definition and relatedness, which I discussed in chapter 4 (this volume).
Extensive research has examined the interaction between the four DEQ
factors and variables (neediness, relatedness, Self-Criticism, and Efficacy)
and aspects of the social context including stressful life events, social sup-
port, and close interpersonal relationships. Earlier studies that examined the
effect of the DEQ variables on depressive symptoms usually treated the social
context as a moderator (Blatt &. Zuroff, 1992) in which contextual variables,
such as stressful events, were expected to augment the maladaptive tenden-
cies of lower levels of self-definition and interpersonal relatedness. Accord-
ing to what has come to be called the "congruency hypothesis" (Blatt &
Zuroff, 1992; Coyne & Whiffen, 1995; Robins, 1995; Zuroff et al., 2004),
individuals with elevated levels of dependency would become depressed in
response to stressful interpersonal events such as rejection and loss. In a simi-
lar way, individuals with elevated levels of self-criticism would become de-
pressed in response to events threatening the self, such as failure. Empirical
support has consistently been found for the congruency hypothesis with re-
spect to dependency, but only on occasion for self-criticism (for reviews, see
Blatt, 2004; Blatt & Zuroff, 1992; Corveleyn et al., 2005; Coyne & Whiffen,
1995; Luyten, 2002; Robins, 1995; Shahar, 2001; Zuroff & Blatt, 2002).
It is important to note that these various attempts to study the congru-
ency hypothesis usually assumed that individuals are passive in relation to
the contextual factors that seem to precipitate their distress (Priel & Shahar,
2000). Other formulations of action theory (e.g., Dennett, 1987; Geertz, 1973;
Parsons, 1964; Scarr & McCarthy, 1983; Shahar, 2006), however, emphasize
that individuals actively generate the contextual conditions implicated in
their distress (Bowlby, 1980; Brandstadter, 1984, 1998; Buss, 1987; Coyne,
1976b, 1999; Hammen, 1991,1999; Joiner, 1994; R. M. Lerner, 1982; Plomin
& Caspi, 1999). As a result, investigators have now begun to focus on the
recursive interactions of the DEQ variables with contextual variables such as
stressful events, social support, and the quality of close relationships (Blatt
& Shahar, 2004a; Luyten et al., 2005b; Zuroff, Blatt, Krupnick, & Sotsky,
2003).
Research findings indicate that self-criticism is a primary instigator of
depressive symptoms because it generates a risk-related social environment
(Dunkley et al., 2003; Shahar, 2001). In particular, elevated self-criticism
interferes with close relations; in fact, it predicts interpersonal ruptures and
tensions (Mongrain, Vettese, Shuster, & Kendal, 1998; Priel & Besser, 2000;

Priel & Shahar, 2000; Vettese & Mongrain, 2001; Zuroff & Duncan, 1999)
and other interpersonal stressful events (Priel & Shahar, 2000; Shahar, Joiner,
Zuroff, & Blatt, 2004; Shahar & Priel, 2003). Self-criticism also predicts re-
duced levels of social support (Mongrain, 1998; Priel & Shahar, 2000) and
fewer positive life events (Shahar & Priel, 2003). Thus, individuals with a
maladaptive sense of self appear to generate contextual conditions that ren-
der them vulnerable to depression and emotional distress (e.g., see research
by Besser & Priel, 2003; Priel & Besser, 2000, 2001, 2002 on postpartum
depression).
Dunkley et al. (2003), studying college men and women, examined both
personal dispositional and situational factors that contribute to high nega-
tive and low positive affect in self-critical individuals. Over a 7-day period,
they assessed daily reports of hassles, stress, social support, and coping styles.
Using structural equation modeling (SEM), they found that Self-Criticism
influenced emotional experiences each day through a number of maladap-
tive tendencies including an increase in daily hassles, the use of an avoidant
coping style, and a reduction of positive affect through a failure to maintain
social support. Also, self-critical individuals were particularly reactive to stres-
sors that implied personal failure, loss of control, and criticism from others,
and were relatively ineffective in using more adaptive coping strategies such
as problem-focused coping. Self-critical individuals appear to generate a risk-
related social context because they have negative representations of self and
significant others (Blatt & Shahar, 2004a). Several investigations (e.g., Blatt,
1974; Blatt, Wein, et al., 1979; Mongrain, 1998; Shahar, 2001) have demon-
strated that self-critical young adults hold particularly negative representa-
tions of parental figures that seem to organize their social exchanges, making
it difficult for them to respond to positive interpersonal cues (Aube & Whiffen,
1996), forcing them to avoid intimacy and self-disclosure (Zuroff & Fitzpatrick,
1995) and to act in a hostile manner in close relations (Zuroff & Duncan,
1999), thereby reducing available social support and creating conflicts, con-
frontations, and other stressful events (Priel & Shahar, 2000; Shahar & Priel,
2003). Self-critical individuals seem to project their own self-criticism onto
others and therefore expect the condemnation from others that they inflict
on themselves. It is ironic that to the extent that these negative representa-
tions generate a risk-related environment, this negative interpersonal envi-
ronment is likely to consolidate and even exacerbate their negative repre-
sentations of themselves and others, thus contributing to a reciprocal, vicious
interpersonal loop that is frequently observed by clinicians treating patients
with depression (Andrews, 1989; Blatt & Zuroff, 1992; Wachtel, 1994;
Wender, 1968; Zuroff, 1992). And as I is discuss in more detail in chapter 7
(this volume), these self-critical introjective individuals have considerable
difficulty responding constructively to brief interventions in treatments for
depression.

Studies have only recently begun to investigate the impact of Efficacy,
the adaptive dimension of self, on the social context. The roles of maladap-
tive and adaptive senses of self, as assessed by the Self-Criticism and Efficacy
factors of the DEQ, respectively, were examined in a study predicting the
effects of these two dimensions in creating a positive social context for young
adolescents (Blatt & Shahar, 2004a). The results of this study, on the basis of
an SEM analysis of the longitudinal effects of Self-Criticism and Efficacy on
the social context, indicated that Self-Criticism and Efficacy produced op-
posite patterns. Self-Criticism significantly predicted an increasingly nega-
tive social context whereas Efficacy significantly predicted an increasingly
positive social context. Also, it was noteworthy that social context at Time 1
strongly predicted Time 2 social context, indicating that the social context
of adolescents tends to be stable over time. Thus, the differential effects on
the social context produced by Self-Criticism and Efficacy over a 1-year pe-
riod are impressive.
In summary, a large body of empirical research with the DEQ demon-
strates that Self-Criticism and Efficacy, which respectively assess maladap-
tive and adaptive dimensions of the self, are intimately tied to social rela-
tions, and in fact generate different contextual circumstances in predictable
ways. Self-Criticism generates a negative, risk-related social context, whereas
Efficacy generates a positive, resilience-related context. And an emerging
body of research has also identified the impact of maladaptive and adaptive
dimensions of interpersonal relatedness on the social context.
In contrast to the disruptive effects of self-criticism and the construc-
tive effects of efficacy on social relationships, the impact of the Dependency
(or the interpersonal) factor on the DEQ on social relationships is more com-
plex because evidence indicates that this personality construct contains ele-
ments of both risk and resilience (Blatt, Zohar, et al., 1995, 1996; R. F.
Bornstein, 1998; Shahar, 2001; Shahar & Priel, 2003). Although Depen-
dency predicts interpersonal problems that contribute to depression, it also
predicts a capacity for intimacy (Fichman, Koestner, & Zuroff, 1994) and
being able to establish and maintain elevated levels of social support
(Mongrain, 1998; Priel & Shahar, 2000). Dependency, like Self-Criticism,
predicts elevated levels of negative events that lead to depression and anxi-
ety; however, unlike Self-Criticism, Dependency also predicts positive events,
which partly explains why dependent individuals report lower levels of dis-
tress than do self-critical individuals (Shahar & Priel, 2002). Dependent
women, for example, are interested in closeness and intimacy and experi-
ence greater feelings of affection and love in their romantic relationships
(Zuroff & de Lorimier, 1989; Zuroff & Fitzpatrick, 1995). They are more
positive about their same-sex relationships; they perceive these relationships
as more friendly and frequently tend to have more positive expressions in
their interactions with other women (Zuroff & Franko, 1986). Dependent

individuals go to remarkable lengths to preserve interpersonal harmony
(Santor et al., 2000), are uncomfortable with feelings of hostility (Zuroff et
al., 1983), and have difficulty being assertive (Fichman et al., 1994). Thus,
they tend to compromise when dealing with interpersonal conflicts (Zuroff
& Fitzpatrick, 1995) and, as reported by Priel and Besser (2000, 2001, 2002)
in the study of postpartum depression, anaclitic personality attributes (e.g.,
dependency) can serve as a protective factor. Dependency is thus correlated
with investment in interpersonal relationships. In nonclinical samples it is
related to valuing emotional closeness and an active interest in maintaining
good interpersonal relationships. In clinical samples, dependency is associ-
ated with apprehensions and resentments about loss, neglect, deprivation,
and abandonment by parents, spouse, and friends (Blatt et al., 1982). The
differentiation of neediness and relatedness within the DEQ Dependency
factor, as discussed earlier, has begun to facilitate further articulation of these
adaptive and maladaptive aspects of the DEQ Dependency factor.
The differentiation of adaptive and maladaptive aspects of interper-
sonal relatedness and self-definition, as assessed by the DEQ, has facilitated
the identification of several levels in the development of interpersonal rela-
tions and in the sense of self. This differentiation of developmental levels
within the two primary dimensions of interpersonal relatedness and self-
definition suggests that the DEQ may provide a methodology for systemati-
cally studying different phases in the development of these two fundamental
personality dimensions.
DISRUPTIONS OF PERSONALITY DEVELOPMENT
The identification of the dimensions of relatedness and self-definition

at different developmental levels has contributed to the understanding of
differences in normal personality or character style and the impact of these
differences on modes of adaptation. This distinction has also contributed to
a fuller understanding of depression and personality disorders. The assess-
ment of the dimensions of interpersonal relatedness and self-definition with
the DEQ and the SAS has facilitated identifying two primary, relatively in-
dependent sources of depression and the systematic investigation of some of
their etiological, clinical, and therapeutic implications including their distal
and proximal antecedents, different clinical expressions, and differential re-
sponse to various types of therapeutic interventions (e.g., Blatt, 1998, 2004;
Blatt & Zuroff, 1992). The identification of these two fundamental experi-
ential dimensions of interpersonal relatedness and self-definition has also
provided an empirically supported differentiation among the various types
of personality disorders, thereby providing some explanation for the fre-
quent observation of the extensive comorbidity often seen among person-
ality disorders.

Depression
In Mourning and Melancholia, S. Freud (1917/1957K) discussed the rela-

tionship of melancholia (depression) to disruptions in a developmentally early
stage before the development of feelings of loving and being loved by a par-
ticular person—distortions that can create a vulnerability to experiences of
loss and abandonment. He also discussed the relationship of depression to
disruptions that can contribute to feelings of guilt and self-reproach in a more
advanced and complex phase of psychological development, a phase that
derives from the triadic interpersonal structure of the family and the inter-
nalization of family and cultural values and standards (the oedipal phase with
the development of the superego). Although in the opening paragraph in his
essay on depression S. Freud cautiously noted that the definition of melan-
cholia varies widely and that one cannot be certain whether the various so-
matic and psychogenetic forms of melancholia can be grouped into a single
entity, he struggled throughout the essay to develop a unified conceptualization
of melancholia that integrated mechanisms from these two very different
phases of psychological development.
Rather than trying to develop a unified conceptualization of melan-
cholia that integrates the processes of early dependency and later superego
formation into a single formulation, clinical investigators have recently
differentiated two different types of depression based partly on Freud's iden-
tification of these two fundamental mechanisms in depression. Thus, several
psychoanalytic theorists have differentiated a depression focused primarily
on interpersonal (anaclitic) issues such as dependency, helplessness, and feel-
ings of loss and abandonment, from a depression derived from a harsh, puni-
tive, judgmental superego that is focused primarily on self-critical
(introjective) concerns about self-worth and feelings of failure and guilt. Dis-
satisfaction with symptom-based diagnostic classifications of depression led
several psychoanalytic investigators to differentiate types of depression based
on phenomenological distinctions among the fundamental concerns that con-
tribute to individuals becoming depressed. Blatt and colleagues (e.g., Blatt,
1974; Blatt, D'Afflitti, & Quinlan, 1976) identified two major foci in depres-
sion: (a) disruptions of gratifying interpersonal relationships (e.g., object loss
or neglect) and (b) disruptions of an effective and essentially positive sense of
self (e.g., feelings of failure or guilt). Extensive clinical and empirical evidence
indicates that depression is organized around these two issues: around interper-
sonal issues such as feelings of abandonment and loneliness, or around an
impaired sense of self expressed in preoccupations with personal failure, in-
adequacy, or transgression (Blatt, 2004; Blatt & Zuroff, 1992). The articula-
tion of a depression associated with themes of loss and abandonment identi-
fies a type of depression frequently overlooked in most studies of depression.
Blatt and colleagues (e.g., Blatt, 1974, 2004; Blatt, D'Afflitti, &
Quinlan, 1976; Blatt, Quinlan, & Chevron, 1990; Blatt et al, 1982), on

the basis of an integration of object relational and ego psychoanalytic and
cognitive-developmental perspectives, differentiated between an anaclitic
(or dependent) depression and an introjective (or self-critical) depression
and discussed the developmental origins, predisposing personality character-
istics, clinical manifestations, and conflicts in these two types of depression.
Anaclitic or dependent depression is characterized by feelings of loneliness,
helplessness, and weakness; the individual has intense and chronic fears of
being abandoned and left unprotected and uncared for. These individuals
have intense longings to be loved, nurtured, and protected. Because of their
failure to have adequately internalized experiences of gratification or the
qualities of the individuals who provided satisfaction, others are valued prima-
rily for the immediate care, comfort, and satisfaction they provide. Separation
from others and object loss create considerable fear and apprehension, and are
often dealt with by primitive means such as denial or a desperate search for
substitutes. Individuals with anaclitic depression often express depression in
somatic complaints, frequently seeking the care and concern of others, includ-
ing physicians. Depression in these patients is often precipitated by object
loss and they often make suicidal gestures by trying to overdose on their
prescribed antidepressant medication (Blatt, 2004; Blatt et al., 1982).
Introjective or self-critical depression, in contrast, is characterized by
self-criticism and feelings of unworthiness, inferiority, failure, and guilt. These
individuals engage in constant and harsh self-scrutiny and evaluation and
have a chronic fear of criticism and of losing the approval of significant oth-
ers. They strive for excessive achievement and perfection, are often highly
competitive and work hard, make many demands on themselves, and often
achieve a great deal, but with little lasting satisfaction. Because of their in-
tense competitiveness, they can be critical and attack others. Through over-
compensation they strive to achieve and maintain approval and recognition
(Blatt, 1974, 1995a, 1995b, 2004). This focus on issues of self-worth, self-
esteem, failure, and guilt can be particularly insidious. Individuals who are
highly self-critical and feel guilty and worthless are at considerable risk for
serious suicide attempts (A. T. Beck, 1983; Blatt, 1974, 1995a, 1998; Blatt et
al., 1982; Fazaa, 2001; Fazaa & Page, 2003). Numerous clinical reports as
well as accounts in the mass media illustrate the considerable suicidal poten-
tial of highly talented, ambitious, and very successful individuals who are
plagued by a severe superego—by intense self-scrutiny, self-doubt, and self-
criticism (Blatt, 1995b).2
Powerful needs to succeed and to avoid public criticism and the appear-
ance of defect and weakness force some individuals to work incessantly to
achieve and accomplish. But they are profoundly vulnerable to the criticism
of others and to their own self-scrutiny and judgment. This harsh punitive
2
Blatt (1995b) presented accounts of three very successful but highly self-critical individuals who
committed suicide, including Vincent Foster, former White House counsel to President Clinton.

superego (S. Freud, 1914/1957f; 1923/1959a) can be a driving force for
achievement, but it can also result in little satisfaction in accomplishments.
Through a marked vulnerability to experiences of failure and criticism, these
individuals can become increasingly vulnerable to depression and suicide.
Because of their need to maintain a personal and public image of strength
and perfection, such individuals are constantly trying to prove them-
selves, are always on trial, feel vulnerable to any possible implication of
failure or criticism, and often are unable to turn to others, even the clos-
est of confidants, for help or to share their anguish. (Blatt, 1995b,
p. 1005)
They thus are vulnerable to intense depression often accompanied by sui-
cidal impulses.
Bowlby (1980, 1988a), from an object relations and an ethological per-
spective, discussed the predisposition to depression in two types of individu-
als: those who are anxiously attached and those who are compulsively self-
reliant. Anxiously attached individuals seek interpersonal contact and are
excessively dependent on others. Compulsively self-reliant individuals are
excessively autonomous and avoid close, intimate, interpersonal relation-
ships. Both of these insecure attachment styles create a vulnerability to de-
pression. Arieti and Bemporad (1978, 1980), from an interpersonal psycho-
dynamic perspective, also distinguished two types of depression—a dominant
other and a dominant goal type of depression. Arieti and Bemporad (1978)
discussed two intense and basic wishes in depression: "to be passively grati-
fied by the dominant other" and "to be reassured of one's own worth, and to
be free of the burden of guilt" (p. 167). In the dominant other type of depres-
sion, the individual seeks to be passively gratified by developing a relation-
ship that is clinging, demanding, dependent, and infantile. In the dominant
goal type, the individual seeks to be reassured of his or her worth and to be
free of guilt by directing every effort toward achieving a goal that has become
an end in itself. Depression, from this perspective, usually results when the
dominant other is lost or when the dominant goal is not achieved.
Congruent with these earlier psychodynamic formulations of depres-
sion, A. T. Beck (1983), from a cognitive—behavioral perspective, distin-
guished between sociotropic (socially dependent) and autonomous types of
depression. Beck described sociotropic depression as focused on disruptions
of interpersonal relationships, and autonomous depression as focused on dis-
ruptions of autonomy and self-definition. Sociotropy (social dependency),
according to A. T. Beck (1983), "refers to the person's investment in posi-
tive interchange with other people . . . including passive-receptive wishes
(acceptance, intimacy, understanding, support, guidance)" (p. 273). Highly
sociotropic individuals are "particularly concerned about the possibility of
being disapproved of by othets, and they often try to please others and main-
tain their attachments" (Robins & Block, 1988, p. 848). Depression is most
TWO PRIMARY CONFIGURATIONS OF PERSONALITY ORGANIZATION 1 57

likely to occur in these individuals in response to perceived loss or rejection
in social relationships.
Individuality (autonomy), according to A. T. Beck (1983), refers to the
person's "investment in preserving and increasing his independence, mobil-
ity, and personal rights; freedom of choice, action, and expression; protec-
tion of his domain . . . and attaining meaningful goals" (p. 272). An indi-
vidual with autonomous depression is "permeated with the theme of defeat
or failure," blaming "himself continually for failing below his standards,"
and being "specifically self critical for having 'defaulted' on his obligations"
(A. T. Beck, 1983, p. 276). Highly autonomous, achievement-oriented indi-
viduals are very concerned about the possibility of personal failure and often
try to maximize their control over the environment to reduce the probabil-
ity of failure and criticism. Depression most often occurs in these individu-
als in response to a perceived failure to achieve or a lack of control over
their environment.
Thus, three groups of psychoanalytic theorists and a preeminent
cognitive-behavioral theorist agree about the importance of differentiating
between a depression focused on interpersonal issues and a depression fo-
cused on issues of self-worth and self-definition (Blatt & Maroudas, 1992).
Although important differences exist between these four theoretical posi-
tions, they share a great deal in common (see Blatt & Maroudas, 1992, for a
comprehensive review of these four theoretical positions and their clinical
implications). Each theoretical position, on the basis of very different as-
sumptions and using somewhat different terms, identified the conflicts, de-
fenses, and fundamental character structure as well as the life experiences
that precipitate these two major types of dysphoric feelings. One type of de-
pression is characterized by a marked vulnerability to disruptions of gratify-
ing interpersonal relationships and is expressed primarily in dysphoric feel-
ings of loss, abandonment, and loneliness. The other type is characterized by
a marked vulnerability to disruptions of an effective and positive sense of self
and is expressed primarily in dysphoric feelings of worthlessness, guilt, fail-
ure, and a sense of a loss of autonomy and of control.
Bleichmar (1996), on the basis of a subtle detailed analysis of depressed
patients in intensive treatment, described the interweaving of a multiplicity
of factors and experiences that contribute to the development of experiences
of helplessness and powerlessness that he viewed as central to the develop-
ment of clinical depression. He differentiated several types of depression in-
cluding a depression derived from aggressive wishes that contribute to in-
tense feelings of guilt and a depression that derives from parental failures
that contribute to disruptions of the individual's self-esteem. He distinguished
two basic motivational systems—self-preservation and the preservation of
the other—and the fundamental needs and wishes in these two motivational
systems. Bleichmar's identification of subtypes of depression and his distinc-
tion between these two motivational systems are consistent with the differ-

entiation between anaclitic and introjective personality organization and
psychopathology.
The development of the DEQ and the SAS has led to extensive empiri-
cal investigation of the developmental origins, personality characteristics,
and aspects of contemporary life situations that characterize anaclitic and
introjective depression in both outpatients and inpatients (see reviews of
this research literature in Blatt, 1998, 2004; Blatt & Zuroff, 1992; Luyten,
2002; Luyten, Blatt, & Corveleyn, 2005b). Extensive empirical investiga-
tion indicates consistent differences in the current as well as early life expe-
riences of these two types of individuals with depression (Blatt & Homann,
1992), in their basic character style, and in their clinical expression of de-
pression (Blatt, 2004; Blatt & Zuroff, 1992; Zuroff et al., 2004). Thus, re-
searchers now understand more fully some of the early and current life expe-
riences that contribute to the development of these two types of depression
as well as the functioning of these individuals both when they are clinically
depressed and when they are in remission. Researchers also appreciate more
fully the differential vulnerability of each type of depressed individuals to
various types of stressful life experiences (Blatt & Zuroff, 1992; Zuroff et al.,
2003). And, as 1 discuss in more detail in chapters 7 and 8 (this volume),
researchers are beginning to appreciate the differential response of these two
groups of patients to various types of brief and long-term intensive psycho-
therapeutic interventions (e.g., Blatt, 1992; Blatt, Besser, & Ford, 2007; Blatt
& Ford, 1994; Blatt, Quinlan, Pilkonis, & Shea, 1995; Blatt & Shahar, 2004b;
Blatt & Zuroff, 2005; Blatt, Zuroff, Bondi, Sanislow, & Pilkonis, 1998; Blatt,
Zuroff, Quinlan, & Pilkonis, 1996).
These clinical and research findings about depression have important
implications for personality theory because they demonstrate, consistent with
the extensive research over the past 2 decades on attachment patterns, that
developmental events and early life experiences have important causative
roles in psychopathology. A wide range of research supports the fundamental
psychoanalytic formulation (e.g., S. Freud, 1914/1957f, 1923/1959a) that
harsh, punitive, intensely critical parent-child relationships lead to the de-
velopment of a punitive superego and to an introjective, self-critical depres-
sion (e.g., Blatt & Homann, 1992) with considerable potential for suicide.
Empirical findings from both longitudinal and cross-sectional research, con-
sistent with clinical observations, indicate that parental rejection and exces-
sive authoritarian control before the age of 8 is predictive of the level of the
child's self-criticism at ages 12 and 13 (Koestner et al,, 1991) and the level of
depression when the child is in late adolescence or young adulthood (Gjerde,
Block, & Block, 1991). This level of self-criticism in early adolescence is
predictive of less education, an occupation of lower socioeconomic status,
and a higher level of maladjustment, depression, and dissatisfaction with work,
family, and other close relationships in later adulthood (Koestner et al., 1991).
Thus, highly self-critical individuals view and judge themselves in the same
TWO PRIMARY CONFIGURATIONS OF PERSONALITY ORGANIZATION J 59

harsh, punitive fashion as they perceive that their parents had judged them
(see also Frost, Marten, Lahart, & Rosenblate, 1990). They struggle to meet
these internalized, harsh, judgmental parental standards—attitudes and stan-
dards that they now direct toward themselves so that whatever they accom-
plish is never fully sufficient (e.g., Asch, 1980; Gabbard, 1995; Jacobson,
1971; Meissner, 1986).
In sum, the differentiation of relatedness and of self-definition as two
fundamental psychological dimensions has enabled investigators from differ-
ent theoretical orientations (e.g., Arieti & Bemporad, 1978, 1980; A. T.
Beck, 1983; Blatt, 1974,1998, 2004; Blatt, D'Afflitti, et al., 1976; Blatt et al.,
1982; Blatt & Zuroff, 1992; Bowlby, 1980, 1988a; Corveleyn et al., 2005;
Luyten, 2002; Zuroff et al., 2004) to identify two types of depression: ana-
clitic and introjective. Extensive research has provided substantial support
for these formulations and has led to further understanding of the etiology,
nature, and treatment of depression (see Blatt, 2004).
Personality Disorders
The differentiation of two personality configurations, between individu-

als preoccupied with issues of relatedness and those preoccupied with issues
of self-definition, and the development of methods for assessing aspects of
these two dimensions (e.g., DEQ and SAS), has also enabled investigators to
identify an empirically derived taxonomy for integrating the diversity of the
frequently overlapping personality disorders described in Axis II of the Diag-
nostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV;
American Psychiatric Association, 1994). Systematic empirical investiga-
tion of outpatients (Morse, Robins, & Gittes-Fox, 2002; Ouimette, Klein,
Anderson, Riso, & Lizardi, 1994) and of inpatients (K. N. Levy et al., 1995),
in which the DEQ or the SAS was used to measure concerns about interper-
sonal issues and about self-definition (e.g., self-worth), found that the vari-
ous Axis II personality disorders are organized into two primary configura-
tions: one around issues of relatedness and the other around issues of
self-definition. Ouimette et al. (1994) and Morse et al. (2002), with outpa-
tients, and K. N. Levy et al. (1995), with inpatients, found that individuals
with dependent, histrionic, and borderline personality disorders (anaclitic
patients with predominant relational concerns) had significantly greater pre-
occupation on measures of relatedness (e.g., the Dependency factor of the
DEQ and the Sociotropy scale of the SAS) than on measures of self-definition
(e.g., the Self-Criticism factor of the DEQ and the Autonomy scale of the
SAS). It is noteworthy that Cogswell and Alloy (2006), as noted earlier,
found that the Neediness scale, the lower developmental level on the De-
pendency (or Interpersonal) factor of the DEQ, was significantly correlated
with the anaclitic personality disorders—the dependent, borderline, and his-
trionic personality disorders. Conversely, K. N. Levy, Morse, and Ouimette

and their respective colleagues found that individuals with paranoid, schiz-
oid, schizotypic, antisocial, narcissistic, avoidant, obsessive-compulsive, and
self-defeating personality disorders (introjective patients with predominant
concerns about self-definition, self-control, and self-worth) had significantly
greater preoccupation on measures of self-definition (e.g., the DEQ Self-
Criticism factor and the SAS Autonomy scale) than on measures of related-
ness (e.g., the DEQ Dependency factor and the SAS Sociotropy scale). Thus,
systematic empirical investigation indicates that the 12 personality disorders
in Axis II of DSM-IV, in both inpatients and outpatients, can be integrated
parsimoniously into two configurations of anaclitic and introjective person-
ality disorders in terms of their primary preoccupation with issues of related-
ness or self-definition, self-control, and self-worth (Blatt & Levy, 1998). These
findings indicate that the Axis II personality disorders are primarily associ-
ated, at possibly different developmental levels, with preoccupation with is-
sues of interpersonal relatedness or with issues of self-definition, perhaps ex-
plaining to some degree the reasons for the frequent extensive overlap
(comorbidity) among many of the personality disorders in Axis II. This clus-
tering of the personality disorders around issues of either relatedness or self-
definition is theoretically grounded and empirically supported, and stands in
contrast to the more intuitively based clusters (odd-eccentric, dramatic-
emotional, and anxious-fearful) proposed in DSM-IV (Blatt & Levy, 1998).
The fact that both depression (a DSM-IV Axis I disorder) and personality
disorders (DSM-IV Axis II disorders) are organized around the same person-
ality factors raises serious questions about a fundamental assumption of DSM—
IV—the independence of these two DSM axes.
Borderline personality disorder was the only personality disorder for
which patient concerns about issues of both relatedness and self-definition
were significantly elevated (Ouimette et al., 1994). It is noteworthy that
Blatt and Auerbach (1988), in an earlier clinical-theoretical contribution,
differentiated between highly dependent patients with borderline personal-
ity disorder (BPD) who conformed to the BPD diagnosis, as described in
DSM-IV, and more overideational, introjective patients with BPD and
obsessive—compulsive and paranoid features. The more dependent patient
with BPD is vulnerable to profound feelings of abandonment and has greater
concerns about issues of relatedness, whereas the more overideational pa-
tient with BPD with obsessive and paranoid features has greater concerns
about issues of self-definition.
In sum, these findings from the study of depression and personality
disorders suggest that the fundamental polarity of relatedness and self-
definition facilitates the differentiation of two primary configurations of psy-
chopathology—anaclitic and introjective disorders—based on differences be-
tween an excessive preoccupation with issues of relatedness or an excessive
focus on issues of self-definition (Blatt, 1990,1995b; Blatt & Shichman, 1983).
Furthermore, working with a relatively large sample of individuals with mild

to severe psychopathology, Sundin (2004) found that Wallerstein's Scales of
Psychological Capacities, a more recently developed and widely acclaimed
measure of psychological change (e.g., Dewitt et al., 1991; Wallerstein, 1988),
is composed of two primary factors that closely parallel the anaclitic-
introjective distinction.
SUMMARY
Personality development involves two primary developmental tasks:

(a) the establishment of the capacity to form stable, enduring, mutually sat-
isfying interpersonal relationships and (b) the achievement of a differenti-
ated, consolidated, stable, realistic, essentially positive self-definition or iden-
tity. The development of stable and meaningful interpersonal relatedness
defines an anaclitic developmental line; the development of a consolidated
and differentiated identity and self-concept defines an introjective develop-
mental line. The two developmental lines of interpersonal relatedness and
self-definition develop synergistically throughout the life cycle, and each
influences the shape and meaning of psychological experiences. As I dis-
cussed in chapters 3 and 4 (this volume), these developmental lines evolve
dialectically in normal psychological development, resulting in an integra-
tion of mature levels of interpersonal relatedness and self-definition. Normal
development involves a complex transaction between these two fundamen-
tal developmental processes and, beginning in late adolescence, their even-
tual integration. Meaningful and satisfying relationships contribute to the
evolving concept of the self, and a revised sense of self leads, in turn, to more
mature levels of interpersonal relatedness. Although these two developmen-
tal lines usually develop in parallel, in a complex and interdependent way
these two developmental lines also develop in a dialectical interaction and
are eventually integrated in the formation of a self-identity—of a self-
in-relation to others—in late adolescence and early adulthood.
The anaclitic and introjective developmental lines also delineate two
basic personality configurations within the normal range, each with a par-
ticular experiential mode; preferred forms of cognition, defense, and adapta-
tion; unique aspects of interpersonal relatedness; and specific forms of object
representations. Thus, these two personality configurations develop through
the life cycle to become more organized modes of functioning that contrib-
ute to the shaping of and establishment of meaning for psychological events.
Relatively recent research indicates that different developmental levels can
be identified within these two basic developmental lines and that these dif-
ferentiations should facilitate future research on personality development.
Biological predispositions and severely disruptive environmental events,
however, can interact in complex ways to disrupt this integrated dialectical
developmental process and lead to a defensive, markedly exaggerated em-

phasis on one developmental dimension at the expense of the other. These
deviations can be relatively mild as in normal character variations or these
deviations can also be extreme. The more extensive the deviation, the greater
the exaggerated emphasis on one developmental line at the expense of the
other, and the greater the possibility of psychopathology. Exaggerated distor-
tion of one developmental line to the neglect of the other reflects compensa-
tory or defensive maneuvers in response to developmental disruptions. The
differentiation and extensive empirical support for two types of depression
and two configurations of personality disorders suggest that a broad range of
psychopathology may be most effectively understood as exaggerated preoc-
cupations with one of these two fundamental developmental dimensions of
relatedness and self-definition. And these distortions are the consequence of
disruptions of the normal dialectical developmental process.
Thus, the anaclitic-introjective distinction appears to provide a basis
for establishing continuity between the psychological principles involved in
normal personality development, variations in personality organization, and
types of psychopathology in both Axis I (e.g., depression) and Axis II (e.g.,
personality disorders) of the DSM-IV. The identification of common psy-
chological principles in personality development, personality organization,
and psychopathology indicates that this theoretical model provides a way of
conceptualizing psychopathology that has important implications for under-
standing the etiology of disorders as well as for therapeutic intervention. The
fact that these principles of personality development are relevant to disor-
ders in DSM Axis I and Axis II also suggests that these principles may pro-
vide the basis for articulating a theoretical model that can integrate a wide
range of psychopathology into a unified theoretical model. This theoretical
model of psychopathology that identifies continuities between concepts of
normal psychological development and concepts of psychopathology has the
potential to resolve the complex and vexing issues of comorbidity in DSM-
IV (see chap. 6, this volume).

TWO PRIMARY CONFIGURATIONS
6
OF PSYCHOPATHOLOGY
The normal evolving dialectical developmental process between relat-

edness and self-definition leading to psychological maturity—to the capac-
ity to form sustained reciprocal, mutually satisfying, interpersonal relation-
ships and to establish a differentiated, integrated, and essentially positive self
(i.e., an identity)—can be disrupted by complex interactions between ge-
netic and biological predispositions and early experiences of conflict and
trauma. These early disruptions can create impairments or vulnerabilities
that can interact with current life stress to lead to a wide range of psychologi-
This chapter incorporates material from (a) "Two Primary Configurations of Psychopathology," by
S. J. Blatt and S. Shichman, 1983, Psychoanalysis and Contemporary Thought, 6, pp. 187-254.
Copyright 1983 by International Universities Press. Adapted with permission; (b) "Psychodynamic
Assessment," by R. S. Behrends and S. J. Blatt, 2003, in ]. Wiggins and K. Trobst (Eds.), Paradigms of
Personality Assessment (pp. 226-342). New York: Guilford Press. Copyright 2003 by Guilford Press,
Adapted with permission; (c) "A Dialectic Model of Personality Development and Psychopathology:
Recent Contributions to Understanding and Treating Depression," by S. J. Blatt and G. Shahar, 2005,
in J. Corveleyn, P. Luyten, and S. J. Blatt (Eds.), The Theory and Treatment of Depression: Towards a
Dynamic Interactionism Model (pp. 137-162). Leuven, Belgium: University of Leuven Press. Copyright
2005 by University of Leuven Press. Adapted with permission; and (d) "A Fundamental Polarity in
Psychoanalysis: Implications for Personality Development, Psychopathology, and the Therapeutic
Process," by S. J. Blatt, 2006, Psychoanalytic Inquiry, 26, 492-518. Copyright 2006 by Taylor &
Francis. Adapted with permission.
165
cal disturbances (e.g., Luyten, Blatt, & Corveleyn, 2005a). S. Freud was among
the early proponents of this diathesis-stress model of psychopathology ac-
cording to which early developmental impairments are activated by current
conflicts and stressors that are congruent with earlier conflicts and vulner-
abilities. Thus, disruptions of normal psychological development create points
of potential vulnerability that, through a process of "deferred action"
(Nachtraglichkeit; S.Freud, 1895/1957e, 1896/1957c, 1917/1963a, 1918/1955),
can lead to subsequent psychopathology (S. Freud, 1905/1963b, 1913/1958b).
In response to the activation of these vulnerabilities, individuals often resort
to earlier modes of adaptation that are inappropriate and ineffective in the
current situation and thus appear as symptoms. As S. Freud noted early in his
work (1911/1951),
One instinct or instinctual component fails to accompany the rest along
the anticipated normal path of development, and, in consequence of
this inhibition in its development, it is left behind at a more infantile
stage. The libidinal current in question then behaves in relation to later
psychological structures like one belonging to the system of unconscious,
like one that is repressed!,] (p. 67)
and thus constitutes a basis for psychological disturbance. S. Freud left open
the possibility that several points of vulnerability could occur in the course
of development. Each of these points "in succession may allow an irruption
of the libido that has been pushed off—beginning, perhaps, with the later
acquired fixations, and going on, as the illness develops, to the original ones
that lie nearer the starting-point" (S. Freud, 1911/1951, p. 78; see also
S. Freud, 1913/1958b, p. 319). Thus in S. Freud's view, these multiple points
of vulnerability could be interrelated in a linear sequence.
In this early version of the diathesis—stress model, adult psychopathol-
ogy was considered partly a consequence of earlier developmental distur-
bances that were activated by current life stress. Patterns of psychopathology
are formed in earlier disruptions of normal development, patterns that are
evoked later in life through the process of deferred action. In this regard,
S. Freud (1911/1951) stated "neuroses arise in the main from a conflict be-
tween the ego and the sexual instinct, . . . the forms which the neuroses
assume retain the imprint of the course of development followed by the
libido—and by the ego" (p. 79). On the basis of these formulations, S. Freud
(1913/1958a) asserted that
there is no fundamental difference, but only one of degree, between the
mental life of normal people, of neurotics and of psychotics. A normal
person has to pass through the same repressions and has to struggle with
the same substitutive structures; the only difference is that he deals with
these events with less trouble and better success, (p. 210)
And it is this continuity between normality and pathology that enables cli-
nicians to understand and appreciate the struggles of their patients.

Early psychoanalytic investigators, especially S. Freud, stressed distur-
bances in instinctual (drive) development in psychopathology, but subse-
quent contributors considered other etiological factors as well, including the
nature of defenses (A. Freud, 1936/1937), disturbances in ego functions such
as cognition, perception, and motility (Hartmann, 1939/1958a, 1939/1958b;
Rapaport, 1954), aspects of character style (Reich, 1933/1972), and differ-
ences in predominant psychosocial mode (Erikson, 1950). Nevertheless, the
model of personality development in all these approaches assumed essen-
tially a linear sequence, and psychopathology, in these views, derived from
impairments in this linear developmental sequence. Anna Freud (1963,1965),
with her conceptualization of development lines, however, broadened this
basically linear model by considering psychopathology as evolving from pos-
sible disruptions across multiple developmental sequences. Healthy person-
ality development, according to Anna Freud, occurs through the relative
coordination and integration of multiple developmental lines; psychological
disturbances occur as the result of disruptions in one or more of these devel-
opmental sequences (Meurs, Vliegen, & Cluckers, 2005).
Bowlby (1973), on the basis of a model derived from Waddington's
(1957) epigenetic theory of biological development and extending Anna
Freud's concepts of developmental lines, considered personality "as a struc-
ture that develops unceasingly along one or another of an array of possible
and discrete pathways" (p. 364). These various pathways are close together
in very early development, but interactions among biological predispositions
and environmental experiences, at critical points in development, create
conditions that favor development along a particular pathway. These diver-
gences into particular pathways can be minimal or rather extreme. Develop-
ment can thus be relatively convergent with a central pathway in which a
variety of patterns and processes develop in coordination, or it can be ex-
tremely divergent. Psychological disturbances occur as a function of the ex-
tent of the divergence of the pathway from a central, integrated, develop-
mental sequence. More extreme divergence from the central developmental
pathway creates greater vulnerability to psychopathology.
Biological dispositions and environmental factors interact in complex
ways in personality development. Biological factors create differential sensi-
tivities to environmental conditions, sensitivities that may vary throughout
the life cycle. Environmental factors vary in their tendency to interact with
biological predispositions, partly depending on an organism's level of devel-
opment (Luyten, Blatt, & Corveleyn, 2005c). Vulnerability to negative en-
vironmental factors is usually greater early in life; in normal maturation this
vulnerability usually diminishes throughout childhood and adolescence as
individuals become increasingly consolidated in their particular developmen-
tal pathway. Once developmental pathways are established, they tend to
maintain their direction. As Bowlby (1973) pointed out, anticipating the
later development of action theory (e.g., Brandtstadter, 1998, 1999; Buss,
TWO PRIMARY CONFIGURATIONS OF PSYCHOPATHOLOGY 167

1987; R. M. Lerner, 1982; Parsons, 1964,1978; Plomin & Caspi, 1999; Shahar,
2006; Shahar, Cross, & Henrich, 2005), each pathway has particular adap-
tive potentials within a specific environment, and individuals tend to seek
environments congruent with this adaptive potential. Bowlby (1973) wrote,
Present cognitive and behavioral structures determine what is perceived

and what is ignored, how a new situation is constructed, and what plan
of action is likely to be constructed to deal with it. Current structures,
moreover, determine what sorts of person and situation are sought after
and what sorts are shunned. In this way an individual comes to influence
the selection of his own environment, (pp. 368-369)
Thus, an individual's mode of adaptation derives from interactions between

biological predispositions and environmental influences, with each matura-
tional stage laying the groundwork for further development and determining
the pathways along which further development proceeds. As development
progresses, structures become more differentiated and pathways become in-
creasingly consolidated. These patterns of adaptation influence how indi-
viduals select, interpret, experience, and create their interpersonal and so-
cial context. Biological proclivities and early caring experiences have
considerable impact in determining the selection of the developmental path-
ways, and subsequent life experiences, including interpersonal relationships,
usually consolidate these initial proclivities and vulnerabilities. These early
developmental pathways usually become increasingly consolidated and elabo-
rated by subsequent experiences because individuals tend to seek experiences
that are congruent with their expectations and to interpret events on the
basis of previously established cognitive-affective schema (Blatt, 2004; Blatt
& Zuroff, 1992; Bowlby, 1973; Buss, 1987; Zuroff, 1992).
When normal development is disrupted, and if no subsequent amelio-
rating circumstances and experiences occur, the maladaptive responses to
these disruptions tend to be repeated over and over again as the individual
attempts to cope with the demands and perturbations of subsequent phases
of the life cycle. These distortions become entrenched in defensive exag-
gerations of one developmental line to the exclusion of others, which lim-
its subsequent growth and experiences. Although earlier and more severe
disruptions of the developmental process usually result in more extreme
and persistent disturbances, it is important to stress that significant con-
structive interpersonal experiences, like a psychotherapeutic relationship,
can ameliorate or even modify the pathways that had been established in
response to earlier developmental disruptions. Thus, developmental path-
ways are not necessarily fixed and immutable but can be altered by subse-
quent experiences.
Disturbances in personality development occur when biological predis-
positions and severely disruptive environmental events interact in complex
ways to disrupt the normally integrative, dialectical development of inter-

personal relatedness and self-definition discussed in chapter 4 (this volume),
resulting in exaggerated and distorted emphases on either relatedness or self-
definition at the expense of the other developmental dimension. Although
mild deviations, with only a relatively minor differential emphasis on one of
these two developmental dimensions, are part of variations in normal char-
acter or personality styles (i.e., the introjective [Apollonian] or anaclitic
[Dionysian] personality styles, as discussed in chap. 5, this volume), more
extensive deviations, that is, markedly exaggerated deviation from a central
developmental pathway that strongly emphasizes either interpersonal relat-
edness or self-definition at the expense of the other, defines two primary
configurations of psychopathology (Blatt, 1974, 1990, 1995a; Blatt &
Shichman, 1983). Extensive deviations, with greater emphasis on one devel-
opmental line at the expense of the other, are expressed in various forms of
psychopathology. These exaggerated preoccupations with aspects of one de-
velopmental line to the relative neglect of the other are compensatory (de-
fensive) attempts to cope with severe developmental disruptions.
As discussed in chapter 4 (this volume), personality development evolves
through the dialectical interaction of two primary tasks: (a) the establish-
ment of the capacity to form stable, enduring, mutually satisfying interper-
sonal relationships and (b) the achievement of a differentiated, consolidated,
stable, realistic, essentially positive identity. These two developmental tasks
delineate two primary developmental lines (A. Freud, 1963, 1965). The es-
tablishment of stable and meaningful interpersonal relatedness defines an
anaclitic developmental line; the development of a consolidated and differ-
entiated identity and self-concept defines an introjective developmental line.
Normal functioning occurs in essentially an open system in which interper-
sonal relations and self-definition develop in mutually facilitating complex
interactions. Meaningful and satisfactory interpersonal relationships contrib-
ute to an evolving concept of the self and, in turn, the new levels in the
development of the self, or identity, lead to more mature levels of interper-
sonal relatedness. The development of the self is influenced by significant
interpersonal experiences, and new types of interpersonal relationships oc-
cur as a consequence of significant revisions of the self. Severe disruptions in
the course of development, however, can distort this reciprocally balanced,
interactive process and lead to the formation of psychopathology. Psychopa-
thology is the consequence of severe developmental impairments that inter-
fere with the reciprocal development of satisfying interpersonal relations and
a meaningful concept of the self. Psychopathological symptoms are compen-
satory attempts or maneuvers; they are exaggerations and extreme distor-
tions of normal development because they focus primarily on less mature
aspects of one or the other developmental lines. Individuals cope with severe
developmental disruptions by attempts to achieve equilibrium through an
exaggerated emphasis either on aspects of interpersonal relatedness or on
aspects of the self. Thus, in the extreme, exaggerated emphasis on one or the

other of the two fundamental developmental lines defines two primary con-
figurations of psychopathology.
The determination of which developmental line (the development of
the self or of interpersonal relatedness) becomes the primary focus of com-
pensatory maneuvers and symptomatic expressions in psychopathology is
influenced by a host of possible parameters. These parameters include bio-
logical predispositions, specific environmental factors and events such as when
and how in development the impairments occur, the specific conflictual is-
sues that are involved, the cultural and family matrix, the character styles of
the primary caregivers, and the values of the individual and the family. But
psychopathology is always characterized by a lack of flexibility and a loss of
the opportunity to grow and change as a consequence of new experiences
and new environmental opportunities. Rigid, fixed concepts of the self re-
strict the opportunity for new types of interpersonal experiences, and repeti-
tive types of interpersonal interactions and experiences restrict and seriously
limit modification, revision, and growth of the self.
ANACLIT1C AND 1NTROJECT1VE CONFIGURATIONS

OF PSYCHOPATHOLOGY
The identification of several levels within the two fundamental dimen-

sions of relatedness and self-definition in personality development, as well as
the articulation of the anaclitic-introjective distinction in personality orga-
nization, discussed in chapter 5 (this volume), contributed to a further un-
derstanding of depression and personality disorders. These findings suggested
that the formulations of anaclitic and introjective personality development
and organization could facilitate the identification of two primary clusters of
psychopathology in which many forms of psychopathology are organized, at
different developmental levels, in two fundamental configurations as exag-
gerated distortions of either of the two fundamental developmental dimen-
sions of interpersonal relatedness and self-definition. This view facilitates
the identification of many forms of psychopathology in Axis I and Axis II of
the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-
IV; American Psychiatric Association, 1994) as involving intense, one-sided
preoccupation with issues of either relatedness or self-definition at different
points in the developmental process (Blatt, 1974, 1990, 1995a; Blatt &
Shichman, 1983). Thus, different forms of psychopathology can be under-
stood as expressions, at different developmental levels, of disruptions in the
development of interpersonal relatedness or self-definition. Differences in
the functional modes of self and in self-feelings, as well as in the quality of
interpersonal relatedness, at various developmental levels, are discussed in
chapter 4 (this volume). These formulations open the possibility, for ex-
ample, of considering some forms of psychopathology as an exaggerated de-

fensive emphasis on autonomy that derives from intense feelings of shame
accompanied by defensive distancing from close interpersonal relationships,
or as an exaggerated (defensive) sense of pride that makes it difficult for the
individual to accept realistic limitations and constructive criticisms from
others. Consideration of the complex interplay among the quality of inter-
personal relatedness and various aspects of self-expression and self-feelings,
at various points in the developmental process, as discussed in chapters 4 and
5 (this volume), allows for a fuller appreciation of the intricacies of the pro-
cesses involved in both normal and disrupted psychological development.
The consideration of personality development and psychopathology from
the perspective of a lifelong coordination and integration of a capacity for
relatedness and for self-definition provides a theoretical model for consider-
ing various forms of psychopathology as attempts to compensate for marked
disruptions of the fundamental dialectical developmental process. Such a
perspective facilitates an appreciation of the continuities between normal
personality development, variations in normal character or personality style,
and various forms of psychopathology. In other words, this approach empha-
sizes the continuity between normal personality development and various
forms of psychopathology and provides the basis for understanding psycho-
pathology not as a series of separate diseases, each assumed to derive from
some hypothetical but as yet often undocumented neurobiological abnor-
mality, but as distorted modes of adaptation that emerge from disruptions of
normal psychological development. These formulations facilitate not only
the specification of continuities between normality and psychopathology but
also an appreciation of the complex relationships among different types of
psychopathology. Such an approach to psychopathology avoids a number of
the problems currently associated with the multiple, frequently overlapping
diagnostic classifications in DSM-IV including its lack of a cohesive unify-
ing theory for various concepts of psychopathology, the forced demarcation
between normal and the pathological through arbitrarily defined threshold
values, excessive preoccupation with manifest symptoms and signs to achieve
acceptable levels of reliability, the high degree of overlap or comorbidity
among presumed distinct disorders, and the failure to consider the possible
relations among the various disorders and their links with variations in nor-
mal personality development as well as their links to considerations of etiol-
ogy and therapeutic intervention (Blatt & Levy, 1998). In the formulations
of anaclitic and introjective configurations of psychopathology considered
in this chapter, various forms of psychopathology are conceptualized as in-
terrelated modes of maladaptation, at different developmental levels, that
occur in response to serious disruptions of the normal dialectical develop-
ment of interpersonal relatedness and self-definition.
Exaggerated and intense preoccupation with interpersonal relatedness
at the expense of developing important aspects of self-definition, or con-
versely, intense preoccupations about preserving and protecting the sense of
TWO PR/MARY CONFIGURATIONS OF PSYCHOPATHOLOGY 171

self at the expense of developing adequate forms of interpersonal relatedness—
defines two primary configurations of psychopathology. Each configuration
contains several types of disordered behavior that range from relatively se-
vere to relatively mild forms of disturbance. Important and fundamental dy-
namic, structural, and experiential similarities exist between dependent (or
infantile) and histrionic psychopathology in an anaclitic configuration that
are qualitatively different from the dynamic, structural, and experiential di-
mensions of psychopathology in the introjective configuration in which there
are dynamic, structural and experiential similarities among paranoid, obses-
sive-compulsive, introjective (guilt-laden) depressive, and narcissistic psy-
chopathologies. These two configurations of psychopathology, anaclitic or
introjective, each involve a fundamentally different experiential mode and
behavioral orientation, with very different types of gratification and preferred
modes of cognition, defense, and adaptation. Each configuration has a differ-
ent emphasis on the representation of the self or on objects as well as a par-
ticular orientation toward interpersonal relationships and the self. The fun-
damentally different structural and experiential modes in each of these
two configurations are expressed in the psychopathologies that occur within
that configuration, but at different developmental levels. Symptoms and char-
acter traits within the two configurations, at different levels, express instinc-
tual strivings, preferred modes of defense and adaptation, and self- and object
representations. The symptoms and character traits in particular forms of
psychopathology maintain an equilibrium that has been achieved and con-
solidated within the configuration at a specific developmental level. Though
pathological processes are usually consolidated at a primary level, these pro-
cesses can also shift across developmental levels within the configuration.
Thus, psychopathology can occur at a predominant developmental level
within one of the two configurations, with a particular potential for regres-
sion (or progression) to lower (or higher) levels of organization within that
configuration.
Various forms of psychopathology are located within one of these two
configurations because they are similar in the nature of their predominant
conflicts and their preferred modes of adaptation and defense. The forms of
psychopathology within the anaclitic configuration are focused primarily on
issues related to the quality of interpersonal relatedness. The development of
self is neglected in the struggle to establish and maintain satisfying interper-
sonal relations. The nature and quality of interpersonal interactions are pri-
mary and determine feelings and thoughts about the self. Likewise, the dif-
ferent forms of psychopathology within the introjective configuration are
excessively focused on issues of self-definition, ranging from primitive at-
tempts to achieve separation and definition from an engulfing consuming
other in paranoia, to somewhat more mature concerns about self-control in
obsessive-compulsive disorders, to concerns about sexual identity and self-
worth in introjective depression and narcissism. The development of satisfy-
ing interpersonal relationships is neglected in the struggle to establish and
maintain self-definition and identity. Preoccupations with issues of self-
definition dominate and determine the nature and quality of interpersonal
interactions.
Forms of psychopathology that evolve later in development in either
configuration have somewhat successfully negotiated earlier developmental
tasks in both the anaclitic and introjective developmental lines. Thus an
individual with a higher level anaclitic disorder, such as a histrionic person-
ality disorder, has developed some degree of self-definition that became im-
paired later in development. Likewise, an individual with a higher level
introjective disorder, such as an obsessive-compulsive personality disorder,
has developed some capacity for interpersonal relatedness that became im-
paired later in development.
Identifying two primary configurations of psychopathology has a num-
ber of important consequences. First, this approach provides a basis for inte-
grating a wide variety of symptomatic expressions of psychological distur-
bance into a unified life-span developmental model in which two major
configurations of psychopathology can range over several levels of organiza-
tion, from more primitive and undifferentiated to more mature and inte-
grated disorders. Second, the various forms of psychopathology are identified
within each configuration on the basis of shared dynamic conflicts and com-
mon structural features. Within each configuration, dynamic and structural
relationships exist among the more and less primitive expressions of psycho-
pathology. Thus, the various forms of psychopathology are no longer consid-
ered as isolated diseases, but rather as interrelated modes of maladaptation
organized around two basic developmental dimensions—interpersonal relat-
edness or self-definition. Third, the dynamic developmental relationships
among the various forms of psychopathology within each configuration de-
fine lines of potential regression and progression along which individuals
may change. Various phases or stages within each development line define
nodal points at which particular individuals can experience difficulty and at
which they can consolidate particular maladaptive modes of functioning.
Thus, each form of psychopathology within the configuration represents im-
pairments at a particular phase in the developmental process, with the po-
tential for patients to regress or progress to other levels within the configura-
tion, depending on particular situations and circumstances and the nature of
the psychopathology (Cramer, 2005).
The Anaclitic Configuration
The anaclitic personality configuration is object-oriented and involves

an emphasis on interpersonal relatedness at different developmental levels.
The basic desire is for feelings of closeness, dependability, love, and inti-
macy. Psychopathology within the anaclitic configuration involves concerns
TWO PRIMARY CONFIG URATIONS OF PSYCHOPATHOLOGY ] 73

and conflicts around the quality of interpersonal relatedness, and the symp-
toms express exaggerated attempts to establish and maintain satisfying inter-
personal relations—at different developmental levels—around feeling loved
and being able to love. Developmental distortions are expressed in anaclitic
psychopathology in exaggerated preoccupations about trust, affection, car-
ing, and the dependability of others, and in issues of intimacy and concerns
about the capacity to give as well as to receive love in a context of security,
cooperation, and mutuality. Some individuals, more often females, deal with
developmental disruptions by becoming preoccupied with issues of related-
ness. Anaclitic patients are desperately concerned about issues of trust, close-
ness, and the dependability of others as well as with their own capacity to
love and express affection. The development of the self is disrupted by in-
tense conflicts and concerns about being deprived of care, affection, and love.
Thus, anaclitic psychopathologies are those disorders in which patients are
primarily preoccupied with issues of interpersonal relatedness, ranging from
experiences of merger and fusion, to issues of trust, caring, intimacy, and
sexuality—from a lack of differentiation between self and other, to intense
dependent attachments, to disturbances in establishing more mature, recip-
rocal, intimate relationships. Patients with anaclitic disorders use primarily
avoidant defenses (e.g., withdrawal, denial, repression) to cope with psycho-
logical conflict and stress to avoid intense feelings of anger and rage as well
as erotic longings and competitive strivings because these intense feelings
could threaten their tenuous interpersonal relations. Depriving, inconsistent,
unpredictable, or overindulgent early relationships have led to conflicts around
issues of care, affection, love, and sexuality. Because disorders within the
anaclitic configuration share a basic preoccupation with interpersonal relat-
edness (e.g., closeness and intimacy), these patients have a better capacity
for affective bonding and a greater potential for developing meaningful in-
terpersonal relations.
In developmental terms, from more to less disturbed, anaclitic disor-
ders include undifferentiated (nonparanoid) schizophrenia, borderline per-
sonality disorder, infantile (or dependent) personality disorder, anaclitic
(abandonment) depression, and histrionic personality disorder. Thus, ana-
clitic issues can be expressed at a primitive level around issues of fusion and
merger in a loss of boundaries between self and nonself (i.e., undifferentiated
schizophrenia), at a more intermediate level around intense fears of aban-
donment and neglect (i.e., borderline and dependent or infantile personality
disorders), or at a more advanced reciprocal level around conflicts with be-
ing able to give as well as receive love (i.e., histrionic personality disorder).
Intense concern about interpersonal issues can be expressed in a form most
relevant to earlier developmental levels around basic caregiving experiences
and unilateral wishes to be cared for (dependent or infantile personality dis-
order), or around developmentally more mature and complex triadic (oedi-
pal) relationships of being able to love as well as being loved (histrionic

personality disorder). At all these levels, from boundary disturbances to the
unilateral dependent level, to the developmentally more advanced recipro-
cal histrionic level, issues focus primarily on interpersonal relationships—
concerns about being close, cared for, loved, and intimate. Blatt, Besser,
and Ford (2007), for example, found that change in thought disorder in-
volving disruptions in establishing and maintaining boundaries between
independent objects including self and nonself (i.e., expressions of merger
and fusion) were central to therapeutic change in patients with severe
psychopathology (i.e., psychosis and borderline states) in the anaclitic
configuration.
Not only do anaclitic patients share an investment in interpersonal
issues, but their interpersonal relations are characterized by an anxious-
ambivalent attachment style that expresses their vulnerability to feelings of
loss and abandonment. K. N. Levy and Blatt (1999) distinguished between
two developmental levels within the anxious-ambivalent attachment using
the distinction, derived from Bowlby, between compulsive careseeking and
compulsive caregiving. Research findings (C. E. Schaffer, 1993) indicate that
compulsive caregiving is on a higher developmental level than is compulsive
careseeking because it is associated with more effective affect regulation. Com-
pulsive careseeking, associated with less effective affective regulation, is more
characteristic of disorders at the lower level of the anaclitic configuration—the
dependent (or infantile) personality—whereas compulsive caregiving, asso-
ciated with more effective affect regulation, is more characteristic of the his-
trionic personality disorder at the upper level of the anaclitic configuration.
Thus, different expressions of an anxious-ambivalent attachment style oc-
cur at several levels and are associated with different forms of psychopathol-
ogy within the anaclitic configuration. Disturbances can range from more
global issues of relatedness in the early basic bond with the caregiving person
(i.e., the mother or her surrogate) in which desires for soothing, care, and
trust predominate, to developmentally more advanced reciprocal relational
concerns about being able to provide as well as receive nurturance and affec-
tion. At the more mature level, concerns and conflicts are focused predomi-
nantly around being able to establish and maintain a reciprocal intimate
relationship.
Dependent or (infantile) and histrionic personality disorders can occur
in relatively pure form, but they are not isolated disorders or diseases. Rather,
they represent relative endpoints on a continuum of the configuration of
anaclitic psychopathology. Many anaclitic patients combine features of both
levels of functioning (Marmor, 1953), and their level of organization varies
depending on environmental circumstances and psychological stress. These
formulations are consistent with Zetzel's (1968) differentiation of the so-
called "good hysteric" and a less organized histrionic personality disorder that
would be better described, according to current views, as an infantile or de-
pendent personality disorder (e.g., Bornstein, 1993b, 1995, 1998).

Disturbances within the anaclitic configuration differ depending on
when in development the difficulties arose and whether these difficulties
extend to lower or higher levels of interpersonal relatedness. Developmental
disruptions can result in psychopathology focused primarily on relationships
at only one level in the configuration or in psychopathology that ranges across
the spectrum of the configuration. Terms used in the clinical and theoretical
literature to designate these two levels of organization within the anaclitic
configuration include unilateral versus reciprocal, dyadic versus triadic, or
pre-oedipal versus oedipal relationships, and oral versus genital (sexual) pre-
occupations. The complex relationship among different developmental lev-
els in the anaclitic configuration—between dependency and mutuality, be-
tween orality and sexuality (S. Freud, 1930/1961), and between infantile
(dependent) and histrionic symptoms (e.g., Marmor, 1953; Shapiro, 1965),
for example—has been noted for many years in the clinical and theoretical
literature. S. Freud (1912/1957g, 1914/19570, for example, stressed that the
love for an other is modeled on the experiences one has had with one's mother.
An adequate relationship with the caregiving mother is considered prerequi-
site for being able to establish a satisfactory sexual relationship. The conti-
nuity between orality and sexuality—between experiences of tenderness with
and the desire to be cherished by an other, and the capacity to cherish an
other and to establish a mature intimate sexual relationship—has long been
noted in psychoanalytic formulations (e.g., Balint, 1952b; Ferenczi, 1924;
S. Freud, 1913/1958a). At both the lower and the developmentally more
mature level, the fundamental aim in the anaclitic dimension is always ob-
ject seeking (Fairbairn, 1952)—establishing unity and preserving relation-
ships by bonding with others (S. Freud, 1926/1959c). Satisfaction of oral
dependent and sexual needs involves relatedness in affectionate and inti-
mate experiences with another person, including bodily sensations of being
soothed, comforted, and loved. Early on, Abraham (1924/1949) noted that
oral and genital (sexual) eroticism both "combine tendencies which are friendly
to their object" (p. 425) and lack an affinity for sadistic impulses. Longings for
support and intimacy are most often satisfied in an interpersonal relationship.
Affection on the dependent level as well as on a more mature reciprocal
level involves positive feelings toward, and an adaptation to, an other. A
mature reciprocal sexual relationship involves the transformation of infan-
tile dependent wishes into a long-range commitment, a transformation of
the wish for primary possession of the person into the capacity for a more
differentiated, reciprocal relationship (e.g., Dicks, 1967; Ducey, 1975).
Psychopathology in the anaclitic configuration is based on the com-
mon struggle to establish and maintain meaningful and satisfactory intimate
interpersonal relations; feelings about the self are defined primarily in terms
of the quality of these interpersonal experiences. Because of the exaggerated
emphasis on interpersonal relatedness, the development of the self is ne-
glected in the struggle to establish and maintain satisfying interpersonal re-

lations. The nature and quality of interpersonal interactions are the primary
preoccupation and the fundamental determinant of how one feels and thinks
about oneself. Avoidant defenses (withdrawal, denial, and repression) are
used at the various developmental levels within the anaclitic configuration,
with different degrees of efficiency. Denial, the less effective avoidant de-
fense, occurs predominantly at the lower levels of the anaclitic configura-
tion, often to defend against intense rage over deprivation and frustration
because expressions of rage can threaten the very hand that feeds. Anger
must be repudiated (denied) to preserve a relationship that one feels is essen-
tial for psychological survival. Anger and rage interfere with gaining satisfac-
tion from the caregiving object and thus only compound the difficulties that
already exist in the vulnerable caregiving relationship. The more effective
avoidant defense, repression, is used at the higher levels of the anaclitic con-
figuration to contain intense erotic longings and competitive strivings to
preserve the relationship. Through passivity and compliance, the individual
attempts to achieve interpersonal harmony and to please others. Intense de-
sires (sexual as well as aggressive) are avoided (repressed) because they can
be dangerous and potentially disruptive to relationships. Avoidant defenses,
denial and repression, typical of the different levels of psychopathology in
the anaclitic configuration, are sometimes bolstered and supported by acting
out and displacement as the individual attempts to gain satisfaction for un-
filled interpersonal needs, occasionally in inappropriate, and sometimes self-
destructive, ways (Blatt, 1974, 1991b; Blatt & Shichman, 1981).
The Introjective Configuration
Primary concerns in the introjective configuration are focused on is-

sues of self-definition: self-control, self-worth, and identity. The focus in the
introjective configuration is not on interpersonal relatedness, on loving and
being loved, but rather on defining the self as an entity separate and different
from others, with a sense of autonomy and control, and feelings of self-worth
and integrity. The basic desire of introjective individuals is to achieve sepa-
ration, autonomy, control, independence, and self-esteem or self-worth—to
be acknowledged, respected, and admired. As discussed in chapters 4 and 5
(this volume), self-definition is achieved progressively in the introjective
developmental line, first in contrast and counterpoint to others; somewhat
later in assertion of one's actions, thoughts, and strength (power); even later
in establishing personal attitudes, moral code, and values (i.e., an identity);
and eventually in mature expressions of this identity in sustained intimate
relationships and productive pursuits that result in feelings of integrity about
well-integrated and effective functioning (Erikson, 1950). With development,
self-definition becomes increasingly adaptive and flexible. These same issues
are expressed in distorted form in introjective psychopathologies: in exagger-
ated concerns about self-definition and in conflicts about autonomy, self-
TWO PRIMARY CONFIG URATIONS OF PSYCHOPATHOLOGY 177

control, and self-worth. Psychopathology in the introjective configuration
expresses distorted and exaggerated struggles to establish and maintain a sense
of self as separate, autonomous, in control, and worthy.
Some individuals, more often men, deal with severe disruptions of the
dialectical developmental process through distorted and exaggerated attempts
to consolidate a sense of self. These exaggerated efforts, expressed in
introjective forms of psychopathology, involve excessive preoccupation with
establishing and maintaining a viable sense of self at different developmental
levels, ranging from establishing a primitive differentiation from others
through exaggerated concerns about separation, autonomy, and control of
one's mind, body, and possessions, to more internalized concerns about power
and strength, sexual identity, and self-worth. Introjective patients are more
ideational and concerned with establishing, protecting, and maintaining a
viable self-concept than they are about the quality of their interpersonal re-
lationships. The development of interpersonal relationships is neglected in
the exaggerated and distorted struggles to establish and maintain a viable
sense of self. Cognitive processes, however, are usually more fully developed,
and thus greater potential exists for logical abstract thought, as discussed in
chapter 5 (this volume). Issues of assertiveness and aggression, directed to-
ward the self or others, are usually central to the attempts of introjective
patients to attain, protect, and assert their self-regard, self-esteem, and self-
worth. Affective experiences usually involve feelings of shame and guilt.
Conflicts within the introjective configuration can involve fears of annihila-
tion and profound feelings of inadequacy, inferiority, worthlessness, and guilt,
as well as difficulty managing affects, especially anger and aggression, toward
others and the self. These patients usually have little spontaneity and express
few positive feelings; their emphasis is usually on separation, autonomy, in-
dependence, power, control, and self-worth. Conflicts around issues of self-
definition are expressed in struggles to achieve and maintain separation, self-
definition (autonomy) and independence from controlling, intrusive, punitive,
excessively critical, and judgmental figures (see research summaries on as-
pects of the etiology of introjective dimensions in Blatt, 1995b, 2004, and
Blatt & Homann, 1992).
Psychopathology within the introjective configuration can occur at sev-
eral developmental levels. More primitive struggles around self-definition
can be expressed in exaggerated isolation and marked juxtaposition of per-
sonal attributes in paranoid forms of pathology; these issues can be expressed
in an intermediate range in the excessive behavioral and ideational control
of obsessive-compulsive symptoms; and at developmentally more advanced
levels, these issues can be expressed in exaggerated concerns about self-worth
in issues of strength, power, and accomplishments that are expressed in in-
tense negative terms in introjective depression or in exaggerated positive,
and sometimes grandiose, form in narcissism. Considerable variation can occur
in psychopathology within the introjective configuration. An individual pa-

tient, for example, can primarily be concerned about guilt, shame, and self-
worth in an introjective depression with little potential for regression, or can
alternate between a depressive internalization of blame (responsibility) and
more primitive externalizing (projective) defenses of paranoia in which blame
is projected outward onto others and the self is vindicated, sometimes in
extreme and profoundly distorted form.
Each form of psychopathology within the introjective configuration
expresses exaggerated and distorted attempts to establish and maintain self-
definition. The patient with paranoia is constantly preoccupied with main-
taining a sense of the self as a separate and intact. In paranoid states, the self
is defined not internally, but in marked contrast with others. Paranoid pro-
jection and splitting establish a boundary between self and others (Blatt &
Wild, 1976) and maintain the self as distinct, separate, and different from
others. Blatt, Besser, et al. (2007), for example, found that therapeutic change
in thought disorder in patients with severe psychopathology (psychosis or
severe personality disorders) in the introjective configuration involved pri-
marily changes in referential thinking between independent objects rather
than difficulties in establishing and maintaining boundaries—thought disor-
der characteristic of severe psychopathology in the anaclitic configuration,
as discussed earlier.
At a somewhat higher developmental level within the introjective con-
figuration, the patient with obsessive-compulsive disorder is preoccupied with
establishing autonomy, control, and mastery of his or her body and mind.
Obsessive-compulsive defenses are exaggerated expressions of the need to
define and defend the self by maintaining control over one's actions, thoughts,
and feelings—to preserve one's autonomy, possessions, and prerogatives.
Concerns about self-definition are expressed in psychopathology at the higher
levels of the introjective configuration—in depressive disorders, in a con-
tinuing sense of a punitive, harsh, relentless introject that creates depressive
self-doubt, self-criticism, self-loathing, and feelings of blame and guilt. Iden-
tification with rigid, overdemanding, judgmental parental figures results in a
proclivity to be harsh and hypercritical toward the self. Excessive involve-
ment in activities often is an attempt to compensate for these intense feel-
ings of inferiority, worthlessness, and guilt. Thus, overcompensation is an
alternative defensive organization that results in attempts to appease judg-
mental and critical introjects by exaggerated expressions of self-worth, such
as in narcissism. Rather than feeling worthless, inferior, or guilty, a person
has an exaggerated sense of self-worth, with little feeling and concern for
others; others are used primarily for self-aggrandizement. Interpersonal rela-
tions in these various forms of introjective psychopathology (paranoia,
obsessionality, guilt-ridden depression, and narcissism) are often infused with
aggressive and sadistic impulses; people are treated as possessions that are to
be controlled, retained or rejected, and even destroyed (Abraham, 1924/1949).
In narcissism, for example, a cold, ruthless, penetrating quality can infuse

interpersonal relationships in an exaggerated and highly inflated sense of
one's attractiveness, power, and capacity.
Introjective forms of psychopathology not only share a common focus
on issues of self-definition at different levels, but also have a basic similarity
in their use of counteractive defenses, including isolation, reversal, and pro-
jection (in paranoid disorders); reaction formation, intellectualization,
rationalization, and negativism (in obsessive-compulsive disorders); introjec-
tion and identification with the aggressor (in depression); and overcompen-
sation (in narcissism). Counteractive defenses are usually more complex than
are avoidant defenses because the underlying impulse and conflict are both
partially expressed in altered, sometimes even opposite, form. Rather than
denying and avoiding conflicts to preserve interpersonal relations, as occurs
in anaclitic disorders, counteractive defenses modify and convert an impulse
or conflict to preserve a sense of self-definition and establish control. These
counteractive defenses range in their effectiveness depending on the devel-
opmental level at which the pathology occurs in the introjective configura-
tion. At lower levels, where the more primitive paranoid defenses of projec-
tion predominate, the complex amalgam of splitting, externalization,
disavowal (repudiation), and reversal (vindication and self-justification) are
relatively inflexible and maladaptive. At the intermediate level, obsessive-
compulsive defenses—oppositionality, negativism, doing and undoing, reac-
tion formation, intellectualization, rationalization, and obstinence—establish
control rather than externalize and repudiate unacceptable impulses. These
attempts at mastery and the establishment of control can be somewhat more
adaptive than is projection, but they are often rigid and inflexible. Defenses
at the higher level of the introjective configuration, in introjective depres-
sion and narcissism, include introjection and internalization (assumption of
blame and responsibility), identification with the aggressor, and overcom-
pensation. These higher level defenses have the potential for greater alloplastic
action (action within the environment) and thus have greater potential to
become more appropriate and realistic. As noted in chapter 5 (this volume),
overcompensation that serves as defensive compensation for intense, unreal-
istic feelings of inadequacy, failure, and guilt can, with treatment, become
more moderate and sublimated, eventually contributing to establishing ap-
propriate, personally meaningful, and socially acceptable (sublimated) forms
of satisfaction.
The various psychopathologies in the introjective configuration can
appear paradoxical because counteractive defenses involve the simultaneous
expression of basic underlying concerns as well as the defensive opposite of
the conflicted wish. Although symptom formation usually involves compro-
mised expressions of impulse and defense, these compromises are particularly
apparent in introjective psychopathology because of the counteractive na-
ture of the predominant defenses. Thus, the very vulnerability to boundary
dissolution in at least one form of paranoia (Blatt & Auerbach, 1988; Blatt

& Wild, 1976; Blatt, Wild, & Ritzier, 1975) appears along with intense,
exaggerated, distorted attempts to establish and preserve boundaries between
self and nonself through splitting and polarization. The difficulties around
self-definition, control, and autonomy in obsessive-compulsive disorders are
expressed in rigidity, focused attention, and obstinacy that alternate with
indecision, ambivalence, and ruminations; feelings of disgust appear along
with fastidiousness. In introjective depression, profound concerns about
self-doubt and self-worth and intensely painful proclivities toward self-criti-
cism appear along with efforts for overachievement and overcompensa-
tion, fantasies of grandiosity and demands for perfection. Exaggerated ex-
pression of more mature counteractive defenses (overcompensation) can
result in a narcissistic overcompensation for depressive feelings of vulner-
ability and worthlessness.
The psychopathologies within the introjective configuration are all in-
terrelated in their struggles to achieve and maintain a sense of self-defini-
tion, to the neglect of developing interpersonal relatedness. The primary
preoccupation with self-definition in these disorders shapes and distorts the
quality of interpersonal experiences. Introjective psychopathologies (para-
noid schizophrenia and paranoid, obsessive-compulsive, introjective depres-
sive, and narcissistic personality disorders) share common dynamics, con-
flicts, and defenses and similar cognitive, affective, and interpersonal styles
that involve preoccupations with issues of self-definition, self-control, and
self-worth. Interest is directed primarily to things rather than to people, and
heightened emphasis is placed on thoughts and accomplishments (deeds)
rather than on feelings and interpersonal relations. Punitive and intrusive
authority figures (e.g., parental images) are experienced in the paranoid and
obsessive-compulsive disorders as dangerous external forces that, at the para-
noid level, can have a more delusional form. In the more advanced levels of
the introjective configuration, harsh, punitive judgmental authorities are more
internalized (introjected). The self-critical individual with introjective de-
pression views himself or herself in the same harsh judgmental terms by which
patients with paranoia and obsessionality fear they will be judged by others.
These harsh, punitive, introjectives can reach delusional proportions in psy-
chotic depression. These similarities among various introjective disorders were
noted early on by S. Freud (1895/1957b, 1895/1957e, 1911/1951,1914/1957f,
1916/19571, 1920/1957a, 1917/1957K) when he discussed self-criticism and
self-reproach as the basic dynamics of paranoia, obsessionality, compulsion,
and melancholia, as well as of persecutory delusions and megalomania. More
primitive forms of psychopathology in the introjective configuration—para-
noid and obsessive disorders—involve a greater rigidity and apprehension
about a dangerous, destructive environment. Archaic and punitive personi-
fications are experienced as potentially dangerous controlling external forces.
The more extreme suspiciousness and reality distortions in paranoia can oc-
cur as part of a regressive decompensation of an obsessive-compulsive

(Shapiro, 1965) or an introjective depressive disorder (Blatt, 1974; Blatt &
Shichman, 1983; Zigler & Glick, 1984) in which the personifications, though
still harsh and judgmental, are usually less archaic, primitive, and external.
The hostile, critical judgments have been internalized, at least partially, in
introjective depression as aspects of the self, often experienced as extreme
external standards and values. But in a regressive decomposition in paranoia,
these introjects can become part of a delusional process. This tendency to-
ward greater internalization in introjective disorders at these higher devel-
opmental levels (e.g., depression) often leads to greater dysphoric and psy-
chic pain, but it can also provide greater potential for therapeutic change,
especially in long-term intensive treatment, a topic discussed in more detail
in chapters 7 and 8 (this volume).
Many introjective patients have a complex balance among introjective
depressive, obsessive-compulsive, and paranoid features. Patients can func-
tion predominantly at a particular level and, depending on environmental
stress and life circumstances, shift toward more or toward less integrated lev-
els of organization. Patients at a narcissistic or introjective depressive level
often have premorbid obsessive-compulsive features and, if they decompen-
sate, can become more actively paranoid as the internalizing introjective
defenses become more projective (externalizing). Patients with paranoia also
often struggle with profound feelings of guilt and depression, frequently in-
termingled with a predominantly premorbid obsessive-compulsive character
style. Likewise, when obsessive-compulsive defenses begin to decompensate,
patients often move toward a more paranoid organization in which thoughts
are no longer experienced as omnipotent and powerful parts of oneself, but as
dangerous external forces no longer under one's control and volition. Dec-
ompensation of obsessive-compulsive defenses can lead to paranoid think-
ing and the belief that one's thoughts come from malevolent external forces
that have taken control of one's actions, thoughts, and even one's life. Be-
cause patients with obsessionality or paranoia are also vulnerable to depres-
sive concerns, they scrutinize individuals and events for implications of criti-
cism and disrespect (Salzman, 1968). Every interpersonal encounter is a
potential source of danger. Because autonomy and control must be main-
tained, every minor failure is experienced in introjective disorders as a threat
that others will take advantage of and humiliate them. The person with
obsessionality is sensitive to criticism and disapproval as threats to his or her
autonomy and thus remains willful, obstinate, and determined to maintain
power and control. And this context of fear, anger, hostility, and suspicion is
an ideal setting for the development of paranoid ideation.
Paranoid and obsessive-compulsive disorders also share a basic similar-
ity in cognitive functioning. Attention is acute, intense, and narrowly fo-
cused on a few relevant ideas. Thinking, as noted in chapter 5 (this volume),
is rigid and focused on technical details, with emphasis on logical sequential
thought and issues of causality. The unexpected is regarded as a danger be-
] 82 POLARITIES OF EXPERIENCE
cause it threatens control, so events are scrutinized for details and hidden
meaning. Affects and feelings are avoided and spontaneity is inhibited. Self-
control is extreme, and interaction with others is stilted, rigid, concrete, and
inflexible. When control is lost, the individual with obsessional qualities
experiences a loss of conviction and becomes filled with intense doubt; when
the person with paranoid features loses a sense of conviction, the loss can
reach extreme proportions and can result in the construction of a false sense
of certainty in delusional ideation (Shapiro, 1965). Rigidity, fixed attention,
emotional and interpersonal isolation, and a preoccupation with control and
power in both persons with obsessional features and persons with paranoid
features, attempt, in exaggerated ways, to deal with intense feelings of uncer-
tainty, self-doubt, and the threat of the loss of autonomy and ultimately of
self-definition.
The person with obsessional features and the person with paranoid fea-
tures also have similar interpersonal styles. They are both concrete and rigid,
relatively impervious to influence, and continually focused on issues of power
and control. Intimacy and sensual experiences are repudiated in favor of a
world of objects, things, and deeds. The general distancing from feelings and
isolation from interpersonal interactions in the person with paranoid fea-
tures and the person with obsessional features attempt to preserve a sense of
self in a threatening universe. They have an antagonism and antipathy to-
ward affective and interpersonal experiences but a deep sense of self-
righteousness and a preoccupation with primitive issues of morality and jus-
tice. External imperatives and forces threaten their self-definition and au-
tonomy and thus these patients actively struggle to preserve a sense of self in
exaggerated expressions of self-determination in intense willfulness and au-
tonomy (Shapiro, 1965).
The person with obsessional features and the person with paranoia fea-
tures also both struggle with aggressive impulses and sadistic, destructive,
vengeful fantasies. But with paranoid features, these qualities are more ex-
treme, intense, and primitive and involve greater distortions of reality. And
in introjective depression, these sadistic and destructive impulses are often
directed toward the self. Both the person with obsessional tendencies and
the person with paranoid tendencies, similar to the person with narcissist
features, can have a sense of grandiosity and entitlement and a desire to be
omnipotent and omniscient. These qualities occur in more subtle forms in
obsessional qualities and in exaggerated, sometimes grotesque, delusional form
with paranoid features, and sometimes in more reality-based form in narcis-
sism. The preoccupation with power and control and the tendencies toward
omnipotence and grandiosity in obsessional and paranoid disorders are exag-
gerated defenses against a seriously impaired sense of self and profound dis-
turbances of self-esteem. Thus, these two disorders also have a close relation-
ship with narcissism and with introjective depression and intense feelings of
guilt and worthlessness.

These similarities among these introjective disorders have long been
noted in the clinical and theoretical literature, beginning with S. Freud (e.g.,
1896/1957c, 1913/1958b, 1914/1957f, 1916/1957i, 1917/1957h) and elabo-
rated on by Abraham (1924/1949), Salzman (1968), and Shapiro (1965). In
paranoia, obsessionality, and introjective depression, individuals are plagued
by profound feelings of self-doubt and inadequacy, are highly vulnerable and
sensitive to criticism, and seek to compensate for their feelings of failure.
The person with paranoid qualities externalizes these difficulties and the per-
son with obsessional qualities seeks to maintain control and avoid censure
and criticism, but the greater access to these painful negative feelings in
introjective depression, as noted earlier, ironically allows for the possibility
of greater reality adaptation. Though depressed individuals experience con-
siderable distress and dysphoria, their self-reflective capacities provide the
possibility for a greater capacity for adaptation and change. Not only have
linkages been identified among various introjective disorders (paranoid,
obsessive-compulsive, and guilt-ridden depressive disorders) but, as previ-
ously discussed, linkages among anaclitic disorders—such as between infan-
tile (dependent) and histrionic personality disorders—were also noted early
on in the clinical and theoretical literature (e.g., Marmor, 1953; Shapiro,
1965). These linkages among the various introjective and anaclitic disorders
provide the basis for articulating a model of two primary configurations of
psychopathology that can integrate disorders from the DSM-IV Axis I with
disorders from the DSM-IV Axis II into a unified and comprehensive model
of psychopathology.
As illustrated in Figure 6.1, exaggerated and distorted preoccupation
with establishing and maintaining satisfying interpersonal relations to the
neglect of the development of the self defines the psychopathologies of the
anaclitic configuration at different developmental levels—between the de-
pendent (or infantile) and histrionic personality disorders. And exaggerated
and distorted concerns about establishing and maintaining an intact sense of
self at the expense of establishing meaningful interpersonal relations defines
the psychopathologies of the introjective configuration at different develop-
mental levels—paranoid, obsessive-compulsive, introjective depressive, and
narcissistic personality disorders. Thus, several levels of organization exist in
each of these two configurations of psychopathology, ranging from more primi-
tive to more integrated attempts to establish meaningful interpersonal rela-
tions or a consolidated self-concept.
The levels of psychopathology within the anaclitic and the introjective
configurations also define lines along which patients can progress or regress.
Thus, an individual's difficulties can be specified as being predominantly in
one or the other personality configuration, and at a particular developmental
level, with a differential potential to regress or progress to other develop-
mental levels within the configuration. As noted earlier, when an individual
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ample, infantile or dependent behavior emerges; when an individual with an
obsessive-compulsive personality organization begins to deteriorate, the re-
sult is usually paranoia. Clinical evidence indicates that paranoia often in-
volves intense defenses against depression and profound feelings of guilt. Thus,
in this conceptualization of two primary configurations of psychopathology,
various disorders are no longer considered as isolated, independent diseases,
but rather as interrelated modes of maladaptation, organized at different de-
velopmental levels within two basic configurations that focus primarily on
issues of either interpersonal relatedness or self-definition.
As noted earlier, disorders of the introjective configuration occur with
greater frequency in men, whereas disorders of the anaclitic configurations
occur with greater frequency in women, possibly because society appears to
place more manifest emphasis on the need for self-definition for men and
greater emphasis for women on the capacity for relatedness—for care, affec-
tion, and love. Developmental disruptions often appear to be expressed in
men and women along the predominant psychological tasks defined by cul-
tural expectations. But, as discussed in chapter 3 (this volume), this gender
difference in the nature of psychopathology may also be a function of more
fundamental psychological developmental processes. Both female and male
children have their initial bonding to the mother, and thus a primary norma-
tive developmental task for a young girl is to maintain her primary object of
identification with her mother and to shift her primary object of affection to
her father. Thus, issues of relatedness are usually of central concern in the
early development of women (e.g., Chodorow, 1978; Lidz, 1976; Stoller, 1996).
The converse occurs with a young boy who normatively maintains his pri-
mary object of affection with his mother but has to shift his primary object of
identification to his father. Thus, issues of identification or self-definition
are usually of central importance in the early development of men. There-
fore, it is not surprising that psychopathology in men is most often expressed
in symptoms that indicate predominant struggles to consolidate their self-
concept and identity, whereas in women psychopathology is most often ex-
pressed in predominant struggles to achieve satisfying interpersonal related-
ness. T. W. Smith, O'Keeffe, and Jenkins (1988) demonstrated the increased
vulnerability of gender-incongruent individuals: of anaclitic men concerned
about interpersonal issues and introjective woman concerned about issues of
self-definition. Students who show gender-incongruency (i.e., anaclitic men
and introjective women), especially the gender-incongruent anaclitic men,
were most vulnerable to stress (T. W. Smith et al, 1988). Subsequent re-
search should be directed toward examining further differences among men
and women with gender-congruent and gender-incongruent personality or-
ganization and forms of psychopathology. As noted in chapter 1 (this vol-
ume), these issues should also be studied in a variety of cultures, cultures that
differ in their emphasis on individualistic and collectivistic values. Such re-
search could also provide further understanding of nonnormative psycho-

sexual development as well as the social stresses and strains experienced by
gay men and lesbians (see Cramer, 2005).
MIXED ANACLITIC AND INTROJECTIVE FEATURES
The validity of the differentiation between an anaclitic and an

introjective personality organization has been supported by a wide range of
empirical research in nonclinical samples, as summarized in chapters 4 and 5
(this volume). Research findings from studies with both clinical and
nonclinical samples with a wide range of criteria clearly indicate the validity
of the anaclitic-introjective distinction both categorically and dimension-
ally. Clinical judges were able to make this categorical distinction with con-
siderable reliability (e.g., Blatt, 1992; Blatt & Ford, 1994; Blatt & Shahar,
2004b, 2004c) and this distinction has been useful in studying therapeutic
process and outcome in both long-term and short-term treatment of inpa-
tients and outpatients (discussed in detail in chap. 7, this volume). Though
the anaclitic-introjective distinction has been quite productive in research
and almost all patients can be reliably classified as either anaclitic or
introjective, the question remains about a "mixed type" of individual with
both predominant anaclitic and introjective features. Although psychopa-
thology in most patients is usually organized around one configuration or the
other (see Blatt, 1992; Blatt & Ford, 1994; Blatt & Shahar, 2004b), a few
patients have predominant features from both the anaclitic and introjective
dimensions; their psychopathology seems to derive from intense issues in
both configurations.
As discussed in chapters 4 and 5 (this volume), one criterion of nor-
mality or mature psychological functioning (e.g., self-actualization; Maslow,
1954) is the integration, at high developmental levels, of aspects of an in-
vestment in both interpersonal relatedness and expressions of self-definition—
in intimacy and generativity (Erikson), or in love and work (Freud). Mature
levels of psychological functioning can be defined as a capacity to establish
and maintain an effective integration of high levels of both anaclitic and
introjective dimensions—to maintain a capacity for reciprocal relatedness as
well as a clear and effective identity. The capacity for mutuality and interper-
sonal reciprocity requires a clear and effective sense of self—an identity in
which one clearly recognizes and acknowledges what one can contribute to, as
well as gain from, a sustained and committed intimate relationship. In addi-
tion, as discussed in chapter 4 (this volume), a relatively balanced expression
of interpersonal relatedness and of self-definition creates a complex and inte-
grated psychological matrix in which investment in higher level expressions
of relatedness and self-definition is mutually supportive and facilitating.
Clinical and research evidence, however, suggests that a small portion
of patients are less amenable to the anaclitic-introjective categorization be-

cause they demonstrate intense and extreme preoccupations in both domains,
with issues of both self-definition and interpersonal relatedness at lower de-
velopmental levels. Though the number of mixed-type patients in studies
has been relatively small, these patients raise important clinical and theo-
retical issues. In two research investigations, important differences were found
among patients clearly diagnosed as either anaclitic or introjective and the
small group of patients who could not be easily classified within the
anaclitic-introjective distinction. Blatt, Quinlan, Chevron, McDonald, and
Zuroff (1982) compared three groups of inpatients with depression: (a) pa-
tients with anaclitic features and elevated scores on the Dependency factor
of the Depressive Experiences Questionnaire (DEQ), (b) patients with
introjective features and elevated scores on the Self-Criticism factor of the
DEQ, and (c) a third group of patients with elevated scores on both DEQ
factors. The mixed group had significantly higher levels of depression, includ-
ing a wide range of neurovegative signs of depression, than did either of the
other two groups. On the basis of these findings, Shahar, Blatt, and Ford (2003)
evaluated patients with both significant anaclitic and introjective features in a
sample of treatment-resistant patients with serious disturbances in a long-term
intensive treatment setting. This group of patients, those with mixed anaclitic
and introjective features, was identified by raters having indicated that they
had substantially less confidence in their rating of these patients as having a
predominantly anaclitic or introjective disorder than they did in their rating
of other patients. Shahar, Blatt, and Ford (2003) found that this "mixed group"
of patients, as compared with the more "pure type" of patients with anaclitic or
introjective features, was significantly more symptomatic and disturbed at the
beginning of treatment. Consistent with earlier findings (Blatt et al., 1982),
the mixed-type patients were significantly more distressed and vulnerable at
admission than were their anaclitic and introjective counterparts. They had
significantly more psychiatric symptoms, greater thought disorder, lower per-
formance IQ and full-scale IQ, less accurate object representations (among
men), and greater utilization of maladaptive defense mechanisms (projec-
tion [among men] and identification [among women]). Contrary to expecta-
tions, however, the mixed group evidenced significantly greater therapeutic
gain over the course of long-term intensive, inpatient treatment. Mixed-type
men improved significantly in terms of psychiatric symptoms and mixed-type
men and women had significantly greater increase in performance IQ and less
frequent utilization of projection, a less effective defense mechanism (Cramer
& Blatt, 1990; Cramer, Blatt, & Ford, 1988).
These findings raise several important theoretical and clinical issues.
These results suggest that the intense focus of anaclitic and introjective indi-
viduals on issues of interpersonal relatedness or on issues of self-definition,
respectively, indicates a capacity to construct a relatively organized mode of
adaptation or defense that enables them to function more effectively at ad-
mission than can less clearly organized patients. The mixed-type patients

appear not to have achieved the same level of defensive consolidation as
either of the pure type of individuals. Although the more consolidated modes
of adaptation and defense used by clearly defined anaclitic and introjective
inpatients seem to leave them initially somewhat less vulnerable to distress
and impaired functioning, these modes appear to significantly impair their
accessibility to treatment and limit the extent of their therapeutic gain. The
lack of consolidation of a well-articulated defensive organization in the mixed
group, at least in inpatients who are seriously disturbed and resistant to treat-
ment, appears to make them more accessible to long-term intensive thera-
peutic intervention (Shahar, Blatt, & Ford, 2003). Further research on these
issues is clearly indicated.
ANACLITIC AND INTROJECTIVE DIMENSIONS

IN DYNAMIC INTERACTION
Recent clinical experience also suggests that on occasion anaclitic and

introjective personality characteristics can co-occur in a dynamic constella-
tion in which one set of qualities serves as a defense against recognizing and
experiencing the other set of qualities. Thus, an exaggerated emphasis on
introjective issues of self-worth, power, and agency can serve as a defense
against recognizing and experiencing intense and painful interpersonal
longings, or, conversely, but possibly somewhat less frequently, intense pre-
occupation with issues of interpersonal relatedness and constantly seeking to
be with others can serve as a defense against self-reflection and the painful
recognition of intense feelings of dissatisfaction with oneself because of pro-
found fears of failure or feelings of guilt (Blatt & Shahar, 2005).
A clinical example of an impressively effective woman demonstrates
how her exaggerated emphasis on powerful agentic introjective qualities served
as a defense against her recognizing and acknowledging the intensity of her
depressive longings for closeness with her mother, a relationship she had
long sought but had never been able to achieve. These desperate longings for
a close relationship with her very distant, aloof, and unavailable mother were
a dominant, but largely unconscious, aspect of her psychological organiza-
tion and part of her marked vulnerability to depression and possibly suicide.
Madeline, a highly successful 35-year-old attorney, volunteered to be
the subject in an investigation of different approaches to psychological as-
sessment (Wiggins & Trobst, 2003). As part of this project, Madeline visited
with several senior psychologists, each of whom had expertise in a particular
approach to psychological assessment. Assessment of Madeline from a psy-
chodynamic perspective (Behrends & Blatt, 2003) demonstrated how her
intense and highly effective agentic (introjective) personality organization
also served as a defense against acknowledging and experiencing profoundly
painful, relatively unconscious, relational (anaclitic) needs. This analysis of

Madeline's psychological test protocols by Behrends and Blatt in Paradigms
of Psychological Assessment (Wiggins & Trobst, 2003) provides an excellent
example of the potential dynamic interaction of anaclitic and introjective
personality dimensions.
Madeline, a single Native American woman, grew up in a highly dis-
rupted environment, raised by seriously abusive parents with alcoholism. She
left home at the age of 12, lived in a series of foster placements, and in her
late adolescence and young adulthood spent several years in prison. During
her incarceration, she was placed in solitary confinement after seriously as-
saulting a fellow female prisoner. After discharge from prison, Madeline
changed her life profoundly. She received a high school diploma through
equivalency examination and eventually graduated from law school. Because
of her criminal record, she had to petition the state bar association to sit for
the bar examination and, after much dispute, was eventually admitted to the
bar in her state. She established an extensive legal practice, successfully de-
fending over 50 clients in criminal proceedings. In her community, she was
considered a most impressive and powerful individual who had overcome
considerable adversity to establish a very successful career. She was much
admired by friends and colleagues, so much so that Wiggins selected her to
be the subject of his book on psychological assessment.
Psychodynamic psychological assessment with the Rorschach, Thematic
Apperception Test (TAT), Wechsler Intelligence Test, and the Object Re-
lations Inventory1 (ORI; e.g., Blatt, Stayner, Auerbach, & Behrends, 1996),
consistent with findings independently reported from other assessment pro-
cedures (e.g., Minnesota Multiphasic Personality Inventory, NEO Five-
Factor Inventory), noted Madeline's remarkable agentic strengths. Equally
impressive, however, was Madeline's intense vulnerability to threat. The in-
tensity of her vulnerability suggested that Madeline's agentic capacities also
served as a counterphobic defense (overcompensation) to deal with intense
fears and apprehensions. But even more basic was the fact that these intense
agentic qualities appeared to also ward off her vulnerability to largely uncon-
scious, profoundly painful feelings of loneliness and loss expressed in her con-
tinued longing to establish a meaningful relationship with her mother. Thus
in many ways, Madeline's impressive introjective qualities and powerful
agentic strengths not only were the basis for her developing very important
adaptive capacities but also provided important defensive functions to pro-
tect her from introjective fears and apprehensions about attack and assault,
and, more important, from fully recognizing and experiencing powerful un-
filled, but deeply repressed, anaclitic longings for a close, need-gratifying re-
lationship with a maternal figure.
Madeline, according to Behrends and Blatt (2003), presented an ex-
tremely complex diagnostic picture of someone headstrong and fiercely in-
'The ORI is discussed in more detail in chapter 7 (this volume).
dependent as well as achingly tender and vulnerable. During psychological
assessment she was provocatively oppositional and defiant as well as selfless
and generous with a capacity for empathy and mutuality in her interactions
with the examiner. In her psychological test protocols (Wechsler Adult In-
telligence Scale, TAT, Rorschach, and the ORI), Madeline communicated a
sense of power and strength that was consistent with her functioning as a
highly competent and successful attorney who had made remarkable achieve-
ments despite an extraordinarily painful, difficult, and traumatic childhood
and adolescence. Her power, strength, and accomplishment were conveyed
in Rorschach responses such as the well-perceived response of a woman in
the center of Card I who was seen as
holding her hands up, got great big wings. Like she's professing! Very
powerful! I like that.... Her back is to you. She's facing the crowd. She'd
have to be giving them information.... Someone important in front of
all these people! Like she'd have something important to say
or in Madeline's accurately perceived response to Card V of the Rorschach:
"A butterfly in flight, quite majestic, out for an afternoon flight."
These responses of power, strength, independence, beauty, and majesty
were juxtaposed with responses indicating intense vulnerability as well as a
profound sense of loneliness and emptiness. Madeline's intense vulnerability
was expressed, for example, in her inaccurately perceived response to Card
IV of the Rorschach of a "Scary monster. Great big monster, getting sick!
Huge feet, small head, claws. Oh, it's like fire, burning this little person. Poor
bugger. Very imposing figure! Tiny head, not very smart, dangerous!" She
elaborated the response further by noting that at the
top is his head, looking down, spraying from the mouth. First looks like
he's getting sick. Then looks like fire, very dark Fire from guy's mouth.
Burning him on purpose! Little bugger didn't stand a chance! ... Like it
wasn't accidental. His back is to us. He's inside of the fire. Little arms
hanging down there. . . . Don't you see that? God, I hope so! It's so
obvious! I need to put some dancing pandas in that picture! [referring to
one of her more positive, playful responses to Card II of the Rorschach]
These Rorschach responses express the polarity of Madeline's experi-
ences: from a sense of personal strength, power, and agency to feelings that
the world is dangerous and destructive in which a poor vulnerable little per-
son can be tortured and destroyed. Madeline's powerful agentic (introjective)
qualities clearly provided her with a considerable sense of strength in a highly
destructive and dangerous world. But it is important to note that Madeline
was vulnerable not only to feelings of danger in a hostile destructive world
but also to a profound sense of loneliness, emptiness, and abandonment—an
active yearning for her mother that was expressed in her comments when she
was asked to describe herself on the ORI (e.g., Blatt & Auerbach, 2003). She
stated that "there was never a baby in our family. The first time I ever kissed

my mother was when she was lying in the hospital, having just slit her wrists
on the kitchen table. I saw my cousin brushing her hair, and I was green with
envy." And in describing her mother on the ORI, Madeline noted that "She
wouldn't let you know her, so your questions remain questions. If you ask her
about her childhood, she just gets up and leaves! So I'm left with just blanks."
Madeline's unfulfilled longings and needs for a close relationship and a
primary attachment with her mother were vividly expressed in several of her
responses to Card X of the Rorschach:
It looks like a party in a psychedelic aquarium. A party! They're having
fun. Everybody's smiling. They live in an ecosystem, all in someway at-
tached. Fine, so no one's trying to get away. All are enjoying themselves
at the party. All so very, very, very, different. Having a great time.
Madeline then noticed a blue crab on the side:

This blue crab. Guy's forlorn, defeated. There is the eye and a big ole
nose. Not so much sad as hopeless. This [on the other side] is not a mir-
ror image. Otherwise, an underwater circus! A great thing going on!
(The examiner noted feeling sad and tearful herself in reaction to these re-
sponses.)
The response of pleasure and excitement in the comfort, stability, and
security in being attached to others within a containing ecosystem seems to
express a deep longing for a primary union with her mother. Thus, Madeline's
exaggerated introjective assertions of autonomy, freedom, independence, and
power seem to have important adaptive and defensive functions. These
introjective strivings and expressions of agency not only are expressed in her
successful career and her remarkable resilience in coping with severe adver-
sity in a potentially dangerous and destructive world but also defend Madeline
from the painful recognition of the intensity of her profound depressive ana-
clitic longings for a primary relationship with her mother. This complex diag-
nostic picture illustrates how, in some individuals, exaggerated emphasis on
one configuration (in this case, on qualities of the introjective configuration)
can defend against recognizing and experiencing profound involvement with
the warded-off elements of more painful and threatening anaclitic issues.
Luyten et al. (2005b) recently speculated that it is probably much more likely
that introjective personality characteristics would serve as a defense against
recognizing, acknowledging, and experiencing anaclitic (relational) strivings,
than the reverse. These formulations await systematic investigation.
Future clinical and empirical research needs to differentiate when ana-
clitic and introjective qualities define a basic personality or character style
from when these two sets of qualities have a more dynamic relationship in
which intense emphasis on one set of attributes defends against recognizing
and experiencing the intensity of concerns in the other domain. This dy-
namic defensive interplay between introjective and anaclitic issues can be

identified in clinical evaluations. But subsequent research on this phenom-
enon will depend on being able to develop methods that enable one to differ-
entiate anaclitic and introjective character or personality organization from
when these two types of personality organization interact in a more dynamic
context.
The findings with Madeline also suggest that the primary differentia-
tion of anaclitic and introjective dimensions on the Rorschach, and possibly
on other unstructured assessment procedures such as the TAT (Morgan &
Murray, 1935), may occur primarily in the thematic content rather than the
structural organization of the responses (see also, for example, the contribu-
tions of McAdams, 1993). This would explain why Blatt (1992); Blatt and
Ford (1994); and Blatt, Besser, and Ford (2007) found so few significant pre-
treatment differences between anaclitic and introjective patients on the Ror-
schach variables that they used to empirically assess therapeutic change. Struc-
tural variables on the Rorschach, such as F + % (i.e., the degree of reality
testing), degree and type of thought disorder (Allison, Blatt, & Zimet, 1968/
1988; Blatt, Besser, et al, 2007), and the differentiation, articulation, and
integration of human responses (Blatt, Brenneis, Schimek, & Click, 1976a,
1976b), may not differentiate anaclitic from introjective personality organi-
zation, but they may be very useful in defining the developmental level of
the anaclitic and introjective personality organization. The content of re-
sponses to the Rorschach and the TAT (whether they focus on issues of
relatedness or self-definition), however, may provide a reliable basis for dif-
ferentiating between anaclitic and introjective personality organization. The
more structural variables on the Rorschach, such as the type and degree of
cognitive organization, may define the developmental level at which the
different behavioral and symptomatic expressions of an anaclitic or
introjective personality organization are expressed. Thus, less differentiated
and integrated anaclitic individuals would have more infantile and depen-
dent features—in DEQ terms, have greater neediness (see chap. 4, this vol-
ume)—whereas patients with anaclitic features and greater differentiation
and integration would have increased concerns about relatedness with more
adaptive potential. And less differentiated and integrated introjective indi-
viduals would have more paranoid, obsessive, and depressive features and be
more self-critical, whereas more differentiated and integrated introjective
individuals would have a greater sense of personal efficacy with greater adap-
tive potential. These formulations also await systematic investigation.
TOWARD AN ETIOLOGICALLY BASED, DIMENSIONALITY

ORGANIZED TAXONOMY OF PSYCHOPATHOLOGY
The identification of dynamic and structural relationships among a

number of the major types of psychopathology in two primary configurations

of psychopathology has a number of important consequences. The consider-
ation of psychopathology as disruptions of the coordinated and integrated
development of a capacity for relatedness and self-definition provides a basis
for considering various forms of psychopathology from an integrated life-
span developmental perspective—a shift from a descriptive, symptom-based,
categorical diagnostic system to an etiologically based dimensional approach
based on concepts of personality development and organization (T. A. Brown
& Barlow, 2005; Charney et al, 2002; L. A. Clark, 2005; Haslam, 2003;
Kupfer, First, & Reiger, 2002; Luyten & Blatt, 2007; McHugh, 2005). This
conceptualization of two primary configurations of psychopathology also pro-
vides a basis for considering the relationships among different forms of psy-
chopathology from both Axis I and Axis II of DSM-IV into a unified devel-
opmental model in which two major configurations of psychopathology range
over several levels of organization, from more primitive and undifferentiated
to more mature and integrated. The various forms of psychopathology within
each personality configuration have dynamic and structural relationships to
one another. They are not separate isolated diseases but are interrelated modes
of adaptation organized along two basic dimensions of personality develop-
ment: interpersonal relatedness or self-definition. The different forms of psy-
chopathology within a particular configuration share basic similarities in the
nature of the predominant conflicts and the preferred modes of adaptation and
defense. Though these processes are usually consolidated or integrated for each
individual at a particular level of development within the configuration, de-
pending on circumstances this level of integration can shift across develop-
mental levels within the configuration. Symptoms and character traits in the
various forms of psychopathology within each of the two configurations can
involve different levels of psychological development and organization.
Many forms of psychopathology are either distorted exaggerations or
preoccupations, at different developmental levels, with establishing satisfy-
ing interpersonal relationships or attempting to establish a coherent sense of
self. Exaggerated and distorted preoccupation with establishing and main-
taining satisfying interpersonal relations to the neglect of the development
of the self defines the psychopathologies of the anaclitic configuration—
undifferentiated schizophrenia, abandonment depression, and borderline,
dependent, and histrionic personality disorders. These disorders within the
anaclitic configuration are interrelated and involve conflicts around the de-
pendability of care and affection and share a preoccupation with struggles to
establish feelings of closeness, trust, cooperation, intimacy, and mutuality as
well as the use of avoidant defenses (i.e., denial, repression, and displace-
ment). In an exaggerated emphasis on interpersonal relatedness, the devel-
opment of the self is neglected and defined primarily in terms of the quality
of interpersonal experiences. Depriving, rejecting, inconsistent, and unpre-
dictable care or overindulgent interpersonal relationships are often central
to pathology in the anaclitic configuration.

In contrast, exaggerated and distorted concerns about establishing and
maintaining a definition of the self at the expense of establishing meaningful
interpersonal relations defines the psychopathologies of the introjective con-
figuration—paranoid schizophrenia and the paranoid, obsessive-compulsive,
introjective depressive, and phallic narcissistic personality disorders. Psycho-
pathology within the introjective configuration focuses around conflicts with
assertion and aggression that express attempts to achieve a sense of separa-
tion and independence from controlling, intrusive, punitive, excessively criti-
cal, and judgmental others. Psychopathological disorders within the
introjective configuration are interrelated and focused around struggles to
establish a sense of self-definition, to the neglect of developing adequate
interpersonal relations. The primary preoccupation with self-definition shapes
and influences the quality of interpersonal experiences. Disturbances within
the introjective configuration suggest that the parental figures are experi-
enced as intrusive and controlling rather than as depriving or overindulgent.
Representations of parents are an inner presence that is confused with, or
limit, the development of a sense of an independent competent self. Whereas
anger is often denied in the search for affectionate feelings in the psycho-
pathologies of the anaclitic configuration, psychopathology in the introjective
configuration usually involves the expression of aggression—anger directed
at others and at the self. Psychopathologies in the introjective configuration
also share the use of counteractive defenses including isolation, doing and
undoing, intellectualization, reaction formation, introjection, identification
with the aggressor, and overcompensation.
The formulation of the anaclitic and introjective configurations of psy-
chopathology provides a comprehensive theoretical structure for identifying
fundamental similarities among many forms of psychopathology and for re-
lating concepts of psychopathology to fundamental dimensions of personal-
ity development and to variations in normal personality organization. In this
view, psychopathological disorders are compensatory exaggerations and dis-
tortions that occur in response to severe developmental disruptions of the
reciprocally balanced, normal dialectical transactive development of satis-
fying interpersonal relations and of a constructive concept of the self. Se-
vere disruptions of this normal developmental process result in exagger-
ated attempts to achieve equilibrium either through an intense and distorted
preoccupation with the quality of interpersonal relationships or through
exaggerated defensive efforts to consolidate the concept of the self. This
approach is consistent with the recent (e.g., Krueger, Watson, & Barlow,
2005) emphasis on seeking a dimensionally organized taxonomy of psycho-
pathology based on a few broad overarching constructs or "multiple dimen-
sions of disordered thought, affect, and behavior" (p. 291) and dimensions of
temperament and personality (e.g., L. A. Clark, 2005; Widiger & Samuel,
2005; Widiger, Simonsen, Krueger, Livesley, & Verheul, 2005) that "tran-
scend a putative distinction between more normal and more abnormal psy-

chological phenomena" and "official nosologies such as the DSM" (Krueger
etal., 2005, p. 291).
In contrast to the descriptive, atheoretical, diagnostic system of the
DSM developed by the American Psychiatric Association primarily on the
basis of differences in manifest symptoms, the diagnostic differentiation be-
tween anaclitic and introjective configurations of psychopathology is based
on dynamic considerations, including differences in primary motivational
forces (libidinal vs. aggressive), types of defensive organization (avoidant vs.
counteractive), and predominant character style (e.g., emphasis on an inter-
personal vs. a self-orientation, and on affects vs. cognition). These formula-
tions of two primary configurations provide a way of dealing with the overlap
between Axis I and Axis II disorders (e.g., L. A. Clark, 2005; Luyten & Blatt,
2007; Westen, Novotny, & Thompson-Brenner, 2004) in a theoretical model
that integrates clinical disorders in Axis I with the personality disorders of
Axis II of the DSM, In addition, these formulations also suggest the possibil-
ity of establishing a hierarchical organization of disorders in which many of
the more symptom-based disorders listed in the DSM can be subsumed within
one of several major configurations of personality organization and psycho-
pathology (e.g., L A. Clark, 2005; Luyten & Blatt, 2007; Watson, 2005), a
view that could provide a parsimonious way of dealing with the vexing prob-
lem of comorbidity (Blatt, 2004; Krueger et al, 2005; Luyten et al., 2005c;
Nemeroff, 2002; Parker, 2005; K. A. Phillips, First, & Pincus, 2003).
Symptom-based diagnoses such as conduct and antisocial disorders, sub-
stance abuse, eating disorders, sleep disturbance, posttraumatic stress disor-
der (PTSD), and chronic fatigue syndrome, for example, can be viewed as
expressions of more primary disorders in either the anaclitic or introjective
configuration. Different expressions of conduct disorder and antisocial activ-
ity (Blatt, 1991b; Blatt & Shichman, 1981) can often be understood more
fully as a defensive attempt to deal with feelings of loneliness and abandon-
ment or as distorted attempts to assert some sense of self to deal with feelings
of failure, worthlessness, and guilt (Blatt, 1991b, 2004; Blatt & Shichman,
1981). Recent research, for example, demonstrated the important role of
personality dimensions such as self-critical introjective personality charac-
teristics in eating disorders (e.g., Bers, 1988; Bers, Blatt, & Dolinsky, 2004;
Bers & Quinlan, 1992; Claes et al., 2006; Speranza et al., 2005; Thompson-
Brenner & Westen, 2005; Westen & Harnden-Fischer, 2001), in chronic
fatigue syndrome (e.g., Luyten, Blatt, Van Houdenhove, & Corveleyn, 2006;
Luyten, Van Houdenhove, Cosyns, & Van den Broeck, 2006; Luyten, Van
Houdenhove, & Kempe, 2007; Van Houdenhove, Egle, & Luyten, in press;
Van Houdenhove, Luyten, & Egle, in press), in sleep disturbance (Norlander,
Johansson, & Bood, 2005), and in PTSD (Gargurevich, 2006; Southwick,
Yehuda, &. Giller, 1995). A clinical study of amphetamine abuse in adoles-
cents, for example, demonstrated that amphetamine abuse was an expression
of an anaclitic syndrome focused on issues of neglect and abandonment (Lidz,

Lidz, & Rubenstein, 1976). In contrast, an extensive empirical investigation
of substance abuse (Blatt, Rounsaville, Eyre, & Wilber, 1984) demonstrated
that patients addicted to opiates, as compared with a matched sample of
patients who abused a variety of drugs but were not addicted to opiates, were
significantly more depressed and that this depression was focused primarily
around introjective issues of self-criticism and guilt rather than anaclitic is-
sues of dependency, abandonment, rejection, and loneliness. The intensity
of self-criticism in individuals addicted to opiates was so extreme that it ex-
ceeded the level of self-criticism even in psychiatric inpatients. Even further,
self-criticism was significantly related to both the intensity and frequency
with which the patients who abused a variety of drugs but were not addicted
to opiates were experimenting with heroin and therefore likely eventually to
become addicted to opiates.
These formulations that many symptom-based disturbances are behav-
ioral expressions of more fundamental anaclitic and introjective disorders
have important implications for intervention because they indicate that dis-
ruptive behavior in many symptom-based disorders is frequently an expres-
sion of distorted attempts to deal with intense concerns about issues of im-
paired interpersonal relatedness or of a disrupted sense of self-worth—issues
that need to be a central focus of treatment in addition to a focus on the
more manifest symptomatic expressions of the disturbance. Even further, an
extensive literature review (Blatt, Cornell, & Eshkol, 1993) demonstrated
that the conceptualization of an anaclitic personality style provided a theo-
retical structure for integrating a diversity of findings predictive of clinical
course in neoplastic immunological disease, including the use of repressive
defenses, feelings of helplessness, emotional lability, and preoccupation with
interpersonal relationships. Likewise, the conceptualization of an introjective
personality style provides a theoretical structure for integrating a diversity of
findings predictive of clinical course in cardiovascular disease, including the
use of counteractive defenses, social isolation, mistrust of others, and pre-
occupations with anger, autonomy, assertion, control, and self-worth. Ana-
clitic individuals who are dependent are more distressed by interpersonal
disruptions and generally respond to this type of stressor with passivity and
resignation, whereas introjective individuals who are self-critical are more
distressed by loss of self-control and self-worth, and generally react to this
type of stressor with heightened behavioral and autonomic arousal. Thus
these personality styles are linked to clinical course in immunological and
cardiovascular disease because they make it difficult for individuals to alter
their behavior and lifestyle habits in ways that could facilitate accommodat-
ing the limitations imposed by the disease and obtaining care from medical
staff and assistance from social systems to cope with the impact of the disease
process.
These findings indicate that personality dimensions not only have an
important role in more symptom-based disorders (e.g., conduct disorders,
TWO PRIMARY CONFIGURATIONS OF PSYCHOPATHOLOGY J 97

eating disorders, sleep disturbance, PTSD, substance abuse, and chronic fa-
tigue syndrome, and in the clinical course in medical disorders) but also have
important implications for establishing a more coherent diagnostic classifi-
catory system than that provided in the DSM. First, these findings suggest
that the differentiation of disorders on Axis I and Axis II of the DSM is
arbitrary and unproductive (e.g., Krueger et al., 2005; Kupfer, First, & Reiger,
2002; Westen et al., 2004). As Luyten and Blatt (2007) noted, personality
factors are an inherent part of primary Axis I clinical disorders such as de-
pression (e.g., Blatt, 2004) and bipolar (Lam, Wright, & Smith, 2004), psy-
chotic (Tsuang, Stone, Tarbox, & Faraone, 2003), and anxiety (e.g., Shafran
& Mansell, 2001) disorders. As discussed earlier in this chapter, considerable
continuity exists between some of the clinical disorders in Axis I (e.g., de-
pression) and some of the personality disorders in Axis II. Second, increasing
evidence suggests that sharply delineated but arbitrary consensus-based thresh-
olds (e.g., T. A. Brown & Barlow, 2005; First, 2005) in categorical diagnostic
distinctions seriously limit clinical practice and clinical research (Luyten &
Blatt, 2007). Even severe psychiatric disorders in addition to depression, such
as psychotic and bipolar disorders, are best understood as being on a con-
tinuum from normality to subclinical pathology to manifest clinical disor-
ders (Luyten & Blatt, 2007; Ruscio & Ruscio, 2000; Tsuang et al., 2003;
Widiger & Clark, 2000). Third, findings indicate the importance of estab-
lishing a hierarchical structure to classify clinical disorders in which some
disorders are primary whereas other disorders, such as conduct disorder, sub-
stance abuse, or sleep disorder, would best considered secondary behavioral
expressions of particular aspects of more primary disorders—as expressions of
anaclitic or introjective depression, for example. This hierarchical view of
clinical disorders provides a way of dealing with the frequent problematic
issue of comorbidity in the DSM-IV. More important, this hierarchical for-
mulation has important implications for intervention by indicating, for ex-
ample, that disruptive behaviors in conduct and antisocial disorders are fre-
quently symptomatic expressions of introjective issues—defensive and
distorted expressions to try to establish some sense of self-worth—issues that
may need to be a central focus of the treatment strategy (see also First et al.,
2004; Kupfer et al., 2002).
SUMMARY
The formulations presented in this chapter identify common structural

elements in various forms of psychopathology that transcend the DSM dis-
tinction between Axis I and Axis II (Krueger et al., 2005).Various forms of
psychopathology are no longer considered as discrete diseases but as interre-
lated disturbances that are the consequence of disruptions of the normal de-
velopment of basic psychological processes. These theoretical formulations

maintain continuity among normal psychological development, variations
in normal character or personality organization, and different forms of psy-
chological disturbance. Even further, continuity is maintained within clus-
ters of various disorders so that pathways of potential regression and progres-
sion, as well as the nature of therapeutic change, can be understood more
fully. Furthermore, these formulations of two primary configurations of psy-
chopathology provide a basis for the investigation of etiologic and pathoge-
netic developmental pathways, from infancy to adulthood (Charney et al.,
2002), that contribute to the development of various forms of psychopathol-
ogy, as discussed previously in chapters 2 and 3 (this volume). These formu-
lations also have important implications for therapeutic intervention, the
focus of chapters 7 and 8 (this volume). Thus, the formulations of two pri-
mary configurations of psychopathology presented in this chapter provide a
comprehensive and integrated theoretical structure for understanding a wide
range of psychopathology—a theoretical structure that has continuity with
fundamental principles of psychological development and that has impor-
tant implications for understanding the etiology of various types of psycho-
pathology as well as some of the processes and mechanisms of therapeutic
change.

7
AND THERAPEUTIC CHANGE
The dimensions of relatedness and self-definition that provide a unique

perspective on personality development and psychopathology, as 1 discuss in
This chapter incorporates material from (a) "The Differential Effect of Psychotherapy and
Psychoanalysis on Anaclitic and Introjective Patients: The Menninger Psychotherapy Research
Project Revisited," by S. ]. Blatt, 1992, Journal of the American Psychoanalytic Association, 40, pp.
691-724. Copyright 1992 by the American Psychoanalytic Association. Adapted with permission;
(b) "Different Kinds of Folks May Need Different Kinds of Strokes: The Effect of Patients'
Characteristics on Therapeutic Process and Outcome," by S. J. Blatt and I. Felsen, 1993, Psychotherapy
Research, 3, pp. 245-259. Copyright 1992 by Taylor & Francis. Adapted with permission;
(c) Therapeutic Change: An Object Relations Perspective, by S. J. Blatt and R. Q. Ford, 1994, New York:
Plenum Press. Copyright 1994 by Plenum Press. Adapted with permission; (d) "The Assessment of
Change During the Intensive Treatment of Borderline and Schizophrenic Young Adults," by S. J.
Blatt, R. Q. Ford, W. Berman, B. Cook, and R. Meyer, 1988, Psychoanalytic Psychology, 5, pp. 127-
158. Copyright 1988 by the American Psychological Association; (e) "Psychoanalysis: For What,
With Whom, and How: A Comparison With Psychotherapy," by S. J. Blatt and G. Shahar, 2004,
Journal of the American Psychoanalytic Association, 52, pp. 393-447. Copyright 2004 by the American
Psychoanalytic Association. Adapted with permission; (f) "Benevolent Interpersonal Schemas
Facilitate Therapeutic Change: Further Analyses of the Menninger Psychotherapy Research Project,"
by G. Shahar and S. J. Blatt, 2005, Journal of Psychotherapy Research, 15, pp. 1—4. Copyright 2005 by
Taylor & Francis. Adapted with permission; and (g) "Empirical Evaluation of the Assumptions in
Identifying Evidence Based Treatments in Mental Health," by S. J. Blatt and D. C. Zuroff, 2005,
Clinical Psychology Review, 25, pp. 459-486. Copyright 2005 by Guilford Press. Adapted with
permission.
203
earlier chapters, also provide a way of understanding important aspects of the
psychotherapeutic process.
More than a half-century ago, Cronbach (1953, 1957; Cronbach &
Gleser, 1953; Edwards & Cronbach, 1952) observed that different types of
patients might respond differentially to various forms of treatment and change
in different, but equally desirable, ways. Despite the cogency of Cronbach's
argument and subsequent efforts of others (e.g., Shoham-Salomon & Hannah,
1991) to urge psychotherapy investigators to adopt more complex research
designs that differentiate among patients to study the interactions between
types of patients and their response to different types of treatment (see also
Paul, 1969), much of psychotherapy research has continued to emphasize
randomized clinical trials that compare the efficacy of different treatments
in reducing a variety of focal symptoms. Since Cronbach's call over a half-
century ago, very few studies have successfully integrated patient variables in
their research designs or in their data analyses to systematically investigate
mechanisms of therapeutic action. One of the primary reasons for this fail-
ure, as Cronbach (1967) noted, is that the introduction of patient variables
into psychotherapy research designs, into the investigation of the interac-
tions between patient dimensions and type of treatment and type of out-
come, depends on being able to identify appropriate qualities of patients out
of the potentially infinite array of personal characteristics that might be rel-
evant to the treatment process (Blatt & Felsen, 1993). Cronbach and others
stressed that these patient variables must be theoretically derived or empiri-
cally justified if investigators are not to be drawn into what Cronbach (1975)
described as a "hall of mirrors" (Beutler, 1991, p. 222; B. Smith & Sechrest,
1991; Snow, 1991). The theoretical formulations of personality development
and psychopathology presented in earlier chapters provided the basis for the
investigation of what Cronbach called aptitude-treatment and aptitude-
outcome interactions, investigations that facilitated further understanding
of the factors and mechanisms that contribute to therapeutic change.
PRETREATMENT PATIENT PERSONALITY CHARACTERISTICS

AND TREATMENT OUTCOME
The personality dimensions of relatedness and self-definition and the

differentiation between anaclitic and introjective forms of personality orga-
nization and psychopathology provide a theoretically justified and empiri-
cally supported conceptual matrix for introducing patient variables into the
study of therapeutic outcome and aspects of the treatment process. The dif-
ferentiation of two fundamental configurations of psychopathology, anaclitic
and introjective, was made reliably from clinical case records (e.g., Blatt,
1992; Blatt & Ford, 1994) and has been used to introduce patient variables
into several studies of long-term intensive treatment. In addition, the devel-

opment of several questionnaires that systematically assess the dimensions of
relatedness and self-definition (e.g., the Depressive Experiences Question-
naire [DEQ; Blatt, D'Afflitti, & Quinlan, 1976, 1979], the Sociotropy-
Autonomy Scale [SAS; A. T. Beck, Epstein, Harrison, & Emery, 1983], the
Personal Style Inventory [PSI; Robins & Luten, 1991], and the Dysfunc-
tional Attitudes Scale [DAS; Weissman & Beck, 1978], as discussed in chap.
5, this volume) has facilitated the introduction of anaclitic and introjective
dimensions into an extensive study that compared medication and two forms
of manual-directed psychotherapy in the brief outpatient treatment of major
depression.
The concepts of relatedness and self-definition and the distinction be-
tween anaclitic and introjective configurations of personality organization
and psychopathology have been introduced into four major treatment stud-
ies: (a) the investigation of therapeutic change in seriously disturbed, treat-
ment-resistant patients in long-term, intensive, psychodynamically oriented
inpatient treatment in the Riggs-Yale Project (R-YP; Blatt &. Ford, 1994;
Blatt, Besser, & Ford, 2007; Blatt, Ford, Berman, Cook, & Meyer, 1988);
(b) the comparison of the differential outcome of psychoanalysis and sup-
portive-expressive psychotherapy in long-term outpatient treatment in the
Menninger Psychotherapy Research Project (MPRP; Blatt, 1992; Blatt &
Shahar, 2004b; Shahar & Blatt, 2005); (c) the study of aspects of the treat-
ment process and treatment outcome in the intensive inpatient treatment of
seriously disturbed patients with personality disorders in the Kortenberg-
Leuven Study (K-LS; Vermote, 2005); and (d) an extensive evaluation of
several forms of brief outpatient treatment for major depression in the Na-
tional Institute of Mental Health (NIMH) Treatment of Depression Col-
laborative Research Program (TDCRP; e.g., see summary in Blatt & Zuroff,
2005).1
In two studies that evaluated therapeutic response in long-term inten-
sive psychodynamically oriented treatment, the R-YP and the MPRP, clini-
cal judges reliably differentiated anaclitic and introjective patients from de-
scriptions of the patients in clinical case records prepared at the beginning of
treatment. The comparison of therapeutic outcome in outpatients in psy-
choanalysis and long-term supportive—expressive psychotherapy in the MPRP
and the investigation of changes in the treatment of treatment-resistant pa-
tients who are seriously disturbed and are in long-term, intensive, inpatient
treatment in the R-YP indicated that anaclitic and introjective patients come
to treatment with different needs, respond differentially to different types of
'Further research is needed with other procedures to assess aspects of the anaclitic-introjective
distinction, such as the research by Vinnars and colleagues (2005, 2007) that found that the
vindictive subscale of the Inventory of Interpersonal Problems (IIP; L. Horowitz, 2004)—likely an
introjective personality quality—predicted outcome in patients with personality disorders in 40
weekly sessions of manualized time-limited supportive-expressive psychotherapy as well as in
nonmanualized open-ended (not time-limited) community-delivered psychodynamic treatment.
RELATEDNESS AND SELF-DEFINITION AND THERAPEUTIC CHANGE 205

therapeutic intervention, and demonstrate change differently in the treat-
ment process.
The Riggs-Yale Project

Therapeutic change was studied in 90 treatment-resistant patients who
were seriously disturbed and who, after a number of years of unsuccessful
outpatient and brief inpatient treatment, sought long-term, intensive, psy-
choanalytically oriented inpatient treatment in a small open therapeutic fa-
cility at the Austen Riggs Center (ARC) in Stockbridge, Massachusetts, that,
in addition to an extensive therapeutic community, involved at least four-
times-a-week psychodynamic psychotherapy (Blatt & Ford, 1994; Blatt, Ford,
et al., 1988).
For many years the ARC has maintained detailed clinical files that
include extensive clinical and psychological test evaluations conducted at
admission and later in the treatment process. The intensive and extensive
evaluation at admission (after the first 6 weeks), on the basis of clinical in-
terviews with the family and the patient, includes family history, the devel-
opmental history of the patient, a description of the present illness and its
onset, the course of any previous treatment and therapy, descriptions by nurses
and activities staff of the patient's initial behavior in the hospital, and an
account by the therapist of the first 6 weeks of the psychotherapeutic inter-
action. This admission evaluation is written primarily from a behavioral and
phenomenological orientation, without the imposition of explicit theoreti-
cal formulations. Another detailed case report, similar to the initial case re-
port, is prepared later in the treatment process, with much attention given to
direct first-hand accounts of experiences with the patient in the various treat-
ment modalities.2 In coordination with both the admission case report and
the later case re-presentation, an extensive battery of diagnostic psychologi-
cal tests, including the Rorschach, Thematic Apperception Test (TAT),
Wechsler Adult Intelligence Scale (WAIS), and, in some cases, Human Fig-
ure Drawings (HFDs), is administered to the patients.
Two hundred and fifty patients, for whom an initial and a second set of
psychological tests were available, had been in treatment for at least 1 year at
the ARC between 1953 and 1975. One hundred of these patients were be-
tween the ages of 18 and 29 at the time of admission and these patients were
selected for study because they would probably be dealing with similar devel-
opmental life issues. All of these patients had a full-scale IQ of at least 80,
showed no indication of central nervous system disturbance, and had each
participated in 200 or more sessions of individual psychodynamically ori-
ented psychotherapy.
Ninety of these one hundred patients had psychological test protocols
sufficiently legible to be used in research. The 45 women and 45 men in this
2
In addition, therapists prepare monthly treatment summaries.

sample had an average age at intake of 20.94 years. These 90 patients had
had an average of 28.45 months of prior outpatient treatment and 57% of
them had previously been admitted, at least once, to a psychiatric hospital
(an average of 1.32 prior admissions) for a total average prior hospitalization
of 4-75 months before being admitted to the clinical treatment program at
the ARC. In terms of conventional diagnoses, approximately 20% (n = 29)
of the sample were considered psychotic at admission, 70% (n = 50) to have
severe personality disorders (including borderline and narcissistic disorders),
and 10% (n = 11) to be primarily depressed. These patients had been hospi-
talized at the ARC, on average, for 26 months, with an average of 15 months
between the initial evaluation at admission and the second clinical evalua-
tion, which was conducted, on average, about 1 year prior to termination of
treatment. Thus the second evaluation was independent of any consider-
ations about termination and discharge from the inpatient treatment pro-
gram. At these same two times, at intake and again on average 15 months
later, patients were administered a series of psychological assessment proce-
dures that included the Rorschach, the TAT, and a form of the WAIS. Thus,
two independent sets of observations (clinical case records and the psycho-
logical test protocols) were available for each patient at two points in the
treatment process. One research team, using a wide range of established clini-
cal rating scales, reliably rated aspects of the patients as they were described
in the clinical case reports; a second research team independently and reli-
ably rated various aspects of the psychological assessment procedures using
well-established scoring procedures.
Evaluation of the Anaclitic-introjective Distinction

Two judges (one had a master's in social work and one was a PhD can-
didate in clinical psychology), using the initial clinical case records, reliably
differentiated anaclitic and introjective patients. They agreed on the ratings
of 17 of the 18 cases they had rated in common. In addition, the two judges,
using a 100-point scale, indicated their level of confidence in making the
anaclitic-introjective distinction for each patient.3 The correlation of their
confidence ratings for the 18 cases they rated in common was highly signifi-
cant (r = .92; p< .001).
Ratings of the Clinical Case Records

One of the major tasks in the R-YP was to transform the extensive
narrative clinical case records at admission and later in the treatment pro-
cess into quantitative data. After exploring a number of rating scales, the
'The two judges were asked to make the binary anaclitic-introjective distinction and then to rate
their level of confidence in making this judgment. Confidence in rating anaclitic organization could
range from a score of 1, indicating very high confidence, to a score of 49, indicating very low
confidence. Confidence in rating introjective organization could range from a score of 99, indicating
very high confidence, to a score of 51, indicating very low confidence.

research team assessing the clinical case records was able to rate reliably sev-
eral scales that seemed to capture clinically relevant dimensions: the assess-
ment of clinical symptoms, social behavior, and interpersonal relations. Af-
ter establishing adequate interrater reliability, two judges independently rated
one half of the cases at Time 1 and the other half of the cases at Time 2.
Raring of Clinical Symptoms. Strauss and Harder (1981) designed the
Case Record Rating System to assess a wide range of clinical symptoms that
yielded four factors: a Psychosis factor (20.6% of the variance), a Neurosis
factor (11% of the variance), and a Labile Affect and a Flattened Affect
factor (8% and 6.5% of the variance, respectively).4 Strauss, Kokes, Ritzier,
Harder, and Van Ord (1978) reported that these four factors significantly
differentiated among several diagnostic groups (those with schizophrenia,
affective disorders, psychosis, or neurosis).5
Rating of Social Behavior. Fairweather and colleagues (1960) developed
a procedure for rating changes in ward behavior on an inpatient therapeutic
setting. The Interpersonal Communication Scale of the Fairweather Ward
Behavior Rating Scale contains 28 dichotomous, forced-choice items that
assess the quality of interpersonal communication among patients who have
serious disturbances in an inpatient setting.6
Rating of Interpersonal Relations. Harty and colleagues (Harty, 1976; Harty
et al., 1981), as part of the MPRP, developed twelve 100-point rating scales,
with well-specified points at each decile, for evaluating broad clinical di-
mensions. Research by Kernberg (1975, 1984) and Harty et al. (1981) sug-
gested that 5 of these 12 scales were particularly appropriate for assessing
therapeutic change in inpatients who are seriously disturbed: motivation for
treatment, social and sublimatory effectiveness, impulsivity, superego inte-
gration, and quality of object relations. Factor analysis of the ratings on these
five scales made on the admission case records indicated that four of the five
scales (all but impulsivity) loaded on a common factor. Scores on these four
scales were transformed to standard scores and combined for each subject,
and this factor was labeled Capacity for Interpersonal Relatedness.
Summary of the Ratings of the Clinical Case Records. The ratings of clini-
cal and social behavior described in the clinical case records at admission
and after at least 1 year of intensive treatment comprised six scales or factors:
the four clinical symptom scales of the Strauss-Harder, interpersonal com-
munication on the Fairweather Scale, and the Capacity for Interpersonal
Relatedness factor derived from the four scales from the MPRP.7
4
These two affect factors were originally labeled Bizarre Disorganized and Bizarre Retarded, but
because the patients in the R-YP did not exhibit much bizarre behavior, these two factors were
renamed to describe the dimensions these two factors seemed to be assessing.
5
Attempts were made to identify common variance among these four symptom scales on the basis of
the ratings made on the case records prepared at admission, but these four factors remained relatively
independent dimensions.
6
The Fairweather is a reverse scale: A high score indicates less interpersonal communication.
'Detailed presentation of these case rating scales is available in Blatt and Ford (1994).

Evaluation of Psychological Test Protocols
An extensive battery of diagnostic psychological tests (Rorschach, TAT,
WAIS, and in some cases the HFD test) had been administered to all pa-
tients at the same time as the preparation of the clinical case evaluations: at
admission and later in the treatment process. Testing was conducted by ad-
vanced postdoctoral fellows in clinical psychology using standard well-
specified formats and a consistent theoretical orientation (Allison, Blatt, &
Zimet, 1968/1988; Rapaport, Gill, & Schafer, 1945) and supervised by senior
clinical psychologists. Test protocols were recorded verbatim and paralleled
the quality of the clinical case records in detail and thoroughness.
The analyses of therapeutic change on psychological tests, as I discuss
subsequently, focus primarily on changes on the Rorschach.8 Therapeutic
change on the Rorschach was assessed in the R-YP with relatively recently
developed methods for systematically evaluating aspects of the Rorschach
protocols. The Rorschach protocols were approached with the assumption
that the evaluation of psychological tests with scoring systems derived from
fundamental developmental and psychoanalytic concepts can provide an
important methodology for the independent evaluation of patients' psycho-
logical development in the treatment process (Blatt & Auerbach, 2003).
These scoring procedures for assessing therapeutic change were based on con-
ceptual models that consider the Rorschach not as a perceptual test (e.g.,
S. J. Beck, 1944; Exner, 1974) but as a procedure for evaluating aspects of
mental representation (Blatt, 1990b; Leichtman, 1996a, 1996b). Thus, re-
sponses to the Rorschach are considered to be a process of attempting to
construct meaning in a context of relative ambiguity (Blatt, 1990b).
Personality and developmental theory provided the conceptual basis
for scoring representational dimensions of Rorschach responses that inte-
grates a multiplicity of potential Rorschach scores into meaningful compos-
ite variables that capture major dimensions of personality organization. Thus,
a series of Rorschach variables were used in the R-YP to assess therapeutic
change: composite thought disorder, the quality of adaptive and maladaptive
Concept of the Object on the Rorschach (COR) scale, and the Mutuality of
Autonomy (MOA) scale. Extensive prior cross-sectional research had dem-
onstrated that these variables can be scored at acceptable levels of interrater
reliability and that these variables had established construct validity distin-
guishing among different types of psychopathology.
Concept of the Object on the Rorschach. The development of the concept
of the object has been an important area of investigation in developmental
psychology (e.g., Piaget, 1937/1954; Werner, 1948; Werner & Kaplan, 1983)
and in developmental psychoanalytic theory (e.g., A. Freud, 1974; Jacobson,
8
Findings concerning the nature of therapeutic change observed in the other psychological tests (i.e.,
the TAT, WAIS, and HFDs), as well as several conventional Rorschach variables (i.e., F + %), are
available in Blatt and Ford (1994).

1964; Mahler, 1968; Westen, 1991a). The structure of the concept of the
object has been discussed in terms of developmental principles (e.g., Werner,
1948; Werner & Kaplan, 1983; Westen et al., 1991) of differentiation, ar-
ticulation, and integration (Crockett, 1965); in terms of dimensions of cog-
nitive organization (Bieri et al., 1966; Todd & Rappoport, 1964; Warr &
Knapper, 1968); as aspects of social cognition (Westen, 199Ib); or as an
issue in "person perception" in Kelly's Repertory Test (Kelly, 1955) and in
Osgood's semantic differential (Osgood, Suci, & Tannenbaum, 1957). Po-
tentially important, but often neglected, sources of data for the study of the
concept of the object are responses given to the TAT cards (e.g., Westen,
1991a; Westen, Lohr, Silk, Gold, & Kerber, 1990; Westen, Lohr, Silk, Kerber,
& Goodrich, 1990), early memories (e.g., Nigg et al., 1991), and Rorschach
responses with human content. Using theoretical conceptualizations derived
from developmental psychology (Werner, 1948; Werner & Kaplan, 1983),
Blatt, Brenneis, Schimek, and Click (1976a, 1976b) developed a proce-
dure for evaluating the developmental level of human responses given to
the Rorschach—the COR scale (Blatt, Brenneis, et al., 1976a; K. N. Levy,
Meehan, Auerbach, & Blatt, 2005). The COR scale assesses all responses
with humanoid features using developmentally defined dimensions to evalu-
ate the degree to which the figure has been differentiated, articulated, and
integrated (Werner, 1948).
Differentiation assesses the extent to which the responses are of a full
human figure, or a full quasi-human figure, or a part property of a human or
of a quasi-human figure. Articulation assesses the degree to which the figure
is elaborated in terms of manifest physical and functional features. And inte-
gration assesses the extent to which the action of the figure is internally
determined (unmotivated, reactive, and intentional action), the degree of
integration of the object and its action (fused, incongruent, nonspecific, and
congruent action), the content of the action (malevolent, benevolent), and
the nature of any interaction with other figures (active-passive, active-
reactive, and active-active interactions). In each category (differentiation,
articulation, motivation of action, integration of the object and its action,
content of the action, and nature of interaction), responses are scored along
a developmental continuum. This developmental analysis is made for those
responses with any human or humanoid features that are accurately perceived
(F+) or inaccurately perceived (F-). These variables can be scored reliably
(e.g., Blatt & Ford, 1994; Blatt, Ford, et al., 1988; Ritzier, Zambianco, Harder,
&Kaskey, 1980).
Scores in each category are standardized, and a weighted sum (develop-
mental index) and an average developmental score (developmental mean)
for the six categories combined are obtained for F+ and for F- responses
separately. The composite weighted sum (developmental index) and the de-
velopmental average (developmental mean) of the differentiation, articula-
tion, and integration of accurately perceived human forms (OR+) assess the

capacity for investing in appropriate interpersonal relationships; the com-
posite weighted sum and the developmental average of differentiated, articu-
lated, and integrated inaccurately perceived human forms (OR-) assess the
degree of investment in inappropriate, unrealistic, possibly autistic fantasies,
rather than in realistic relationships.
Longitudinal research (Blatt, Brenneis, et al, 1976b) indicated that
the developmental level (i.e., the degree of differentiation, articulation, and
integration) of accurately perceived human responses (OR+), as assessed with
the COR, systematically develops from ages 12 or 13 to 30 and is related to
adaptive capacities. The developmental level of inaccurately perceived hu-
man responses (OR-) is significantly related to estimates of the severity of
psychopathology in inpatients who are seriously disturbed (Blatt, Brenneis,
et al., 1976b; Ritzier et al., 1980). Subsequent research (see summary in
K. N. Levy et al., 2005) supports the assumptions that OR+ responses on the
COR assess the capacity to become engaged in meaningful and realistic in-
terpersonal relations and that OR- responses on the COR assess the ten-
dency to become involved in unrealistic, inappropriate, possibly autistic types
of relationships.
Mutuality of Autonomy Scale. The quality of interpersonal relations was
assessed on the Rorschach with the MOA scale (Urist, 1977; Urist & Shill,
1982), which assesses the thematic content of interactions explicitly or im-
plicitly portrayed in a Rorschach protocol. All human, animal, and inani-
mate interactions, stated or implied, are rated along a 7-point continuum,
ranging from mutually empathic and benevolent interactions of separate and
autonomous figures (scale score = 1) to themes of malevolent engulfment
and destruction by an overwhelming powerful force of a completely passive
and helpless victim (scale score = 7). Judges can make these distinctions
with a high degree of reliability. The average MOA score is assumed to ex-
press the individual's usual quality of interpersonal relatedness. Each subject's
single most pathological (malevolent) score and single most adaptive (be-
nevolent) score reflect the individual's range or repertoire of interpersonal
interactions. The average MOA score is highly correlated with the level of
the single most maladaptive (malevolent) response (r = .82) but only mar-
ginally with the level of the most adaptive (benevolent) score (r = .40).
These findings suggest that the level of the single most benevolent response
probably reflects the individual's capacity to give at least one socially con-
ventional response, whereas the level of the single most malevolent response,
as well as the average MOA score, reflects the potential range and depth of
an individual's psychopathology (Blatt, 1992; Blatt & Shahar, 2004b). MOA
scores have been found to correlate significantly with measures of interper-
sonal and social functioning in clinical and nonclinical groups (e.g., Blatt,
Ford, et al., 1988; Harder, Greenwald, Wechsler, & Ritzier, 1984; Ryan, Avery,
& Grolnick, 1985; Spear & Sugarman, 1984; Tuber, 1983; Urist, 1977; Urist
& Shill, 1982).

These two conceptual schemas for evaluating interpersonal dimensions
in Rorschach responses (COR and MOA) were scored separately by two in-
dependent judges who had previously established acceptable levels of interrater
reliability in rating the various dimensions of these two scoring schemas.
Research evidence (Blatt, 1992; Blatt & Shahar, 2004b) indicates that the
relationships between these two outcome measures (COR and MOA) are
modest to low, suggesting little overlap among these measures. Blatt, Tuber,
and Auerbach (1990), in an exploration of the COR and MOA scales, found
that the COR is related primarily to measures of the quality of interpersonal
relationships whereas the MOA correlated primarily with measures of thought
disorder.
Thought Disorder. Thought disorder is often considered a primary di-
mension in severe psychopathology. Relatively recent research with the Ror-
schach (e.g., Blatt & Ritzier, 1974; Harrow & Quinlan, 1985; Holzman, 2005;
Johnston, 1975; Johnston & Holzman, 1979), consistent with earlier research
(e.g., W. T. Powers & Hamlin, 1955; Rapaport et al, 1945; J. G. Watkins &
Stauffacher, 1952), indicates that thought disorder measures on the Rorschach
not only differentiate psychotic from nonpsychotic patients but can also dif-
ferentiate within the psychotic range (e.g., nonparanoid and paranoid schizo-
phrenia, borderline disorders, and manic and depressive psychosis; H. Lerner,
Sugarman, & Barbour, 1985; A. Wilson, 1985).
Blatt and Ritzier (1974), on the basis of developmental and psychoana-
lytic theory, differentiated several major forms of thought disorder in terms
of their degree of boundary disturbance. These levels of boundary distur-
bance included the differentiation between independent objects (including
self and nonself) and the differentiation between the actual object and the
mental representation and verbal signifier used to designate the object (be-
tween outside and inside). Failure to maintain these fundamental boundary
differentiations occurs primarily in psychosis and severe borderline personal-
ity disorder (Blatt & Ritzier, 1974; Blatt & Wild, 1976; Blatt, Wild, & Ritzier,
1975; Rapaport et al., 1945; Weiner, 1966; A. Wilson, 1985). These bound-
ary disturbances are often expressed in thought-disordered responses to the
Rorschach, in contamination, confabulation, and fabulized combination re-
sponses (Rapaport et al., 1945).
Contamination responses, often considered pathognomonic of schizo-
phrenia (e.g., Weiner, 1966; A. Wilson, 1985), express an inability to main-
tain a fundamental boundary or separation between independent objects or
concepts (e.g., an accurately perceived "hand" and "rabbit's head," on the
bottom of Card X, merge into an idiosyncratic "rabbit's hand"). Confabula-
tion responses, in contrast, express an inability to maintain a boundary or
separation between inside and outside, between what is perceived and one's
reactions to the perception. Confabulation responses are characterized by
extensive, arbitrary, ideational, or affective elaborations that seriously dis-
tort an initially accurately perceived response (e.g., "two fetuses, represent-

ing good and evil, heaven and hell" on Card II) and most frequently occur in
patients with borderline personality disorder who are seriously disturbed (Blatt
& Auerbach, 1988; A. Wilson, 1985). Fabulized combination responses, the
least serious form of these three types of thought disorders, reflect an attribu-
tion of arbitrary relationships between separate and independent events or
objects because of spatial or temporal contiguity (e.g., "two elephants danc-
ing on a butterfly" on Card II, or "two tigers standing on a flower" on Card
VIII). Fabulized combination responses involve less boundary disturbance
and thus are considered the least serious of the three major forms of thought
disorder, and they occur primarily in more organized outpatients with bor-
derline personality disorder who are depressed, often with paranoid features.
These three types of thought disorder can be scored with a high degree of
reliability and they can be studied independently or combined into a com-
posite measure of thought disorder.9
Summary of Evaluation of Rorschach Protocols. Rorschach protocols ob-
tained at admission and later in the treatment process were evaluated with
three scoring systems: the COR scale, the MOA scale, and the Boundary
Disturbance Scale assessing the degree of thought disorder.
Therapeutic Change in Inpatients Who Are Seriously Disturbed

Systematic differences were found in the therapeutic response of ana-
clitic and introjective patients on several measures derived from clinical case
records and the independently administered and scored psychological test
protocols. Overall, patients demonstrated significant therapeutic improve-
ment; but introjective patients consistently demonstrated greater improve-
ment than did anaclitic patients on multiple measures of clinical change in
both the clinical case records and the psychological assessment protocols.
Independent of the extent of therapeutic gain, anaclitic and introjective
patients demonstrated different patterns of therapeutic change. Introjective
patients changed primarily in the frequency and intensity of their clinical
symptoms (as reliably rated from clinical case reports) and in the level of
their cognitive functioning (or IQ), as independently assessed on psychologi-
cal tests. Therapeutic change occurred more slowly and in more subtle form in
anaclitic patients and was expressed primarily in changes in the quality of their
interpersonal relationships (as reliably rated from clinical case reports) and
in the developmental level of their representation of human forms on the
Rorschach as assessed on the COR scale. Thus, anaclitic and introjective
patients changed mainly in ways congruent with their basic concerns and
'Blatt, Ford, and colleagues (1988; Blatt & Ford, 1994) constructed a weighted sum of these three
thought disorder scores. Contamination and Contamination Tendency responses were weighted 6 and
5, respectively; Confabulation and Confabulation Tendency responses were weighted 4 and 3,
respectively; and Fabulized Combination and Fabulized Combination Tendency responses were
weighted 2 and 1, respectively. This composite weighted sum was controlled statistically for total
number of responses to the Rorschach.

preoccupations. Anaclitic patients changed primarily in dimensions that as-
sessed interpersonal relationships; change in introjective patients occurred
primarily in the level of cognitive functioning and in the intensity of their
manifest clinical symptoms (Blatt & Ford, 1994; Blatt, Ford, et al., 1988).
Therapeutic change in the representation of interpersonal relationships
in the R-YP was expressed primarily in the reduction of maladaptive, inap-
propriate representations of human figures (OR-) on the Rorschach as mea-
sured by the COR scale, primarily in anaclitic patients. Reduction in mal-
adaptive representations (OR-) on the Rorschach was significantly correlated
with increases in the ratings of the quality of interpersonal behavior in the
narrative clinical case records, again principally with anaclitic patients. It is
noteworthy that over the course of treatment of these seriously disturbed,
treatment-resistant inpatients, no significant changes were observed in adap-
tive representations (OR+) of human forms on the Rorschach. Thus, thera-
peutic progress was noted in these seriously disturbed anaclitic patients pri-
marily in a reduction of investment in maladaptive representations (OR—).
Therapeutic progress in introjective patients, in contrast, was reflected pri-
marily in a reduction in the degree of malevolence attributed to interactions
on the Rorschach as measured by the MOA. Thus, change in anaclitic pa-
tients occurred primarily on the structural dimensions of maladaptive repre-
sentations, as assessed by the COR scale (i.e., the extent of differentiation,
articulation, and integration), whereas changes in introjective patients oc-
curred for the most part in the thematic content of representations as as-
sessed by the MOA scale. Change in the degree of malevolence on the MOA
scale was related to therapeutic change primarily in the overideational
introjective patients because the MOA scale is closely related to the degree
of thought disorder on the Rorschach (Blatt, Tuber, & Auerbach, 1990).
Changes in the structural organization of the representation of the human
figure on the Rorschach on the COR scale, in contrast, occurred in the more
interpersonally oriented anaclitic patients because the COR scale primarily
assesses aspects of interpersonal relatedness (Blatt, Tuber, & Auerbach, 1990).
Both anaclitic and introjective patients in the R-YP had substantial re-
ductions in the composite measure of thought disorder that was derived from
the Rorschach protocols, but this reduction in overall thought disorder, con-
trary to theoretical expectations, reached statistical significance for the ana-
clitic patients but not for the introjective patients (Blatt & Ford, 1994). Con-
sistent with the nature of anaclitic psychopathology, reduction in overall thought
disorder on the Rorschach in the affectively labile anaclitic patients was sig-
nificantly correlated with improvement in the ratings of their affect regulation
(labile and flattened affect) in the clinical case records (Blatt & Ford, 1994).
Further analyses of the thought disorder data (Blatt et al., 2007), how-
ever, revealed that this reduction occurred in different types of thought dis-
order for anaclitic and introjective patients. Anaclitic patients had a reduc-
tion in thought disorder that expressed severe boundary disruptions:

disruptions of self-other boundaries in contamination responses and of
inner-outer boundaries in confabulation responses. In contamination re-
sponses, two independent percepts or concepts merge or fuse into a single
highly idiosyncratic response:
Objects or concepts cannot maintain their separateness or independence
and become fused in a single distorted unit. . . . The basic issue is the
instability of boundaries between objects and ideas . . . [expressing] a
tendency not to differentiate oneself from others and to blur and confuse
conventional boundaries. (Blatt &. Ford, 1994, p. 245)
Confabulation responses indicate disturbances in "inner-outer boundaries"
in which intense personal reactions are expressed in "extensive and arbitrary
ideational or affective elaboration" that seriously distort a usually accurately
perceived response and "overwhelm the perception with often grandiose and
highly unrealistic personal elaborations and associations" (Blatt & Ford, 1994,
p. 246). Distance is lost between perceptions and personal reactions or asso-
ciations to the perception; reality is distorted by intense, exaggerated per-
sonal reactions and associations.
Reduction in thought disorder in anaclitic patients occurred mainly in
these two more serious types of boundary disturbances in which the bound-
ary is lost between independent objects or between realistic experiences and
one's intense personal reaction to these experiences. It seems consistent that
therapeutic progress in anaclitic patients, with their intense and sometimes
primitive longings for merger and interpersonal closeness, should be expressed
primarily in a reduction of thought disorder expressing disturbances in bound-
aries (Blatt et al., 2007). Reduction in thought disorder in introjective pa-
tients, in contrast, occurred primarily on fabulized combination responses
that express referential thinking but not boundary disturbances per se. In
fabulized combination responses, the spatial contiguity between two inde-
pendent percepts is experienced as indicating a relationship between the two
percepts. But each percept is maintained as a separate and independent im-
age with its own definition and integrity. Thought disturbance is indicated
by the attribution of an arbitrary and illogical relationship between two in-
dependent percepts because of their spatial or temporal contiguity. Consis-
tent with formulations about the nature of introjective psychopathology, re-
duction in thought disorder in introjective patients was significantly correlated
with reductions in ratings of clinical symptoms (psychotic and neurotic) in
the clinical case records (Blatt & Ford, 1994).10
"These findings also explain the initially anomalous findings in Blatt and Ford (1994) that reduction
in the composite thought disorder measure was statistically significant with anaclitic and not with
introjective patients. These findings of Blatt et al. (2007) indicate that this theoretically inconsistent
anomalous finding with the composite thought disorder measure in Blatt and Ford (1994) was the
consequence of the greater weighting given to the thought disorder responses (contamination and
confabulation) indicating more severe boundary disturbances, responses that are more relevant to
anaclitic patients.

These broad-ranging, theoretically consistent different expressions of
therapeutic progress in anaclitic and introjective patients indicate that these
two types of patients who are seriously disturbed both change in the treat-
ment process, but in different ways—in ways congruent with their basic per-
sonality organization. These findings also suggest that these two types of pa-
tients might also have divergent responses to different forms of therapy or to
different aspects of the therapeutic process.
The Menninger Psychotherapy Research Project
The distinction between anaclitic and introjective patients was also

introduced into further analyses of data gathered as part of the MPRP
(Wallerstein, 1986) which compared the effects of psychoanalysis (PSA) and
long-term, psychodynamically oriented, supportive-expressive psychotherapy
(SEP) with outpatients. The now-classic MPRP (see Wallerstein, 1986) was
one of the earliest systematic treatment studies. Carefully designed and so-
phisticated both methodologically and clinically, the project compared five-
times-per-week PSA with two- and three-times-per-week SEP.11 The MPRP
is one of a very few studies that have attempted to systematically compare
these two treatment modalities—two psychodynamically informed, long-term
intensive treatments that differ primarily in the emphasis they place on the
role of interpretation and insight in the treatment process (Wallerstein, 1986).
Although the MPRP was not a randomized clinical trial (patients were
provided with the treatment the clinical staff thought would be most effec-
tive with them), the study was well conceptualized and carefully implemented,
and included extensive clinical ratings and psychological assessments (in-
cluding the Rorschach) at intake, termination, and follow-up. The various
qualitative and quantitative analyses of the clinical and empirical data in the
MPRP have resulted in more than 70 publications, including 5 books, that
have made important contributions to understanding various aspects of psy-
chopathology and the therapeutic process (Rosen, 2003). But one of the major
disappointments with the MPRP was its failure to find significant empirical
differences between PSA and SEP (Wallerstein, 1986). As Wallerstein (1986)
noted, "psychotherapy accomplished more stable and enduring results than
expected, . . . [whereas] psychoanalysis . . . was more limited . . . than had
been anticipated or predicted" (p. 205). Wallerstein (1986) described PSA
in the MPRP as operating "essentially through the establishment of a full-
fledged regressive transference neurosis, and its ultimate resolution comes
"By design, the weekly frequency of treatment sessions was significantly different in the two treatment
conditions (on average, SEP = 2.72 and PSA = 4.67 sessions per week; F(l, 32) = 41.26, p < .001),
but the total number of treatment sessions was not significantly different in the two treatment groups
(on average, SEP = 453.16 and PSA = 733.73 sessions; F(l, 32) = 2.17, ns). Thus, SEP and PSA were
both long-term intensive treatments (Blatt, 1992).

about centrally through interpretation leading to insight and mastery" (p.
54; see also Gill, 1988). According to Wallerstein, SEP in the MPRP is
similar to psychoanalysis in mechanism but differs sharply in degree. It is

limited in focus to agreed-upon sectors of psychic distress and personal-
ity malfunction . . . operating through means that do not evoke a full
transference regression, all leading to less extensive (more 'intermedi-
ate') results, (p. 54)
SEP in the MPRP also included emotional support, reassurance, advice, and
sometimes active suggestions and directions.
Sandell and colleagues (e.g., Blomberg, Lazar, & Sandell, 2001; Grant
& Sandell, 2004; Sandell et al., 2000), in a systematic empirical attempt to
differentiate psychoanalysis and long-term psychodynamic psychotherapy,
noted many similarities but also important differences between these two
forms of treatment, including differences in outcome and in the clinician's
therapeutic attitudes and techniques. They noted that it is important to think
of psychoanalytic psychotherapy not as a diluted form of psychoanalysis but
as a unique treatment in its own right. They called for further systematic
studies addressing the differences between the two modalities, not only to
deal with the increasingly extensive research on empirically validated short-
term therapies but also to provide a substantive basis to clarify the distinc-
tion between these forms of treatment (see Kernberg, 1999) and establish a
fuller understanding of the mutative factors in the therapeutic process.
The MPRP (see, e.g., Luborsky, Fabian, Hall, Ticho, & Ticho, 1958;
Sargent, 1956a, 1956b; Wallerstein & Robbins, 1956) was designed to evalu-
ate the interaction among aspects of patient, therapy, therapist, and evolv-
ing life circumstances and to determine how they affected the therapeutic
process and contributed to therapeutic outcome. In accordance with these
goals, the distinction between anaclitic and introjective forms of psychopa-
thology (Blatt & Shichman, 1983) was introduced into subsequent analyses
of data from the MPRP (Blatt, 1992; Blatt & Shahar, 2004b; Shahar & Blatt,
2005). These subsequent analyses of the MPRP data demonstrated signifi-
cant differences between these two treatment modalities when two major
innovations were introduced into the data analyses: (a) the differentiation
between two primary types of patient, anaclitic and introjective, and (b) the
introduction of the relatively new methods that had been previously used in
the R-YP, discussed earlier, for evaluating the Rorschach protocols that had
been obtained in the MPRP at admission and at termination of treatment.
These analyses of data from the MPRP are based on 33 of the 42 patients for
whom Rorschach protocols were available both pre- and posttreatment. The
design of the MPRP, the characteristics of the patients, and details of the two
treatment conditions have been extensively described in a number of publi-
cations, including Forty-Two Lives in Treatment (Wallerstein, 1986).

Differentiation of Anaclitic and Introjective Configurations of Psychopathology
The anaclitic-introjective distinction was introduced into further analy-
ses of data from the MPRP (Blatt, 1992; Blatt & Shahar, 2004a) from ratings
by two judges who reliably differentiated between anaclitic and introjective
patients on the basis of their evaluation of the clinical case records that had
been prepared at the beginning of treatment. These two senior clinicians
agreed on the differentiation of 26 of the 33 patients as either anaclitic or
introjective. The anaclitic-introjective differentiation of the remaining 7
was made by a third senior clinician. Of the 33 outpatients, 15 (2 female and
7 male anaclitic; 3 female and 3 male introjective) had been seen in psycho-
analysis. At intake, 7 of these patients were diagnosed as neurotic and 8 as
having a personality disorder. Their mean age was 30.0 years. Of the 33 pa-
tients, 18 (6 female and 6 male anaclitic; 3 female and 3 male introjective)
had been seen in SEP. At intake, 7 of these patients were diagnosed as neu-
rotic, 9 as having a personality disorder, and 2 as latent psychotic. Their
mean age was 32.67 years. No significant differences were found among these
four groups in their level of clinical functioning at admission (Blatt, 1992),
as assessed with the Health-Sickness Rating scale (e.g., Luborsky, 1962;
Luborsky & Bachrach, 1974).
Assessment of Therapeutic Change
The Rorschach protocols gathered at the beginning and the end of treat-
ment in the MPRP were evaluated with the same procedures that had been
used previously to evaluate the Rorschach protocols in the R-YP (Blatt &
Ford, 1994), including (a) composite thought disorder, (b) the quality of
adaptive and maladaptive object representation (OR+ and OR-), and
(c) the MOA scale. It is important to note, however, that the participants in
the MPRP were outpatients, in contrast to the R-YP treatment-resistant in-
patients who were seriously disturbed. Thus, significant treatment effects in
the MPRP were not expected to occur on the measures included in the R-YP
to assess more psychotic levels of functioning: thought disorder and the de-
velopmental level of maladaptive, inaccurately perceived object representa-
tion (OR-). Rather, significant treatment effects were expected in the MPRP
on the measures designed primarily to assess functioning in the neurotic and
borderline range: the developmental level of adaptive, accurately perceived
object representations (OR+) and the MOA scale. Changes in object repre-
sentation on the Rorschach, assessed with the COR and the MOA scales,
seemed particularly relevant to evaluating the therapeutic effects of PSA
and SEP in the treatment of the outpatients in the MPRP.
Therapeutic Change of Anaclitic and Introjective Patients in Psychoanalysis and
Supportive-Expressive Psychotherapy
Further analyses of the data from the MPRP indicated that anaclitic
and introjective patients were differentially responsive to SEP and PSA. The

evaluation of psychological test data gathered at the beginning and at the
end of treatment, specifically the scales for evaluating qualities of responses
of the human figure on the Rorschach (i.e., the COR scale) and the nature of
interactions (the MOA scale), indicated that PSA was significantly more
effective than SEP in facilitating the development of adaptive, benevolent
interpersonal schemas in both anaclitic and introjective patients (OR+). SEP,
in contrast, resulted in a decline of these more adaptive representations among
introjective patients. It is noteworthy that, consistent with theoretical ex-
pectations (Blatt, Brenneis, et al., 1976b), therapeutic progress in the outpa-
tients in the MPRP was expressed primarily in increases in adaptive object
representations (OR+) on the Rorschach, whereas therapeutic progress in
the R-YP treatment-resistant anaclitic and introjective inpatients who were
more seriously disturbed, as noted earlier, was expressed primarily in decreases
in maladaptive object representations (OR-)—responses that assess func-
tioning primarily in the psychotic and severe borderline range.
In addition, both PSA and SEP were effective in reducing the intensity
of maladaptive malevolent interpersonal schemas on the MOA scale, but
with different types of patients. PSA was significantly more effective than
SEP in reducing the intensity of malevolent, destructive representations in
introjective patients, whereas SEP was significantly more effective than PSA
in reducing the intensity of these malevolent representations in anaclitic
patients (Blatt, 1992; Blatt & Shahar, 2004b). Not only was the therapeutic
response of these two groups of patients significantly different within the two
types of treatment, but the patient-by-treatment interaction was a signifi-
cant (p < .001) crossover interaction (Blatt, 1992). Elements of this statisti-
cally significant patient-by-treatment interaction were found even in those
few patients for whom the two primary clinical judges disagreed in classifying
as either anaclitic or introjective, such that the decision had to be made by a
third judge (Blatt & Shahar, 2004c).12
These findings indicate that the relative therapeutic efficacy of psycho-
analysis versus psychotherapy was contingent to a significant degree on the
patient's pretreatment pathology or character structure. More dependent,
interpersonally oriented anaclitic patients responded more effectively to SEP
in which there is more direct and supportive interaction with the therapist.
The more ideational introjective patients, who stressed separation, autonomy,
and independence, responded more effectively to the relative interpersonal
isolation and the more interpretive and exploratory focus of psychoanalysis.
It seems consistent that the more dependent, interpersonally oriented ana-
clitic patients were more responsive in a therapeutic context that provided
more direct personal interaction with the therapist, and that the ideational
12
The stability of these patient-by-treatment interactions was assessed with the MOA mean score
because the MOA mean is a more reliable measure than is the level of the single most malevolent
response (Blatt & Shahar, 2004c).

introjective patients were more responsive in psychoanalysis (Blatt, 1992).
Thus, the statistically significant (p < .001) patient-by-treatment interac-
tions indicated that congruence between patients' character or personality
style and important aspects of the therapeutic process contributed to the
nature and efficacy of treatment outcome. Patients come to treatment with
varying problems, character styles, and needs and appear to be responsive in
divergent ways to different types of therapeutic intervention.
These findings suggest that PSA is particularly effective with introjective
patients, whereas SEP is relatively ineffective, or even detrimental, with this
type of patient. And the reverse effect occurs with anaclitic patients, who are
particularly responsive to SEP but responsive only to a limited degree to PSA.
This greater therapeutic response of introjective patients in PSA in the MPRP
is consistent with findings of the R-YP, as discussed earlier, that introjective
patients had more extensive therapeutic gains in long-term, psychodynami-
cally oriented intensive treatment. These findings of positive outcome for
introjective patients in long-term psychodynamic treatment of inpatients in
the R-YP and for outpatients in the MPRP are also consistent with the find-
ings of Fonagy et al. (1996) and the conclusions by Gabbard et al. (1994)
about the constructive response of introjective patients to long-term, insight-
oriented psychodynamic treatment. This constructive response of introjective
patients to long-term psychodynamic treatment is in marked contrast to the
relatively poor response of these patients to brief manual-directed treatment
for depression, which is discussed later in this chapter.
The Kortenberg-Leuven Study
Rudi Vermote (2005) studied therapeutic change in a 9-month psycho-

dynamically oriented inpatient treatment program for patients with diag-
nosed personality disorder. Although Vermote did not differentiate anaclitic
and introjective patients before beginning his investigations, he noted in
conclusion that his findings were very congruent with the differential thera-
peutic response of anaclitic and introjective patients in both the R-YP and
the further analyses of data from the MPRP.
Using trajectory analyses, Vermote (2005) assessed patterns of thera-
peutic change in 78 patients and identified two groups of patients, both of
whom had moderate levels of symptoms at admission. But one group (50% of
the sample) made substantial therapeutic gain that continued into the fol-
low-up assessment, whereas the other group (25% of the sample) made little
therapeutic gain. He discovered that these two groups had important differ-
ences in pretreatment personality characteristics. The group with substantial
and sustained therapeutic gain usually had a dismissively avoidant insecure
attachment style and were responsive primarily to the exploratory interpre-
tive aspects of the treatment process. Vermote noted the similarity of this
group of patients to the introjective patients reported in other studies to be

responsive to long-term psychodynamic treatment (e.g., Fonagy et al., 1996;
Gabbard et al., 1994) as well as to the introjective patients in the R-YP and
MPRP discussed earlier. The other group of patients stayed in treatment longer
and fewer dropped out of treatment, but they generally had poorer outcomes.
These patients more frequently reported early sexual abuse, usually had a
preoccupied insecure attachment style, and were more responsive to the sup-
port and structure of the treatment program than to exploration and inter-
pretation. Vermote noted the similarity of these patients to the anaclitic
patients in the R-YP (Blatt & Ford, 1994) and MPRP (Blatt, 1992; Blatt &
Shahar, 2004b) studies. Vermote concluded that treatment outcome in his
study seemed more determined by patients' pretreatment personality charac-
teristics (coping style and the quality of interpersonal relationships) than by
the initial level of their symptom severity.
In a more extensive and intensive analysis of his data, Vermote (2005)
evaluated treatment changes in symptoms and personality functioning, as
well as characteristics of the treatment process over 9 months of inpatient
treatment of a subset of 44 (13 men and 31 women) patients with personality
disorders for whom data were available at various points during treatment
(every 2 months) and at 3 and 12 months after termination of treatment.
Vermote also assessed aspects of personality organization with several mea-
sures derived from analyses of spontaneous descriptions given by the patients
of self and of significant figures in their lives (parents, therapist, and person-
ally designated significant other) on the Object Relations Inventory (ORI;
e.g., Blatt, Stayner, Auerbach, & Behrends, 1996). These measures included
the level of differentiation-relatedness (D-R; Diamond, Blatt, Stayner, &
Kaslow, 1991) and the level of reflective function (RF) or mentalization
(Fonagy, Target, Steele, & Steele, 1998).13 Vermote also assessed the degree
to which the patient reported "Felt Safety" in the treatment process.
Vermote explored the relationships among change in symptoms, per-
sonality characteristics, and personality organization over the course of treat-
ment and in follow-up assessments conducted at 3 and 12 months after dis-
charge. He addressed three basic issues in his data analyses: (a) the extent of
therapeutic change, (b) the relationship among different measures of thera-
peutic change (i.e., symptoms, personality characteristics, and personality
organization), and (c) patterns of therapeutic change.
Evaluation of the Extent of Therapeutic Change

Evaluating changes over treatment, Vermote (2005) found significant
(p < .001) change over the course of treatment in symptoms14 and personal-
"The ORI and the D-R Scale are discussed in detail in chapter 8 (this volume).
'''Symptoms were measured with the Beck Depression Inventory (A. T. Beck & Beamesderfer, 1974);
Hopkins Symptom Checklist (SCL-90; Derogatis, Lipman, & Covi, 1973); Spielberger State-Trait
Anxiety Inventory (Spielberger, Gorsuch, & Lushene, 1970); State-Trait Anger Inventory
(Spielberger et al., 1985); and Self-Harm Inventory (Sansone, Wiederman, & Sansone, 1998).

ity characteristics15 and that most of these changes occurred primarily in the
second half of treatment. He also found significant change (p < 001) on
several measures of personality organization—in the report of experiencing
Felt Safety in the treatment process and in the D-R score in the descriptions
of self and significant others on the OKI. Mentalization as measured by the
RF scale on the descriptions obtained with the OKI only tended (p = .07) to
improve.
Relationship Among Different Measures of Therapeutic Change

Vermote (2005) evaluated the relationships of changes in the three
measures of personality organization (Felt Safety and the D-R and RF mea-
sures on the ORI) to changes in symptoms and personality functioning.
Change in the symptoms and personality functioning was significantly (p <
.001) related to changes in Felt Safety and D-R score on the ORI.
Patterns of Therapeutic Change

Vermote (2005) also sought to systematically delineate patterns of
change through a k-means cluster analysis of patients' scores on the variables
derived from the patients' descriptions of self and significant others on the
ORI—the D-R and RF scales. He found that a two-cluster solution was the
most parsimonious and meaningful. Scores in one cluster fluctuated over time
(labeled the Fluctuating cluster), whereas the measures in the other cluster
showed consistent and stable improvement over time (labeled the Stable
cluster).
The Fluctuating cluster was characterized by a rapid improvement (what
Vermote (2005) called the honeymoon phase), followed by a marked decline
throughout treatment and follow-up. In contrast, patients in the Stable clus-
ter had a more consistent pattern of change, particularly in the latter portion
of the treatment process with steady increases to termination and into the
follow-up period.
It is interesting to note that the patients in the two clusters did not
differ in the severity of their pathology at the beginning of treatment and
had similar histories of suicidal threats and self-harm and past traumatic ex-
periences, and approximately equal scores on the sum score of the Structural
Clinical Interview for DSM-IV Axis II personality disorders (SCID-II) scales.
The two clusters, however, had significantly different initial clinical pictures.
Patients in the Fluctuating cluster initially had more severe symptoms and
reported greater anger and depression. They tended to have more borderline
features, in contrast to the patients in the Stable cluster who had more nar-
cissistic features. Vermote (2005) noted that the borderline characteristics
"Personality characteristics were measured with the Inventory of Personality Organization (Kernberg
& Clarkin, 1995), SCID-II, (Spitzer & Williams, 1985), and IIP, Circumplex Version (Alden,
Wiggins, & Pincus, 1990).

of patients in the Fluctuating cluster corresponded with the theoretical de-
scriptions of the anaclitic patients, whereas the narcissistic characteristics of
patients in the Stable cluster corresponded to the descriptions of introjective
patients. Furthermore, therapeutic progress in the Fluctuating cluster seemed
to derive primarily from the quality of the therapeutic relationship, but these
therapeutic gains were not sustained in the follow-up period.16 Therapeutic
gain in the Stable cluster, like the therapeutic progress noted in introjective
patients in the R-YP and the MPRP, and as noted by Gabbard et al. (1994),
was much more stable and sustained.
Summarizing the substantially different patterns of therapeutic progress
of the patients in the Fluctuating and Stable clusters, Vermote (2005) noted
that the Fluctuating-anaclitic group (who had strong borderline features)
had a more rapid decrease in depressive and anger symptoms, but had diffi-
culty sustaining these improvements after discharge. The Stable-introjective
cluster, in contrast, had substantially greater therapeutic gain that continued
to increase after discharge. Vermote (2005) concluded that not only were
specific patterns of change noted in these two different types of patients, but
that different aspects of the therapeutic process seemed to have facilitated
their change—that the anaclitic group appeared to profit from the more sup-
portive structured aspects of the treatment process, whereas the introjective
group appeared to profit more from the explorative dimensions. Vermote
noted the consistency of these findings with the differential therapeutic fac-
tors that seem to result in therapeutic change in anaclitic and introjective
patients in the MPRP.
Vermote noted that the continued improvement in the posttreatment
phase of the introjective patients in the Stable cluster seemed to be the con-
sequence of their greater capacity for intemalization (e.g., Bateman & Fonagy,
1999, 2001; Blatt & Behrends, 1987). The highly significant increase in the
developmental level of their representations of self and of others (increased
D-R), and the tendency for increase in the capacity for mentalization, is
consistent with a report by Sandell (2005) regarding the importance of pa-
tients being able to establish a presence of inner objects in the treatment
process. These conclusions by Vermote (2005) and by Sandell (2005) are
consistent with the formulations of Blatt and Behrends (1987), which I dis-
cuss in chapter 8 (this volume); that treatment is facilitated by the patients'
development of the capacity to rely on more mature and benevolent repre-
sentations of self and significant others (Blatt, Stayner, et al., 1996; Fonagy
& Target, 2005; Sandell, 2005) that have been established in the treatment
process—to rely on "inner objects" to which the patient can turn in difficult
moments that may be encountered after the termination of treatment.
"Vermote had also obtained periodic ratings throughout treatment from patients about their
experiences of therapeutic change on the Leuven Psychotherapy Scale (Vermote, 2005) and from
therapists on the Psychoanalytic Process Rating Scale (Gerber, Fonagy, Bateman, & Higgitt, 2004).

Vermote's findings of changes in the structural organization of mental repre-
sentations (i.e., the level of D-R), like earlier reports by Blatt and Auerbach
(2001); Blatt, Stayner, et al. (1996); and Fonagy (1999), suggest that changes
in "deeply engrained patterns" may be essential for consolidated long-term
therapeutic gain (Vermote, 2005).1V
Taken together, findings from the study of therapeutic change in long-
term intensive treatment in the R-YP, the MPRP, and the K-LS investiga-
tions provide strong confirmation of Cronbach's formulations (1953) that
personality characteristics of patients are important dimensions that influ-
ence therapeutic response (Blatt & Felsen, 1993). The mounting evidence
of the crucial role of patients' pretreatment characteristics in the treatment
process reflects a major shift in psychotherapy research as it begins to go
beyond comparisons of various forms of treatment for the reduction of a
particular focal symptom (e.g., depression or anxiety) to address more com-
plex issues, such as identifying mechanisms of therapeutic change and differ-
entiating what kinds of treatment are more effective, in what kinds of ways,
with which types of patients (Blatt & Shahar, 2004a; Blatt, Shahar, & Zuroff,
2002; Paul, 1969).
Vermote's (2005) findings also indicate the importance of assessing the
content and structure of the representation of interpersonal relationships as
measures of therapeutic change. The findings in the R-YP and in further
analyses of data from the MPRP indicate that the assessment of mental rep-
resentations with the Rorschach, especially with the COR and the MOA
scales, can be an effective way of assessing therapeutic change. Findings in
the K-LS, consistent with findings reported by Blatt, Stayner, et al. (1996)
and Blatt and Auerbach (2001, 2003), indicate that the ORI can be another
valuable method for assessing the content and structural organization of
mental representations (or cognitive—affective schemas of self and of signifi-
cant others) that has the potential for making important contributions to
assessing therapeutic change. I discuss the contributions of the ORI for as-
sessing therapeutic change and aspects of the therapeutic process more fully
in chapter 8 (this volume).
Brief Treatment of Depression in the NIMH-Sponsored TDCRP
A remarkably extensive and diverse data set on the brief outpatient

treatment of serious depression was established by the NIMH-sponsored
TDCRP.18 The TDCRP is probably the most extensive and comprehensive
"Vermote and colleagues at the University of Leuven are planning to evaluate his original sample of
patients 5 years after their termination from treatment. This emphasis on the importance of changes in
vulnerability rather than symptom dimensions in the treatment process was further elaborated by
Hawley et al. (2006), is discussed in the next section, Brief Treatment of Depression.
18
The National Institute of Mental Health (NIMH) Treatment for Depression Collaborative Research
Program (TDCRP) was a multisite program initiated and sponsored by the Psychosocial Treatments
Research Branch, Division of Extramural Research Programs (now part of the Mood, Anxiety, and

data set ever established in psychotherapy research, and the empirical data
from this research program became available to the scientific community in
1994, after the TDCRP investigators concluded their primary explorations
of it. The TDCRP was a very well-designed, carefully conducted randomized,
multisite clinical trial comparing two forms of brief outpatient manual-
directed psychotherapy for depression (cognitive behavior therapy [CBT] and
interpersonal therapy [IPT]) with antidepressant medication (imipramine,
the antidepressant of choice at the time of the investigation) and clinical
management, and a double-blind placebo also with clinical management.19
The TDCRP data set contains extensive and diverse evaluations of patients
before, during, and after treatment. These extensive clinical evaluations were
conducted by a PhD-level clinical evaluator before treatment began, every 4
weeks during the treatment process, and again at 6, 12, and 18 months fol-
lowing the termination of treatment. In addition, periodic evaluations and
reports were obtained from the therapists and the patients. Thus, the TDCRP
data set contains extensive and diverse evaluations of the patient, therapeu-
tic outcome, and aspects of the treatment process. In addition, all therapy
sessions were video recorded.
Therapeutic progress was periodically assessed by clinical interview and
self-report measures of depression (the Hamilton Rating Scale for Depres-
sion [HRS-D] and the Beck Depression Inventory [BDI], respectively), inter-
view and self-report measures of general clinical functioning (the Global
Assessment Scale [GAS] from the Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition [DSM-IV; American Psychiatric Association, 1994]
and the SCL-90, respectively), and an interview measure of social adjust-
ment (SAS; Paykel, Weissman, & Prusoff, 1978). Although the TDCRP
investigators (e.g., Elkin, Parloff, Shea, & Docherty) used the HRS-D as their
primary outcome measure (e.g., J. T. Watkins et al., 1993), Blatt, Zuroff,
Quinlan, and Pilkonis (1996) found that the residualized gain scores at ter-
mination of the five outcome measures (HRS-D, BDI, GAS, SCL-90, and
SAS) were highly intercorrelated, each loading substantially (> .70) on a
common factor. Blatt, Zuroff, et al. (1996) converted these five measures to
standard scores to construct a composite measure of therapeutic gain that
reflected the overall level of clinical functioning, with a particular emphasis
on depressive symptoms.
Personality Disorders Research Branch, Division of Clinical Research), NIMH. The program was
funded by cooperative agreements to six participating sites: George Washington University (Grant
MH 33762), University of Pittsburgh (Grant MH 33753), University of Oklahoma (Grant MH
33760), Yale University (Grant MH 33827), Clark Institute of Psychiatry (Grant MH 38231), and
Rush Presbyterian-St. Luke's Medical Center (Grant MH 35017).
"The clinical management component was designed to manage the medications and to "provide a
generally supportive atmosphere and to enable the psychiatrist to assess the patient's status. . . . The
manual and training . . . include guidelines for providing support and encouragement to the patient
and giving direct advice when necessary. This clinical management component thus approximates a
'minimal supportive therapy' condition" (Elkin, Parloff, Hadley, & Autry, 1985, p. 311).

In the primary analyses of their data, the TDCRP investigators found
"no evidence of greater effectiveness of one of the psychotherapies as com'
pared with the other and no evidence that either of the psychotherapies was
significantly less effective than . . . imipramine plus clinical management"
(Elkin, 1994, p. 971). Comparison of the effects of 16 weeks of treatment
indicated that although medication (imipramine) resulted in more rapid re-
duction in symptoms (Elkin, Gibbons, Shea, & Sotsky, 1995), no significant
differences were found in symptom reduction among the three active treat-
ment conditions at termination (e.g., Elkin, 1994) and at the follow-up as-
sessment conducted 18 months after the termination of treatment (Blatt,
1999b).
Differentiation of Anaclitic and Introjective Dimensions

The differential response of anaclitic and introjective patients in the
long-term, intensive, psychodynamically oriented treatment in the R-YP and
the MPRP studies suggested that the anaclitic—introjective distinction might
be useful in evaluating the effectiveness of various forms of brief outpatient
treatment for depression. Because of these prior findings (e.g., Blatt, 1992;
Blatt & Felsen, 1993; Blatt & Ford, 1994; Blatt & Shahar, 2004b) demon-
strating the value of the anaclitic-introjective distinction in understanding
patient-treatment (P-T) and patient-outcome (P-O) interactions in long-
term intensive treatment of both inpatients and outpatients, the P-T and
P-O interactions were explored in the brief treatments for depression evalu-
ated in the extensive TDCRP data set. These explorations have provided
considerable understanding about the complex interactions among aspects
of the treatment as well as of patients and therapists with regard to therapeu-
tic process and outcome in the brief treatment of depression. The introduc-
tion of the anaclitic-introjective distinction into the further analyses of data
from the TDCRP not only facilitated more effective evaluation of the differ-
ential effects of the various forms of treatment (medication and the two forms
of brief, manual-directed psychotherapy) on therapeutic outcome but also
resulted in fuller understanding of the processes of therapeutic change as well
as of some of the mechanisms of therapeutic action in the brief outpatient
treatment of depression.
The distinction between anaclitic and introjective forms of psychopa-
thology, as I noted in chapter 5 (this volume), has been useful in defining
subtypes of depression (e.g., A. T. Beck, 1983; Blatt, 1974,1998, 2004; Blatt,
D'Afflitti, et al., 1976; Blatt, Quinlan, Chevron, McDonald, & Zuroff, 1982).
Dissatisfaction with symptom-based classifications of depression had led sev-
eral clinical investigators (i.e., Arieti & Bemporad, 1978, 1980; A. T. Beck,
1983; Blatt, 1974,1998, 2004; Blatt, D'Afflitti, et al., 1976; Blatt et al., 1982;
Blatt, Quinlan, & Chevron, 1990; Bowlby, 1988a, 1988b) to differentiate
types of depression on the basis of the fundamental concerns that lead indi-
viduals to become depressed. These formulations, derived from diverse theo-

retical perspectives (i.e., attachment theory, cognitive-behavioral theory,
psychoanalytic object relations theory), clinical experiences, and research
findings (e.g., Blatt, 2004; Blatt & Zuroff, 1992), indicate impressive agree-
ment regarding the value of differentiating between relational and self-defi-
nitional forms of depression—between anaclitic and introjective depression.
As I discussed in chapter 5 (this volume), investigators from both psychody-
namic (e.g., Arieti & Bemporad, 1978, 1980; Blatt, 1974, 1998, 2004; Blatt,
D'Afflitti, et al., 1976; Blatt et al, 1982; Bowlby, 1980, 1988b) and
cognitive behavioral (A. T. Beck, 1983) perspectives identified two major
types of experiences that result in depression: (a) disruptions of gratifying
interpersonal relationships (e.g., loss of a significant figure) and (b) disrup-
tions of an effective and essentially positive sense of self (e.g., feelings of
failure, guilt, and worthlessness; Blatt & Maroudas, 1992). Anaclitic (depen-
dent or sociotropic) depression and introjective (self-critical or autonomous)
depression have been differentiated and studied in a broad range of studies
with several well-established scales: the DEQ (Blatt, D'Afflitti, & Quinlan,
1976, 1979), SAS (A. T. Beck, 1983), PSI (Robins & Luten, 1991), and
DAS (Weissman & Beck, 1978). Studies in which these scales are used dem-
onstrate important differences between anaclitic and introjective patients in
the clinical expression of depression as well as in the early and current life
experiences that are related to the onset of depression (e.g., Blatt, 1998, 2004;
Blatt & Homann, 1992; Blatt et al., 1982; Blatt & Zuroff, 1992).
To introduce the anaclitic-introjective distinction into analyses of the
data from the TDCRP, colleagues and I reviewed the initial clinical intake
evaluations of patients in the TDCRP, but these case reports focused prima-
rily on the neurovegetative symptoms of depression rather than on experien-
tial aspects of the patients' lives. Fortunately, however, patients in the TDCRP
had been administered the DAS (Weissman & Beck, 1978) at intake and
throughout treatment and follow-up. The DAS comprises two primary fac-
tors, Need for Approval (NFA) and Perfectionism (PFT; e.g., Cane, Olinger,
Gotlib, & Kuiper, 1986; Oliver & Baumgart, 1985), that, respectively, are
closely related to measures of anaclitic and introjective dimensions of de-
pression (e.g., Blaney 6k Kutcher, 1991; Dunkley & Blankstein, 2000; Enns
& Cox, 1999; T. A. Powers, Zuroff, & Topciu, 2002). Thus, pretreatment
DAS scores were used to introduce the anaclitic-introjective distinction into
the TDCRP data analyses.
The DAS (Weissman & Beck, 1978), a 40-item questionnaire, assesses
attitudes presumed to predispose an individual to depression. Factor analysis
of the DAS obtained at pretreatment in the TDCRP (Imber et al., 1990),
consistent with prior findings (e.g., Cane et al., 1986; Oliver & Baumgart,
1985; Rude & Burnham, 1995; Segal, Shaw, & Vella, 1987), identified two
major factors in the DAS: (a) NFA and (b) PFT. The first factor taps pa-
tients' need for approval by others and corresponds to the anaclitic, depen-
dent, or sociotropic form of depression; the second factor, which assesses

patients' tendency to set extremely high and unrealistic self-standards and to
adopt punitive and critical attitudes toward the self, corresponds to the
introjective, self-critical, or autonomous form of depression. In the analyses
of data from the TDCRP, the anaclitic and introjective distinctions were
used as continuous dimensions rather than as the binary (categorical) differ-
entiation used in the R-YP and the MPRP.
Anaclitic and Introjective Dimensions in Treatment Outcome and Aspects of the

Therapeutic Process
The introduction of the anaclitic-introjective distinction into further
analyses of data from the TDCRP provided understanding of some of the
factors, other than the type of treatment, that influenced therapeutic out-
come. The introduction of the anaclitic-introjective distinction also pro-
vided understanding of some of the processes of therapeutic change.
Impact on Therapeutic Outcome
Although, as already noted, no significant differences were found in

symptom reduction among the three active treatments in the TDCRP at
termination and follow-up (e.g., Elkin, 1994), highly significant relation-
ships were found between pretreatment level of perfectionism, as measured
by the PFT factor of the DAS, and treatment outcome across all four treat-
ment conditions (Blatt, Quinlan, Pilkonis, & Shea, 1995). Introjective quali-
ties, as assessed by the DAS PFT factor, significantly (ps = .031 to .001)
predicted less positive outcome at termination, as assessed by the residualized
gain scores of all five primary measures of clinical change in the TDCRP
across all four treatment groups (Blatt, Quinlan, et al., 1995). Pretreatment
PFT predicted the composite residualized gain score (Blatt, Zuroff, et al.,
1996) at termination at a highly significant level (r = .29, p < .001). In con-
trast, NFA, a measure of anaclitic personality qualities, had a consistent
marginally positive relationship to treatment outcome on all five outcome
measures, as well as to the combination of all five residualized gain scores
(p = .11). Thus, although anaclitic interpersonal concerns, as assessed by
NFA, tended to facilitate therapeutic gain, pretreatment preoccupation with
introjective self-critical issues of self-definition and self-worth, as measured
by DAS PFT, significantly impeded response to short-term treatment for
depression, whether the treatment was pharmacotherapy (imipramine and
clinical management), psychotherapy (CBT and IPT), or placebo (Blatt,
Quinlan, et al., 1995). Pretreatment PFT also had consistent and significant
negative relationships with ratings made by the therapists, by independent
clinical evaluators, and by the patients themselves at termination, and with
ratings by clinical evaluators of their assessments of the patients' clinical
condition and need for further treatment at termination and follow-up, as
well as with ratings by patients at termination of their satisfaction with treat-

ment (Blatt, 1999b). Thus, the disruptive effects of pretreatment PFT on
treatment outcome was apparent in assessments from multiple perspectives
and persisted even at a follow-up evaluation conducted 18 months after the
termination of treatment.
Therapeutic progress had been assessed every 4 weeks during the 16-
week treatment process in the TDCRP, and thus it was possible to evaluate
when and how PFT disrupted therapeutic progress. Patients at three levels of
perfectionism were compared on the composite residualized measure of thera-
peutic gain at each evaluation point in the treatment process. Repeated mea-
sures analysis of variance of the composite measure (the combination of all
five measures) of therapeutic gain indicates a significant Perfectionism X Time
interaction, in which the negative effect of pretreatment PFT on therapeutic
outcome emerged primarily during the second half of treatment. Only one
third of the sample, those patients with low pretreatment perfectionism scores,
continued to improve in the latter half of treatment, whereas two thirds of
the patients, those with moderate and high levels of perfectionism, made no
further progress in the last half of the treatment process, beginning between
the 9th and 12th treatment session (Blatt, Zuroff, Bondi, Sanislow, & Pilkonis,
1998), independent of the type of treatment the patients had received. These
findings suggest that perfectionist (introjective) patients may be negatively
affected by the anticipation of an arbitrary, externally imposed termination.
As perfectionistic introjective patients begin to confront the end of treat-
ment, they may experience a sense of personal failure, dissatisfaction, and
disillusionment with themselves and the treatment (Blatt, Zuroff, et al., 1998).
Also, because perfectionist individuals often need to maintain control and
preserve their sense of autonomy, as I discussed in chapters 5 and 6 (this
volume; see also Blatt, 1974, 1998; Blatt & Zuroff, 1992), they may react
negatively to a unilateral, externally imposed termination date (Blatt, Zuroff,
et al., 1998). These issues appeared to disrupt the therapeutic progress of a
substantial segment (approximately two thirds) of the patients in the TDCRP
in the latter half of the treatment process in all four treatment conditions.
Additional analyses indicated that pretreatment level of perfectionism
affected therapeutic outcome primarily by disrupting patients' interpersonal
relations both in the treatment process and in their social relationships out-
side of treatment. Krupnick and colleagues (1996), using a modified version
of the Vanderbilt Therapeutic Alliance Scale (Hartley & Strupp, 1983), rated
the therapeutic alliance from videotaped recordings of the 3rd, 9th, and 15th
treatment sessions and found that the contributions of patients to the thera-
peutic alliance (but not the contributions of the therapists) were significantly
related to treatment outcome at termination. Zuroff and colleagues (2000),
using these ratings of the therapeutic alliance, found that the participation
of more perfectionistic patients in the therapeutic alliance significantly de-
clined in the latter half of the treatment process (beginning at the 9th ses-
sion) and that this decline significantly mediated the effect of pretreatment

perfectionism on treatment outcome at termination. Furthermore, Shahar,
Blatt, Zuroff, Krupnick, and Sotsky (2004) found that pretreatment perfec-
tionism also led to significant decline in level of social support available to
the patient outside of treatment, and that this impaired social support also
significantly mediated the relationship of perfectionism to treatment out-
come. Using ratings by clinical evaluators on the Social Network Form (Elkin
et al., 1985) to assess patients' social network, Shahar, Blatt, et al. (2004)
found that patients with high levels of pretreatment perfectionism reported
less satisfying social relationships over the course of treatment and that this
disruption in social relationships in turn predicted poorer therapeutic out-
come at termination. Thus, perfectionist (introjective) patients appeared to
experience greater interpersonal difficulty both in and out of the treatment
process; they established a poorer therapeutic alliance (Zuroff et al., 2000)
and had a more limited social network (Shahar, Blatt, et al., 2004) in the
latter half of the treatment process. In addition, patients with higher pre-
treatment levels of perfectionism were also more vulnerable to stressful life
events during the follow-up period, and this vulnerability led to increased
depression (Zuroff et al., 2000) in the follow-up period.
In summary, the distinction between anaclitic and introjective dimen-
sions facilitated the identification of a large segment of the patients in the
TDCRP (about two thirds of the sample) who failed to make progress in the
second half of the treatment process. It also provided understanding of some
of the mechanisms through which introjective personality characteristics
disrupted therapeutic response in the brief outpatient treatment of depres-
sion. These various analyses indicated that the effects of brief treatment for
depression in the NIMH-sponsored TDCRP were significantly determined
by patient dimensions, especially by pretreatment level of self-critical per-
fectionism (introjective qualities), independent of the type of treatment pro-
vided. This negative effect of PFT in brief treatment, including medication,
stands in marked contrast to the findings that self-critical perfectionist
introjective outpatients did relatively well in long-term, intensive, outpa-
tient treatment in the MPRP (Blatt, 1992; Blatt & Shahar, 2004b); in long-
term, intensive inpatient treatment of seriously disturbed, treatment-
resistant patients in the R-YP (Blatt & Ford, 1994); and in the K-L study of
the treatment of patients with personality disorder (Vermote, 2005).
In accordance with Cronbach's (1953) formulations about the impor-
tance of P-T and P-O interactions in psychotherapy research, the findings
from the R-YP, MPRP, K-LS, and TDCRP indicate that different types of
patients may be responsive to different aspects of the treatment process and
that different types of patients may respond to treatment in different ways
(Blatt et al., 2002). Introjective patients, who emphasize separation, au-
tonomy, control, and independence, did relatively poorly in brief treatment
in the TDCRP but had substantial constructive therapeutic response in in-
tensive psychodynamic treatment in the MPRP, R-YP, and L-KS investiga-

tions. These findings are consistent with the findings of Fonagy et al. (1996)
and the conclusions of Gabbard et al. (1994) about the constructive response
of introjective patients to long-term psychodynamic treatment. In contrast,
dependent, interpersonally oriented anaclitic patients were more construc-
tively responsive to SEP in the MPRP, a therapeutic context with greater
interpersonal interaction. These findings are consistent with the conclusions
of Vermote's (2005) in the K-LS that anaclitic patients were responsive pri-
marily to the supportive aspects of the treatment provided in extended
(9 months) inpatient treatment of patients with personality disorders.
Future investigations are needed to replicate and extend these findings
of the anaclitic-introjective distinction in both long-term intensive and brief
treatment. More systematic research should prospectively include the
anaclitic-introjective distinction in the research design and test for the dif-
ferential response of these two types of patients to different types of thera-
peutic interventions.
Impact on Aspects of the Therapeutic Process
The extensive data gathered as part of the NIMH TDCRP also pro-
vided an opportunity to evaluate circumstances within the TDCRP that served
to reduce the negative effects of pretreatment perfectionism (introjective
personality characteristics) on treatment outcome in the brief treatment of
depression. The Barrett-Lennard Relationship Inventory (B-L RI) had been
administered as part of the TDCRP research protocol to assess the quality of
the therapeutic relationship early in treatment (after two sessions) and at
termination. The B-L RI is based on the views of Carl Rogers (1951, 1957,
1959) that the therapist's empathic understanding, unconditional positive
regard, and congruence are the "necessary and sufficient conditions" for thera-
peutic change. Using these formulations, Barrett-Lennard (1962) developed
four scales (Empathic Understanding, Level of Regard, Unconditionality of
Regard, and Congruence) to assess the patient's perception of the therapeu-
tic relationship. Several reviews of research (Barrett-Lennard, 1985; Gurman,
1977a, 1977b) indicated acceptable levels of reliability and validity for the
B-L RI scales. Prior research, for example, indicated that these scales predict
therapeutic change and are related significantly to independent estimates of
the therapist's competence (Barrett-Lennard, 1962).
The degree to which patients in the TDCRP perceived their therapists
at the end of the second treatment hour as empathic, caring, open, and sin-
cere, as assessed by the B-L RI, had a significant (p < .05) positive relation-
ship to therapeutic outcome, as assessed by four of the five outcome measures
(BDI, SCL-90, GAS, and SAS; Blatt, Zuroff, et al., 1996), as well as by the
composite residualized outcome variable. The perceived level of the thera-
peutic relationship at the end of the second treatment hour, as measured by
the B-L RI, was independent of the patients' pretreatment level of DAS per-

fectionism (r = -.09). Although highly perfectionist patients appear capable
of perceiving their therapists positively, they are relatively less able to ben-
efit from treatment. It is surprising that the interaction of DAS PFT and
B-L RI did not add significantly to the prediction of therapeutic outcome.
Exploratory analyses indicated, however, a significant curvilinear (quadratic)
component to the interaction between DAS PFT and the B-L RI in predict-
ing therapeutic outcome. The level of B-L RI at the end of the 2nd hour had
only marginally significant effects on therapeutic outcome at low and high
levels of perfectionism (ps < .10 and .15, respectively), but the level of the
B-L RI significantly (p < .001) reduced the negative effects of perfectionism
on treatment outcome at the midlevel of perfectionism (Blatt, Zuroff, et al.,
1996).
The TDCRP design also allowed for a comparison of the characteristics
of more and less effective therapists. Blatt et al. (Blatt, Sanislow, Zuroff, &
Pilkonis, 1996), using the composite outcome measure that integrated the
five primary outcome variables used in the TDCRP, aggregated the outcome
scores at termination of all the patients seen by each of the 28 therapists who
had participated in the TDCRP (10 each providing IPT and pharmacotherapy
and 8 providing CBT). The 18 MD psychiatrists and the 10 PhD-level clini-
cal psychologists had an average of more than 11 years of clinical experience.
All the therapists received training in the treatment they provided in the
TDCRP, and only therapists who met competency criteria participated in
the study. Tapes of sessions were reviewed periodically to ensure adherence
to treatment protocols, and therapists received consultation throughout the
study (Elkin, 1994).
To explore the contributions of the therapists to treatment outcome,
Blatt, Sanislow, and colleagues (1996) identified three groups of therapists—
more, moderately, and less effective therapists—defined by the average thera-
peutic gain achieved by the patients that each therapist had seen in active
treatment in the TDCRP. These therapists had completed a questionnaire
assessing aspects of their clinical experiences and their attitudes toward the
treatment of depression. Significant differences were found among the three
groups of therapists, independent of the type of treatment they provided.
Differences in therapeutic efficacy were associated with a basically clinical
orientation, especially about the treatment process. More effective thera-
pists had a more psychological than biological orientation and reported that
in their personal clinical practice they predominantly used psychotherapy
with patients with depression and rarely used biological interventions (i.e.,
medication and electroconvulsive therapy).
The therapists in the TDCRP had been asked to describe their general
clinical practice in terms of the percentage of time they usually devoted to
psychotherapy alone, to medication alone, and to a combination of psycho-
therapy and medication. Less effective therapists, somewhat like the more
effective therapists, reported that they tended to use psychotherapy alone in

their clinical practice (42.1% of the time). More effective therapists responded
that they primarily used psychotherapy alone (73.8% of the time) and only
occasionally (19.6%) combined their psychotherapy with medication. Mod-
erately effective therapists used primarily medication, either alone (14.4% of
the time) or in combination with psychotherapy (56.1%), and relatively rarely
used psychotherapy alone (29.4%) in their clinical practice. Thus, the mod-
erately effective therapists appear to be more biologically oriented. Less ef-
fective therapists, like the more effective therapists, were primarily inter-
ested in psychotherapy, but they much more often combined their
psychotherapy with the use of medication than did the more effective thera-
pists. In addition, more effective therapists, compared with moderately and
less effective therapists, expected therapy with patients with depression to
require more treatment sessions before patients began to manifest therapeu-
tic change. Also, more effective therapists had significantly fewer patients
who dropped out of treatment and significantly less variability (lower stan-
dard deviation) in the therapeutic outcome among the patients they treated
in the TDCRP than did moderately and less effective therapists. The greater
variability in therapeutic outcome among the patients of less effective thera-
pists suggests that the less effective therapists are able to work effectively with
only a limited number of patients, whereas more effective therapists were able
to work effectively with almost all the patients that had been randomly as-
signed to them for treatment. It is important to stress that these differences
among these three levels of effective therapists are particularly impressive be-
cause they occurred in a relatively homogeneous group of well-trained and
experienced therapists who participated in three well-specified, manual-
directed treatment conditions in three independent research sites. Relatively
few significant differences were found, however, among the three groups of
therapists regarding their attitudes about the etiology of depression or about
the techniques they considered essential for the treatment of depression.
The overall results from the comparison of the more, moderately, and
less effective therapists in the TDCRP indicate that qualities of the therapist
are important dimensions that appear to influence therapeutic outcome.
Overall, the results from these analyses of data from the TDCRP are consis-
tent with prior findings (Burns & Nolen-Hoeksema, 1992; Horvath &
Symonds, 1991; Krupnick et al., 1996) that therapeutic outcome is signifi-
cantly influenced by the interpersonal dimensions of the treatment process—
by personal qualities of patients and therapists and their ability to establish
an effective therapeutic relationship—rather than by the techniques and tac-
tics described in treatment manuals.20
"Several studies of brief cognitive and pharmacological treatment of depression provide further
support for the influence of the patients' personality styles on therapeutic outcome. Peselow, Robins,
Sanfilipo, Block, and Fieve (1992), investigating the response to pharmacotherapy among 217
outpatients with depression, found that patients with high autonomous-low sociotropic profile on the
SAS (introjective patients) responded better to antidepressants than did patients who had a high

Various aspects of the therapeutic relationship had been assessed over
the course of the treatment process in the TDCRP. A detailed evaluation of
these data from the TDCRP (Blatt & Zuroff, 2005; Zuroff & Blatt, 2006),
consistent with extensive literature reviews (e.g., Lambert & Barley, 2002;
Luyten, Blatt, Van Houdenhove, & Corveleyn, 2006; Norcross, 2002;
Wampold, 2001; Westen, Novotny, & Thompson-Brenner, 2004), indicated
that primary among the factors that contribute to therapeutic gain in the
brief outpatient treatment of serious depression was the quality of the thera-
peutic relationship that the patient and therapist established very early in
the treatment process (at the end of the second treatment session). These
findings indicate the importance of the therapeutic relationship and its in-
teraction with patients' pretreatment personality characteristics, especially
level of pretreatment perfectionism, in understanding some of the processes
involved in therapeutic change.
The consistently significant negative impact of patients' pretreatment
levels of perfectionism on treatment outcome in the TDCRP is consistent
with an extensive and wide-ranging literature that demonstrates the destruc-
tive effects of introjective personality characteristics (e.g., Blatt, 1995b, 2004;
Dunkley, Zuroff, & Blankstein, 2006). These findings raise very interesting
questions about the relative importance of therapeutic change in personality
factors of vulnerability (i.e., Self-Critical Perfectionism) and changes in the
symptoms of depression as well as their differential role in the treatment
process. Hawley, Ho, Zuroff, and Blatt (2006) addressed these questions us-
ing advanced statistical procedures (Latent Difference Score [LDS] analysis)
for the analysis of longitudinal data and found a significant unidirectional
longitudinal relationship between personality organization, as measured by
Self-Critical Perfectionism on the DAS, and change in symptoms of depres-
sion in the brief outpatient treatment of depression in the TDCRP. Their
findings reveal that symptoms of depression diminish rapidly early in therapy
and proceed to a gradual slowing of this therapeutic progress. In contrast,
Self-Critical Perfectionism gradually and consistently diminished through-
out treatment and, most important, predicted change in symptoms of depres-
sion. These findings indicate that brief treatment in the TDCRP was most
effective if it had an impact on the introjective personality factor of Perfec-
sociotropic-low autonomous profile (anaclitic patients). According to Peselow and colleagues (1992),
these findings support A. T. Beck's (1983) contention that the autonomous form of depression
includes endogenomorphic characteristics. Rector, Bagby, Segal, Joffe, and Levitt (2000),
investigating outpatients with depression treated with either cognitive therapy (N = 51) or
pharmacotherapy (N = 58), found that DEQ self-criticism did not influence the response to
medication but did predict poorer response to cognitive therapy. Zettle and colleagues (Zettle,
Haflich, & Reynolds, 1992; Zettle & Herring, 1995) compared the responses of sociotropic and
autonomous (anaclitic and introjective) outpatients with depression with individual and group
cognitive therapy for depression and found that sociotropic patients had greater therapeutic response
to group therapy, whereas autonomous patients had greater therapeutic response to individual therapy.

tionism, which in turn had an impact on depressive symptoms. Hawley et al.
(2006) also found that the quality of the therapeutic alliance significantly
predicted longitudinal change in Self-Critical Perfectionism that, in turn,
predicted change in symptoms of depression (see also Luyten, Corveleyn, &
Blatt, 2005).21 They concluded that the unidirectional relationship between
vulnerability (Self-Critical Perfectionism) and depression suggests that treat-
ment needs to extend beyond symptom reduction and focus on more struc-
tural personality dimensions such as vulnerability rather than solely on symp-
tom reduction. The quality of the therapeutic alliance had only an indirect
effect on symptom reduction but was significantly related to reduction in
personality vulnerability that in turn related to symptom reduction.
In subsequent LDS analysis, Hawley, Ho, Zuroff, and Blatt (2007) found
that the report of stressful life events in follow-up assessments conducted 6,
12, and 18 months after termination in the TDCRP was associated with in-
creased symptoms of depression but only in those patients receiving medica-
tion. This stress reactivity in the follow-up period did not occur in patients
who had received psychotherapy (either CBT or IPT). Psychotherapy, as
compared with pharmacotherapy, appears to provide patients with capaci-
ties that enable them to cope with the occurrence of stressful life events
following the termination of treatment. These findings are consistent with
the findings by Zuroff, Blatt, Krupnick, and Sotsky (2003) that psychotherapy
(CBT and IPT) in the TDCRP resulted in significantly greater increase in
enhanced adaptive capacities (EAC) than did medication, and that EAC
was related to more constructive therapeutic gain in the final follow-up as-
sessment conducted 18 months after the termination of treatment.
Findings from these further analyses of data from the TDCRP indicate
that evaluation of therapeutic gain, in addition to symptom reduction, should
include assessments of changes in vulnerability and the development of resil-
ience as expressed in increased EAC in the ability to manage stressful life
events (Blatt & Zuroff, 2005; Zuroff & Blatt, 2006; Zuroff et al., 2003). These
findings also question the validity of current efforts to identify empirically
supported treatments (ESTs) by comparing different types of treatment in
their relative efficacy and effectiveness in reducing symptoms (Blatt & Zuroff,
2005). Efforts to identify ESTs require a much more complex view of the
treatment process, one that needs to include other dimensions of the treat-
ment process, especially the quality of the therapeutic relationship and pa-
tients' pretreatment characteristics, as well as the impact of these factors of
the therapeutic process across a range of outcome measures beyond symptom
reduction at termination and later (Blatt & Zuroff, 2005).
21
Similarly, Cox, Walker, Enns, and Karpinski (2002) found that changes in level of self-critical
perfectionism or autonomy were significantly related to outcome in brief group CBT of patients with
generalized social phobia. The extent of change of self-critical perfectionism predicted therapeutic
outcome.

Patient-Therapist Congruence (Match)
The significant influence of the quality of the early therapeutic rela-

tionship (e.g., Zuroff & Blatt, 2006) and characteristics of the therapists (Blatt,
Sanislow, et al., 1996; Blatt, Zuroff, et al., 1996) on treatment outcome in
short-term treatment in the TDCRP suggests that it might be valuable to
also consider the impact of the therapist's personality on treatment outcome.
Although no studies have yet attempted to differentiate anaclitic and
introjective therapists and address the impact of these personality styles of
the therapist on treatment outcome with different types of patients, these
issues of the match between patient and therapist have begun to be addressed
in research on the role of attachment styles in the therapeutic process. Re-
search on attachment styles of patients and therapists and their impact on
the therapeutic process is relevant to the differences observed between ana-
clitic and introjective patients in their differential response to the two types
of treatment investigated in the MPRP because several studies have demon-
strated that the anaclitic-introjective distinction is closely linked to pat-
terns of insecure attachment. Several reports (e.g., Blatt & Homann, 1992;
Blatt & Levy, 2003; K. N. Levy & Blatt, 1999; S. Reis & Grenyer, 2002;
Zuroff & Fitzpatrick, 1995) have noted significant links between introjective
personality organization and dismissive—avoidant insecure attachment, as well
as between anaclitic personality organization and resistant-preoccupied in-
secure attachment. In addition, several investigations (e.g., Alexander, 1993;
Alexander & Anderson, 1994; Brennan & Shaver, 1998; Meyer, Pilkonis,
Proietti, Heape, & Egan, 2001; Rosenstein & Horowitz, 1996) found that
resistant (preoccupied) attachment is noted in patients with anaclitic disor-
ders (i.e., dependent, histrionic, and borderline personality disorders), whereas
dismissive attachment is noted in patients with introjective disorders (i.e.,
narcissistic, antisocial, and paranoid personality disorders), as 1 discussed in
chapter 5 (this volume).
Several studies indicate that securely attached patients have greater
therapeutic gain in both brief and long-term treatment than do insecurely
attached patients (e.g., Eames & Roth, 2000; Fonagy et al., 1996; Kanninen,
Salo, & Punamaki, 2000; Mallinckrodt, Gantt, & Coble, 1995; Meyer,
Pilkonis, Proietti, Heape, & Egan, 2001; Mosheim et al., 2000). But in ac-
cordance with the findings that introjective patients did better in PSA than
in SEP in the MPRP (Blatt, 1992), several of these studies (e.g., Eames &
Roth, 2000; Fonagy et al., 1996; Mallinckrodt et al., 1995; Meyer et al., 2001)
found that patients with a dismissive-avoidant attachment style (introjective
patients) responded best to psychodynamically oriented interpretive therapy.
Emotionally detached, isolated, avoidant, and wary (Mallinckrodt et al., 1995)
introjective patients, who tended to recall more family conflicts and who
viewed relationships with others, including the therapist, "as potentially hos-
tile or rejecting" (Meyer & Pilkonis, 2002, p. 375), found the exploratory

emphasis in treatment liberating and conducive to therapeutic change (Hardy
et al., 1999). Meyer and Pilkonis (2002), in an extensive review of the litera-
ture on attachment style and psychotherapy, concluded that dismissively at-
tached, avoidant (introjective) patients "may benefit... from strategies that
facilitate emotional involvement" (p. 378) and "require more concentrated
. . . interventions, helping them overcome their characteristic detachment"
(p. 373). They also noted, similar to the constructive response of introjective
patients in the long-term treatment in the MPRP (Blatt, 1992; Blatt & Shahar,
2004b), the R-YP (Blatt & Ford, 1994) and the K-LS (Vermote, 2005), that
once dismissively or avoidantly attached (introjective) patients "connect
emotionally with a therapist[,] . . . improvement might be all the more dra-
matic" (p. 373).
Findings in the MPRP (Blatt & Shahar, 2004b), as I noted earlier in
this chapter, suggest that PSA is effective with introjective patients because
the intensity of the treatment facilitates the engagement of these more inter-
personally distant and isolated patients in the therapeutic process, and that
SEP is more effective with anaclitic patients because it controls and modu-
lates their affective lability and associative activity (see also Vermote, 2005).
These findings from the MPRP are consistent with a report by Eames and
Roth (2000) that patients with a preoccupied attachment style (anaclitic
patients) are responsive to the support and structure of psychotherapy, strive
to establish a close therapeutic relationship, and appear to benefit most from
a therapeutic strategy that helps contain and modulate their overwhelming
feelings. Patients with an avoidant attachment style (introjective patients),
by contrast, appear to benefit most from a therapeutic strategy that facilitates
their emotional engagement (see Hardy et al., 1999).
The significant Patient X Treatment interactions identified in the MPRP
(Blatt, 1992; Blatt & Shahar, 2004b) are also consistent with reports that
patients with preoccupied insecure attachment (anaclitic patients) who "yearn
for intimacy and fear abandonment might strive ... to establish a close,
supportive relationship with a therapist" (Meyer & Pilkonis, 2002,
p. 374). Mallinckrodt et al. (1995) have discussed how patients with a preoc-
cupied resistant insecure attachment yearn "to be at one" (p. 311) with a
therapist and in a frantic effort to avoid rejection "may try to submissively
please and appease their therapist without engaging in ... [or] identifying
and openly discussing difficult personal problems" (Meyer & Pilkonis, 2002,
p. 375). The structure and supportive context of psychotherapy appear to
contain the fears and apprehensions (Hardy et al., 1999) of affectively labile,
insecure preoccupied (anaclitic) patients, who often feel emotionally over-
whelmed (Eames & Roth, 2000). Therapists are often more supportive in an
effort to contain the apprehensions of these patients.
Hardy et al. (1998, 1999) found that therapists adjust their interven-
tions in response to different attachment characteristics. Therapists respond
to insecure preoccupied attachment with reflection, containment, and sup-

port and to dismissive attachment with interpretation meant to facilitate the
engagement of introjective patients who are emotionally detached and who
defensively deny problems or establish a superficial relationship and remain
reluctant to relate to the therapist "on a more genuine, personal level" (Meyer
& Pilkonis, 2002, p. 374). Hardy et al (1998) also found that therapists adopt
more affective, relationship-oriented interventions with patients with a preoc-
cupied attachment style but use more cognitive interventions with patients
with an unresolved or dismissive attachment style. As noted by Gabbard et
al. (1994) in discussing treatment of patients with borderline personality dis-
order, "introjective patients . . . appear to be more responsive to insight and
interpretation, while anaclitic patients ... are more responsive to the inter-
personal dimensions of the psychotherapeutic process" (p. 67).
Securely attached patients form an effective therapeutic alliance, but
insecurely attached patients (both preoccupied and dismissive) experience
difficulties in the treatment process (Eames & Roth, 2000). But patients
with preoccupied and dismissive insecure attachment styles have different
patterns of involvement over the course of treatment. Kanninen et al. (2000),
as well as Satterfield and Lyddon (1998) and Eames and Roth (2000), found
that patients with preoccupied attachment had low levels of therapeutic
alliance at the beginning of treatment but a very strong alliance as they
approached termination. Anxiety about the dependability of the relation-
ship seems to initially impede the development of a therapeutic alliance
for preoccupied anaclitic individuals, but their strong desire for intimacy
appears to facilitate the development of a better alliance in the latter phases
of the treatment process.22 Meyer and Pilkonis (2002), in a summary of this
research, noted that patients with preoccupied attachment are particularly
sensitive
to changing interventions over the course of therapy. In the middle stages
of treatment, when therapists challenge and confront problematic pat-
terns . . . [these preoccupied] patients tended to infer rejection and . . .
notice problems in the therapeutic relationship. ... Toward the end of
therapy, however, as gains are consolidated and the tone becomes much
more supportive, they came to view the therapeutic alliance in unrealis-
tically positive terms, issues that need to be considered in the treatment
process if therapeutic gains are to be consolidated and sustained subse-
quent to the termination of treatment. In contrast, patients with dis-
missive attachment may superficially rate the alliance as strong in early
and middle phases of therapy. By the end . .. they remain detached and
fail to establish genuine emotional connectedness, (pp. 374-375)
22
This finding may be a consequence of the developmental level of the anaclitic concerns of the
patients included in this study (as discussed in chap. 6, this volume), so these findings should be
explored with patients whose anaclitic concerns are at different developmental levels (i.e., as
discussed in chap. 5, this volume, concerns about neediness as compared with concerns about
relatedness).

As I discussed earlier in this chapter, in one study, dismissively attached
introjective patients had marked difficulties in the latter half of brief, manual-
directed, outpatient treatment for depression (Blatt, Zuroff, et al., 1996; Zuroff
et al., 2000).
Several studies have extended this type of research by evaluating the
attachment styles of therapists and their impact on the therapeutic process.
Rubino, Barker, Roth, and Fearon (2000) found that therapists with an anx-
ious (preoccupied) insecure attachment tended to respond with less empa-
thy, especially to patients who were securely attached or who had an inse-
cure dismissive attachment. Rubino et al. speculated that "more anxious
therapists may interpret ruptures as an indication of their patients' intention
to leave therapy, and their own sensitivity towards abandonment might di-
minish their ability to be empathic" (p. 416).
Securely attached case managers tended to challenge the patient's in-
terpersonal style, whereas insecurely attached case managers were more likely
to complement it (Dozier, Cue, &. Bamett, 1994; Tyrell, Dozier, Teague, &
Fallot, 1999). Patients with attachment styles different from their clinician
showed better therapeutic outcome and stronger therapeutic alliance (Dozier
et al., 1994; Tyrell et al., 1999). Patients had the best therapeutic outcome
when treated by securely attached clinicians or by a complementary, rather
than a congruent, combination of insecure attachment styles between clini-
cian and patient. Preoccupied patients fared best with dismissing clinicians
whereas dismissive patients fared best with preoccupied clinicians (Dozier et
al., 1994; Tyrell et al., 1999). Consistent with earlier empirical research on
patient-therapist match (e.g., Beutler, 1991), dissimilarity in the interper-
sonal styles of patient and therapist was found to facilitate the treatment
process because patients benefit from interventions that run counter to their
own problematic interpersonal style. Consistent with the findings from the
MPRP (Blatt & Shahar, 2004b), affectively labile patients seem to require
emotion-containing interventions, whereas emotionally detached patients
seem to benefit from interventions that facilitate affective expression (see
Hardy et al., 1999; Stiles, Honos-Webb, & Surko, 1998). The study of the
match of attachment styles (and of anaclitic-introjective personality styles)
of patient and therapist, and their impact on therapeutic process and out-
come, provides a potential research methodology for systematically investi-
gating an important phenomenon that has been elucidated extensively in
the psychoanalytic literature by Kantrowitz (1986, 1992, 1993, 1995;
Kantrowitz et al., 1989) in a series of provocative and informative case illus-
trations of the positive and negative consequences of different types of
patient-therapist match. The findings of the therapeutic effectiveness of a
complementary rather than a congruent attachment style between patient
and therapist (see also Vane, 2002) suggest that similarities as well as differ-
ences, that experiences of attachment as well as separation, may have impor-

tant roles in the treatment process, a topic that I consider in detail in chapter
8 (this volume).
SUMMARY
The distinction between the two primary dimensions of personality

development—relatedness and self-definition—and the two types of person-
ality organization and psychopathology—anaclitic and introjective—
facilitated the introduction of patient dimensions into psychotherapy research
in the investigation of long-term intensive treatment in both inpatient and
outpatient settings, as well as in the investigation of brief, manual-directed,
outpatient treatments of depression. The results of these investigations dem-
onstrate the cogency of Cronbach's (e.g., 1953) early emphasis on the need
to include patient characteristics in studies of therapeutic outcome and the
mechanisms of therapeutic change. The research findings of Hawley and
colleagues (2006, 2007) demonstrate the centrality of anaclitic and
introjective personality characteristics in the treatment process. Hawley et
al. (2006) found that therapeutic progress (i.e., symptom reduction) in brief
treatments for depression was significantly mediated by a reduction in
introjective personality characteristics (i.e., Self-Critical Perfectionism).
These findings indicate that changes in personality organization or structure
(in this instance, introjective personality characteristics) are a vital step in
the therapeutic process, even in brief, manual-directed treatments of depres-
sion. Findings of Hawley and colleagues (2006, 2007) emphasize how aspects
of the personality organization of patients and of the therapeutic relation-
ship contribute to therapeutic change, and that treatment research needs to
address more complex questions such as what kind of treatment is best for
what kind of patient (Roth & Fonagy, 1996), with what kind of therapist,
leading to what kinds of therapeutic change, through different mechanisms
of therapeutic change (Blatt et al., 2002).
Psychoanalysis and supportive-expressive psychotherapy result in dif-
ferent kinds of therapeutic change and that the nature of these changes can
vary as a consequence of patients' pretreatment personality features. Differ-
ent therapeutic mechanisms are differentially effective, sometimes in differ-
ent ways and at different points in the treatment process, with different types
of patients. Anaclitic patients make therapeutic progress if the therapist is
supportive (Hardy et al., 1999) and aware of the intense desires of these
patients to remain in treatment (Eames & Roth, 2000; Kanninen et al., 2000).
Affectively labile, emotionally overwhelmed anaclitic patients do better in
long-term supportive-expressive psychotherapy because it seems to contain
their affective lability, possibly by reducing their associative (Blatt &. Shahar,
2004b) or referential (Fertuck, Bucci, Blatt, & Ford, 2004) activity. Intro-
jective patients, in contrast, make significantly greater progress in treatment

if they are more fully engaged in referential (Fertuck et al, 2004) and asso-
ciative (Blatt & Shahar, 2004b) activity in the treatment process, and if they
are in intensive long-term psychoanalytically oriented treatment (Blatt &
Ford, 1994; Fonagy et al., 1996) that helps them overcome their interper-
sonal and emotional detachment (see also Eames & Roth, 2000; Mallinckrodt
et al., 1995; Meyer et al., 2001) through interpretations (Hardy et al., 1999).
Emotionally and interpersonally detached introjective patients do better in
psychoanalysis than in supportive-expressive psychotherapy, possibly because
psychoanalysis liberates their associative processes and more effectively en-
gages them in the treatment process.
The findings of the effects of different types of attachment styles on the
treatment process are further indication of the importance of including quali-
ties of the patient and the therapist in studies of the complex and subtle
interpersonal processes in psychoanalysis and psychotherapy. Studies indi-
cate the constructive effects of complementary, as compared with congru-
ent, attachment styles in the therapeutic dyad, and suggest that experiences
of separation, as well as attachment, are important in the treatment process,
as they are in psychological development more generally (see chaps. 2 and 3,
this volume). The role of experiences of attachment and separation in the
treatment process is considered at length in an exploration of the processes
of therapeutic change in long-term, intensive treatment in chapter 8 (this
volume).
The issues considered in this chapter stress the need to consider the
impact of the complex interactions among characteristics of patients, thera-
pists, and the treatment process on therapeutic outcome, as well as the need
to evaluate dimensions beyond symptom reduction. These issues raise impor-
tant questions about the limitations of the current emphasis in treatment
research on a disease model of psychopathology (e.g., DSM-IV) and treat-
ments that focus primarily on the reduction of symptoms in a wide range of
psychological disturbances and disorders.
Research findings from the R-YP, MPRP, and K-LS investigations, dis-
cussed in this chapter, also indicate the value of assessing the thematic con-
tent (episodic dimensions) and the structural organization (procedural di-
mensions) of cognitive-affective schemas of self and of significant others
throughout the treatment process. These procedures can provide a measure
of therapeutic change as well as investigate the subtle dynamics of the pro-
cesses of internalization that seem so central to psychological development
in the treatment process. Findings from the R-YP, MPRP, and K-LS indicate
the importance of studying the thematic content and structural cognitive
organization of interpersonal schemas, representations of self and significant
others, with the COR, MOA, and ORI as measures of the extent and nature
of therapeutic change. These more open-ended assessments might have pro-
vided fuller understanding of some of the mechanisms and processes of thera-
peutic change that occurred in the brief treatments in the TDCRP, as they

did in the R-YP, MPRP, and K-LS. I address these issues more fully in chap-
ter 8 (this volume), which explores how observations of changes in these
cognitive-affective schemas during long-term intensive treatment can fa-
cilitate the exploration of the intricacies of the therapeutic relationship and
provide an understanding of some of the mechanisms of the therapeutic
process—how distorted and pathological introjects are relinquished, revised,
and eventually replaced by more constructive and adaptive representations
that have greater adaptive potential because they are more flexible and not
restricted to repetitions of conflict-laden themes.

8
IN THE THERAPEUTIC PROCESS
The research I reviewed in chapter 7 (this volume) demonstrates that

anaclitic and introjective patients respond differentially to different types of
therapeutic interventions and possibly through different mechanisms of thera-
peutic change. The anaclitic-introjective diagnostic distinction not only is
This chapter incorporates material from (a) "Internalization and Psychological Development
Throughout the Life Cycle," by R. S. Behrends and S. ]. Blatt, 1985, Psychoanalytic Study of the
Child, 40, pp. 11-39. Copyright 1985 by Yale University Press. Adapted with permission;
(b) "Representational Structures in Psychopathology," S. ]. Blatt, 1995, in D. Cicchetti and S. Toth
(Eds.), Rochester Symposium on Developmental Psychopathology: Vol. 6. Emotion, Cognition, and
Representation (pp. 1-33), Rochester, NY: University of Rochester Press. Copyright 1995 by the
University of Rochester Press. Adapted with permission; (c) Experiences of Depression: Theoretical,
Clinical, and Research Perspectives, by S. ]. Blatt, 2004, Washington, DC: American Psychological
Association. Copyright 2004 by the American Psychological Association; (d) "Mental
Representation, Severe Psychopathology, and the Therapeutic Process," by S. ]. Blatt and ]. S.
Auerbach, 2001, Journal of the American Psychoanalytic Association, 49, pp. 113-159. Copyright 2001
by the American Psychoanalytic Association. Adapted with permission; (e) "Mental Representations
in Personality Development, Psychopathology, and the Therapeutic Process," by S. ]. Blatt, ]. S.
Auerbach, and K. N Levy, 1997, Review of General Psychology, I, pp. 351-374. Copyright 1997 by the
American Psychological Association; (f) "Internalization, Separation-Individuation, and the Nature
of Therapeutic Action," by S. J. Blatt and R. S. Behrends, 1987, International Journal of Psychoanalysis,
68, pp. 279-297. Copyright 1987 by International Journal of Psychoanalysis. Adapted with
permission; (g) "A Dialectic Model of Personality Development and Psychopathology: Recent
Contributions to Understanding and Treating Depression," by S. J. Blatt and G. Shahar, 2005, in
]. Corveleyn, P. Luyten, and S. J. Blatt (Eds.), The Theory and Treatment of Depression: Towards a
Dynamic Interacttonism Model (pp. 137-162). Leuven, Belgium: University of Leuven Press. Copyright
2005 by University of Leuven Press. Adapted with permission; and (h) "Change in Object and Self
243
useful in introducing personality dimensions into psychotherapy research but
it also facilitates understanding some of the mechanisms of therapeutic change
including the differential role of two major components of the treatment
process—interpretation and the therapeutic relationship. This chapter ex-
tends the explorations of the processes of therapeutic change I began in chapter
7 (this volume) by considering how the dialectical developmental interac-
tion of processes of relatedness and self-definition is expressed in the treat-
ment process and contributes to further understanding of the mechanisms of
therapeutic change.
The dialectical interaction of processes of interpersonal relatedness and
self-definition in normal personality development, which I discussed in chap-
ters 2, 3, and 4 (this volume), provides a theoretical model for understanding
the processes of psychological development that can occur in psychotherapy.
The complex developmental dialectical interaction between these two ma-
jor developmental lines leads to psychological development in the therapeu-
tic process, as it does throughout life, through a hierarchical series of gratify-
ing involvements and experienced incompatibilities (Behrends & Blatt, 1985;
Blatt & Behrends, 1987). This developmental process results in changes in
the content and procedural dimensions (structural organization) of mental
representations (cognitive-affective schemas) of self and of significant oth-
ers. As I noted in chapter 2 (this volume), the dialectical developmental
process of relatedness and self-definition begins in normal development in
early mother-infant experiences of engagement and disengagement that con-
tribute to the development of self- and interactive regulation and the estab-
lishment of prerepresentational interpersonal schemas in infancy (e.g., Beebe,
Lachmann, & Jaffe, 1997a, 1997b). Subsequent experiences of attachment
and separation (e.g., Bowlby, 1973, 1979) contribute in the 2nd year of life
and beyond to the construction of mental representations or schemas of self
and others. Development of these cognitive-affective schemas derives from
the internalization of experiences of engagement and disengagement, of at-
tachment and separation, of gratifying involvement and experienced incom-
patibility in psychological development throughout life. These same processes
contribute to psychological development in the psychotherapeutic process,
especially in long-term, intensive, psychodynamically oriented treatment.
Long-term intensive psychological treatment can, in fact, provide ideal con-
ditions for observing processes of psychological development and change.
Although the formulations 1 present in this chapter derive primarily from
observations in long-term, intensive treatment, aspects of these formulations
may also be applicable to processes of therapeutic change in brief treatment
as well.
Representations in Long-Term, Intensive, Inpatient Treatment of Seriously Disturbed Adolescents

and Young Adults," by S. J. Blatt, D. Stayner, J. Auerbach, and R. S. Behrends, 1996, Psychiatry:
Interpersonal and Biological Processes, 59, pp. 82-107. Copyright 1996 by Guilford Press. Adapted with
permission.

DEVELOPMENT OF REPRESENTATIONS OF SELF
AND SIGNIFICANT OTHERS
Research findings from the Riggs-Yale Project (R-YP), the Menninger

Psychotherapy Research Project (MPRP), and the Kortenberg-Leuven Study
(K-LS), which I discussed in chapter 7 (this volume), clearly indicate the
value of assessing changes in the structural organization or procedural di-
mension of mental representations as a measure of therapeutic change. As I
discussed in chapters 2 and 4 (this volume), salient aspects of experiences in
caring relationships are internalized and expressed in the development of
representations of self and significant others that are central organizing struc-
tures in personality development. Experiences of gratifying involvement and
experienced incompatibility contribute to the formation of
prerepresentational schemas in infancy and, toward the end of the 1st year of
life, to the formation of "internal working models" of attachment relation-
ships—"a set of conscious and unconscious rules for the organization of in-
formation relevant to attachment and for obtaining or limiting access to that
information, that is, to information regarding attachment-related experiences,
feelings and ideations" (Main, Kaplan, & Cassidy, 1985, p. 67). The emo-
tional bond between infant and caregiver established during the 1st year of
life evolves during the 2nd year into a capacity for object permanence and
evocative object constancy that provides a secure base (Ainsworth, 1969;
Bowlby, 1988b) that enables the child to leave the mother to more fully
explore the world beyond the primary relationship with her. The nature of
this attachment relationship—both the quality of the affective bond and the
child's developing capacity for evocative object constancy—markedly influ-
ences the way the child deals with separation. Thus, in addition to noting
behavioral continuities in interpersonal processes across the life cycle, at-
tachment theory and research posited an important theoretical construct:
internal working models, which are cognitive-affective schemas or repre-
sentational structures of self and other that are established in experiences
of attachment and separation in caregiving relationships. These cognitive-
affective schemas provide templates that maintain the continuity of inter-
personal behavior from infancy into adulthood (e.g., Brumbaugh & Fraley,
2006). Attachment theorists have become increasingly interested in un-
derstanding more precisely the nature of these cognitive schemas of the
representational world and extended their investigations of interactive
behavioral patterns to study ways in which early attachment relationships
are subjectively experienced and internally constructed. Main et al. (1985),
for example, noted that the internal working model of attachment estab-
lished at the end of the 1st year of life functions as a "template of previously
unrecognized strength" (p. 94) that is "related not only to individual pat-
terns in nonverbal behavior, but also to patterns of language and structures
of mind" (p. 67). As Bowlby (1988b) observed,
RELATEDNESS AND SELF-DEFINITION IN THE THERAPEUTIC PROCESS 245

The working models a child builds of his mother and her ways of com-
municating and behaving towards him, and a comparable model of his
father, together with the complementary models of himself in interac-
tions with each, are being built by a child during the first few years of his
life and, it is postulated, soon become established as influential cognitive
structures, (p. 130)
The patterns of secure, insecurely avoidant, and insecurely preoccupied (re-

sistant) attachments are based on fundamental differences in cognitive-
affective schemas that not only influence behavior in childhood but also
form the basis for normal and deviant behavior in adolescence and beyond
(e.g., Brumbaugh & Fraley, 2006).
The emphasis on cognitive-affective schemas or internal working models
identified in attachment research is consistent with the research and theo-
retical formulations of developmental psychoanalysts, especially object rela-
tions theorists, who consider mental representations as pivotal psychological
structures in personality development. The concepts of internalization and
the differentiation and integration of self- and object representations de-
scribed by psychoanalytic investigators elucidate further the cognitive or rep-
resentational dimension of the attachment process. It is important to note
that the study of mental representations in psychoanalytic object relations is
based primarily on the study of psychopathology, especially in adults, whereas
the investigation of internal working models in attachment theory derives
predominantly from the study of normal infants and their mothers. Com-
parisons between attachment and object relations theories have thus far been
primarily theoretical (e.g., Blatt, Auerbach, & Behrends, in press; Blatt & Blass,
1990,1996; K. N. Levy & Blatt, 1999; Lyons-Ruth, 1991; Patterson & Moran,
1988; Silverman, 1991; Zelnick & Buchholz, 1990), but an integration of con-
cepts from object relations and attachment theories offers the possibility of
understanding more fully the complex relationships among interpersonal, af-
fective, and cognitive dimensions in both normal and deviant psychological
development (Calabrese, Farber, & Westen, 2005; Diamond & Blatt, 1994;
Hauser, Golden, & Allen, 2006; Luyten ck Corveleyn, 2007).
The concept of the internal working model of attachment theory is
similar to psychoanalytic concepts of mental representation, such as Sandier
and Rosenblatt's (1962) view of the representational world as the internal
drama in which the individual establishes representations of self and others
in multiple roles and Kernberg's (e.g., 1966, 1991) presentation of self-
affect-object units that are the basis for the formation of self- and object
representation. Both psychoanalytic and attachment theorists emphasize how
the internalization of interactions with caregivers results in the formation of
representations of self and others in actual and potential relationships (Blatt,
1974; Blatt, Wild, & Ritzier, 1975; Kernberg, 1976; Kohut, 1971; Mahler,
Pine, & Bergman, 1975; Main et al., 1985).

The interest in representational structures in psychoanalysis, as I noted
in chapter 2 (this volume), is part of a shift from a one-person psychology
focused on the internal balance between the intensity of drives and the thresh-
olds of defense, to a two-person psychology focused on the quality of early
fundamental caring experiences. The shift to object relations theory within
psychoanalysis is consistent with, and in part influenced by, psychoanalyti-
cally informed research in infant development (e.g., Beebe, 1986, 2005; Emde,
1981; Lichtenberg, 1985; Spitz, 1957a; Stem, 1985). The concept of mental
representations and of an internal working model of caring relationships, for
example, is consistent with Stern's (1985) concept of representations of in-
teractions that have been generalized. Repeated experiences organized around
particular affects associated with a caregiving other (e.g., mother, father)
and invariant attributes of that interaction (Schank & Abelson, 1977; Stern,
1985) result in the representation of attributes of the self and the other and
of the affects experienced in their relationship.1
Both attachment and psychoanalytic object relations theorists have
increasingly recognized that the infant internalizes not a static image of self
and other or actual attachment-related transactions, but constructions of
various aspects of affect-laden relationships, especially those involving fun-
damental experiences of gratification and frustration (Behrends & Blatt, 1985;
Bretherton, 1987; Kernberg, 1995; Loewald, 1962; Zeanah & Anders, 1987).
Both emotional relatedness and moments of separation, or experiences of
attachment and disruptions of that relatedness that inevitably occur in the
course of development, contribute in important ways to the child's construc-
tion of working models and representations of caring relationships. The psy-
choanalytic hypothesis that internalization of caring experiences leads to
the differentiation, articulation, and integration of self- and object represen-
tations extends and enriches the contributions of attachment theory regard-
ing the establishment of internal working models in patterns of secure and
insecure attachment (e.g., Blatt, 1974, 1995a; Blatt & Lerner, 1983; Blatt et
al, 1975; Calabrese et al, 2005; Hauser, Golden, & Allen, 2006; Luyten &
Corveleyn, 2007). A basic postulate of both attachment theory and psycho-
analytic object relations theory is that experiences with primary caregivers
result in the development of cognitive-affective schemas that act as heuris-
tic guides for subsequent interpersonal relationships. Consistent positive af-
fective experiences between child and attachment figures result in relatively
'The emphasis on representations in psychoanalysis and on mental models in attachment theory is

also consistent with the development of interests in interpersonal or relational schemas in social
cognition (e.g., Abelson, 1981; J. S. Auerbach, 1993; M. W. Baldwin, 2005; Brewer & Nakamura,
1984; Cantor, 1981; Fehr, 2005; Fiske & Taylor, 1984; H. Gardner, 1985; M. J. Horowitz, 1988; Kelly,
1955; Kihlstrom & Cantor, 1984; Mandler, 1988; Markus, 1977; Nelson & Orundel, 1981; Rosch,
1973a, 1973b; Rosenberg, 1988; Scarvalone et al., 2005; Taylor & Crockett, 1981) and in cognitive
information processing (e.g., Anderson, 1983; Blum, 1985; Erdelyi, 1985; H. Gardner, 1985;
Kihlstrom & Cunningham, 1991; Rumelhart, 1980, 1984; Westen, 1991a).

integrated and differentiated working models of attachment relationships in
which stable attributes of the attachment relationship become elaborated
and consolidated. These cognitive-affective structures or schemas are core
aspects of psychological development; they provide the templates for pro-
cessing and organizing information so that new experiences are assimilated
into existing mental structures. The content and structural organization of
these mental representations have both conscious and unconscious compo-
nents, explicit declarative and implicit procedural dimensions, that serve as
heuristic guides that organize and direct an individual's behavior, particu-
larly in interpersonal relationships (Blatt & Lerner, 1983). New experiences
over succeeding years and developmental periods are integrated into earlier
mental representations and result in advances in structural organization over
prior stages in the development of object and self-constancy and of symbolic
activity more generally (Bowlby, 1973). Significant fluctuations, inconsis-
tencies, and negative experiences in caretaking interactions, however, can
disrupt this developmental process and lead to less differentiated, integrated,
and consolidated representational schemas that are organized in more lim-
ited ways as individuals attempt to establish a sense of stability in distorted
and maladaptive ways.
Structural Organization of Interpersonal Schemas
As I discussed briefly in chapter 4 (this volume), various levels of con-

stancy in the structural organization of representation identify differences in
the procedural organization of representations of interpersonal or relational
schemas (e.g., Baldwin, 2005; Clyman, 1991; Fehr, 2005; Kihlstrom & Can-
tor, 1984; Rosch, 1973a, 1973b)—the implicit rules that guide interpersonal
interactions (Beebe & Lachmann, 2002; Grigsby & Hartlaub, 1994; Lyons-
Ruth et al, 1998; Sander, 1999; Squire & Cohen, 1984; Stern, 1998; Stem et
al., 2002).
Evocative object constancy is an essential component of working models
of attachment relationships (Zeanah & Anders, 1987). Evocative constancy
is defined in psychoanalytic theory (e.g., Fraiberg, 1969) as the capacity to
establish and sustain a representation of the caregiver, independent of his or
her physical presence and of variations in the infant's need states. This psy-
choanalytic conception of evocative constancy is consistent with its defini-
tion in cognitive-developmental theory (e.g., Piaget, 1945/1962) as the abil-
ity to sustain a sense of the presence of an object (i.e., a toy) and its action
during its absence from the perceptual field. It is important to stress, how-
ever, that evocative constancy is only one, albeit very important, milestone
in the development of cognitive-affective schemas. Other levels in the struc-
tural organization of cognitive-affective schemas are established in psycho-
logical development, some of which precede, whereas others follow, the de-
velopment of evocative constancy. In normal development, these cognitive-

affective schemas of self and significant others become increasingly differen-
tiated, articulated, and integrated. These various levels in the structural or-
ganization of cognitive-affective schema, like evocative constancy, have major
roles in psychological development and provide markers that identify devel-
opmental changes that occur in normal development and can occur in the
therapeutic process as well. Disruptions at different points in this develop-
ment of the structural organization of representations of self and others are
an inherent aspect of different forms of psychopathology in adults (Blatt,
1991a, 1995a).
Cognitive-developmental psychologists, beginning with Piaget and
Werner, studied how the child develops cognitive schemas, primarily of in-
animate objects (i.e., a toy) in essentially neutral circumstances. Psychoana-
lytic developmental and attachment investigators and theorists have studied
the same developmental process but, in contrast, focused primarily on how
the child develops cognitive—affective schemas of the interpersonal world
(i.e., concepts of self and others) in states of disequilibrium (e.g., during sepa-
ration or moments of unrest), especially in caring relationships. Despite ba-
sic differences in methodology, these various approaches to the study of the
development of cognitive-affective schemas describe the same essential de-
velopmental sequence and differ primarily in the specification of the time at
which a revision of a particular level of the structural organization of a
cognitive-affective schema first appears. Cognitive-developmental theorists
usually specify that a particular schema occurs somewhat later than do the
developmental psychoanalysts and attachment investigators. These differ-
ences, however, are consistent with the findings (e.g., Bell, 1970) that cogni-
tive-affective structures emerge initially in the intensity of the caring inter-
personal relationship and are subsequently extended as generalized cognitive
schemas that the child also uses to understand the inanimate world. Devel-
opments in cognitive-affective schemas emerge first and foremost in the car-
ing relationship and are then stabilized as generalized cognitive structures.
Because these various developmental investigators and theorists describe es-
sentially the same developmental sequence for the emergence of the struc-
tural organization of cognitive—affective schemas, their findings can be inte-
grated into a theoretically coherent model. These cognitive-affective schemas
are long-term enduring psychological structures, modes of processing and
organizing information and affective experiences, and these schemas provide
templates that guide and direct an individual's interactions in both the im-
personal and the interpersonal world (Blatt, 1974; Blatt et al., 1975; Blatt &
Lerner, 1983).
An integration of concepts from cognitive-developmental psychology,
developmental psychoanalytic theory, and attachment theory and research
facilitates the specification of several major nodal points, from infancy through
adulthood, in the development of the structural organization (or procedural
dimensions) of cognitive-affective schemas (Blatt, 1974,1991a, 1995a).The

first level of structural organization that can be identified is boundary con-
stancy. The development of this level of organization, about the age of 2 to 3
months,2 is indicated behaviorally by the infant's intentional smile to others
and the capacity to initiate engagement with them. The infant's early
spontaneous smile to another person suggests that the infant has articulated
the physical form of a person from the embedding perceptual field and is
responsive to it. This suggestion that the infant has articulated a boundary of
an object is consistent with early experimental studies of visual gaze in in-
fants (e.g., Fantz, 1963, 1966; Fantz & Nevis, 1967) and in infrahuman spe-
cies (e.g., Hubel & Wiesel, 1959, 1962), as well as with the formulations of
Piaget (1926) and Werner (1948; Werner & Kaplan, 1983), who noted that
the child's first cognitive schema involves the articulation of the fundamen-
tal contour or boundary of an object from its embedding context.
Later in development, about 6 months, the infant begins to distinguish
among people, develops an intense investment in a few people, and differen-
tiates these particular persons from others. The child responds to mother and
father in a special way, in contrast to how he or she responds to strangers.
The child has developed a new structural organization of cognitive-affective
schemas that can be called recognition, libidinal, or affect constancy (e.g.,
Fraiberg, 1969) in which the child no longer just articulates the form of an
individual from an embedding field but is now differentially responsive to
the familiar and the special. The development of this affective bond to a
particular person or persons indicates that the child can now differentiate
among objects and has developed a stable and consolidated capacity for rec-
ognition. This recognition or affect constancy is essential for later develop-
ment because it provides the base necessary for the development of secure
attachment. As I discussed in chapter 2 (this volume), experiences of both
gratifying involvement and experienced incompatibility are essential for psy-
chological development. Bowlby, Ainsworth, Bretherton, and other attach-
ment investigators stressed that the security of attachment is influenced by
the way the mother and the child establish an affective bond, as well as by
the way they manage separations and other disruptions that naturally occur
to interrupt their developing affective bond.
At about 16 months, a third level emerges in the structural organiza-
tion of cognitive-affective schema: evocative or object constancy, the capacity
to retain and recall aspects of an object that is no longer immediately present
in the perceptual field. The importance of the development of evocative
object constancy has long been noted in psychoanalytic observations (e.g.,
S. Freud, 1920/1957a) of the infant struggling with increasing awareness that
he or she is a separate being in a large world in which mother and father can
2
The specification of the time in development at which these various levels of structural organization
or constancy emerge is influenced by the sensitivity of the observing conditions. Thus, the times are
only approximations; what is central to these formulations is the sequence in which these constancies
emerge.

disappear, in the descriptions by Mahler et al. (1975) of the child's struggles
in the rapprochement phase, as well as in attachment theory and research on
the development of a secure base (Ainsworth, 1969; Bowlby, 1988b). This
development of evocative constancy enables the child to begin to leave the
mother without undue distress because the child can now maintain a sense of
the mother in her absence. The emergence of the child's capacity for evoca-
tive constancy was initially noted in cognitive-developmental research by
Piaget (e.g., 1926) and Werner (1948) in their observations of the develop-
ment of the child's ability to anticipate invisible displacements of an object.
Likewise, the quality of evocative constancy becomes apparent in the child's
response to separation in secure and insecure attachment patterns. But it is
important to note that attachment theorists also observed that internal work-
ing models of caring relationships consist of the representation of the self in
interaction with others and thus include not only the availability and consis-
tency of attachment figures but also the worthiness of the self as deserving of,
and able to obtain, security and comfort (Bowlby, 1969; Kobak & Hazan,
1991). Thus, evocative object constancy marks not only the development of
an increasingly stable concept of the object but also the emergence of a stable
sense of self.
At about 3 years of age, the child begins to consolidate a sense of self
separate from and independent of others. The emergence of this self-
constancy begins at about 18 months of age (e.g., Lewis & Brooks-Gunn,
1979) and its consolidation is indicated by the child's increasing capacity to
use the terms mine, me, and I with specificity and precision. The child is
increasingly able to differentiate between self and others and to be aware of
differences in his or her relationship with others. Concepts of the self and of
others now develop in a reciprocal or dialectical interaction. This dialectical
interaction contributes to further differentiation in the representation of self
and of others, as well as to the relationship between self and others. As I
discussed in chapter 4 (this volume), the emerging sense of self facilitates the
development of more mature levels of interpersonal relatedness and, con-
versely, new levels of interpersonal relatedness facilitate the development of
new levels in the sense of self. In normal development, these two develop-
mental lines, self-definition and interpersonal relatedness, develop in a mu-
tually facilitating and synergistic fashion. The development of the sense of
self facilitates the development of more mature forms of interpersonal relat-
edness that, in turn, contribute to the further development of a more differ-
entiated, articulated, and integrated sense of the other and of the self.
The dialectical synergistic development of concepts of self and of the
relationship with others leads to subsequent levels in the development of the
structural organization of cognitive-affective schemas, beginning with con-
crete operational thought, which involves increased coordination and inte-
gration of the relatedness and self-definitional developmental lines in the
representation of self and other. Piaget's and Werner's identification of the

development of operational thought, at about age 6 years (Piaget, 1926;
Werner, 1948; Werner & Kaplan, 1983), describes the emergence of a new
structural organization in which the child is able to coordinate and transform
relationships among several manifest dimensions of inanimate objects. The
child now understands the processes involved in the transformation of mani-
fest aspects of an object and has developed the capacity for the cognitive
operations of reversibility and conservation.3 The beginning development of
this important capacity to coordinate multiple dimensions in processes of
reversibility, transformation, and conservation of inanimate objects in op-
erational thought at about age 6 years is consistent with observations of psy-
choanalytic investigators of a major shift in the interpersonal relations of the
child, at about 4 or 5 years of age, from a focus on a separate dyadic relation-
ship with each parent alone to a beginning appreciation of a triadic interper-
sonal structure involving coordination of relationships with both parents. As
I discussed in chapter 4 (this volume), the appreciation of triadic relation-
ships in both impersonal operations and interpersonal relationships enables
the child to consider relationships in comparative terms. The child's think-
ing is no longer restricted to simple contrasts (e.g., pleasure-pain, good-bad,
strong-weak) that exist in dyadic relationships; but instead the child can
now begin to reflect on and compare and contrast the type and quality of the
relationships that he or she has with each parent and that the parents have
with each other.
The coordination and integration of aspects of individuality (or self-
definition) and of relatedness in a triadic family system and in the advent of
operational thought results in a functional sense of we. As I discussed in
chapter 4 (this volume), George Klein (1976) stressed the importance of an
integration of individuality and affiliation and its expression in the develop-
ment of the concept of we that emerges from the dialectic between the de-
velopment of a sense of self and the development of a sense of relatedness to
others. Investigators, mainly in infant research (e.g., Emde, 1985), have also
elaborated the development of the concept of we in this dialectical develop-
mental process (see chap. 4, this volume).
Further changes in the structural organization of cognitive—affective
schema occur in adolescence when various components of self and others are
integrated and coordinated even further in a new gestalt or synthesis. The
two lines of development of concepts of self and of others are now more fully
coordinated in a more abstract sense of we that was initially experienced in
concrete manifest terms with the beginning of operational thought and tri-
adic interpersonal experiences at about age 5 to 6. Beginning in adolescence,
at about age 11 to 12, the concept of we is formulated in more abstract terms
as the child begins to deal with more complex and symbolic properties of the
'For example, the height and width of a container can be varied although the volume remains the
same.

self and others (i.e., psychological attributes, values). As I discussed in chap-
ter 4 (this volume), the development of formal operational thought and the
increased appreciation of abstract or symbolic psychological qualities define
yet another level in the coordination and integration of individuality and
relatedness in a sense of we or of a self-in-relation to others.
As Exhibit 8.1 illustrates, these theoretical formulations facilitate the
identification of a series of levels of constancy in the development of implicit
structural or prototypic dimensions of concepts or mental representations of
self and other.4
Extensive research (see summary in Blatt & Wild, 1976) demonstrates
that a wide range of symptoms and cognitive, perceptual, and interpersonal
disturbances in schizophrenia involve disruptions in establishing and main-
taining boundary constancy as well as in emotional or recognition constancy.
Likewise, many symptoms and impairments in borderline psychopathology
involve disturbances in the capacity to establish and maintain evocative and
self-constancy that leave patients with borderline personality disorder par-
ticularly vulnerable to experiences of abandonment. Less severe forms of psy-
chopathology (e.g., depression and the personality disorders) involve disrup-
tions in the integration of self and other into a sense of we and in the
development of effective operational thought. Thus, as I discussed in chapter
6 (this volume), these less severe forms of pathology focus on maintaining a
sense of self at the expense of the development of interpersonal relatedness
(introjective psychopathology) or focus on interpersonal relatedness at the
expense of developing a sense of self (anaclitic psychopathology). These early
developmental deviations in the development of these various levels of con-
stancy—boundary, recognition, object and self-constancy, and operational
thought—are amplified, through a process of deferred action, in later cogni-
tive, affective, and interpersonal disturbances in various forms of psychopa-
thology in adolescence and adulthood (Blatt, 1991a, 1995a).
Differentiation and Relatedness in Descriptions of Self

and Significant Others
In addition to developing methods for the systematic assessment of the

content and structural organization of mental representations in responses to
the Rorschach I report in the discussion of the Riggs-Yale Project and the
4
Differential impairment in the development of these structural or prototypic dimensions of mental
representations provides a way of going beyond an emphasis on manifest symptoms in the study of
psychological disturbances to identify aspects of the cognitive structural organization underlying various
forms of psychopathology, from schizophrenia to personality disorders and the neuroses. As I discussed in
chapter 6 (this volume), impairments in early development distort subsequent development by creating
deviant developmental pathways (Bowlby, 1973; Waddington, 1947). From the perspective of a
diathesis-stress model, developmental disturbances in the structural organization of representations are
activated and expressed later in life because of their congruence with current life stresses, in a process
that S. Freud (1917/1963a, 1918/1955) much earlier had called "deferred action."

EXHIBIT 8.1
Levels of Structural Organization
Developmental Level Behavioral Indication

I. Boundary constancy (2-3 months) Smiling response, initiates engagement
with others.
II. Recognition (libidinal) constancy Stranger anxiety, differentiation among
(6-8 months) people, emotional attachment to a
specific individual.
III. Evocative constancy Sense of object not immediately present
(16-18 months) in perceptual field.
Anticipation of invisible displacement
(Piaget), initiate separation from
caring agent (Mahler).
IV. Self- and object constancy Stable concepts of self and other
(30-36 months) expressed in precise use of terms
such as me, mine, and /.
V. Concrete operational thought Capacity for coordinating several
(5 years) dimensions.
Capacity for anticipation, transformation,
conservation, and reversibility of
external manifest features.
Triadic interpersonal configurations, and
the emergence of a concept of we.
VI. Formal operational thought Transformation, reversibility, and
(11-12 years) conservation of abstract inner
features, dimensions, and processes
such as values and principles.
Recognition that one constructs
meaning and a sense of reality.
Appreciation of personal and cultural
relativism.
VII. Self-identity (late adolescence- Synthesis and integration of mature
young adulthood) expressions of both individuality and
relatedness in a capacity to be
intimate with another and to contribute
to a collective without losing one's
individuality.
VIII. Integrity (mature adulthood) Emergence of a fuller sense of we (i.e.,
"self-in-relation" [Chodorow, 1978,
1989; Gilligan, 1982; J. B. Miller,
1976] or "ensembled individualism"
[Sampson, 1985, 1988]).
Note. From "Representational Structures in Psychopathology," by S. J. Blatt, 1995, in D. Cicchetti and S.
Toth (Eds.), Rochester Symposium on Developmental Psychopathology: Vol. 6. Emotion, Cognition, and
Representation (pp. 1-33), Rochester, NY: University of Rochester Press. Copyright 1995 by the
University of Rochester Press. Adapted with permission.
Menninger Psychotherapy Research Project in chapter 7 (this volume), my

colleagues and I developed procedures to assess aspects of mental representa-
tions by evaluating the structural organization and content of spontaneous
descriptions of self and of significant others (e.g., Blatt, Wein, Chevron, &
Quinlan, 1979). On the basis of the formulations of Bruner (1964) and M. J.

Horowitz (1972) about cognitive development, my colleagues and I (Blatt,
Chevron, Quinlan, Schaffer, & Wein, 1988; Blatt, Wein, Chevron, &
Quinlan, 1979) initially constructed a method for systematically assessing
aspects of the thematic content as well as the level of cognitive organization
(conceptual level, CL) of descriptions given by individuals of their signifi-
cant others (i.e., mother, father). Other colleagues and I (Diamond, Blatt,
Stayner, & Kaslow, 1991) more recently approached the analyses of these de-
scriptions of self and significant others from an object relations perspective as
well as from the perspective of intersubjectivity theory, evaluating
(a) the developmental level of the differentiation of self from other and
(b) the quality of the interpersonal relatedness between self and others ex-
pressed in these descriptions of self and of significant figures. The development
of a Differentiation-Relatedness (D-R; Diamond et al., 1991) scale derives
from theoretical formulations (Blatt, l'991a, 1995a) discussed earlier about levels
of structural constancies that occur in the development of the representation
of self and others and of their interrelatedness, as identified in Exhibit 8.1.5
Drawing from theoretical formulations and clinical observations about
very early processes of boundary articulation (Blatt & Wild, 1976; Blatt et
al., 1975; Jacobson, 1964; Kernberg, 1975, 1976), processes of separation-
individuation (Coonerty, 1986; Mahler, Pine, & Bergman, 1975), the for-
mation of the sense of self and the development of intersubjectivity (Stern,
1985), and the interplay between the development of self-definition and in-
creasingly mature levels of interpersonal relatedness (Blatt & Blass, 1990,
1996; Blatt & Shichman, 1983), Diamond et al. (1991) constructed a 10-
point scale to assess the degree of differentiation and relatedness in descrip-
tions of self and significant others. In general, higher ratings of differentia-
tion-relatedness in descriptions of self and other are based on increased
articulation and stabilization of the concept of the object and an increased
appreciation of mutual, emphatically attuned relatedness. The D-R scale iden-
tifies the following 10 points:
• A lack of basic differentiation between self and others (Levels
1 and 2).
• The use of mirroring (Level 3), self-other idealization or deni-
gration (Level 4), and an oscillation between polarized nega-
tive and positive attributes (Level 5), as maneuvers to estab-
lish, consolidate, or stabilize representations.
'Summary descriptions of these scoring systems for assessing the thematic content and aspects of the
structural organization of descriptions of self and significant others (the CL and D-R scales) are
available in Blatt (2004); Blatt and Auerbach (2001); Blatt et al. (1997); and Blatt, Stayner, et al.
(1996). Summaries of research findings using these assessment procedures are available in Blatt et al.
(1997) and K. N. Levy et al. (1998). Extensive presentation of these scales, with illustrative examples
for scoring them, is available in unpublished research manuals (Blatt, Bers, & Schaffer, 1992; Blatt,
Chevron, et al., 1988; Diamond et al., 1991) that are available from S. ]. Blatt
(Sidney.Blatt@yale.edu).

• An emergent differentiated, constant, and integrated represen-
tation of self and other, with increasing tolerance for complex-
ity and ambiguity (Levels 6 and 7).
• Representations of self and others as empathically interrelated
(Level 8).
• Representations of self and other in reciprocal and mutually
facilitating interactions (Level 9); and reflectively constructed
integrated representations of self and others in reciprocal rela-
tionships (Level 10).
In general, higher ratings of differentiation-relatedness in descriptions

of self and other are based on increased differentiation of the representation
of the self and of others, increased articulation and stabilization of interper-
sonal schemas, and an increased appreciation of mutual and empathically
attuned relatedness between the self and significant figures.
This scale, summarized in Exhibit 8.2, is based on the fundamental as-
sumption that psychological development moves toward the emergence of
(a) a consolidated, integrated, and individuated sense of self-definition and
(b) empathically attuned, mutual relatedness with significant others (Aron,
1996; Auerbach & Blatt, 2002; J. Benjamin, 1995; Blatt, 1991a, 1995a, 2006;
Blatt & Blass, 1990, 1996; Blatt & Shichman, 1983; Jordan, 1986; Miller,
1984; Mitchell, 1988; Stern, 1985; Surrey, 1985). Differentiation (separa-
tion) and relatedness, in this model, are interactive dimensions that unfold
throughout development. The dialectical interaction between these two de-
velopmental dimensions facilitates the emergence and consolidation of in-
creasingly mature levels of both self-organization and reciprocally attuned,
empathic relatedness. The scale assumes that, with psychological develop-
ment, representations of self and other become increasingly differentiated
and integrated and also begin to reflect an increased appreciation of inter-
personal relatedness (Diamond et al., 1991).
The 10 levels of differentiation-relatedness identified in the D-R scale
were established on the basis of the theoretical formulations I articulated in
chapters 3 and 4 (this volume) as well as on clinical and developmental
findings, and reflect what are generally regarded as clinically significant dis-
tinctions from grossly pathological to intact and healthy object relations
(Auerbach & Blatt, 2002; Blatt, Auerbach, & Levy, 1997). The various lev-
els of this scale describe a developmental sequence but they may not be equi-
distant from each other, and the specific number of scale points is to some
extent arbitrary. That is, new levels of differentiation-relatedness can be
added in light of new clinical observations, theoretical formulations, and
research findings. Nevertheless, higher differentiation-relatedness ratings
reflect a greater degree of psychological health. Differentiation—relatedness
Levels 8, 9, and 10 are indicative of mental health, and differentiation-
relatedness Level 7 (consolidation of object constancy) is regarded as a pre-

requisite for normal psychological and interpersonal functioning (Diamond
etal., 1991).
With regard to the dimension of differentiation, the scale reflects, at
the lowest levels, the compromise of boundaries with regard to basic body
awareness, emotions, and thoughts. Subsequent scale levels reflect a unitary,
unmodulated view of self and of the other as extensions of each other or as
mirrored images (i.e., images in which aspects of self and other are identical).
At an intermediate level of differentiation, representations are organized
around a unitary idealization or denigration of self or other (i.e., around an
exaggerated sense of the goodness or badness of the figure described). At the
next level, these exaggerated aspects of self and other alternate in a juxtapo-
sition of polarized (i.e., all-good or all-bad) extremes. Later scale levels of
differentiation reflect an increased capacity to integrate disparate aspects of
self and other and an increased tolerance for ambivalence and ambiguity
(Kernberg, 1999).
With regard to the dimension of relatedness, the D-R scale assesses the
progression toward empathically attuned mutuality and reciprocity in com-
plex interpersonal relationships. At lower levels, the sense of relatedness in
representations may involve being overwhelmed or controlled by the other
(e.g., trying to resist the onslaught of an other who is experienced as bad and
destructive). At increasingly higher levels, relatedness may be expressed pri-
marily in parallel interactions, in expressions of cooperation and collabora-
tion, in understanding the other's perspective, or in expressions of
empathically attuned mutuality (Blatt & Blass, 1990, 1996). At the highest
levels, descriptions reflect a sense of one's participation in complex relational
matrices that determine perceptions, attributions, and the constructions of
meaning.
Interrater and retest reliability of this scoring procedure are at accept-
able levels (K. N. Levy, Blatt, & Shaver, 1998; Stayner, 1994; Vermote, 2005),
and research findings indicate the validity of this scale as a measure of differ-
entiation and relatedness (e.g., Blatt, Auerbach, & Aryan, 1998; Blatt,
Stayner, et al, 1996; Diamond et al., 1991; Diamond, Kaslow, Coonerty, &
Blatt, 1990; K. N. Levy et al., 1998; Vermote, 2005). Levy et al. (1998), for
example, assessing the content and structural organization of descriptions of
significant others (mother and father) given by young adults, found signifi-
cant differences, as measured by the D-R scale, in descriptions of parents
given by individuals with different attachment styles. The descriptions of
parents given by insecurely attached individuals were more malevolent and
punitive and less cohesive, differentiated, and integrated than were those
given by securely attached persons. Secure attachment was associated with
more positive, stable, consistent, and integrated representations of signifi-
cant others. In addition, securely attached individuals described both of their
parents as caring and emotionally supportive and were able to grasp more
fully the complexities of interpersonal relationships and were better able to

EXHIBIT 8.2
Differentiation-Relatedness Scale
Two Dimensions
Differentiation:
Articulation and stabilization of a consolidated, individuated, and integrated
sense of self and other.
Relatedness:
Appreciation of mutual, empathically attuned, reciprocal, interpersonal
relatedness.
Level/Scale Point Description
A. Impairments in basic differentiation between self and others
1. Self-other boundary Basic sense of physical cohesion or the integrity of
compromise. separate representations is lacking or is
breached.
2. Self-other boundary Self and other are represented as physically intact
confusion. and separate, but feelings and thoughts are
amorphous, undifferentiated, or confused.
Description may consist of a single global
impressionistic quality or a flood of details with a
sense of confusion and vagueness.
B. Attempts to establish and maintain object and self-constancy
3. Self-other mirroring. Characteristics of self and other, such as physical
appearance or body qualities (e.g., shape or
size), are virtually identical.
4. Self-other idealization Attempt to consolidate representations based on
or denigration. unmodulated idealization or denigration.
Extreme, exaggerated, one-sided descriptions.
5. Semidifferentiated, Attempt to consolidate representations by a marked
tenuous consolidation of oscillation between dramatically opposite
representations through qualities, or an emphasis on manifest external
splitting (polarization) or features.
an emphasis on
concrete part properties.
C. Differentiated and integrated concepts of self and other (Object
Constancy)
6. Emergent, ambivalent Emerging consolidation of disparate aspects in a
constancy (cohesion) of somewhat hesitant, equivocal, or ambivalent
self and other, an integration. A list of appropriate characteristics,
emergent quality of but they lack a sense of uniqueness. Tentative
interpersonal movement toward a more individuated and
relatedness. cohesive sense of self and other.
7. Consolidated, constant Thoughts, feelings, needs, and fantasies are
(stable) self and other in differentiated and modulated. Increasing
unilateral relationships. tolerance for and integration of disparate
aspects. Distinguishing qualities and unique
characteristics. Sympathetic understanding of
others.

D. Capacity for empathic, reciprocal relationships
8. Cohesive, individuated, Cohesive, nuanced, and related sense of self and
empathically related self others. A definite sense of identity, an interest in
and others. interpersonal relationships, and a capacity to
understand the perspective of others.
9. Reciprocally related Cohesive sense of self and other in reciprocal
integrated unfolding of relationships that transform both the self and the
self and others. other in complex, continually unfolding ways.
10. Creative, integrated, Integrated reciprocal relations with an appreciation
reflective constructions that one contributes to the construction of
of self and other in meaning in complex interpersonal relationships,
empathic, reciprocally
attuned relationships.
Note. From "Change in Object and Self-Representations in Long-Term, Intensive, Inpatient Treatment of
Seriously Disturbed Adolescents and Young Adults," by S. J. Blatt, D. Stayner, J. Auerbach, and R. S.
Behrends, 1996, Psychiatry: Interpersonal and Biological Processes, 59, pp. 82-107. Copyright 1996 by
Guilford Press. Adapted with permission.
differentiate themselves from their parents while still maintaining a sense of

relatedness. Dismissive avoidant and preoccupied individuals often gave less
differentiated, one-sided, unidimensional descriptions of their parents as pu-
nitive, malevolent, and lacking in warmth or as highly idealized. Dismissive
avoidant and preoccupied individuals seemed to have rigid categorization of
their parents, either as extremely negative or as idealized caregivers (see also
Calabreseetal., 2005).
Within the insecurely attached group, avoidant individuals described
their parents as cold, judgmental, punitive, and less constructively involved.
Preoccupied individuals also described their parents as punitive and judg-
mental, but in contrast to avoidant individuals, they also described their par-
ents as affectionate, warm, and benevolent. Preoccupied individuals also de-
scribed their parents as less effective—that is, less successful, less constructively
involved, and less of a positive ideal (K. N. Levy et al., 1998). Fearful avoidant
individuals, like dismissively avoidant insecure individuals, represented their
parents as more malevolent and punitive. But their descriptions of their par-
ents were more differentiated. Although fearful avoidant individuals were
highly ambivalent about their parents, they, like securely attached individu-
als, saw the complexity of their relationships with their parents and gave
more differentiated descriptions of their parents and differentiated themselves
from their parents. They, like securely attached individuals, were able to
integrate good and bad aspects of their parents and to differentiate them-
selves from parental figures (see also Blatt, Auerbach, & Levy, 1997). Thus,
fearful avoidant individuals appear developmentally more mature than do
dismissive avoidant individuals. The dismissive attachment style appears to
be a less adaptive expression of avoidant attachment than does the fearful
avoidant style (K. N. Levy et al., 1998), perhaps because fearful avoidant
individuals have more complex object representations in which they, like
preoccupied individuals, want to get closer, but are fearful of rejection.

CHANGES IN THE STRUCTURAL ORGANIZATION
AND CONTENT OF REPRESENTATIONS OF SELF
AND OTHER IN THE TREATMENT PROCESS
Beebe and Lachmann (2002) noted the centrality of these procedural

dimensions of representations in early development, and they, like others
(e.g., Baccus & Horowitz, 2005; Blatt et al, 1975; Blatt, Stayner, et al., 1996;
Hermans, 2005; M. J. Horowitz, 1979, 1991; Lyons-Ruth et al., 1998;
Scarvalone, Fox, & Safran, 2005), discussed changes in the prototypic di-
mensions of representations in the treatment process. Lyons-Ruth and her
colleagues in the Process of Change Study Group (e.g., Lyons-Ruth et al.,
1998; Stem et al., 2002), like Blatt and colleagues (e.g., Blatt, 1974; Blatt &
Lerner, 1983; Blatt et al., 1975; Blatt et al., in press; Blatt, Stayner, et al.,
1996; Diamond et al., 1990; Gruen & Blatt, 1990), discussed how represen-
tations become more differentiated, articulated, integrated, and flexible in
the treatment process. Developmental advances in procedural dimensions of
interpersonal schema provide the basis for more coherent and adaptive in-
terpersonal relationships. Changes in implicit (procedural) and explicit (de-
clarative) dimensions of mental representations of self and significant others
are part of a transformational process that emerges from the intensity of the
relational aspects of the treatment process (Blatt et al., in press; Blatt, Stayner,
et al., 1996), in what the Process of Change Study Group (e.g., Lyons-Ruth
et al., 1998; Sander, 1999; Stern, 1998; Stern et al., 2002) described as mo-
ments of meeting.
The D-R scale was used to systematically study changes in descriptions
of significant figures by adolescent and young adult inpatients who were seri-
ously disturbed and involved in long-term, comprehensive, psychoanalyti-
cally oriented treatment. The centrality of cognitive-affective schemas in
psychological development in adult interpersonal relationships and in differ-
ent forms of psychopathology suggests that the implicit structural organiza-
tion and the more explicit thematic content of these schemas may have im-
portant implications for the study of the therapeutic process (see also Eklund
& Nilsson, 1999; McCallum, Piper, Ogrodniczuk, & Joyce, 2003; Piper &
Duncan, 1999; Piper et al., 2002; Shahar & Blatt, 2005). If various forms of
psychopathology involve distorted object and self-representations (e.g., Blatt,
1995a), and if satisfactory childhood attachments result in the formation of
increasingly mature interpersonal schemas in normal development (e.g., Main
et al., 1985), then constructive interactions between patient and therapist
should facilitate revisions of impaired or distorted representations of self and
of others and lead to the development of more integrated and mature inter-
personal schemas. The therapeutic relationship should create a process through
which impaired or distorted interpersonal schemas are relinquished, reworked,
and revised into more adaptive cognitive-affective representations of self
and others.

Shortly after admission to the hospital and at 6-month intervals there-
after, treatment-resistant patients who were seriously disturbed6 were asked
to describe mother, father, a significant other, therapist, and self. Changes in
D-R in descriptions of self and those significant figures were significantly
correlated with changes in level of psychosocial functioning, as indepen-
dently assessed from clinical case records with the Global Assessment scale
(GAS; Endicott, Spitzer, Fleiss, & Cohen, 1976).7 Highly significant posi-
tive correlations were found between changes in level of clinical functioning
and changes in the content and structural organization of object representa-
tions in descriptions of mother, father, therapist, and self (Blatt, Stayner, et
al., 1996), as well as in descriptions of a figure designated by the patients as
their significant other (Harpaz-Rotem & Blatt, 2005). Therapeutic progress
was thus clearly associated with significant increases in the level of D-R of
descriptions of self and significant others: with increased articulation and
differentiation of significant figures, especially the mother and the therapist,
and with an increased capacity for representing mutual interpersonal relat-
edness. This pattern of the relationship between clinical improvement and
changes in the structural dimensions of representation were consistent across
the representation of mother, therapist, and self (Blatt, Stayner, et al., 1996).8
These changes in the structural dimensions of representations were indepen-
dent of change in the length of the descriptions. Improved clinical function-
ing was also related to descriptions of mother as warmer and to therapist as
more benevolent, warmer, and more constructively involved, and tended to
be related to descriptions of both mother and therapist as a positive ideal.
Furthermore, over the course of treatment this sample of treatment-
resistant patients who were seriously disturbed, as a whole, showed a signifi-
cant increase in mean D-R score from a predominance of polarization and
splitting (D-R Level 5) to emergent object constancy (D-R Level 6). In addi-
tion, those patients who showed the greatest clinical improvement (as deter-
mined by a median split of the distribution of differences between GAS scores
derived from ratings of independently prepared clinical case records at ad-
mission and after at least 1 year of treatment) initially described their thera-
pists in a manner that was already approaching the emergence of object con-
stancy, whereas those who were to show less improvement started at the
level of polarization and splitting in describing their therapists. At discharge,
'These adolescent and young adult patients usually had many years of unsuccessful outpatient
treatment and a number of prior brief psychiatric hospitalizations before being admitted to this long-
term, intensive, comprehensive treatment program.
7
A unidimensional scale, derived from Luborsky's (1962; Luborksy & Bachrach, 1974) Health-
Sickness Rating scale, the GAS assesses functioning and severity of psychopathology on a 100-point
scale with well-specified scale points for each of 10 intervals. A slightly revised version of the GAS is
included in the Diagnostic and Statistical Manual of Mental Disorders, fourth Edition (American
Psychiatric Association, 1994) as the Global Assessment of Functioning.
8
Changes in the representation of father were an exception to this pattern, and this is discussed in
detail in Blatt, Stayner, et al. (1996).

those patients with greater therapeutic change had a consolidation of object
constancy in their descriptions, in which there was evidence of a preliminary
integration of positive and negative elements (D-R Level 7), consistent with
an ability to tolerate and to begin to integrate contradictory aspects of sig-
nificant figures. Patients with less improvement had achieved only an emer-
gence of object constancy (D-R Level 6) in their descriptions of their thera-
pist (Blatt, Auerbach, & Aryan, 1998). These findings are consistent with
findings reported by Vermote (2005) of significant increases in D-R scores of
patients with personality disorder in an extended inpatient treatment pro-
gram (as discussed in chap. 7, this volume), and with findings by Luyten,
Meganck, Jansen, De Grave, and Corveleyn (2006) of significant differences
in level of D-R in descriptions of parents and of self given by psychiatric
inpatients and by a normal community sample of adults. Philips, Wennberg,
Werbart, and Schubert (2006) reported similar findings in the psychody-
namic treatment of adolescents.
To be sure, in the study by Blatt and colleagues (Blatt, Auerbach, et al.,
1998; Blatt, Stayner, et al., 1996), the inpatients remained some distance
from fully mature object relations and object representations—that is, from
the ability to appreciate fully the uniqueness of, and the nature of one's relat-
edness to, another. But the development of the capacity to tolerate and be-
gin to integrate ambivalent feelings about self and significant others is an
important and necessary step on the way to more mature levels of interper-
sonal relatedness, a particularly impressive development in some of these
inpatients. The findings also indicated the crucial role of the therapist in
facilitating clinical change. Patients with greater therapeutic gain had higher
initial D-R scores for their descriptions of their therapist than did patients
with less change. And differentiation-relatedness was higher for therapist
descriptions than for patients' descriptions of each of the other figures—that
is, mother, father, and self, or a significant other (Blatt, Auerbach, et al.,
1998). The importance of the role of the therapist and the therapeutic rela-
tionship in the treatment process is amplified further in the report by Vermote
(2005) that several of the patients who were seriously disturbed and had a
personality disorder in the K-LS established long-term therapeutic relation-
ships with their therapist after termination, something they had been unable
to do before their treatment.
Future research needs to be directed toward how these changes in rep-
resentations of self and others occur in the treatment process and how they
are related to changes in the broad range of cognitive processes and to the
quality of interpersonal relationships, both in the clinical context (i.e., the
therapeutic process) and in interpersonal experiences more generally. Fur-
ther research should also be directed toward understanding the processes,
such as internalization, through which the therapeutic process leads to these
changes in the structural organization of the cognitive-affective schemas and
mental representations both during treatment and beyond (e.g., see Auerbach

& Blatt, 2001; Blatt & Auerbach, 2001; Blatt, Auerbach, et al., 1998; Blatt,
Stayner, et al., 1996; Blatt et al., in press; Calabrese et al., 2005; Diamond et
al., 1990; Gruen & Blatt, 1990; Hartlaub, Martin, & Rhine, 1986; Philips et
al., 2006; Ticho, 1972). These analyses of descriptions of self and significant
others over the course of long-term treatment of inpatients who are seriously
disturbed (Blatt, Stayner, et al., 1996; Blatt et al., in press; Diamond et al.,
1990; Gruen & Blatt, 1990) demonstrate that careful evaluation of changes
in the content and structural organization of representations can provide
further understanding of the processes of clinical change.
INTERNALIZATION IN THE THERAPEUTIC PROCESS
Changes in the structural organization and the thematic content of

representations of self and others are the consequence of the internalization
of constructive interpersonal experiences. I discussed the processes of inter-
nalization in normative psychological development in chapter 4 (this vol-
ume), and in this chapter I address the role of internalization in therapeutic
process. Both cognitive-developmental and psychoanalytic developmental
theory discuss the process of internalization (or interiorization; Piaget, 1945/
1962) as a fundamental process in the development of mental representa-
tions or cognitive-affective schemas of self and of others. The dialectical
interaction of gratifying involvement (relatedness) and experienced incom-
patibility (separation and individuation) results in internalizations that are
central in psychological growth throughout life in normal psychological de-
velopment (see chap. 4, this volume) as well as in the therapeutic context.
Despite differences that occur in normal psychological development and in
long-term intensive treatment, aspects of the fundamental mechanisms of
psychological growth are the same. As in normal development, an oscilla-
tion between engagement and disengagement, between relatedness and sepa-
ration, between gratifying involvement and experienced incompatibility, is
central to the therapeutic process. Psychoanalysis is conducted in what Stone
(1961) described as a state of "intimate separation" (pp. 89) or "deprivation
in intimacy" (p. 105). The mutative power of long-term intensive psycho-
therapy appears to derive from the ongoing tension between closeness and
distance, between attachment and separation, between the development of
relatedness and the development of self-definition in repeated sequences of
gratifying involvement and experienced incompatibility.
Gratifying involvement occurs in various ways in long-term intensive
treatment. By remaining relatively nonjudgmental and dispassionate while
simultaneously concerned and compassionate (see Luyten & Corveleyn,
2003), the therapist creates a context in which the patient is able to experi-
ence gratifying involvement in the transference at different developmental
levels. Gratifying involvement evolves from the patient's feeling respected

and understood and finding the therapist accepting, empathic, and capable
of assuming the patient's frame of reference (Rogers, 1961). Gratifying in-
volvement grows as patient and therapist together give voice to the multi-
plicity of subtle feelings, emotions, and thoughts that occur within the thera-
peutic hour. The patient develops feelings of affection and attachment by
repeatedly experiencing the therapist as caring and perceptive. Both the qual-
ity of the therapeutic relationship and the sensitivity of interpretations con-
tribute to the creation of a "holding environment" (Modell, 1976; Winnicott,
1953,1965,1971). Interpretations, if accurate, well-timed, and tactfully stated,
can be experienced as expressions of the therapist's concern and understand-
ing (Modell, 1976). Interpretations that give voice to subtle personal experi-
ences that the patient is struggling to articulate convey not only ideas and
observations about the patient's psychological state but also the therapist's
emotional attitudes toward the patient (Rycroft, 1956). Sensitivity to the
patient's struggle to communicate feelings and experiences enables the thera-
pist to capture these experiences in coherent verbal expressions that facili-
tate the patient's receiving and being able to work effectively with the
therapist's interpretations. Interpretations made from an internal perspec-
tive (Rogers, 1961), from the perspective of the experiential field of the pa-
tient, facilitate this process. Stating, for example, that the patient is being
"resistant" in dealing with a difficult matter is an intervention from an exter-
nal perspective. But noting, from an internal perspective (Rogers, 1961),
how difficult it is for the patient to discuss a particular topic is more effective
because it captures the patient's feelings and struggles, both internally as well
as in the therapeutic process, in a way that enables the patient to feel under-
stood rather than evaluated, judged, or even criticized. In a similar way, com-
ments from an external perspective on the patient's difficult life situation
can be experienced as sympathy (or pity), but articulating that the patient
feels overwhelmed by life events can be experienced as empathic because it
gives voice to the multiplicity of the patient's subjective experiences. Accu-
rate interpretations stated from the patient's frame of reference (Rogers, 1961)
enable patients to achieve the sense that they can make contact with others,
that they are able to communicate, and that their feelings and experiences
have an inherent logic and coherence that can be understood and accepted
by another person (Atwood & Stolorow, 1980; Blatt & Erlich, 1982; Rycroft,
1956). In many ways, this sharing of affective experiences in treatment is
similar in basic form and function to the affective communication between
child and caregiver that is so vital to psychological growth in normal devel-
opment. Gratifying involvement is basic for the development of interper-
sonal relatedness as well as for self-definition.
In his discussion of the role of interpretation in the psychoanalytic pro-
cess, S. Freud stressed the importance of empathy in enabling the analyst to
understand a wide range of the patient's subtle feelings, fantasies, and thoughts
on both a conscious and unconscious level. S. Freud (1921/1959b) viewed

empathy as "the mechanism by means of which we are enabled to take up
any attitude at all towards another mental life" (p. 110) and as "the process
. . . which plays the largest part in our understanding of what is inherently
foreign to our ego in other people" (p. 108). Kohut (1959) noted that people
understand the physical world through physical senses and the psychological
world through psychological senses—through empathy and introspection.
Empathy has a primary role not only in the therapist's formulation of inter-
pretations but also in his or her knowing how, when, and in what ways to
present them. Empathy is more than a sharing in the patient's conscious
experience; it also involves sharing and knowing how to share what the pa-
tient is avoiding experiencing or what he or she may experience in the future
with further analytic work. As S. T. Levy (1985) noted, numerous psycho-
analysts, beginning with S. Freud (e.g., Fliess, 1942, 1953; Greenson, 1960;
Knight, 1940), described how the therapist freely alternates between a mode
of unconscious perception and a more objective evaluation of the patient's
experience (e.g., see Schafer's [1959] generative empathy; Kohut's [1959,1966]
vicarious introspection; Greenson's [1960] emotional knowing; and Ogden's
[1979] projective identification). Unconscious modes of perception and the
vicarious sharing of conscious and unconscious experiences are more vulner-
able to distortion than is the direct sharing of objective facts and observa-
tions, but this form of coming to know the patient has the potential for the
richest of insights.
Basch (1983), in an extensive discussion of the concept of empathy,
noted that opinions vary widely about the role of empathy in the therapeutic
process. Some theorists (e.g., Hartmann, 1950/1964) consider empathy as
impressionistic and unscientific and therefore not central to clinical work.
Others (e.g., Brenner, 1968; Shapiro, 1965; Shevrin, 1978), such as many
cognitive-behavioral therapists (e.g., Bums & Auerbach, 1996), do not rule
out altogether the use of empathy in the clinical process but view it as poten-
tially misleading and therefore not a vehicle for systematic observation. Still
others (e.g., Basch, 1983; Buie, 1981; Kohut, 1959) view empathy as facili-
tating the treatment process by providing the groundwork that makes in-
terpretations effective. Most therapists agree that empathy has a primary role
in enabling the therapist both to formulate interpretations and to communi-
cate them in ways that facilitate the patient's ability to receive and work
effectively with the interpretations. In addition, the therapist's capacity for
empathy gives the patient the sense of being both understood and under-
standable. But others argue that empathy has an even more central and cru-
cial role in the therapeutic process—a role beyond facilitating interpreta-
tion. They argue that empathy is an inherent aspect of the evolving therapeutic
relationship and that the relationship, in and of itself, constitutes an essen-
tial (although not necessarily a sufficient) mutative factor in the treatment
process as I discussed in chapter 7 (this volume; see also Norcross, 2002;
Wampold, 2002; Zuroff & Blatt, 2006).

The degree and form of attachment (gratifying involvement) and of
separation (experienced incompatibility) that foster individuation depends
on the developmental level and the personality organization of the patient.
The relative contributions of these two dimensions of the treatment
process—the therapeutic relationship and interpretation—will vary at dif-
ferent points in the therapeutic process as the patient moves to new develop-
mental levels. As the patient's level of functioning undergoes change, even
within a single hour, it is expressed in fluctuations of the therapeutic rela-
tionship and may call for different types of interventions in facilitating sepa-
ration or of gratifying involvement in the immediate therapeutic context.
Like a parent with a developing child, the therapist can respond appropri-
ately to the developmental needs or can be too frustrating—either by prema-
turely demanding a degree or type of differentiation that exceeds the patient's
capacity for intemalization or by thwarting appropriate strivings for separa-
tion and independence. As a result of the therapist's effectively interpreting
the various forms of gratifying involvements and experienced incompatibili-
ties as they are expressed in the therapeutic relationship, patients increas-
ingly experience the therapist and themselves in new ways. These changes in
experiencing oneself and the therapist provide greater opportunity for the
intemalization of more mature aspects of the therapeutic relationship and of
more differentiated and integrated schemas of self and of interpersonal rela-
tionships (Blatt & Behrends, 1987). As a consequence of interpretation and
working through, the therapeutic relationship moves toward more mature
forms of relatedness, in which more advanced psychological needs are satis-
fied on increasingly higher levels and the self becomes more differentiated
and integrated. As Loewald (1960) noted, "the satisfaction involved in the
analytic interaction is a sublimated one, in increasing degree as the analysis
progresses" (p. 239).
Although psychological growth in therapy occurs through some of the
same processes as normal psychological development, the sequences of psy-
chological growth in therapy do not necessarily recapitulate the sequences or
stages of normal psychological development. Patients often have serious de-
velopmental impairments that frequently emerge and are resolved in treat-
ment only through temporary regression, unlike the course of normative de-
velopment. Such regressions in therapy are often necessary for more disruptive
and pathological introjects to emerge so that psychological development can
be reinstated (Blatt et al., in press). Two important areas of subsequent in-
vestigation would be (a) the consideration of the similarities and differences
between the sequences of development that occur in therapy and those of
normal psychological development and (b) a determination of whether dif-
ferent developmental sequences in therapy depend on the character style,
developmental level, and psychopathology of the patient (e.g., between ana-
clitic and introjective patients).

Interpretation and insight lead to the capacity to relinquish or revise
disruptive pathological internalizations—that is, conceptions of self and of
others that limit openness to new experiences and thwart possibilities for the
development of new aspects of the self and new dimensions of interpersonal
relatedness (Blatt & Erlich, 1982). Revising and relinquishing distorted or
pathological internalizations creates the opportunity to achieve new internal-
izations that are essential for more mature functioning. But new internaliza-
tions do not take place through interpretation and insight alone. Rather, they
also occur as a function of the patient's internalization of aspects of the thera-
peutic relationship. As Loewald (1960) stated, the resumption of ego develop-
ment in the therapeutic process "is contingent on the relationship with a new
object, the analyst" (p. 221). As I discussed in chapter 4 (this volume), inter-
nalization occurs in therapy in essentially the same way and through the same
basic process by which internalization takes place in normal development—
through a hierarchical spirality of gratifying involvements and experienced
incompatibilities within an interpersonal relationship. This hierarchical
spirality and revised internalizations lead to more mature forms of interper-
sonal relatedness and a more integrated sense of self (Blatt & Behrends, 1987).
These formulations of the mutative forces in the treatment process do
not necessarily suggest alterations of basic therapeutic technique. But these
formulations suggest that the mechanisms of therapeutic action can be bet-
ter understood by considering both the gratifying and depriving aspects of
interpretation and the therapeutic relationship—by considering how engage-
ment and disengagement or attachment and separation contribute to the
development of relatedness and self-definition in different types of patients
(e.g., anaclitic and introjective patients) in the treatment process. Patients
continually oscillate between seeking gratifying involvement with the thera-
pist and experiencing incompatibilities with this gratifying involvement in
its current form. This oscillation eventually enables the patient to internal-
ize crucial aspects of the therapeutic relationship, with this internalization
facilitating movement toward progressively higher and more mature forms of
interpersonal relatedness and self-definition. As Loewald (1960) stated, "the
analyst relates to the patient in tune with the shifting levels of development
manifested by the patient at different times but always from the viewpoint of
potential growth" (p. 230; see also Gedo& Goldberg, 1973). Loewald (1960)
also noted, "Mature object relations are not characterized by a sameness of
relatedness but by an optimal range of relatedness and by the ability to relate
to different objects according to their particular levels of maturity" (p. 230).
A mature relationship combines the gratification of intimate union with the
recognition and enhancement of separateness and personal or self-development
of both members of the relationship (Schafer, 1959).
A previously thwarted developmental process is reinitiated in therapy
by the relative neutrality of the therapist (e.g., Luyten & Corveleyn, 2003)

that allows the patient to construct the therapist in ways that meet the
patient's needs within the therapeutic relationship. The therapist comes to
directly know the patient's needs as they are expressed in the therapeutic
relationship, and interprets these needs in a way and at a pace that the pa-
tient can tolerate and work at effectively. Such interpretations constitute a
disruption or frustration of the gratifying involvement of the therapeutic re-
lationship, and this disruption encourages the patient to begin to assume for
himself or herself aspects of the functions that he or she previously depended
on the therapist to provide. Interpretations enable the patient to recognize
the nature of his or her gratifying involvement with the therapist and to
experience a sense of incompatibility with less mature types of involvement.
Less mature introjects expressed in the therapeutic relationship are eventu-
ally replaced by an identification with the therapeutic process that contrib-
utes to more stable and autonomous identifications (Meissner, 1979). The
patient's internalization of significant aspects and functions of the therapeu-
tic relationship is consistent with S. Freud's (1921/1959b) observation, "In
the individual's mental life someone else is invariably involved, as a model,
as an object, as a helper, as an opponent" (p. 69).
Tarachow (1963) pointed out that interpretations challenge the illu-
sion that the therapeutic relationship will reenact aspects of actual, wished
for, or feared gratifications and frustrations of more primary infantile rela-
tionships. As Tarachow (1963) noted,
We assist our patients to develop access to their real feelings, especially
to the therapist, and then refuse to treat these feelings as real. . . . The
very basis for an analysis involves really disappointing the patient. . . .
Mourning is a necessary part of treatment, from the very first interpreta-
tion. ... In a therapeutic relationship both partners must be capable of
moments of loneliness, (pp. 13-15)
But it is important to stress that this sense of disappointment and loss occurs
in the context of a gratifying involvement—in a therapeutic relationship in
which the patient feels accepted, respected, and understood.
Experienced incompatibility can take many forms in therapy besides
interpretation, such as interruptions of the cadence of hours because of the
absence of the therapist or patient, failures in communication and empathy,
or the patient's own increasing dissatisfaction with his or her level of func-
tioning. It is important to stress that experienced incompatibility not only is
externally imposed by the therapist through interpretations or by events such
as the therapist's silence, neutrality, or absence, but can also originate with
the patient, who may become increasingly dissatisfied with a particular level
of gratifying involvement. These experienced incompatibilities propel the
patient and the therapist to reestablish the gratifying involvement of the
therapeutic relationship in a new form. This redefinition of the self and this
recasting of the relationship sometimes occur in bold and dramatic form.

Often, however, this process is subtle and even imperceptible as it occurs
from moment to moment (Behrends & Blatt, 1985).
Interpretations are generally conceptualized as a major form of con-
frontation or experienced incompatibility. But it is important to stress that
for an interpretation to be truly mutative, it must embody both a gratifying
involvement, in the patient's feeling understood, and an incompatibility in
limiting the patient experiencing the therapist as a gratifying transference
object. Simply because an interpretation is technically correct, however, does
not ensure that it will necessarily be therapeutic and mutative. The timing
and tact of the intervention, as well as the tone of the intervention and the
quality of the therapeutic relationship, influence its therapeutic effective-
ness. In this sense, interpretations and the therapeutic relationship are inex-
tricably intertwined and are interdependent.
Interpretations implicitly encourage the patient to seek a real object—
the empathic and concerned therapist in a more mature relationship that has
evolved with the patient's emerging sense of self. Relinquishing less mature
forms of gratification (including masochistic forms of gratification) requires
the patient and the therapist to try to reestablish the gratifying involvement
on a new level. Following an experienced incompatibility, the patient tries
to restore the sense of a gratifying relationship with the therapist. Much as
when the mother is absent and the child struggles to form some sense of her
gratifying presence, the patient struggles to establish a fuller sense of the
therapist and of himself or herself in the therapeutic relationship. The pa-
tient, having internalized a significant aspect of the therapeutic relationship,
will revise his or her sense of self and be able to relate to the therapist in a
new way. Likewise, the therapist will feel the need to move to a new level of
therapeutic involvement and interpretation. The next series of interpreta-
tions, if accurate, empathically stated, and well timed, should lead to the
next level of gratifying involvement and it, in turn, will be disrupted by an
experienced incompatibility fostering yet a new level of internalization and
development of a new sense of self. Research findings (Jimenez, Kachele, &
Pokorny, 2006), for example, indicate that important constructive changes
can occur in the therapeutic process shortly before or subsequent to a separa-
tion over weekends or holidays if they are adequately managed by the thera-
pist. According to Jimenez and colleagues, the stereotypical interpretation
that all patients deteriorate with separations "is in a way, a self-fulfilling proph-
ecy" (Kachele et al., 2006, p. 12). As the formulations in this chapter sug-
gest, experiences of separation can facilitate the therapeutic process if the
importance of separation and of experiences of incompatibility is recognized
in the treatment process. Separation or experienced incompatibilities can
consolidate internalizations that have begun to emerge in the gratifying in-
volvements within the therapeutic relationship. Early in treatment, construc-
tive changes in psychological organization and representational structures
may occur after a separation or a major interpretation. Later in treatment,

major changes may also occur in anticipation of separation rather than as a
reaction to it (Blatt & Behrends, 1987).
Atwood and Stolorow (1980) noted that "empathic failure or separa-
tions" result in "structuralization through internalization" as the patient at-
tempts to "invoke an image of the analyst's empathic responsiveness"
(p. 279). As Atwood and Stolorow implied, internalization, however, is a
complex process and occurs in response not only to disruptions of the em-
pathic bond but also to any experienced incompatibility that alters the
patient's level of gratifying involvement with the therapist. Internalization
results not just from separation or empathic loss, but from the multiplicity of
ways a patient can experience a loss of gratifying involvement with the thera-
pist. Thus, the process of internalization is more than just establishing an
image or a sense of an empathic therapist. Rather, it is a complex process
that can range across a wide spectrum that depends on the patient's level of
psychological development and is expressed in the integration of the patient's
sense of self with aspects of the therapist and of the therapeutic relationship.
As therapy progresses, the content and the developmental level of the patient's
intemalizations can gradually shift in numerous ways. These shifts in inter-
nalization can include re-creations of sensorimotor experiences of feeling
soothed and comforted in the therapeutic hour, establishment of a contin-
ued sense of the presence of the therapist initially in a concrete and literal
form, fantasies of hearing the therapist's voice or imagining certain aspects of
his or her comments, asking questions and making observations of oneself as
the therapist might, and eventually assuming for oneself the empathic, inter-
pretive, self-reflective analytic function (Blatt, 1974). More recent research
findings of a significant increase in the capacity for "mentalization" (e.g.,
Bateman & Fonagy, 1999, 2003; K. N. Levy, Clarkin, et al., 2006; K. N.
Levy, Meehan, et al., 2006) and for "mindfulness" (e.g., Dimidjian & Linehan,
2003; Heard & Linehan, 1993; Robins, 2002; Segal, Williams, & Teasdale,
2002) in the treatment of patients with borderline personality disorder are
consistent with these formulations. These changes in the capacity for
mentalization are consistent with the changes noted in the structural organi-
zation of representations of self and significant others in treatment-resistant
patients who are seriously disturbed, as I discussed earlier in this chapter. As
Hartmann, Kris, and Loewenstein (1946) noted, internalization is a process
through which autonomous self-regulation comes to replace regulation by
the object.
McLaughlin (1981), summarizing follow-up studies of patients in psy-
choanalysis (Norman, Blacker, Oremland, & Barrett, 1976; Oremland,
Blacker, &Haskell, 1975; Pfeffer, 1959,1961,1963; Schlessinger & Robbins,
1974, 1975) and of training analyses with analytic candidates (Baum, 1977;
Shapiro, 1965), concluded that "improvement and change depend not truly
upon obliteration of old structures and conflicts, but upon their inactivation
through internalization of higher level psychic structures built up through

processes of transference in the analytic work" (p. 629). Experiences of the
therapeutic relationship and memories of the attitudes and enactments of
the therapist remain vivid memories and a vital part of the patient's inner
life, with effects that seem to be enduring. What was "crucially different" in
successful cases was that adaptation toward dynamic and object-related is-
sues was "altered for the better through the patient's internalization of as-
pects of the analyst's way of looking at things, now a self-analytic function
and probably permanent new intrapsychic representation" (McLaughlin, 1981,
pp. 652-653). Therapy produces change, concluded McLaughlin, "through
the internalization, as new psychic structures, of attitudes and values experi-
enced in the relationship to the analyst" (p. 658) and the "intrapsychic trans-
formation of old transferences into new and more adaptive transferences,
organized around a new object, the . . . analyst" (p. 657).
As the patient develops a progressively more differentiated representa-
tion of self, therapist, and therapeutic relationship and process, the therapist
likewise establishes a "special kind of internal object representation" of the
patient (Greenson, 1960, p. 423) that grows in subtlety and complexity dur-
ing the therapeutic process (Buie, 1981; Schafer, 1959). The therapist's work-
ing representation of the patient evolves and changes as the therapist expe-
riences the patient's growth in the context of the therapeutic relationship.
The therapist's representation of the patient is constantly revised and re-
worked throughout the therapy and becomes a series of highly differentiated,
rich, and diverse sets of concepts and images of the patient and his or her
past, present, and wished-for future life. The continual refinement of these
representations enables the therapist to move increasingly more readily and
effectively into the patient's subjective world (Blatt & Behrends, 1987).
Therapy may initially be experienced by the patient primarily as a hold-
ing environment that keeps experienced incompatibilities to a minimum.
With time and psychological development, however, the patient may be able
to tolerate and work with interpretations at much greater depth. As a conse-
quence, the therapist begins to develop a representation of the patient as a
person who increasingly functions independently. And eventually, in the
closing phases of the therapy, the therapist gradually relinquishes the inter-
pretive function by becoming increasingly silent. As a result of internaliza-
tion in the closing phases of therapy, the patient achieves a fuller sense of
self, with a growing sense of autonomy and independence, and acquires the
interpretive function that he or she previously depended on the therapist to
provide. It is crucial to emphasize in this regard that the patient internalizes
not only the interpretive activity but also the therapist's sensitivity, compas-
sion, and acceptance. Both the therapeutic relationship and interpretations
(gratifying involvement and experienced incompatibility or attachment and
separation)—two mutative forces in the therapeutic process—are internal-
ized by the patient in successful therapy. For example, a patient who has
internalized only the interpretive function could conduct the process of self-
RELATEDNESS AND SELF-DEFINITION IN THE THERAPEUTIC PROCESS 2 71

inquiry with the harshness of a critical, punitive, external judge. By the time
of termination, ideally the patient can conduct the process of self-inquiry
with the concern and empathy experienced in a relationship with a caring
parent or therapist. Internalizations that combine aspects of gratifying in-
volvement and experienced incompatibility (relatedness and self-definition),
as brought about by empathically stated mutative interpretations, contribute
to the development of the patient's ability to conduct self-inquiry and ex-
amination with a balanced acknowledgment and acceptance of his or her
limitations and strengths. Also, the experience of feeling accepted, under-
stood, and cared for by another enables patients to feel eventually that they,
in turn, might also be capable of understanding and loving others (Nacht,
1962). Internalization is not just simple imitation or an appropriation of the
activities or characteristics of the other, but an integration into the self of
aspects of gratifying interactions experienced in the relationship, as well as a
consolidation of one's own activities established in relation to the other, of
what was identified in chapter 4 (this volume) as features of the expressive
mode of self (Blatt & Blass, 1996). Thus, internalization in therapy enables
the patient to continue the therapeutic process after termination (Blatt &
Behrends, 1987; Hartlaub et al, 1986; Ticho, 1972).
Internalization occurs throughout therapy, but it is particularly central
for both the patient and the therapist in the termination phase. With termi-
nation, the ultimate experienced incompatibility in therapy, the patient must
carry on the therapeutic work alone, with the initial task of working through
the difficult process of mourning. In termination, a fundamental uncertainty
always remains for both patient and therapist. Neither can be absolutely cer-
tain of the outcome because internalization of the therapeutic relationship
and a consolidation of the sense of self can reach its fullest extent only subse-
quent to formal termination. The therapist, however, can feel confident about
termination when he or she has established a well-consolidated and stable
representation of the patient as being able to conduct the therapeutic dia-
logue in his or her own right.
If the locus of therapeutic action resides in the evolving therapeutic
relationship (Blatt & Erlich, 1982), the patient is not the only one likely to
be affected by the analytic process (e.g., see Tower, 1956; Weigert, 1952). As
with normative development, as I discussed in chapter 4 (this volume), the
inevitable revisions that can occur in any intensive relationship are likely to
result in new internalizations for both participants. These formulations di-
rectly raise the question of the impact of therapy on the therapist. S. Freud
(1954), in fact, noted that one's own self-analysis can proceed by way of
analyzing others. Subsequent research should be directed toward considering
the psychological impact of the therapeutic process on the therapist. The
experience of conducting long-term, intensive treatment, for example, en-
ables the therapist to extend and enrich his or her self-concept, if only to
grow in the sense of himself or herself as an effective and competent thera-

pist. But participating in the therapeutic process also stimulates the therapist's
further clarification of his or her own personal issues as well. Certainly the
significance and intensity that the therapeutic relationship has for the thera-
pist is different from the depth of meaning it has for the patient. But the
issues with which patients struggle, and the infinite variety of ways they can
relate to the therapist, require continued self-analysis of the therapist's re-
sponses and reactions to them, and this self-analysis results in further inter-
nalization and revisions of self-definition for the therapist as well (Blatt &
Behrends, 1987).
Thus, therapeutic progress appears to occur through the same mecha-
nisms and in a way similar to normal psychological development. Therapeu-
tic change occurs as a developmental sequence that can be characterized as a
constantly evolving process of attachment and separation-individuation, of
evolving levels of interpersonal relatedness and self-definition that derive
from sequences of gratifying involvement, experienced incompatibility, and
intemalization. Patients gradually come to experience the therapist and them-
selves as separate, increasingly free of distortion by narcissistic needs or pro-
jections from past relationships. Union and separation, relatedness and self-
definition, are fundamental and universal psychological needs and experiences
that occur repeatedly in the course of psychological growth and develop-
ment (see.also Nacht, 1962) and are essential in the therapeutic process.
Therapy involves interpretation and confrontation as well as the establish-
ment of an empathic bond in the therapeutic alliance. Both interpretation
and the therapeutic relationship are essential components of the therapeutic
process (Blatt & Behrends, 1987; Fonagy, Gergely, Jurist, & Target, 2002;
Munich, 1983).
Interpretation and working through provide recognition and insight
into the distorted modes of interpersonal interaction and the distorted sense
of self that emerge in the transference, but the therapeutic relationship pro-
vides basic experiences that allow the individual to revise and extend his or
her sense of self, as well as to explore and develop new modes of relatedness.
The basic mutative factor is the patient's experience of himself or herself and
of the therapist within the context of the therapeutic relationship (e.g., Zuroff
& Blatt, 2006). Both attachment and separation, gratifying involvement and
experienced incompatibility, are essential elements in the process of inter-
nalization that must take place if psychological development is to occur within
the therapeutic process. As noted earlier, the mutative factors that facilitate
growth in intensive therapy involve some of the same fundamental mecha-
nisms that lead to psychological growth in normal development. Repeated
cycles of attachment, separation, and intemalization are the central mecha-
nism of the therapeutic process. The therapeutic process is a series of gratify-
ing involvements and experienced incompatibilities that facilitate intemal-
ization, whereby the patient internalizes gratifying interactions with the
therapist by appropriating aspects of these interactions, transforming them

into his or her own enduring, self-generated functions and characteristics
(Blatt & Behrends, 1987). Patients internalize the therapist's interpretive
activity and emphasis on self-understanding as well as the therapist's sensi-
tivity, compassion, and acceptance. Patients also internalize aspects of their
own activity in the treatment process such as free association, self-reflectivity,
and feelings of appreciation and affection in relation to the therapist. Grati-
fying involvements and experienced incompatibilities lead to more mature
expressions of self-definition and the capacity for reciprocal interpersonal
relatedness. This integration often begins with the patient's experience of
himself or herself in the relationship with the therapist in the therapeutic
process.
MECHANISMS OF THERAPEUTIC CHANGE
Fundamental differences occur in the therapeutic process with anaclitic

and introjective patients. I (Blatt, 2004) recently discussed the differential
role of two primary mechanisms of therapeutic action—the therapeutic rela-
tionship and interpretation and insight—in the treatment of anaclitic and
introjective depression. The research findings I presented in chapter 7 (this
volume) indicate that these considerations of the dynamics of the treatment
process extend well beyond the treatment of two types of depression and
apply to anaclitic and introjective patients more generally, to patients whose
difficulties can be located in either of two primary configurations of psycho-
pathology, as I discussed in chapter 6 (this volume).
Further analyses of data from the MPRP suggest that supportive-ex-
pressive psychotherapy (SEP) and psychoanalysis (PSA) have therapeutic
effects through different therapeutic mechanisms. SEP led to a significant
reduction in the number of Rorschach responses in both anaclitic and
introjective patients, whereas PSA led to a significant increase in the num-
ber of Rorschach responses in both types of patients (Blatt & Shahar, 2004b).
The increase in associational activity in PSA and a decrease in SEP, and the
constructive effects of PSA with introjective patients and of SEP with ana-
clitic patients in the MPRP, is consistent with findings (Fertuck, Bucci, Blatt,
& Ford, 2004) that therapeutic progress in seriously disturbed, treatment-
resistant, anaclitic inpatients in the R-YP was associated with a reduction in
referential activity, whereas progress in introjective patients was significantly
associated with its increase. Fertuck and colleagues, using computer analyses
developed by Bucci (1984), evaluated linguistic discourse in narrative re-
sponses to a standard set of Thematic Apperception Test (TAT) cards at
intake and much later in the treatment process in the R-YP. They assessed
changes in the degree to which emotional experiences in the TAT narra-
tives were translated into language capable of evoking corresponding experi-
ences in a listener, what Bucci (1984) called referential activity. The findings

by Fertuck et al. about the differential relationship between referential think-
ing in the TAT narratives and the therapeutic response of anaclitic and
introjective patients in the R-YP, consistent with the results from the MPRP
(Blatt & Shahar, 2004b), suggest that anaclitic patients have better thera-
peutic response in a treatment process that inhibits associational and refer-
ential activity, whereas introjective patients have better therapeutic response
in a treatment that facilitates these activities.
The differential role of associative and referential thinking in the thera-
peutic process of anaclitic and introjective patients in both the MPRP and
the R-YP suggests that different treatment modalities may have unique ef-
fects on associative activity and that changes in this associative activity may
be an important part of the mechanism through which each treatment mo-
dality results in constructive therapeutic change with different types of pa-
tients. Thus, SEP may have been more effective with anaclitic patients in
the MPRP because it provided a supportive therapeutic context that con-
tained associative activities and expressions of maladaptive interpersonal
schemas of the affectively labile, emotionally overwhelmed, and vulnerable
anaclitic patients. PSA, in contrast, may have facilitated the development of
adaptive interpersonal schemas and the decrease of maladaptive schemas
primarily in introjective patients because the intensity of the explorations
and interpretations in PSA may have effectively engaged these more distant,
interpersonally isolated patients. These conclusions are partly consistent with
findings by Fonagy et al. (2002) that increases in reflective function (RF), or
mentalization, as assessed on the Adult Attachment Interview (AAI), is an
important dimension of the therapeutic process (see also K. N. Levy, Clarkin,
et al., 2006).9
Increases in referential thinking (e.g., Fertuck et al., 2004), associative
activity in Rorschach responses (Blatt & Shahar, 2004b), and mentalization
or RF in the AAI (Fonagy et al., 2002) appear to have an important role in
9
RF assesses the degree to which an individual has developed an appreciation of mental states, both
one's own and those of others. Using the AAI, Fonagy and colleagues (e.g., 2002) evaluated
individuals' capacity for RF and demonstrated that the development of this capacity is significantly
related to therapeutic progress (see also K. N. Levy, 2002). According to Fonagy et al. (2002), two
primary dimensions of the therapeutic process, interpersonal and interpretive dimensions, contribute
to the development of mentalized connections for fundamental affective experiences. Meanings are
connected to affective experiences in the treatment process through the development of "second-order
representations" derived from "interpersonal interpretive mechanisms" (Fonagy et al., 2002, p. 16).
Fonagy and colleagues viewed the establishment of linkages between affect and cognition in therapy
as essential for the development of an agentic sense of self and the capacity to establish close
relationships. They assumed that the development of mentalization, or RF, is critical to therapeutic
progress with all patients. But, as Fonagy et al. noted, therapeutic progress stems from both
interpersonal and interpretive mechanisms, and findings in the MPRP and the R-YP, as well as the
findings from the K-LS (Vermote, 2005), and discussed in chapter 7 of this volume, suggest that some
patients may be more responsive to the interpersonal dimensions and other patients may be more
responsive to the interpretive aspects of the treatment process (see also Blatt & Behrends, 1987, and
Blatt, Shahar, & Zuroff, 2001). Vermote and colleagues are systematically exploring these hypotheses
in an extension of the K-LS.
RELATEDNESS AND SELF-DEFINITION IN THE THERAPEUTIC PROCESS 2 75

the treatment of introjective patients who, with their primarily ideational
orientation, seem responsive to the interpretive dimensions of the treatment
process.10 Affectively labile anaclitic patients, in contrast, with their prima-
rily interpersonal orientation, appear to be more responsive to the support-
ive and containing dimensions of the therapeutic relationship. Although the
interpersonal and interpretive dimensions (Blatt & Behrends, 1987; Fonagy
et al., 2002) are intertwined in the therapeutic process (interpretations are
effective primarily in the context of a constructive therapeutic relationship,
and the therapeutic relationship, in turn, is enhanced by accurate, well-timed,
empathic, tactfully stated interpretations), some patients seem to respond
primarily to the quality of the therapeutic relationship, whereas others seem
responsive primarily to interpretations and the gaining of insight and self-
understanding. Although most patients undoubtedly gain from both of these
therapeutic dimensions, the differential response of anaclitic and introjective
outpatients to PSA and SEP in the MPRP and the results from the R-YP and
K-LS suggest that different types of patient may be differentially responsive
to these two different aspects of the therapeutic process.
These findings offer empirical support for the importance of the thera-
peutic relationship in the treatment of anaclitic patients, patients whose con-
cerns and conflicts focus primarily on issues of interpersonal relatedness, and
the central role of interpretation and insight in the treatment of introjective
patients, whose concerns and conflicts focus primarily on issues of self-
definition and self-worth. The differential response of anaclitic and
introjective patients to SEP and in PSA is consistent with findings about the
differential therapeutic response of individuals with different types of inse-
cure attachment (see Meyer & Pilkonis, 2002, for a summary). As I discussed
in chapter 7 (this volume), patients with a resistant attachment style (ana-
clitic patients) are responsive primarily to the containing and supportive
aspects of the therapeutic process, whereas patients with an avoidant attach-
ment style (introjective patients) are responsive primarily to more explor-
atory aspects of the treatment process. In sum, these findings indicate that
affectively labile anaclitic patients are most responsive to containment, or-
ganization, and support provided by the therapeutic relationship, whereas
therapeutic progress with introjective patients is primarily the consequence
'"Although a number of studies have found that changes in cognitive activity are an important aspect
of therapeutic change, research groups have different conceptions of this cognitive activity and its
assessment. Blatt, Shahar, and Fertuck (2003), for instance, found no significant relationship between
changes in referential activity in narratives told to the TAT and changes in the number of Rorschach
responses during the treatment of seriously disturbed treatment-resistant inpatients in the R-YP. Thus,
future research needs to examine the conceptual assumptions and measurement procedures in these
various approaches to the study of the cognitive processes considered important in the process of
therapeutic change, especially with introjective patients. Research is also needed to examine further
the effects of different treatment processes on cognitive activity and how different measures of this
cognitive activity—RF (Fonagy et al., 2002), referential activity (Bucci, 1984), and associative
activity on the Rorschach—are interrelated and contribute to therapeutic change in different types of
treatment with different types of patients (see also K. N. Levy, Meehan, et al., 2006).

of the engagement of these interpersonally distant, isolated, and emotionally
controlled patients in more extended and intensive exploratory treatment
(see also Fonagy et al., 1996, and Gabbard et al., 1994).
Although SEP, in a broad and general sense, highlights the interper-
sonal or relational dimension and PSA emphasizes more the interpretive
dimension, both dimensions exist in most psychotherapeutic approaches.
These two dimensions appear in a relative balance in every psychotherapeu-
tic endeavor. Although different types of patients appear differentially re-
sponsive to these two dimensions, these results do not necessarily indicate
that therapists should alter their therapeutic style to accommodate the char-
acterological emphasis of particular patients (Blatt, 1992). The findings do
suggest, however, that therapists need to be alert to the fact that different
patients, particularly in the early phases of treatment, may be differentially
responsive to one or the other of these two dimensions and that these dimen-
sions have important implications for understanding transference and coun-
tertransference dynamics.
Hugo Bleichmar (1996) also addressed the question of whether differ-
ent types of therapeutic intervention are necessary for different types of pa-
tients. On the basis of Kilingmo's differentiation between interpretations
and "affirmative interventions" that validate the patient's perception of real-
ity (the differentiation between interpretations and the therapeutic relation-
ship), Bleichmar noted that different types of interventions may be required
to deal with certain personality traits in the treatment process. He found
that uncovering interpretations were more effective with a man with depres-
sion who had strong aggressive tendencies (an introjective patient); for this
patient who was unresponsive to attempts to create an empathic relation-
ship, only interpretations were able to produce the desired effects. In con-
trast, Bleichmar noted that a young woman whose severe depression was in
response to having been abandoned by her boyfriend (an anaclitic patient)
responded primarily to aspects of the therapeutic relationships—to the tone,
cadence, rhythm, and timing rather than the content of the interventions.
Although Bleichmar's examples are consistent with the formulations of the
differential therapeutic response of anaclitic and introjective patients, he
correctly noted that each patient presents a unique configuration of many
dimensions and that in the clinical application of research findings, it is nec-
essary to recognize the particularity of each patient and each treatment.
The research findings suggest that anaclitic patients who are more at-
tentive to interpersonal dimensions are usually more responsive to aspects of
the interpersonal or relational dimensions of the treatment process—to
the dependability, empathic, and supportive aspects of the therapeutic
relationship—and they express their therapeutic gains primarily in changes
of their interpersonal relations (Blatt & Ford, 1994). Introjective patients,
by contrast, are more responsive to the interpretive aspects of the treatment
process because it is congruent with their more intellectualized cognitive

style. They are comfortable with a more objective, task-oriented, detached
therapeutic relationship and the insights gained in treatment than they are
with the relational aspects of the treatment process. And they express their
therapeutic progress primarily in changes in their manifest symptoms and
cognitive functioning (Blatt & Ford, 1994). More alienated and interper-
sonally distant introjective patients are wary about personal feelings in the
treatment process; such feelings about the therapy and the therapist can pro-
voke concerns about losing power and control in the therapeutic process,
possibly even precipitating feelings of distrust and suspicion. Although these
more alienated and distant introjective patients usually have self-reflective
capacities that can enable them to benefit from more intensive exploratory
treatment, therapy usually has to be more extended and intensive to enable
these patients to begin to feel safe and secure enough with the therapist to
begin to establish a meaningful therapeutic alliance based on feelings of trust
and mutuality.
In the treatment process, anaclitic patients initially focus on their diffi-
cult and disrupted interpersonal relationships—on feeling unloved, unwanted,
neglected, and abandoned early in their lives as well as on their current ef-
forts to establish gratifying involvements with others. Because anaclitic pa-
tients are concerned about the dependability of care, affection, and love in
interpersonal relationships, transference enactments often involve concerns
about the consistency and dependability of the therapist—on experiences of
loss and abandonment as well as failures in empathy they experience within
the treatment process. These patients will test aspects of the therapeutic re-
lationship and seek manifest assurance about the therapist's care, concern,
and commitment. Thus, anaclitic patients are more likely to be more respon-
sive initially to the supportive and interpersonal dimensions of the therapeu-
tic process. As these issues are expressed, enacted, and eventually resolved to
some degree in the treatment process, anaclitic patients begin to develop a
more mature level of interpersonal relatedness with the therapist involving
an increased capacity for shared concern, empathy, mutuality, and reciproc-
ity, rather than unilateral dependency. As intense feelings of frustration and
rage over deprivation of care, affection, and love begin to diminish, anaclitic
patients are strengthened by their increased access to positive interpersonal
experiences and begin to deal more effectively with painful affects and to
develop more mature forms of interpersonal relatedness, initially in the treat-
ment process and eventually beyond the therapeutic relationship.
Introjective patients, in contrast, focus in treatment on issues of self-
definition, such as feelings of worthlessness, failure, and guilt and shame that
they have failed to live up to expectations and standards. These conflicts
around self-definition, self-control, and self-worth, as well as around intense
anger at others and at oneself for experiences of vulnerability, worthlessness,
failure, and transgressions of omission and commission, become major issues
in the treatment process. Harsh, critical, judgmental, intrusive, punitive, and

controlling early relationships are expressed in transference enactments over
issues of power, control, autonomy, criticism, and self-worth, issues that are
the initial focus in treatment. These issues are explored in experiences of
success and failure in struggles to establish and consolidate self-definition
including feelings of recognition and power. Overideational introjective pa-
tients are initially more responsive to the exploratory and interpretive as-
pects of the treatment process and the insights and knowledge they gain than
they are to the more relational aspects of the therapeutic process. As these
experiences of personal vulnerability, self-loathing, and self-criticism and of
intrusive, judgmental, and punitive relationships are expressed, enacted, and
worked through in the treatment process, the distorted and disruptive inter-
nalizations of introjective patients become less critical, harsh, and punitive.
As these disruptive, punitive, judgmental introjective experiences become
less intense and pervasive in the representational field of introjective
patients, they begin to construct a more realistic and differentiated self-
definition and identity. The therapist and other significant people in the
environment can become an essential part of the treatment process as alter-
native figures with whom the patient can begin to establish meaningful and
constructive identifications. The intemalization of these more constructive
identifications contributes to the construction of a more realistic, stable, and
flexible self-definition—to feelings of self-worth, an effective and flexible
moral code, and appropriate and realistic standards and aspirations.
Thus, anaclitic and introjective patients both struggle with distorted
and pathological introjects. Anaclitic patients have to deal with their lack of
internalized caring experiences with their parents and have, instead, inter-
nalized aspects of figures experienced as uncaring, inconsistent, and unlov-
ing, who have induced in them feelings of being unwanted, uncared for, and
unloved. Introjective patients, in contrast, deal with figures they have expe-
rienced as harshly critical, punitive, and judgmental and who have induced
in them feelings of being bad, worthless, even evil. Thus, therapy with ana-
clitic and introjective patients follows the same basic principles—dealing
with disruptive and pathological introjects that have been experienced as
either neglectful and uncaring, in the case of anaclitic patients, or as in-
tensely critical, judgmental, and punitive, in the case of introjective patients.
In effective psychotherapy, these distorted and disruptive introjects are re-
vised, relinquished, and replaced with experiences of dependability, care,
affection, mutuality, and reciprocity in anaclitic patients, and by a diminu-
tion of harsh and rigid standards for oneself and for others in introjective
patients, together with increased feelings of pride, competence, and self-
respect.
The therapeutic goal with both anaclitic and introjective patients, thus,
is essentially the same: to enable them to develop and integrate increasingly
mature levels of both interpersonal relatedness and self-definition. Anaclitic
and introjective patients, however, usually approach this goal from some-

what different perspectives and directions, as expressed in divergent initial
focal concerns and differing types of transference and countertransference
enactments in the treatment process—enactments that derive from very dif-
ferent early-life experiences. The expression of these focal concerns and trans-
ference enactments in the treatment context enables the therapist to ob-
serve the nature and power of the repetitive distorted self-images and modes
of interpersonal relatedness, and to discover ways to intervene that help the
patient to begin to recognize, understand, and eventually relinquish these
maladaptive and distorted modes of functioning and to replace them with
more adaptive representations of self and others—representations that are
more realistic and linked to present life circumstances, rather than to repeti-
tions of early traumatic and destructive relationships.
As therapy progresses, the need for exaggerated emphasis on one devel-
opmental line diminishes and thus allows the patient to begin to consider
and explore issues from the neglected developmental line as well. Patients
with anaclitic psychopathology begin, later in treatment, to explore issues of
self-definition and to consider themselves as independent and autonomous
individuals with personal needs and values. When anaclitic patients feel se-
cure in the therapeutic relationship and are no longer threatened by appre-
hensions of abandonment and loneliness, they can begin to consider issues of
self-definition and assert a sense of agency. Thus, for example, they may no
longer simply seek to be loved but can now begin to consider the type of
person with whom they wish to share feelings of love and intimacy. Patients
with predominantly introjective psychopathology begin, later in treatment,
to allow themselves to consider issues of interpersonal relatedness and feel-
ings of intimacy and mutuality. As introjective self-critical patients begin to
feel secure in their self-definition and are no longer threatened by interper-
sonal closeness, they can begin to allow themselves to get close to and trust
others. Thus, as anaclitic and introjective patients make therapeutic progress
and resolve to some degree their unique vulnerabilities—the former to loss
and abandonment, the latter to impaired feelings of self-definition and self-
worth—issues from the alternative developmental line begin to emerge in
the treatment.
In the later stages of the treatment process with both anaclitic and
introjective patients, a normal dialectical interaction between the develop-
ment of relatedness and that of self-definition, as I discussed in chapter 4
(this volume), begins to emerge in the treatment. Thus, the therapeutic pro-
cess enables both anaclitic and introjective individuals to reactivate "a pre-
viously disrupted developmental process" (Blatt & Shichman, 1983, p. 249)
in which an integrated and coordinated development of both self-definition
and interpersonal relatedness evolves in each developmental line in its own
right, with both lines synergistically contributing to overall development
(Blatt & Blass, 1990, 1996). The therapeutic process should facilitate access
to this normal dialectical developmental process and lead ultimately to the

integration of more mature levels in both the relatedness and the self-
definitional developmental lines—to establishment of an identity of a self-
in-relation to others that provides the basis for mature engagement in pur-
poseful and constructive activities and to the development of mutually satis-
fying and reciprocal interpersonal relationships (Erikson, 1954). The
reactivation of this normal process, one that has its own developmental tra-
jectory, enhances the therapeutic process and leads eventually to the devel-
opment of more differentiated and integrated levels of interpersonal related-
ness (e.g., the capacity for intimacy) and self-definition (e.g., identity and
integrity). In addition, in therapy, both anaclitic avoidant and introjective
counteractive defenses (as discussed in chap. 4, this volume) become more
effective and flexible. These formulations need to be evaluated systemati-
cally in detailed clinical and empirical observations of therapeutic change
throughout the treatment process and beyond, but it is noteworthy that these
considerations are beginning to address dimensions that are central to the
therapeutic process—the identification of possible mechanisms of therapeu-
tic change.
Although diagnostic formulations indicating that the patient's pathol-
ogy seem to be primarily in one configuration or the other (i.e., anaclitic or
introjective) and may initially be quite clear, diagnostic formulations may
become more problematic as therapy progresses and the patient begins to
explore issues from both developmental lines. As I discussed in chapters 4
and 6 (this volume), therapy ideally enables the patient to reinstitute the
complex dialectical developmental transaction between the development of
the capacity to establish satisfying interpersonal relationships and the estab-
lishment of meaningful concepts of self. The reactivation of this disrupted
developmental process should allow both of these developmental lines to
progress to higher levels of organization.
In effective psychotherapy, as in normal development, the anaclitic
and introjective developmental lines become integrated in a complex trans-
action and synthesis. Psychological maturity involves the integration of
mature levels of interpersonal relatedness and self-definition, as well as a
synthesis of the higher levels of anaclitic (avoidant) and introjective (coun-
teractive) defenses. The synthesis of these higher order defenses leads to the
development of the capacity for sublimation, in which well-modulated, so-
cially appropriate, and personally meaningful behavior derives from and, in
turn, contributes to the further development of a full sense of personal iden-
tity, of a self-in-relation to others, and of the capacity to develop mutually
satisfying and reciprocal interpersonal relationships (Blatt & Shahar, 2005).
These more mature levels of interpersonal relatedness and self-definition are
expressions of more differentiated and integrated representations of self and
representations of more mutual and reciprocal interpersonal relatedness.
These clinical observations and theoretical formulations suggest that
therapeutic change involves two fundamental processes:
RELATEDNESS AND SELF-DEFINITION IN THE THERAPEUTIC PROCESS 28 J

• Relinquishing, revising, and transforming disruptive introjects
that have had powerful distorting effects on patients' lives and
that are expressed in the therapeutic relationship and may be
projected on the therapist in the treatment process.
• As these pathological introjects are expressed and begin to be
resolved in the therapeutic process, patients begin to construct
more adaptive interpersonal schemas through internalizing as-
pects of the relationship with the therapist and of the thera-
peutic process, aspects that express patients' own adaptive ca-
pacities, the development of which has been thwarted by their
psychological disturbances (Blatt, Auerbach, Zuroff, & Shahar,
2006; Blatt, Stayner, et al., 1996).
As these more adaptive representations are experienced and expressed

in the therapeutic relationship, patients more fully appropriate these more
mature interpersonal schemas through internalization (i.e., identification).
These revised cognitive-affective schemas include the construction of a more
coherent self-definition (an identity) and a capacity to appreciate and estab-
lish mutual reciprocal interpersonal relationships. Distorted internalizations
that impair functioning are relinquished, revised, and replaced by new psy-
chic structures that are organized around experiences with a new figure—the
therapist (Loewald, 1973; McLaughlin, 1981). Some research findings and
clinical reports (e.g., Fonagy & Target, 2005; K. N. Levy, Clarkin, et al.,
2006; Vermote, 2005), like those of Blatt, Stayner, et al. (1996) that I discuss
earlier in this chapter, demonstrate the importance of changes in the inte-
gration of representations of self and of significant others in the treatment
process.
These revisions of representations of self, of others, and of their actual
and potential interpersonal interactions are essential in the therapeutic pro-
cess with all patients, but they are particularly apparent in long-term and
intensive treatment of patients who are seriously disturbed. Qualitative analy-
ses of changes of representations of self and others over the course of long-
term intensive treatment of treatment-resistant patients who are seriously
disturbed (see Blatt, 2004; Blatt & Auerbach, 2001; Blatt et al., in press;
Blatt, Stayner, et al., 1996; Fonagy & Target, 2005, for clinical examples of
this process) indicate that patients may not only internalize the therapeutic
activities, attitudes, and functions they have experienced in the therapeutic
interaction but also actively seek to identify and construct in their therapist
qualities that derive from or meet some of the patients' own needs, their
development of which had previously been thwarted by their psychological
disturbances and conflicts. With the resolution of more pathological introjects
in the treatment process, some patients then appropriate as their own quali-
ties that they have long sought to acquire for themselves and have now iden-
tified and experienced in the therapeutic process or have constructed as at-

tributes of the therapist. These more adaptive psychic structures are eventu-
ally appropriated in a consolidated way through internalization—through
identification with aspects of the therapeutic process and of the therapist
(Blatt et al., in press; Blatt, Stayner, et al., 1996).
In the therapeutic relationship, patients discover qualities of themselves
and of the therapist that they eventually take on as their own because these
qualities are congruent with their own fundamental needs, goals, aspirations,
and capacities. These new, more adaptive representational structures are based
not only on the revised qualities they have found in themselves but also on
aspects of the therapeutic process and of the therapist that are congruent
with preexisting adaptive partial introjects that the patient has long sought
to express but was unable to sustain because of distorting pathological inter-
nalizations. Thus, patients are active agents in the treatment process and
seek in the therapeutic relationship to construct and identify personally mean-
ingful and functionally significant aspects of themselves, the therapist, and
the therapeutic relationship that they must experience in interactions with
others before they can more fully acquire and consolidate these attributes
and functions for themselves. As these functions and attributes are experi-
enced within the therapeutic relationship, patients can begin to consolidate
and make these functions their own and become less reliant on others to
provide these functions for them (Blatt & Behrends, 1987). Fuller expres-
sion of this complex process of externalization (expressing and experiencing
these functions in a relationship) and of internalization of these more adap-
tive interpersonal schemas through identification is often prompted by the
recognition of the eventual loss of the object—by the anticipation of the
termination of treatment. Acknowledgment and acceptance of one's sepa-
rateness, as well as the separateness of the other (i.e., the therapist), results
in a fuller internalization of these more integrated and adaptive interper-
sonal schemas—more differentiated and integrated representations of self
and of significant others.
SUMMARY
In this chapter I considered the mechanisms of the therapeutic process

as extensions of the processes of normal psychological development, pro-
cesses that involve experiences of engagement and disengagement, of grati-
fying involvement and experienced incompatibility, that contribute to the
revisions and extensions of mental representations of self and significant oth-
ers. Psychotherapy, particularly in the long-term, intensive treatment of pa-
tients who are seriously disturbed, but probably with a broad range of pa-
tients and in different forms of treatment as well, consists of enabling patients
to relinquish and revise repetitive maladaptive internalizations—the
cognitive-affective schemas or representations of self and others that limit

patients' capacity to be open and responsive to an ever-changing environ-
ment. Both the content and the structural cognitive organization of these
maladaptive schemas are revised in the treatment process. Research findings
suggest that in therapy, these schemas become more differentiated, articu-
lated, and integrated and move toward more mature and constructive and
representations of self and of others. The structural organization of these
representations of self and others begins to approach object constancy, in
which diverse and sometimes contradictory elements are integrated, with
increasing capacity to tolerate and even integrate ambiguity and ambiva-
lence as a result. And the content and explicit aspects of these representa-
tions of interpersonal relatedness progress from themes of dependency to
themes of cooperation and collaboration, and eventually to themes of
empathically attuned reciprocity and mutuality, with a greater capacity to
contribute to, as well as gain from, interpersonal relationships. Research find-
ings (e.g., Blatt, Stayner, et al., 1996; Vermote, 2005) indicate that change
in the thematic content (or episodic) dimensions, as well as in the cognitive
structural organization (procedural dimensions) of these representations,
parallels independent estimates of therapeutic gain. Observation of these
changes in mental representation in long-term intensive treatment provides
a reliable indicator of therapeutic progress as well as the opportunity to study
the intricacies of the treatment process and the mechanisms of therapeutic
change. Increased understanding of the mechanisms of therapeutic change
in both brief and long-term intensive treatment is essential for the further
development of refinements of the psychotherapeutic process, refinements
that can enable therapists to be more effective in assisting individuals in
distress to establish fuller and more satisfying lives—to develop a more adap-
tive and constructive sense of self and to establish more meaningful interper-
sonal relationships.

EPILOGUE
In this volume I presented a broad-ranging theoretical model that iden-

tifies fundamental commonalities among factors central in personality de-
velopment, personality organization, psychopathology, and the therapeutic
process. These theoretical formulations have important implications for fu-
ture research in four major areas (a) the study of personality development
across a wide range of cultures and social contexts; (b) the development of a
diagnostic system of psychological disorders that has greater coherence and
demonstrated validity than does the current system in the Diagnostic and Sta-
tistical Manual of Mental Disorders (DSM) of the American Psychiatric Asso-
ciation; (c) the establishment of a research paradigm for the investigation of
recursive interactions among biological, psychological, and social factors in
the etiology of adaptive and maladaptive personality organization; and
(d) the investigation of mutative factors that contribute to psychological
development in the psychotherapeutic process.
PERSONALITY DEVELOPMENT
Personality development proceeds throughout life, from infancy to se-

nescence, through a hierarchical series of dialectical synergistic interactions
285
between the development of the self and the development of a capacity for
interpersonal relatedness. Progress in each fundamental dimension facilitates
development in the other. Meaningful interpersonal experiences throughout
life contribute to a fuller articulation, differentiation, and integration of the
self, which in turn facilitates the establishment of more mature forms of in-
terpersonal relatedness. Extensive cross-cultural research, as I discussed in
chapter 1 (this volume), indicates that this fundamental polarity of interper-
sonal relatedness and self-definition is central across a wide range of cultures.
Although the relative balance between these two developmental dimensions
and the specific life experiences that contribute to the development of a
sense of self and the capacity for interpersonal relatedness varies across cul-
tures, these two fundamental dimensions evolve essentially through a similar
synergistic developmental process.
The details of this developmental process are specified in this volume
primarily from the perspective of normative development in industrialized
Western society, and this perspective provides a baseline for investigating
the impact of variations in cultural and social context on personality devel-
opment (e.g., Kagitcibasi, 2005). Thus the developmental model specified in
the second part of this volume (chaps. 2-4) provides a basis for investigating
the impact of deviations in family structure and cultural emphasis in West-
ern society on the psychological development of children such as those raised
by a single parent or in a single-sex family. It also provides a method, for
example, for studying the impact of immigration to a new culture on psycho-
logical development in different types of individuals at different points in
their development (e.g., Kagitcibasi, 2003; Tafarodi & Smith, 2001;
Vansteenkiste, Lens, Soenens, & Luyckx, 2006; Walsh & Shulman, 2006) or
the differential effects of various processes through which individuals attempt
to integrate commitment to the values of a subculture with an adaptation to
those of the dominant culture (e.g., R. E. Steele, 1978).
The specification of this normative developmental process also pro-
vides a basis for identifying adaptive and maladaptive variations of this fun-
damental developmental process. Throughout life individuals struggle to
achieve and maintain a balance between the two dimensions of this funda-
mental polarity—between an investment in interpersonal relatedness and
an investment in self-definition. Within the normal range, individuals differ
in the relative emphasis they place on the two dimensions of this fundamen-
tal polarity. Some individuals, more often women, tend to place somewhat
greater emphasis on relatedness (an anaclitic personality organization),
whereas other individuals, more often men, place somewhat greater empha-
sis on self-definition (an introjective personality organization). Extensive
research (see summaries in Blatt, 2004; Blatt & Zuroff, 1992) documents the
value of the differentiation of these two normal but fundamentally different
personality styles with which individuals engage and experience life differ-
ently. Future research is needed on the influence of historical and (sub)cultural

factors on the expression of these two dimensions in men and women under
varying societal conditions (Green, Deschamps, & Paez, 2005).
PSYCHOPATHOLOGY AND THE DEVELOPMENT

OF A VALID CLASSIFICATION OF MENTAL DISORDERS
Severe disruptions of this synergistic dialectical developmental process
at different points in development can lead to the various forms of psychopa-
thology described in Axis I and Axis II of the DSM, from schizophrenia and
depression to the personality disorders. As I discussed in the third part of this
volume (chaps. 5 and 6), some individuals deal with severe disruptions of
this normal dialectical developmental process by attempting to achieve some
degree of equilibrium by placing exaggerated emphasis on one of these di-
mensions to the neglect of the other. The nature of this distorted one-sided
emphasis identifies two primary configurations of psychopathology. Anaclitic
forms of psychopathology (undifferentiated schizophrenia, abandonment
depression, and the borderline, dependent, and histrionic personality disor-
ders) all involve, at different developmental levels, a distorted one-sided
emphasis on interpersonal relatedness. Introjective forms of psychopathol-
ogy (paranoid schizophrenia and the paranoid, obsessive-compulsive, self-
critical depressive, and narcissistic personality disorders), in contrast, are
characterized, at different developmental levels, by a distorted and one-sided
emphasis on self-definition. Again, considerable research evidence (e.g., Blatt,
2004, 2006; Blatt & Zuroff, 1992) supports the validity of this distinction of
two primary configurations of psychopathology. Anaclitic patients, who have
a distorted one-side preoccupation with issues of interpersonal relatedness,
and introjective patients, who have a distorted one-sided preoccupation with
issues of self-definition, have very different early and later life experiences
and different concerns and preoccupations.
Research evidence I presented in the fourth part of this volume (chaps.
7 and 8) also indicates that these two groups of patients respond differently
to different forms of psychotherapy and change in psychological treatments
in different, although equally desirable, ways (e.g., Blatt, Besser, & Ford, 2007;
Blatt & Ford, 1994; Blatt & Shahar, 2004b; Vermote, 2005). Patients appear
to change in dimensions most salient to their basic personality organization.
Thus, the formulation of two primary configurations of psychological distur-
bances based on the identification of the fundamental polarity of human
experience, of relatedness and self-definition, is supported by evidence re-
garding aspects of the etiology of these two types of disturbance as well as
their differential response in the therapeutic process.
These views of psychopathology as disruptions of normal psychological
development differ markedly from the symptom-based formulations of the
DSM. The identification of commonalities across normal and disrupted psy-
chological development presented in this volume suggests that various forms
EPILOGUE 287
of psychopathology are not separate independent diseases that derive from
presumed, but often as yet undocumented, specific biological and genetic
disturbances, as implied in most psychiatrically informed diagnostic manu-
als. Rather, research deriving from the unifying theoretical model proposed
in this volume indicates that most forms of psychopathology are the conse-
quence of severe disruptions of basic developmental psychological processes.
As I discussed in chapter 6 (this volume), the differentiation between ana-
clitic and introjective configurations of psychopathology is based on dynamic
considerations, including differences in primary motivational focus (libidi-
nal vs. aggressive), types of defensive organization (avoidant vs. counterac-
tive), and predominant character style (emphasis on an interpersonal vs.
self-orientation, on affects vs. cognition). The anaclitic and introjective con-
figurations of personality development and psychopathology provide a com-
prehensive theoretical structure for identifying fundamental similarities among
many forms of psychopathology and for maintaining conceptual continuity
across processes of psychological development, normal variations in charac-
ter or personality organization, and different forms of psychological distur-
bance. Furthermore, continuity is maintained among various disorders within
the anaclitic and introjective configurations so pathways of potential regres-
sion and progression and the nature of therapeutic change can be more fully
understood (see brief clinical examples in Blatt, Auerbach, & Behrends, in
press; Blatt et al., in press; and Blatt & Ford, 1994).
In this view, psychopathological disorders are compensatory exaggera-
tions and distortions in response to severe disruptions of the reciprocally
balanced, normal synergistic dialectical development of interpersonal relat-
edness and self-definition. Severe disruptions of this developmental process
result in exaggerated attempts to achieve equilibrium through either an in-
tense distorted preoccupation with the quality of interpersonal relatedness
or exaggerated defensive efforts to consolidate the sense of self. This empha-
sis on the role of differences in personality organization in most forms of
psychopathology is consistent with the emphasis on establishing a dimension-
ally organized taxonomy of psychopathology based on a few broad overarching
constructs or multiple dimensions of disordered thought, affect, behavior, tem-
perament, or personality (e.g., L. A. Clark, 2005; Krueger, Watson, & Barlow,
2005; Lahey et al., in press; Widiger & Samuel, 2005; Widiger, Simonsen,
Krueger, Livesley, & Verheul, 2005; Widiger & Trull, 2007) that "transcend a
putative distinction between more normal and more abnormal psychological
phenomena" and the "official nosologies such as the DSM" (Krueger et al.,
2005, p. 491). The anaclitic and introjective differentiation in personality
organization and psychopathology stresses personality dimensions as the ba-
sis for establishing a coherent diagnostic classificatory system.
Findings of a number of studies suggest that the differentiation between
Axis I and Axis II of the DSM is arbitrary and unproductive (e.g., Blatt et al.,

2007; Blatt & Ford, 1994; Blatt & Levy, 1998; L. A. Clark, 2005; Krueger et
al., 2005; Kupfer, First, & Reiger, 2002; Luyten & Blatt, 2007; Westen,
Novotny, & Thompson-Brenner, 2004). Personality factors are inherent in
Axis I disorders such as in unipolar (A. T. Beck, 1983; Blatt, 2004; Blatt,
D'Afflitti, &. Quinlan, 1976; Blatt, Quinlan, Chevron, McDonald, & Zuroff,
1982; Luyten & Blatt, 2007) and bipolar (Lam, Wright, & Smith, 2004)
depression; eating disorders (Thompson-Brenner & Westen, 2005; Westen
& Harnden-Fischer, 2001); anxiety disorders (Shafran & Mansell, 2001);
and severe psychopathology, such as psychotic disorders (Tsuang, Stone,
Tarbox, & Faraone, 2003), as well as in the clinical course of neoplastic
immunological and cardiovascular disease (e.g., Blatt, Cornell, &. Eshkol,
1993; Helgeson, 1994). In addition, evidence increasingly suggests that cat-
egorical symptom-based diagnostic distinctions limit clinical practice and
research (Luyten & Blatt, 2007). Psychopathological disorders are therefore
best understood as a continuum from normality to subclinical pathology to
manifest clinical disorders (Blatt, 1974, 2004; Blatt & Shichman, 1983;
Haslam, 2003; Luyten & Blatt, 2007; Ruscio & Ruscio, 2000; Tsuang et al.,
2003; Widiger & Clark, 2000).
The formulations of two primary configurations of psychopathology not
only provide a theoretical model for integrating clinical disorders in Axis I
with the personality disorders of Axis II of the DSM but also suggest the
possibility of identifying a hierarchical organization in which many
symptom-based disorders can be subsumed within one of several major clini-
cal disorders (Blatt, 2004; Blatt & Shichman, 1983; L. A. Clark, 2005; Krueger
et al., 2005; D. Watson, 2005). As I discussed in chapter 6 (this volume), a
hierarchical view of clinical disorders provides a parsimonious way of dealing
with the problematic and vexing issue of comorbidity. Symptom-based diag-
noses, such as conduct and antisocial disorders (e.g., Blatt, 2004; Blatt &
Shichman, 1981), substance abuse (e.g., Blatt, Rounsaville, Eyre, & Wilber,
1984; Lidz, Lidz, & Rubenstein, 1976), eating disorders (e.g., Bers, Blatt, &
Dolinsky, 2004; Claes et al., 2006; Speranza et al., 2005; Thompson-Brenner
& Westen, 2005; Westen & Harnden-Fischer, 2001), sleep disturbance
(Norlander, Johansson, & Bood, 2005), posttraumatic stress disorder (e.g.,
Gargurevich, 2006; Southwick, Yehuda, & Giller, 1995), and chronic fa-
tigue syndrome (e.g., Luyten, Van Houdenhove, Cosyns, & Van den Broeck,
2006; Luyten, Van Houdenhove, & Kempe, 2007; Van Houdenhove, Egle,
& Luyten, in press), for example, can be viewed as behavioral expressions of
more primary disorders in either the anaclitic or introjective configuration.
These formulations have important implications for intervention because
they indicate that disruptive behavior in many symptom-based disorders,
including conduct and antisocial disorders, is frequently a defensive and dis-
torted attempt to establish some form of interpersonal relatedness or some
sense of self-worth—issues that, in addition to the more manifest symptom-
EPILOGUE 289
atic expressions of the disorder, need to be a central focus of treatment (Blatt
& Schichman, 1985; First et al., 2004; Kupfer et al., 2002).
The primary advantages of these formulations of psychopathology are
that they are based on the identification of continuities among processes in
personality development, normal variations in personality organization, and
various forms of psychopathology—formulations that avoid many of the pit-
falls that have been discussed in frequent contemporary criticisms of the DSM
approach to the diagnosis of psychopathology including the problematic is-
sue of extensive comorbidity (e.g., Blatt &L Levy, 1998; Luyten, 2006; Luyten
& Blatt, 2007; Luyten, Blatt, Van Houdenhove, 6k Corveleyn, 2006;
Nemeroff, 2002; Parker, 2005; Widiger & Trull, 2007). Now that some of
the necessary information is available, researchers can begin to develop a
classification system of disorders based on systematic empirical research on
the etiology and treatment response of the various disorders—a classification
system that will have important implications for clinical practice as well as
for clinical research.
These formulations of two fundamental personality dimensions in per-
sonality development and psychopathology also facilitate the understanding
of some of the motivational forces behind social behavior that, although not
pathological, may be quite disruptive. Wachtel (2005), for example, using
the anaclitic-introjective distinction to understand the phenomenon of greed,
noted that greed can be the consequence of (a) an anaclitic "insatiable hun-
ger, in feelings of emptiness and lack of support and nurturance that fuel a
relentless sense of needing more"; (b) an introjective "heedlessness ... an
inability to integrate the needs and feelings of others into one's own aims
either because the boundaries of the self . . . [are] too permeable [or] are
defensively bolstered and hardened or because driving voices from within
drown out the voices of other people's needs and experiences"; and (c) an
"insatiability [that] can derive from an unquenchable desire for achievement
. . . [or] from a sense of entitlement" (p. 248). In summary, Wachtel noted
that "The two configurational model helps us to see more clearly a distinc-
tion between the kinds of greed or motives for greed that may not be imme-
diately evident in the morphology of the behavior itself (p. 250). Wachtel's
thoughtful observations demonstrate how seemingly similar manifest behav-
ior can derive from and express very different psychological issues.
CLINICAL RESEARCH AND RECURSIVE INTERACTIONS

AMONG PSYCHOSOCIAL AND BIOLOGICAL FACTORS
These formulations also provide the basis for studying the etiology, na-
ture, and treatment of psychological disturbances from a biopsychosocial
dynamic interactionism model that seeks to identify recursive interactions
among biological, psychological, and sociological factors in the etiology of

psychological disturbances (e.g., Luyten, Blatt, & Corveleyn, 2005a; Ursano,
2004). Recursive interactions among biological, psychological, and social
context factors in the etiology of psychopathology are most effectively stud-
ied from a theory-based comprehensive model that specifies well-established
developmental pathways from infancy to adulthood (Chamey et al., 2002)
rather than the orientation characteristic of much of psychiatric research
based on post hoc attempts to reconstruct etiological factors that could have
contributed to the various disorders identified in a clinical context. Such
post hoc analyses are plagued by the fact that similar symptoms can emerge
from different etiological pathways (equifinality) and, depending on a vari-
ety of factors and circumstances, can be expressed in different disorders
(multifinality). In contrast, the two-configuration model of personality de-
velopment and psychopathology I propose in this volume provides a pro-
spective developmental approach to the investigation of the etiology of vari-
ous forms of psychopathology as variations and disruptions of well-specified
processes in normal psychological development. Research on the develop-
ment of secure and insecure attachment patterns (e.g., Ainsworth, Blehar,
Waters, & Wall, 1978; Fonagy, Steele, & Steele, 1991; H. Steele, Steele, &
Fonagy, 1996), for example, demonstrates the impact of mother's attach-
ment style on the early development of her child's personality organization
and how mother's attachment style derives from her relationship with her
own mother. Some evidence (Besser & Priel, 2005) indicates that these at-
tachment and personality patterns are transmitted across at least three gen-
erations of women—from grandmother to mother and then to daughter. Sub-
stantial research also demonstrates the impact of mother's psychological
disturbances on the child's development of different types of psychopathol-
ogy including depression (e.g., Blatt & Homann, 1992; Goodman & Gotlib,
2002; Kaminer, 1999) and schizophrenia (e.g., Lidz, 1973; Singer & Wynn,
1965a, 1965b). This early systematic research on family dynamics in schizo-
phrenia by Lidz and by Singer and Wynn was sharply criticized at the time as
"mom bashing" but these early findings now take on renewed significance as
attachment research demonstrates mother's role in shaping the very early
personality development of her child.
Some research (Beebe et al., 2007), in fact, demonstrates how mother's
personality organization influences the infant's development of self- and
interactive regulation as early as 4 months of age. Using the Depressive Ex-
periences Questionnaire (DEQ; Blatt et al., 1976; Blatt, D'Afflitti, & Quinlan,
1979), Beebe et al. (2007) assessed, 6-weeks postdelivery, the extent to which
primiparous mothers of a healthy first-born child in an ethnically diverse,
low-risk sample of well-educated women experienced feelings of dependency
or disturbances in self-worth and self-criticism—the two dimensions discussed
in this volume as central in personality development and psychopathology.
Beebe et al. (2007) examined the impact of these feelings of dependency and
self-criticism on self- and interactive contingency (i.e., autocorrelations across
EPILOGUE 291
time and contingency correlations between infant and mother, respectively)
during face-to-face play in these mothers and their infants at 4 months,
using well-established second-by-second microanalysis of mother-infant in-
teraction from split-screen videotape, and time-series techniques to assess
contingency.
Beebe et al. (2007) found that elevated maternal scores on DEQ de-
pendency at 6 weeks postpartum predicted mainly lowered infant self-
contingency at 4 months of age; self-contingency findings were absent in the
mothers. In contrast, elevated maternal DEQ self-criticism scores predicted
both lowered and heightened infant self-contingency, but lowered maternal
self-contingency.
These two DEQ dimensions also predicted very different patterns of
mother-infant interactive contingency at 4 months. Dependant mothers and
their infants showed heightened facial and vocal coordination, a dyadic "emo-
tional vigilance"; mothers also showed heightened coordination of on-off
gaze patterns with infant gaze patterns: an attentions! vigilance. This dyadic
vigilance may indicate excessive maternal concern about the infant's
attentional and emotional availability that may limit the infant's affect regu-
lation and individuation.
In contrast, mothers with elevated scores on self-criticism showed low-
ered attentional and facial contingency with infant attention and vocal af-
fect. They thus had difficulty sharing their infant's attentional focus and
emotional fluctuations. These mothers appeared to try to compensate for
their disengagement with their infants by coordinating their touch patterns
(measured from affectionate to intrusive) more contingently with infant touch
(measured as amount of touch). These mothers thus had difficulty tuning in
to the emotional sphere but could relate on the more concrete level of touch.
In response to the disengagement of self-critical mothers, their infants seemed
to disengage from their mothers by lowering vocal affect coordination with
maternal touch.
An important hypothesis emerging from this research is that this recip-
rocal distancing and disengagement in self-critical mothers and their infants
may be precursors of dismissive insecure attachment. The intense involve-
ment of dependent mothers and their infants, in contrast, are hypothesized
to be precursors of preoccupied or anxious-ambivalent insecure attachment.
It remains for subsequent research to examine the associations of these early
interpersonal interactive patterns observed at 4 months of age, and in at-
tachment patterns observed in the second year of life, to the development of
anaclitic and introjective forms of personality organization and psychopa-
thology. Of course, mothers with relatively low levels of dependency and
self-criticism, mothers who effectively and appropriately engage with their
infants, would be expected to contribute to the development of a secure at-
tachment pattern in their infants.

The research paradigm established by Beebe et al. (2007) investigating
the impact of personality variations in a nonclinical sample of first-time
mothers on infants' early interpersonal engagement provides a structure for
systematically examining the impact of neurobiological and genetic dimen-
sions on psychological development. Infants at 4 months of age have begun
to establish prerepresentational schemas of self and others that become in-
creasingly consolidated in the symbolic representational structures associ-
ated with secure and insecure attachment patterns observed in the 2nd year
of life. The identification of the emergence of the behavioral, cognitive, and
interpersonal expressions of these representational structures can be used to
establish extensive research paradigms to evaluate the impact of neurobio-
logical and genetic aspects of the mother on her caring patterns and their
impact on neurobiological development, particularly the development of the
hypothalamic pituitary adrenal axis (Caspi et al., 2003; Claes & Nemeroff,
2005; Gutman & Nemeroff, 2003; Kaufman et al., 2004; Kendler, Kuhn,
Vittum, Prescott, & Riley, 2005; Levinson, 2006; Luyten, Blatt, & Corveleyn,
2005c) of their infants and its role in their subsequent biological and psycho-
logical development. As noted by Gunnar and Quevedo (2007), individual
differences in the social regulation of neurobiological reactions to stress ob-
served in mother-infant interactions can provide a lens for examining ques-
tions about the impact and management of stress throughout development.
Rather than the post hoc searching for specific genetic and neurobiological
markers of particular psychiatric diseases or disorders seen in the clinical
context, an approach plagued by complex issues of the equifinality and
multifinality of symptoms and of etiological pathways (Cichetti &. Rogosch,
1996), the developmental approach to personality development and psycho-
pathology, as exemplified by the research by Beebe et al. (2007), has consid-
erable promise, but will require extensive, long-term, longitudinal develop-
mental research. But as suggested by the impressive findings of Beebe and
colleagues, this approach has considerable potential.
Throughout the work presented in this volume, clinical observations
led to theoretical formulations and empirical investigations, which in turn
sharpened clinical observations. Thus this volume, much like my work on
depression (e.g., Blatt, 1974, 1998, 2004), derives from the integration of
clinical, theoretical, and empirical perspectives. This work illustrates the value,
even the necessity, of integrating observations from idiographic individual
case analyses with nomothetic approaches to clinical research and how these
two perspectives can enrich and extend each other (Luyten, Blatt, &
Corveleyn, 2006), each contributing to empirical supported formulations that
have clinical relevance. Future research, for example, should be devoted to
trying to identify particular subpatterns of personality organization in de-
tailed clinical analysis in the therapeutic process with anaclitic and
introjective forms of personality organization and psychopathology. Hugo
Bleichmar (1996), for example, has demonstrated the value of detailed sen-
EPILOGUE 293
sitive study of individual patients in long-term psychoanalytic treatment for
differentiating subpattems of anaclitic and introjective forms of psychopa-
thology, especially depression, and considering their implications for the treat-
ment process. Bleichmar's contributions demonstrate how detailed individual
case analyses can contribute to, as well as gain from, systematic nomothetic
empirical research to facilitate the further understanding of complex clinical
phenomena (Luyten, Blatt, & Corveleyn, 2006).
THERAPEUTIC PROCESS
Not only does the two-configuration model of personality development

and psychopathology have important implications for developing a more
coherent and comprehensive nosological diagnostic system and for estab-
lishing effective longitudinal research paradigms to investigate the complex
recursive interactions among biological, genetic, psychological, and social
contextual factors that affect personality development, but this theoretical
model also has important implications for understanding some of the mecha-
nisms that can lead to therapeutic change in the psychotherapeutic process.
Further exploration of the therapeutic implications of this theoretical model
of personality development and psychopathology has also led to a fuller un-
derstanding of the basic mechanisms and processes through which the fun-
damental polarity of relatedness and self-definition is expressed in psycho-
logical development. Experiences of engagement and disengagement, of
attachment and separation, and of gratifying involvement with others, and
experiences of incompatibility with aspects of that involvement, contribute
throughout life, as well as in the treatment process, to modifications and
revisions in the representation of self and significant others. And these re-
vised internalizations are expressed behaviorally and psychologically in more
mature levels of self-definition and interpersonal relatedness. Experiences of
gratifying involvement and experienced incompatibility that are central in
the development of self-definition and interpersonal relatedness throughout
life are also central to the personality development that can occur in the
psychotherapeutic process. Hierarchical experiences of engagement and dis-
engagement in the treatment process result in new and revised internaliza-
tions that lead to the development of more articulated, differentiated, and
integrated representations of self, of others, and of their actual and potential
relationships (e.g., Blatt et al., in press; Blatt et al., 2007; Blatt, Stayner, et
al, 1996; Diamond, Kaslow, Coonerty, & Blatt, 1990; Gruen & Blatt, 1990;
Harpaz-Rotem & Blatt, 2005). Thus, development in the psychotherapeutic
process is similar in fundamental ways to the processes of normal psychologi-
cal development. The systematic study of these revisions in mental represen-
tations (of cognitive-affective schemas of self and of others) provides a method
for assessing the extent and nature of therapeutic change—the reparative

interpersonal therapeutic process in which individuals are able to move to-
ward more mature levels of self-definition and more mature levels of inter-
personal relatedness with a capacity to find personal satisfaction in mutually
enhancing and facilitating interpersonal relationships (e.g., Blatt, Auerbach,
& Aryan, 1998; Blatt, Stayner, et al., 1996; Calabrese, Farber, & Westen,
2005; Eklund & Nilsson, 1999; Philips, Wennberg, Werbart, & Schubert,
2006; Piper, Joyce, McCullum, Azim, & Ogrodniczuk, 2002). This focus on
changes in mental representation of self and of others in the treatment pro-
cess provides links between treatment research and the newly emerging field
of social cognitive neuroscience (e.g., Kandel, 1999; Lieberman, 2007) that
seeks to use neuroscience research tools to examine social processes includ-
ing the understanding of oneself and others and the "processes that occur at
the interface of self and others" (Lieberman, 2007, p. 259).
SUMMARY
In summary, the approach presented in this volume represents a psy-

chological approach to personality development, personality organization,
psychopathology, and the therapeutic process. Biological and genetic factors
undoubtedly contribute to the unfolding of these processes in normal devel-
opment and in the occurrence of severe disruptions of this fundamental de-
velopmental process. These biological and genetic factors create differential
sensitivities and vulnerabilities to, as well as contribute to the development
of adaptive mechanisms to cope with, particular types of difficult and stress-
ful life events. These biological and genetic factors are expressed, however,
primarily through their impact on psychological processes in the evolving
development of a sense of self and in the capacity to establish meaningful
interpersonal relationships. Thus, the psychological perspective presented in
this volume provides an essential orientation that facilitates a fuller under-
standing of both normal and impaired psychological development as well as
the processes through which individuals evolve to function more effectively
in both normal development and the therapeutic process. This perspective
provides direction for further explorations of the complex recursive interac-
tions of genetic, biological, social, experiential, and psychological factors in
normal and disrupted psychological development.
EPILOGUE 295
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AUTHOR INDEX
Abelson, R. P., 247, 247nl Azim, H. F., 123, 295

Aber.J.L, 31 Aziza, C., 142
Aber, L. J., 67
Abraham, K., 27, 176,179,184 Baccus, J. R., 59, 123, 260
Abramson, L. Y., 52 Bach, S., 52, 55, 58
Adkins, K. K., 137 Bachrach, H., 218, 261n7
Adler, A., 27 Bagby, R. M., 146, 234n20
Ainsworth, M. D. S., 48, 55, 61, 65, 66, 82, Bakan, D., 16, 24, 28-30, 78, 93, 134
83, 103, 245, 251, 291 Baldwin, ]. M., 55, 89
Akhtar, N., 64 Baldwin, M. W., 58, 59, 110, 123, 247nl,
Albersheim, L., 67 248
Albert!, L. B., 18 Balint, M., 28, 88, 176
Alden, L. E., 137, 138, 150, 222nl5 Barbour, C. G., 212
Alexander, P. C, 236 Barker, C., 239
Allen, J. P., 246, 247 Barley, D. E., 234
Allison, J., 193, 209 Barlow, D. H., 5, 194, 195, 198, 288
Alloy, L. B., 148, 149, 160 Barnett, L., 239
Als, H., 46 Barrett, W. G., 270
American Psychiatric Association, 5, 160, Barrett-Lennard, G. T., 231
170, 261n7 Barry, ]., 141
Anders, T. R, 67, 247, 248 Bartholomew, K., 68
Anderson, C. L., 236 Basch, M., 265
Anderson, J. R., 247nl Bateman, A., 223, 223nl6, 270
Anderson, R., 8, 160 Baum, O. E., 270
Andrews,]. D. W., 152 Baumeister, R. R, 16, 20, 23, 29, 46, 56, 82,
Angyal, A., 28, 29, 93 95, 110
Antill, ]. K, 84 Baumgart, B. P., 227
Arieti, S., 7, 157, 160, 226, 227 Beamesderfer, A., 221nl4
Aron, L., 55, 58, 83, 88, 256 Beck, A. T., 7, 8, 134, 137, 146, 149, 156-
Aryan, M. M., 257, 262, 295 158, 160, 205, 221nl4, 226-227,
Asch, S. S., 160 234n20, 289
Astington, ]. W., 56 Beck, S. ]., 209
Atkinson, J. W., 30 Beebe, B., 44-49, 51, 53, 54, 60, 66, 83, 86,
Atwood, G. E, 88, 264, 270 102,109n3,118,123,124,244,247,
Aube, J. A., 136, 138, 152 248, 260, 291-293
Auerbach, A., 265 Behrends, R. S., 9, 27, 43n, 51, 52, 55, 59,
Auerbach, E., 19 67,99n, 109n3, 118-120,122-124,
Auerbach, J. S., 8,9,43n, 48,55,56,58,59, 165n, 189, 190, 221, 223, 243n,
122, 123, 161, 180, 190, 191, 209, 244, 246, 247, 259, 266, 267, 269-
210, 212-214, 221, 224, 243n, 246, 274, 275n9, 276, 283, 288
247nl, 255n5, 256, 257, 259, 262, Belenky, M. R, 91
263, 282, 288, 295 Bell, S., 80, 249
Autry, J. H., 225nl9 Bellah, R. N., 23, 80
Avery, R., 211 Belsk y ,J.,48,49nl,50, 51,60
Avery, R. R., 94 Bern, S. L, 24, 94
Axelrod, R., 38 Bemporad, ]. R., 7, 157, 160, 226, 227
373
Benafeld, J., 32 Bios, P., 72
Benedek, T., 127 Blum, H., 247nl
Benedict, R., 34 Boehm, C, 33
Benjamin, J., 56, 83, 88, 122, 256 Bond, M., 23
Benjamin, L. S., 28, 33, 117 Bondi, C. M., 159, 229
Bergman, A., 49, 54, 103, 246, 255 Bood, S. A., 196, 289
Berman, W., 9, 203n, 205 Booth-Kewley, S., 30
Berne, E., 140 Borgmann, A., 80
Berry, J., 23, 24, 38 Bornstein, M. H, 51,63, 65
Bers, S. A., 21, 55, 136, 196, 289 Bornstein, R. R, 43n, 85,103, 142,153,175
Berscheid, E., 142 Bourne, E. ]., 23
Besser, A., 9,35,82,138-140,145,151,152, Bowen, M., 97
154,175, 205, 287, 291 Bowlby, J., 28,31,44,48,52,55,61,66,82,
Bettelheim, B., 58 83,85,86,93, 103, 118, 123, 151,
Bettes, B., 62 157, 160, 167, 168, 226, 227, 244,
Beutel, M. E., 137, 145 245, 248, 251, 253n4
Beutler, L. E., 10, 142, 204, 239 Bradshaw, D., 68
Bibring, E., 145 Brandchaft, B., 88
Bieling, P. J., 137, 138, 150 Brandstadter, J., 151, 167
Bieri,]., 210 Brazelton, T. B., 46, 60, 61
Bigelow, A., 48 Brennan, K., 68
Binstock, W, 127 Brennan, K. A., 68, 236
Bishop, M., 18 Brenneis, C. B., 9, 193, 210, 211, 219
Blacker, K. H., 270 Brenner, C., 265
Blaney, P. H., 227 Bretherton, I., 51, 56, 66-67, 247
Blankstein, K. R., 79, 136, 137, 149, 227, Brewer, W. R, 247nl
234 Broberg, A. G., 46
Blass, R. B., 7, 25, 67, 71n, 73, 88, 96, 97, Brooks-Gunn, J., 55, 251
99n, 100, 104, 105, 106, 107, 108, Brothen, T., 142
110, 116, 117, 125-129, 147, 151, Broucek, F. J., 55
246, 255-257, 272, 280 Brown, G. W., 82
Blatt, E. S., 15n, 19, 20 Brown, R., 32
Blatt, S. J., 4, 6-9, 15n, 19-25, 27, 32, 38, Brown, T. A., 5, 194, 198
43n, 47, 48, 49-60, 63-69, 66n7, Brumbaugh, C. C., 245, 246
71n, 73, 78, 79, 82, 83, 85, 88, 90- Bruner, J., 255
92, 96, 97, 99n, 100, 102-108, Bryant, F. B., 84
109n3, 110, 116-120, 122-129, Bryne, R. W., 33
133n, 134-142, 144-161, 146nl, Buber, M., 33, 43, 44
156n2, 165n, 166-171, 175, 177- Bucci, W., 123, 240, 274, 275, 276nlO
182, 185, 187-191, 193, 194, 196- Buchholz, E. S., 246
198, 203n, 204-206, 208n7, 209- Buck, K., 47
221, 209n8, 213n9, 215nlO, Buhr, K., 137
219nl2, 223-232, 234-237, 239- Buie, D. H., 265, 271
241, 243n, 244, 246-249, 253-257, Bumham, B. L, 85, 103, 147, 148, 227
255n5, 259-267, 261n8, 269-284, Burns, D. D, 233, 265
275n9, 276nlO, 286-291, 293-295 Busch, F., 86
Blehar, M. E., 48, 291 Buss, D.M., 35,151,167,168
Bleichmar, H. B., 158, 277, 293 Butler, R.N., 127
Block, J., 159 Butterfield, H., 18
Block, J.H., 77, 159 Byrne, E., 141, 142, 143
Block, P., 157, 233n20
Blomberg, J., 217 Calabrese, M. L., 246, 247, 259, 263, 295
374 AUTHOR INDEX

Callander, L, 137 Coon, H. M., 35, 83
Campbell, D. G., 137 Coonerty, S., 255, 257, 294
Campbell, T. L, 136 Copeland, J. R., 82
Campos, R. C., 145 Corboz-Warnery, A., 57
Cane, D. B., 146 Cornell, C. E, 78, 197, 289
Cantor, N. C., 123, 140, 247nl, 248 Cortina, M., 33, 35
Carlson, R., 100, 103 Corveleyn,]., 142, 144, 146, 151, 159, 160,
Carriger, M. S., 51 166, 167, 196, 234, 246, 247, 262,
Carson, E., 32 263, 267, 290, 291, 293, 294
Carson, R. C., 32 Costa, P. T., Jr., 136
Carstens, A., 48 Cosyns, N., 196, 289
Carter, A. S., 61 Cote, S., 136
Caspi, A., 151,168, 293 Covi, M. D., 221nl4
Cassidy, J., 51, 65-67, 82, 103, 245 Cox, B. ]., 137, 149, 227, 235n21
Cecero, ]. ]., 85, 103 Coyne,]. C, 151
Chance, M. R. A., 36, 39, 40 Craig, J., 136
Chappell, P. R, 45 Cramer, P., 173, 187, 188
Charney, D. S., 194, 199, 291 Crockenberg, S., 60
Chen, H., 47 Crockett,]., 247nl
Chevron, E. S., 7, 9, 24, 91, 137, 146, 155, Crockett, W. H., 210
188, 226, 254, 255, 289 Cronbach, L. ]., 10, 204, 224, 230, 240
Chodorow, N., 83, 84, 91, 103, 186, 254 Cronin, H., 37
Choi, S.-C., 23 Cross, L, 168
Choi, S.-H., 23 Crowell, ]., 67
Claes, L., 196, 289 Crowley, C., 48
Claes, S. J, 293 Crown, C., 44, 47
Clark, A., 198, 289 Crystal, D. S., 35
Clark, D. A., 146 Cue, K. L., 239
Clark, E. S., 30 Cunningham, R. L., 247nl
Clark, F. L., 35
Clark, L. A., 194-196, 288-289 D'Afflitti, J. P., 7, 8, 53,134,145,146,149,
Clark, M. S., 87, 116 150, 155, 160, 205, 226, 227, 289,
Clark, R. A., 30 291
Clarkin, J. F, 222nl5, 270, 275, 282 Damon, W., 55, 56, 58
Clinchy, B., 91 Darwin, C., 20, 37
Cluckers, G., 167 Davidson, ]. R., 142
Clyman, R., 123, 248 Davidson, L., 140
Coble, H. M., 236 Davidson, R. ]., 36
Cogswell, A., 148, 149, 160 Davis, J. D., 142
Cohen, D. J., 56 Davis, P. J., 142
Cohen, J., 261 DeCasper, A., 48
Cohen, M. B., 145 deCharms, R., 77
Cohen, N., 123, 248 deCharms, R. W., 31
Cohen, P., 47 Deci, E. L, 28, 31, 32, 78, 94, 97, 117
Cohler, B. J., 73 De Grave, C., 262
Cohn, J. F., 47, 48, 61 de Lorimier, S., 138, 153
Colarusso, C. A., 127 Demos, V., 48
Collins, G. M., 45 Dennett, D. C., 151
Conger, J.J., 80,81,100 Derogatis, L. R., 221nl4
ConnellJ.P., 31,46 DeRosa, T., 137
Cook, B., 9, 203n, 205 Desaulniers, J., 24
Cooley, C. H, 55, 56, 89, 95 Descartes, R., 19, 56
AUTHOR INDEX 375

Deschamps, J.-C, 36, 287 113-116, 125, 126, 167, 177,281
de Tocqueville, A., 22 Erlich, H. S., 53, 264, 267, 272
Deutsch, M., 30, 74, 86 Eshkol, E., 78, 197, 289
de Waal, F. B. M., 33, 37, 38 Essock-Vitale, S. M., 82
Dewitt, K. N., 162 Etzioni, A., 24
Diamond, D., 221, 246, 255, 255n5, 257, Exner, J. E., 209
260, 263, 294 Eyre, S., 6, 136, 197, 289
Dicks, H. V., 176 Eysenck, H., 141, 143
Diehl, M., 24
Dimidjian, S., 270 Fabian, M., 217
Doi, T., 18, 23, 83 Fagiga, L., 52
Dolinsky, A., 196, 289 Fahey, M. R., 54
Dore, ]., 45 Fairbairn, W. R. D., 83, 88, 140, 176
Dorpat, T. L, 117 Fairbanks, L. A., 82
Dozier, M., 239 Fairweather, T., 208
Draguns, J. G., 23 Fallot, R. D., 239
Ducey, C. P., 176 Fantz, R. L, 250
Duncan, N., 136, 137, 152 Faraone, S. V., 198, 289
Duncan, S. P., 260 Farber, B. A, 246, 295
Dunham, F., 64 Fast, I., 55
Dunham, P. J., 64 Faterson, H. I., 92, 135, 138
Dunkley, D. M., 79,136-137,139,149,151, Fazaa, N., 137, 149
152, 227, 234 Fearon, P., 239
Durkin, K., 51 Federn, P., 58
Duval, S., 55 Feeney, B. C., 68
Dweck, C. S., 78 Feffer, M., 57, 82, 83, 89, 90
Dyk, R. B., 92, 135, 138 Fehr,B.,58, 59, 123, 247nl,248
Dziokonski, W., 142 Feiring, C., 47, 50
Feldman, R., 43n, 47, 49-51, 63-65
Eames, V., 236-238, 240, 241 Feldstein, S., 44, 47, 60, 61
Easterbrook, ]. A., 22 Felsen, I., 203n, 204, 224, 226
Ebert, M. H., 45 Fenz, W., 142
Edwards, A. L., 204 Ferenczi, S., 176
Egan, M., 236 Ferrari, M., 58
Egle, U, 196, 289 Fertuck, E., 240, 241, 274, 275, 276nlO
Eisenberg, N., 82 Fichman, L., 153, 154
Eklund, M., 123, 260, 295 Field, D. T., 145
Ekman, P., 51 Field, T., 45-47, 51,61
Elicker, ]., 66, 67 Fiese, H. B., 64
Elkin, I., 225nl9, 226, 228, 230, 232 Fieve, R. R., 233n20
Elliott, E. S., 78 Findji, A., 51
Emde, R. N., 46, 48-50, 63, 64, 99, 109n3, First, M. B., 196, 198, 289, 290
112,247,252 Fiske, S. T., 247nl
Emery, G., 8, 205 Fitzpatrick, D., 137, 140,150,152-154, 236
Endicott, ]., 261 Fivaz-Depeursinge, E., 57
Englund, M., 66 Flavell, E. R., 56
Enns, M. W., 137,149, 227, 235n21 Flavell, ]. H., 56
Epstein, N., 8, 205 Fleiss, ]. L, 261
Epstein, S., 142 Flett, G. L., 79, 136, 137, 149
Erdelyi, M. H., 247nl Fliess, R., 265
Erikson, E. H., 26,55, 73, 74,84,86,87,89, Foa, U. G., 32
96, 100, 101, 104, 106n2,109, 110, Fodor, J. C., 33
376 AUTHOR INDEX

Fogassi, L., 52 Gergely, G., 48, 55, 56,118,122, 273
Fogel, A., 50, 61 Gergen.K.]., 20, 22, 23,95
Fonagy, P., 56, 58, 67, 122, 220-221, 223, Gergen, M. M., 23
223nl6, 224, 231, 236, 240, 241, Gianino, A., 45, 47, 62
270, 273, 275-277, 275n9, 276nlO, Gibbon, ]., 46, 61
282, 291 Gibbons, R. D., 226
Ford,R.Q.,9,159,66n7,140,175,187,188, Gilbert, P., 33
189, 193, 203n, 204-206, 208n7, Gill, MM., 209, 217
209n8, 210, 211, 213n9, 214, 215, Oilier, E. L., 6, 196, 289
215nlO, 218, 221, 226, 230, 237, Gilligan, C, 23, 24, 32, 82-85, 91, 99,100,
240, 241, 274, 277, 278, 287-289 103, 115,254
Fox, M, 59, 123, 260 Gittes-Fox, M., 8, 160
Fox, N. A., 36, 47 Gjerde, P. F., 159
Fracasso, M., 50 Gleser, G. G., 204
Fracasso, M. P., 46 Click, M., 9, 182,193, 210
Fraiberg, S., 123, 248, 250 Gold, L., 210
Fraley, R. C., 245, 246 Goldberg, A., 267
Frank, S. ]., 145 Goldberger, N. R., 91
Franko, D. L., 136, 153 Golden, E., 246, 247
Franz, C. E, 100, 103 Golding, ]. M., 24, 91
Freeman, W., 124 Goldstein, S., 51, 61
Fremmer-Bombik, E., 66 Goodall, ]., 33
Freud, A., 73, 123, 167, 169, 209 Goode, M. K., 49nl,51
Freud, S., 20, 21, 25, 26, 44, 60, 73, 83, 84, Goodenough, D. R., 92, 135, 138
87, 90, 93, 102nl, 114, 121, 133, Goodman, G., 48
134, 145, 155, 157, 159, 166, 176, Goodman, S. H., 291
181,184,250,253n4,264,265,268, Goodrich, S., 210
272 Gordon, C., 20, 22, 95
Friedman, H. S., 30 Gorsuch, R., 221nl4
Friedman, M., 83 Gotlib, I. H., 146, 227, 291
Friesen,W. V., 51 Gottheil, N., 136
Fritz, H. L., 28 Gottman, J. M., 48
Frost, R. O, 136, 137, 160 Gould, S. J., 38
Gouldner, A., 96
Gabbard, G. O., 160,220,221,223,231,238, Cove, P. B., 134
277 Grant, J., 217
Gable, S., 51 Graziano, W. G., 142
Gable, S.L., 31 Green, E. G., 36, 287
Gaensbauer, T. J., 46 Green, F. L., 56
Galatzer-Levy, R. M., 73 Greenson, R. R., 265, 271
Gallagher, L. F., 150 Greenwald, D., 211
Gallese, V., 52 Grenyer, B. F. S., 236
Gantt, D. L., 236 Grigsby,]., 123, 248
Gardner, G., 142 Grolnick, W. S., 31,94, 211
Gardner, H., 247nl Grossmann, K., 35, 66, 67, 83
Gardner, R. W., 135, 138 Grossmann, K. E., 35, 67, 83
Gargurevich, R., 6, 196, 289 Gruen, A., 22, 74
Garvey, C., 83 Gruen, R., 260, 263, 294
Gauvin, L., 136 Grundel, J., 247nl
Gedo, J. E., 267 Guisinger, S., 15n, 23, 38, 71n, 83
Geertz.C., 23, 38, 80, 151 Gunnar, M., 293
Gerber, A. ]., 223nl6 Guntrip, H., 44, 53, 83, 88
AUTHOR INDEX 377

Gurman, A. S., 231 Hermans, H.J.M., 59, 123, 260
Gurtman, M. B., 85, 103 Heron, W., 59
Gutman, D. A., 293 Herring, L., 234n20
Gutmann.D., 91,127 Hertzog, C., 150
Hewitt, P. L., 79, 136, 137
Hadley, S. W., 225nl9 Higgitt, A., 223nl6
Haflich, J. L, 234n20 Hill, D, 142
Haft, W., 45 Ho, D. F., 23, 38
Haith, M., 48 Ho, R. M., 234, 235
Hall, H., 217 Hoeksma, ]. B., 64
Halsall, ]., 136, 137 Hofer, L., 45
Hamilton, C., 67 Hofer, M. A., 52, 59
Hamilton, V., 142 Hoffman, J., 46, 61
Hamilton, W. D., 37, 38 Hoffman, M. L, 82
Hamlin, R. M., 212 Hoffman, R., 82
Hammen, C., 151 Hoffmann, J. M, 47, 63
Hannah, M. T., 204 Hogan, R., 20, 32, 80, 82, 83
Harder, D.W., 208, 210, 211 Hojat, M., 86, 90
Hardin, G., 79 Holm, R., 48
Hardman, C., 21 Holzman, P. S., 135, 212
Hardy, G. E., 237-241 Homann, E., 136, 137, 139, 146, 159, 178,
Harley, D. E., 229 227, 236, 291
Harlow, H. F., 44, 82 Honos-Webb, L., 239
Harmon, K. J., 51,54 Homer, T., 86
Harmon, R. J., 46 Hornerk, T. M., 48
Harnden-Fischer, T., 196, 289 Homey, K., 24, 28
Harpaz-Rotem, I., 261, 294 Horowitz, H. A., 236
Harre, R., 23 Horowitz, L. M., 33, 68, 205nl
Harris, M.J., 137, 149 Horowitz, M. J., 59, 123, 247nl, 255, 260
Harris, P., 56 Horvath, A. O., 233
Harris, T., 82 Howell, S., 23
Harrison, R. P., 8, 205 Hsu, F. L., 23, 80
Harrow, M., 212 Hubel, D. H., 250
Hart, B., 85, 103, 147, 255n5 Hui, C. H., 35
Hart, D., 55, 56, 58 Hutt, M., 68
Harter, S., 55
Hartlaub, G. H., 123, 248, 263, 272 Imber, S. D., 227
Hartmann, H., 26, 121, 167, 265, 270 Inayatulla, M., 149
Harty, M. K., 208 Inhelder, B., 57, 58, 90
Haskell, F. N., 270 Iqball, Z., 140
Haslam, N., 194, 289 Isabella, R. A., 48, 49nl, 51, 60
Hauser, S. T., 246, 247 Israeli, A. L., 138
Hawley, L. L, 224nl7, 234, 235, 240
Hazan, C., 48, 67, 68, 251 Jabalpurwala, S., 136
Heape, C. L., 236 Jacklin, C. N, 92
Heard, H. L., 270 Jackson, D. N., 135
Heelas, P., 24, 38, 81 Jacobson, E., 58, 123, 160, 209, 255
Heine, S. ]., 23 Jae Im, C., 145
Helgeson, V. S., 28, 78, 85, 93, 94, 289 Jaffe, ]., 44,47-50, 53, 60,61,62, 65,66n6,
Helmrich, R. L., 77, 78 69, 244
Henkins, A., 48 James, W., 21,55
Henrich, C. C., 32, 148, 168 Jansen, B., 262
378 AUTHOR INDEX

Jasnow, M., 61 Klein, G. S., 99, 111, 112, 120, 128, 135,
Jasnow, M. D., 47 252
Jenkins, M., 24, 186 Klein, M., 27, 60
Jimenez, J. P., 269 Kleinknecht, A., 142
Joffe, R. T., 234n20 Knapper, C., 210
Johansson, A., 196, 289 Kobak,R.R., 251
Johnson, D. T., 142 Kobassa, S. C., 94
Johnston, M. H., 212 Koestner, R., 136-138, 153, 159
Joiner, T. E., 151,152 Kohlberg, L., 21, 32, 75, 79
Jordan, J.V., 82-84, 91,256 Kohut, H., 28, 54n3, 55, 246, 265
Josephs, R. A., 29 Kojima, H., 23, 83
Joyce, A. S., 123, 260, 295 Kokes, R. F., 208
Jung, C. G., 140 Kolligian, J., Jr., 43n
Jurist, E. L, 56, 122, 273 Kopp, C., 47
Koslowski, B., 60
Kachele, H., 269 Koyre,A., 18, 19
Kagan, J., 55, 100 Kraemer, G. W., 45, 46
Kagitcibasi, C., 23, 34, 35, 83, 97, 286 Kramer, R., 21, 32, 75
Kahn, S., 94 Kriegman, D., 30, 44
Kaminer, T., 53, 56, 291 Kris.E., 17, 26, 270
Kandel, E. R., 295 Krueger, R. F., 195, 196, 198, 288-289
Kanninen, K., 236, 238, 240 Krupnick, J. L., 151, 229, 230, 233
Kantrowitz, J. L., 239 Kuhn, J. W., 293
Kaplan, A. G., 82 Kuiper, N. A., 146, 227
Kaplan, B., 209, 210, 250, 252 Kuperminc, G. P., 35, 147, 148, 150
Kaplan, L., 66, 82, 103, 245 Kupfer, D. J., 194, 198, 289, 290
Kappas, A., 48 Kurdek, L. A, 142
Karp, S. A., 92, 135, 138 Kurz, O., 17
Karpinski, D. C., 235n21 Kutcher, G. S., 227
Kashima, Y., 23 Kwon, P., 137
Kaskey, M., 210 Kymlicka, W., 24
Kaslow, N., 221, 255, 257, 294
Kasser,T.,31,94 Lachmann, F., 44, 46, 48, 49, 66, 86, 102,
Kaufman, J., 293 109n, 118
Kavanaugh, R. D., 56 Lachmann, F. M., 44, 45, 47-49, 51, 123,
Kaye, K., 61 124, 244, 248, 260
Kelly, G. A, 210, 247nl Laforge, R., 136, 140
Kemmelmeier, M., 35, 83 Lahart, C. M., 137, 160
Kempe, S., 289 Laing, R. D., 21,93
Kendal, N., 136, 137, 151 Lam, D. H., 289
Kendler, K. S., 293 Lam, S. V., 198
Kennedy, S. H., 146 Lamb, M. E., 46, 49, 50
Kerber, K., 210 Lamb, W., 142
Kemberg, O. R, 67, 208, 217, 222nl5, 246, Lambert, M. J., 234
247, 255, 257 Lapidus, L. B., 37
Khan, M., 54n3 LaplancheJ., 121, 134
Kihlstrom, J. F., 123, 247nl, 248 Larson, D., 50
Kim, U., 23, 24, 38 Lasch, C., 80
Kirkpatrick, L. A., 68 Laurendeau, M., 57
Kitayama, S., 23, 29, 35, 83 Lazar, A., 217
Klein, D. F., 150 Leadbeater, B. J, 147, 148, 150, 255n5
Klein, D. N, 8, 160 Leary, M. R, 29, 46, 79, 80, 82
AUTHOR INDEX 379

Leary, T., 28, 32 Luthar, S., 140
Leekam, S. R., 56 Luthar, S. S., 85, 103, 147
Lehman, A. K., 136 Luyckx, K., 286
Lehman, D. R., 23 Luyten, P., 6, 138, 142, 144-146, 151, 159,
Leichtman, M., 209 160, 166, 167, 192, 194, 196, 198,
Lens, W., 286 234, 235, 246, 247, 262, 263, 267,
Leowald, H. W., 266, 267 289-291, 293, 294
Lerner, H. D., 67, 212, 247-249, 260 Lyddon, W. ]., 238
Lerner, R. M., 151, 168 Lykes, M. B., 80, 84
Leslie, A. M., 56 Lynch,]. H., 31,94
Lester, B. M., 46, 61 Lynch, T. R., 146
Leung, F. Y, 136 Lyons-Ruth, K., 123, 246, 248, 260
Leung, K., 35
Levenson, R., 51 Maccoby, E. E., 92
Levinson, D. R., 293 Maddi, S. R., 20, 32, 94, 134
Levitt, A., 234n20 Madsen, R., 23, 80
Levy, K. N., 6, 8, 43n, 48, 68, 69, 136, 139, Mahler, M. S., 49, 55, 58, 72, 73, 103, 117,
144, 160, 161, 171, 175, 210, 211, 123, 210, 246, 251, 255
236, 243n, 246, 255n5, 256, 257, Main, M., 60, 66-67, 82, 83, 103, 245, 246,
259, 270, 275, 275n9, 276nlO, 282, 260
289, 290 Malatesta.C. Z., 48, 50, 61,64
Levy, S. T., 265 Malkin, C. M., 49
Lewin, I., 142 Malley, J. E., 93
Lewis, M., 47, 50, 55, 251 Mallinckrodt, B., 236, 237, 241
Leyendecher, B., 48, 50 Mandler, J. M., 247nl
Lichtenberg, J. D., 48, 49, 112, 247 Mann, D. W., 55
Lidz, R. W., 6, 140, 197, 289 Mansell, W., 198, 289
Lidz, T., 6, 91,140,186,197, 289, 291 Markus, H. R., 23, 28, 29,35, 83,140, 247nl
Lieberman, M. D., 295 Marmor, J., 175, 176, 184
Linehan, M. M., 270 Maroudas, C., 158, 227
Linton, H. B., 135 Marten, P., 160
Liotti, G., 33, 35 Martin, G. C., 263
Lipman, R. S., 221nl4 Masling, J., 43n
Lipton, R. C., 44, 82 Maslow, A. H., 88, 187
Little, T. D., 32 May, R., 21
Livesley, W. J., 195, 288 Maybury-Lewis, D., 19, 38
Lizardi, H., 8, 160 Mayes, L. C., 56, 61
Lock, A., 24, 38, 81 McAdams, D. P., 16, 28, 30, 31, 84, 94, 140,
Loevinger, ]., 75 141, 193
Loewald, H. W., 26, 27, 58, 67,91,117,118, McCall, R. B., 51
121, 247, 282 McCallum, M., 260
Loewenstein, R. M., 26, 270 McCarthy, K., 151
Lohr, N., 210 McCaully, M. H., 141
Lombrosa, G., 24 McClelland, D. C., 28, 30, 32, 77
LoPiccolo, ]., 92 McCluskey, K., 60
Lovejoy, A. O., 18, 19 McCrae, R. R., 136
Lowell, E. L, 30 McCullum, M., 123, 295
Lubbers, R., 136 McDonald, C., 7, 137, 188, 226, 289
Luborsky, L., 217, 218, 261n7 McHugh, P. R., 194
Lukes, S., 16, 20, 35, 74 McKinney, W. T., 45
Lushene, R., 221nl4 McLaughlin, J. T., 270, 271, 282
Luten, A. G., 146, 205, 227 Mead, G. H., 55, 56, 89, 95
380 AUTHOR INDEX

Meares, R., 56 Newton, S., 39
Meehan, K. B., 210, 270, 276nlO Nietzel, M. T., 137, 149
Meganck, S., 262 Nietzsche, F., 134
Meissner, W. W., 117, 160, 268 Nigg,J.T.,210
Meltzoff,A.N.,51 Nilsson, A., 123, 260, 295
Merleau-Ponty, M., 55 Nisbet, R. A., 116
Merrick, S., 67 Noddings, N., 84, 86, 87
Messick, S. J., 135 Nolen-Hoeksema, S., 233
Metzinger, T., 52 Norcross, J. C., 234, 265
Meurs, P., 167 Norlander, T., 196, 289
Meyer, B., 236-238, 241, 276 Norman, H. F., 270
Meyer, R., 9, 203n, 205 Norton, G. R., 137
Michod, R. E, 37, 38 Norton, P. J., 137
Mikulincer, M., 68 Novotny, C. M., 196, 234, 289
Miller, H. B., 143 Nurius, P., 140
Miller,]. B., 24,48,80,82-84,91,103,254,
256 Oberman, L. M., 52
Mills, J., 30, 87, 116 Ogden, T. H., 122, 265
Mischel, W., 140 O'Gorman, J. G., 142
Mitchell, S. A., 88, 256 Ogrodniczuk, J. S., 123,260, 295
Modell, A. H., 55, 93, 264 O'KeefeJ.Q, 24, 186
Moller, L, 36, 40 Olinger, L. ]., 146, 227
Mongrain, M., 85,103,136-140,144,147- Oliver, J. M., 227
149, 151-153 Olson, D., 57
Moran, G., 60, 246 Oremland, ]. D., 270
Morgan, C., 193 Osgood, C. E, 210
Morris, C., 16, 20, 23, 80 Ouimette, P. C., 8, 160, 161
Morris, K, 142 Overton, W. F., 47
Morrison, D. C., 49 Owen, S. K., 24
Morse, J. Q., 8, 160 Oyserman, D., 28, 29, 35, 83
Moscovici, S., 23
Mosheim, R., 236 Padeh, B., 142
Moskowitz, D. S., 24, 136, 138 Paez, D., 36, 287
Most, R., 49nl,51 Page, S., 137, 149, 156
Munich, R., 273 Panofsky, E., 18
Murray, H. A., 77, 193 Papousek, H., 45, 46, 48
Murray, L., 48 Papousek, M., 45, 46, 48
Mussen, P. H., 82, 100 Parker, G., 196, 290
Myers, I. B., 141 Parker, W., 137
Parloff, M. B., 225nl9
Nachshon, O., 68 Parsons, T., 20, 22, 34, 90, 91, 95, 151, 168
Nacht, S., 272, 273 Patterson, B. J., 246
Nakamura, G. V., 247nl Paul, G. L, 204, 224
Nelli ga n,J.S.,68 Paykel, E. S., 225
Nelson, D., 141 Pearce, J., 39
Nelson, K., 247nl Pederson, D. R., 60
Nemeroff, C. B., 196, 290, 293 Perloff, R., 74, 75, 80, 84
Nemiroff, R. A., 127 Perls, F. S., 21
Neurgarten, B, L., 127 Pettier, ]., 56
Neville, C. W., Jr., 142 Peselow, E. D., 233-234n20
Nevis, S, 250 Pfeffer, A. Z., 270
Newton, J., 137 Philips, B., 262, 263, 295
AUTHOR INDEX 381

Phillips, K. A., 196 Rholes, W. S., 68
Piaget, ]„ 46, 55, 57, 58, 83, 89, 90, 102, Riley, B., 293
117, 119, 123, 127, 209, 248, 250- Riso, L. P., 8, 160
252, 263 Ritzier, B. A., 181, 208, 210-211, 212, 246
Pilkonis, P. A., 159,225,228,229,232,236- Rizzolatti, G., 52
238, 276 Robbins, R, 270
Pinard, A., 57 Robbins, L. L., 217
Pincus, A. L, 85, 103, 222nl5 Roberts, L. K., 142
Pincus, H. A., 196 Robertson, J., 82
Pine, R, 49, 103, 246, 255 Robins, C. J., 8,146,151,157,160,205,227,
Piper, W. E., 123, 260, 295 233n20, 270
Pipp, S., 50, 51,54 Rodin, J., 136
Plomin, R., 151, 168 Rofe, Y., 142
Pokorny, D., 269 Rogers, A. G., 84
Pontalis, J. B., 121,134 Rogers, C. R., 231,264
Poorman, M. O., 145 Rosch, E. H., 59, 123, 140, 247nl, 248
Porter, K., 51,61 Roscoe,]., 31
Powell, M. C.,87, 116 Rosen, I. C., 216
Powers, T. A., 136, 137, 227 Rosenberg, S., 247nl
Powers, W. T., 212 Rosenblate, R., 137, 160
Prescott, C. A., 293 Rosenblatt, B., 246
Price, V. A., 78 Rosenstein, D. S., 236
Priel, B., 35,82,137-139,145,149-154,291 Roth, A., 236-238, 240, 241
Pringle, J. D., 138 Roth, T., 239
Proietti, J. M., 236 Rounsaville, B. J., 6, 136, 197, 289
Provence, S., 44, 82 Rovine, M., 50, 60
Prusoff, B. A., 225 Rubenstein, R., 6, 140, 197, 289
Puentes-Neuman, G., 136 Rubino, G., 239
Punamaki, R. L., 236 Rude, S. S., 85, 103, 147, 148, 227
Pyle, C., 82 Rumelhart, D. E., 247nl
Ruscio, A. M., 198, 289
Quevedo, K., 293 Ruscio, ]., 198, 289
Quinlan, D. M., 7-9, 24, 53, 85, 91, 103, Rutter, D. R., 51
134, 137, 145-147, 150, 155, 159, Ryan, R. M., 28, 31, 32, 78, 94, 97, 117, 211
188, 196, 205, 212, 225-228, 255, Rycroft, C., 264
255n5, 289, 291
Sackett, G. P., 48
Radke-Yarrow, M., 82 Safran,]. D., 59, 123, 260
Ramachandran, V. S., 52 Sagi, A., 82
Rank, O., 28 Sagi, M., 35, 83
Rapaport, D., 167, 209, 212 Salo, J., 236
Rappoport, L. A., 210 Salzman, L, 182, 184
Rector, N. A., 146, 234n20 Sameroff, A. ]., 64, 123
Rees, W. D., 59 Sampson, E. E., 23, 80-82, 84,99, 115,128,
Reff, R. C, 137 254
Reich, W., 167 Samuel, D. B., 195, 288
Reiffer, L., 67 Sandell.R., 217, 223
Reiger, D. A., 194, 198, 289 Sander, L. W., 45, 47, 49, 63, 65, 123, 248,
Reis,H.T.,31 260
Reis, S., 236 Sandier, ]., 52, 246
Reynolds, R. A., 234n20 Sanfilipo, M. P., 233n20
Rhine, M. W., 263 Sanislow, C. A., 159, 229, 232, 236
382 AUTHOR INDEX

Sansone, L. A., 221nl4 Shichman, S., 6, 7, 25, 83,91,97, 99n, 100,
Sansone, R. A., 221nl4 102-104,129,133n, 134,135,138,
Santor, D. A., 138, 139, 144, 154 140-142,151,161,165n, 169,170,
Sanville, ]., 28, 97 177, 182, 185, 196, 217, 255, 256,
Saragovi, C., 138 280, 289
Sargent, H., 217 Shikanai, K., 23
Satterfield, W. A., 238 Shill.M, 211
Scarpetti, W., 142 Shoham-Salomon, V., 204
Scarr, S., 151 Shor, J., 28, 97
Scarvalone, P., 59, 123, 247nl, 260 Shouval, R., 142
Schafer, R., 55, 57, 58,93,95,117,121, 209, Shulman, S., 286
265, 267, 271 Shuster, B., 136, 137, 151
Schaffer, C. E, 43n, 52,54,59,69,143,144, Shweder, R. A., 23
175, 255 Sigman, M. D., 51,65
Schaffer, H. R., 46 Silk, K. R, 210
Schank, R. C., 247 Silverman, D. K., 49, 246
Schimek, J. G., 9, 193,210 Simon, H. A., 37-39
Schlessinger, N., 270 Simonsen, E., 195, 288
Schmidt, D. E., 45 Simpson, J. A., 68
Schmitt, A., 28 Singer, J.L., 24, 43n, 91
Schmitt, J. P., 142 Singer, M. T., 291
Schmolling, R., 37 Slade, A., 67
Scholmerich, A., 46, 50 Slater, P., 74, 80, 81
Schonbar, R., 48 Slavin, M. O., 30, 44
Schubert, J., 262, 295 Sloan, M., 142
Schulte, R, 148 Slough, N. R., 142
Schultz, L. H., 89, 90 Smith, A. J., 286
Schwartz, G. E., 142 Smith, B., 204
Schwartz, S. H., 23 Smith, L., 50, 124
Sechrest, L., 204 Smith, M. B., 23
Segal, Z. V., 227, 234n20, 270 Smith, N., 198, 289
SeguinJ.R., 136 Smith, P. B., 23, 60
Seligman, M. E. P., 52 Smith, T. W., 24, 186
Selman, R. L., 89, 90 Snow, R. E., 204
Settlage, C. F., 72, 127 Sober, E., 33, 34
Shafran, R., 198, 289 Soenens, B., 286
Shahar, G., 9, 32, 66n7, 137, 140, 145-147, Sotsky, S. M., 151, 226, 230, 235
149-153,159,165n, 168,187-189, Southwick, S. M., 6, 196, 289
203n, 205, 211, 212, 217-219, Spasojevic, ]., 148
219nl2, 221, 224, 226, 230, 237, Spear, W., 211
239-241, 243n, 260, 274, 275, Spence, D., 135
275n9, 276nlO, 281, 282, 287 Spence, ]. T., 24, 74-78, 80, 84
Shapiro, D., 31, 105, 141, 143, 176, 182- Spencer, M. B., 31
184, 265, 270 Speranza, M., 196, 289
Shaver, P., 68, 69, 257 Sperber, Z., 52
Shaver, P. R., 67, 68, 236 Spiegel, D., 33, 134-136, 138, 139, 141
Shavit, H., 142 Spiegel, H., 33, 134-136, 138-140
Shaw, B. F., 227 Spielberger, C. D., 221nl4
Shea, T., 159, 226, 228 Spitz, R. A., 44, 49, 73, 82, 247
Sheldon, A. E. R., 67, 69 Spitzer, R. L., 222nl5, 261
Sheldon, K.M., 31,94 Sprangler, G., 66
Shevrin, H., 265 Squire, L., 123, 248
AUTHOR INDEX 383

Sroufe, L. A., 35, 60, 64-67 Takata, T, 23
Stair, L. H., 142 Tamayo, A., 91
Stapp, J., 78 Tamis-LeMonda, C. S., 63
Starbird, D. H., 143 Tannenbaum, P. H., 210
Stauffacher, J. C, 212 Tarabusly, G., 48
Stayner, D., 9, 59, 123, 190, 221, 223, 224, Tarachow, S., 268
243n, 255, 255n5, 257, 259-263, Tarbox, S. I., 198, 289
261n8, 282-284, 294, 295 Target, M., 56, 122, 221, 223, 273, 282
Stayton, D., 82 TaruleJ.M., 91
Steele, H., 67, 221,291 Tausk, V., 27
Steele, M., 67, 221, 291 Taylor, C., 17, 24
Steele, R. E., 286 Taylor, D. C., 50, 60
Steiger, H., 136 Taylor, M., 95, 116
Stern, D. N., 34, 44, 45-49, 55, 56, 59-63, Taylor, S. E., 247nl
67, 83, 84, 86, 99,102,103,109n3, Teague, G. B., 239
113,118,247,248,255,256,260 Teasdale, J. D., 52, 270
Sternberg, R. J., 43n, 58 Tempone, V. ]., 142
Stewart, A. S., 93 Tessier, R., 48
Stifter, C. A., 47 Thelen, E., 50, 64, 124
Stiles, W. B., 239 Thompson, J. M., 136
Stiller,]. D., 31, 94 Thompson, R., 47
Stiver, I. P., 82 Thompson-Brenner, H., 196, 234, 289
Stober, J., 136 Thorndike, R. M., 142
Stoller, R. J, 186 Ticho, E., 217
Stolorow, R. D., 88, 264, 270 Ticho, E. A., 263, 272
Stone, L., 263 Ticho, G. R., 217
Stone, W. S., 198, 289 Tipton, S. M., 23, 80
Stotland, S., 136 Tobey, A. E., 68
Strauss,]. S., 208 Todd, F. ]., 210
Stroud, L. R., 92 Tolman, D. L., 84
Strupp, H. H., 229 Tolpin, M., 118
Struthers, W., 136 Tomasello, M., 33, 34
Suci, G.J., 210 Tomkins, S. S., 62
Suczek, R. R, 136, 140 Tonnies, F., 34
Sugarman, A., 211, 212 Topciu, R., 136, 227
Suh,E.].,24 Tower, L. E., 272
Sullivan, H. S., 28, 52, 89, 90, 102, 140 Trapnell, P. D., 136, 140
Sullivan, P. R, 142 Trebous, D., 67
Sullivan, W. M., 23, 80 Trevarthen, C., 48, 49
Sulloway, F. ]., 37 Triandis, H. C., 23, 34, 35
Sundin, E., 162 Trilling, L., 19
Surko, M., 239 Trivers, R., 37, 38
Surrey, ]. L, 82, 83, 85, 91, 99, 100, 103, Trobst, K., 189, 190
115,128,256 Tronick, E., 45, 47, 63, 118
Sutherland, J. D., 44 Tronick, E. Z., 45, 47, 48, 61, 62, 118
Sweetman, E., 136 Trower, P., 140
Swindler, A., 23, 80 Troy, M., 35
Symonds, B. D., 233 Trull, T. G., 5
Symons, D., 60 Trull, T.J., 288, 290
Szumotalska, E., 135, 138, 139 Tsuang, M. T., 198, 289
Tuan, Y.-F., 23, 76, 79, 80
Tafarodi, R. W., 29, 286 Tuber, S.B., 211, 212, 214
384 AUTHOR JNDEX

Tucker, D., 36 Wechsler, S., 211
Tyrell, C. L, 239 Weigert, E., 272
Wetland, I. H., 52
UristJ.,211 Wein, S. ]., 9,146,152, 254, 255
Ursano, R. J., 291 Weinberg, K. M., 63
Weinberger, D. A., 142
Vaillant, G. E., 84 Weiner, I. B., 212
van den Boom, D. C., 64 Weinfurt, K., 35
Van den Broeck, A., 196, 289 Weintraub, K.J., 17
Vane, ]. D., 239 Weiss, R. S., 82
Van Egeren, L. A., 145 Weissman, A. N., 146, 205, 227
Van Houdenhove, B., 196, 234, 289, 290 Weissman, M. M., 225
van IJzendoorn, M. H., 35, 83 Weller, L., 142
Van Ord, A., 208 Wender, P., 152
Vansteenkiste, M., 286 Wennberg, P., 262, 295
Vega-Lahr, N., 51,61 Werbart, A., 262, 295
Vella, D. D., 227 Werner, H., 57, 90,122, 209, 210, 250-252
Vergote, A., 91 West, M., 67, 69
Verheul, R., 195, 288 Westen, D., 196,198, 210, 234, 246, 247nl,
Vermote, R., 9, 205, 220-224, 223nl6, 230, 289, 295
231,237,257,262,275n9,282,284, Whiffen, V. E., 136, 151, 152
287 White, G. M., 32
Vettese, L. C., 136, 137, 151,152 White, K. M., 100, 103
Villarela, M., 35 White, M. D., 142
Vinnars, B., 205nl White, R. W.,28,31, 78
Virtue, C., 67 Whiteside, M. E, 86
Vittum, ]., 293 Whitten, A., 33
Vliegen, N., 167 Wicklund, R. A., 55
von der Lippe, A., 77 Widiger, T. A., 5, 195, 198, 288-290
Wiederman, M. W., 221nl4
Wachtel, P. L., 79, 152, 290 Wielgus, M. S., 136
Waddington, C. H., 167, 253n4 Wiesel, T. N., 250
Wagner, E., 82 Wiggins, ]. S., 28,32,33,136,140,189,190,
Walker, J. R., 137, 235n21 222nl5
Wall, S., 48, 291 Wilber, C., 6, 136, 197, 289
Wallerstein, R. S., 162, 216-217 Wild, C. M., 179, 181, 212, 246, 253, 255
Walsh, S., 286 Wilkins, W., 142
Wampold, B. E., 234, 265 Wilkinson, G., 38
Waniel, A., 35 Williams, ]., 222nl5
Warner, R. W., 48 Williams, ]. M. G., 270
Warr, P. B., 210 Williams, M., 136, 137
Watanabe, H., 35 Williams, M. G., 137
Waterman, A. S., 74,95, 110 Wilson, A., 212, 213
Waters, E., 48, 67, 291 Wilson, D. S., 33, 34
Watkins, J. G., 212 Wilson, E. O., 37
Watkins, J. T., 225 Wilson, K. R., 85, 103
Watson, D., 195, 196, 288, 289 Wimmer, H., 56
Watson,]. S., 48, 55, 118 Wink, P., 28nl
Waugh, R. M, 45-46, 50n2, 55 Winkworth, G., 136, 137
Weber, C., 137 Winnicott, D. W., 31, 53, 56, 83, 86, 88,
Weber, M., 75, 77 117,122,264
Weber, S. ]., 142 Winter, D., 30
AUTHOR INDEX 385

Witkin, H. A., 92, 135, 138 Zanna, M. P., 142
Wolf, E. S., 54n3 Zeanah, C. H., 67, 247, 248
Wolf, K. M., 44, 82 Zelnick, L, 246
Wortman, C. B., 78 Zettle, R. D., 234n20
Wright, K., 198, 289 Zetzel, E. R., 175
Wu, C., 35 Zigler, E. G., 182
Wynn, L. C., 291 Zimet, C. N., 193, 209
Zohar, A. H., 85, 103, 147-149, 153
Yankelovich, D., 77, 80, 81, 86, 116 Zuroff, D. C., 8, 9, 79, 85, 103, 134, 136-
Yehuda, R., 6, 196, 289 140, 144-155, 159, 160, 168, 188,
Yonas-Segal, M, 35 203n, 205, 224, 225, 226, 227-232,
Youngblade, L. M., 24 234-236,239, 265, 273, 275n9,282,
286, 287, 289
Zahn-Wexler, C., 82
Zambianco, D., 210
386 AUTHOR INDEX

SUBJECT INDEX
Abandonment, fear of, 174 Anaclitic depression, 8, 155, 156, 188. See
Abraham, Karl, 27, 176 also Dependent (sociotropic) depres-
Achievement, 30-31, 76-81 sion
Acting out, 177 Anaclitic disorders, 8
Action theory, 151 Anaclitic patients
Adaptation, mode of, 168 later treatment focus of, 280
Adler, Alfred, 27-28 SEP with, 237
Adolescence therapeutic change mechanisms in, 278,
changes during, 106, 109, 127 280
cognitive-affective schemas in, 252- therapeutic focus of, 278
253 therapeutic relationship with, 276-278
integration in late, 110, 126 therapeutic response of, 9
risk and resilience in early, 150 treatment of, 231
self-criticism in, 159 Anaclitic personality disorders, 8
Adolescents Anaclitic personality organization, 4. See also
amphetamine abuse in, 196-197 Interpersonal relatedness
social context for, 153 characteristics of, 138-141
Adrenocortical response, 92 levels of, 176
Affect arousal, 46 Anaclitic psychopathology, 172-177, 287
Affect constancy, 250 and attachment style, 175
Affection, 174, 176 avoidant defenses of, 174, 177
Affectionate relationships, 90 common features of, 194
Affective experiences, sharing of, 52-53, 61 dependent/histrionic, 175
Affiliation, 30 developmental distortions in, 174-175
Affiliative needs, 111 and interpersonal relatedness, 176
Affirmative interventions, 277 model of development of, 185
Agency, 29, 30, 75 and self, 176-177
caregiver's contribution to, 53-54 Androgyny, 24, 94
and communion, 93 Anger, 177, 178, 195
unmitigated, 78 Angyal, A., 29
Aggression, 92, 178, 195 Anktitas, 134
Aggressive impulses, 183 Annihilation, fear of, 178
Agonic mode, 36, 39-40 Antecedents, 43-70
Agreeableness, 136 in early development, 48-51
Alertness, 65 . of individuality, 51-60
Alienated individualism, 21 of interpersonal relatedness, 60-69
Alienation, 31,80, 102 Antidepressants, 225, 226
Allocentrism, 35 Antisocial personality disorder, 161
Altercentric, 24 Anxiety, 26
Altruism, 25, 37-39 Anxious-ambivalent insecure attachment,
Ambitiousness, 81 175, 292
Amphetamine abuse, 196-197 Anxious attachment, 157, 239
Anaclitic (term), 134 Apollonian personality organization, 134. See
Anaclitical development, 169 also Introjective personality organi-
Anaclitic borderline personality disorder, 8 zation
Anaclitic choice, 26 Aquinas, Thomas, 17
387
ARC (Austen Riggs Center), 206 and love in adults, 68
Arendt, Hanna, 116 organization of, 68-69
Art, 18, 20 over time, 67
Asian culture, 23 and separation, 66
Assertion, 195 Avoidant defenses, 141, 143, 144, 174, 177
Assertiveness, 81, 92, 178 Avoidant personality disorder, 161
Assessment of personality dimensions, 144- Avoidant attachment, 50
154 Axis II personality disorders, 8,161,170,196,
developmental levels, 146-154 198, 288-289
primary factors in, 145
Associational society, 34 Bakan, David, 29, 134
Athens, 17 Balint, Michael, 28
Attachment Barrett-Lenard Relationship Inventory (B-L
in epigenetic psychosocial model, 100 RI), 231-232
and love, 87 Beck, Aaron T., 146, 157, 158
and mother-child bond, 250 Beliefs, physical reality and, 56
and relatedness, 85-87 Benedict, Ruth, 34
Attachment style(s), 50 Biological factors, in psychopathology, 167-
in adults, 67-68 168
and depression, 157 Biopsychosocial dynamic interactionism
of infant, 35 model, 290-294
of mother, 291 Bizarre Disorganized factor, 208n4
and patient-therapist congruence, 236- Bizarre Retarded factor, 208n4
240 Bleichmar, H. B., 158-159
precursors of, 292 Bios, P., 72
and prerepresentational schemas, 293 B-L RI. See Barrett-Lenard Relationship In-
and separation, 66 ventory
stability over time of, 66-67 Bonding, to mother, 186, 245, 250
of therapists, 239 Borderline personality disorders (BPDs), 160,
Attachment theory, 28, 245-248 161, 174
Attention, 51 confabulation responses of, 213
Attentional vigilance, 53-54, 292 and self-constancy disturbances, 253
Augustine, 17 treatment of, 238, 270
Austen Riggs Center (ARC), 206 types of, 8
Autobiographical writing, 17, 19 Boundary(-ies)
Autonomous action, 45 disruptions in establishing/maintaining,
Autonomous depression, 157, 158 175
Autonomous motivation, 31 loss of, 174
Autonomy, 29, 30, 101, 111 Boundary constancy, 250, 253
as basic need, 31 Boundary dissolution, 180-181
capacity for, 109 Boundary disturbance, 212, 215
expression of, 107 Bounded rationality, 39
sense of, 49, 102,104 Bowlby, John, 28, 85-86, 157, 167-168,
and separation, 74 245-246
shame vs., 104, 105 BPDs. See Borderline personality disorders
Aversion of gaze, 49 Buber, Martin, 33, 43^4
Avoidant attachment Buss, David, 35
descriptions of parents in, 259
emotion-engagement strategies with, Calvin, John, 17
237 Capacity for Interpersonal Relatedness fac-
exploratory treatment with, 276 tor, 208
in introjective individuals, 143-144 Cardiovascular disease, 197
388 SUBJECT INDEX

Caregiver(s) Communal well-being, 116
attachment and inconsistent, 248 Communication, 62
and cognitive-affective schemas, 249 competence in, 90
dependability of, 55 maternal acknowledgment of, 61
depression in, 62 of mother's/father's feelings, 107
identifying with, 86 Communion, 29, 30. See oho Interpersonal
as personality type, 140 relatedness
physiological regulation facilitated by, and agency, 93
52 unmitigated, 78, 85
and self-awareness, 56 Comorbidity, 6, 196, 198, 289, 290
self-regulation aided by, 45-46 Competence, 31, 115
Caregiving Competitive system, 33, 77, 78
in anaclitic individuals, 143 Composite thought disorder measure,
compulsive, 69, 175 215nlO
and emerging sense of self, 51 Compromise, 89
Careseeking, compulsive, 69, 175 Compulsive careseeking/caregiving, 69,175
Case Record Rating System, 208 Concept of Object on the Rorschach (COR),
CBT. See Cognitive behavior therapy 209-211, 224
Chance, M. R. A., 36, 39-40 Conceptual level (CL) of descriptions, 255
Change(s) Confabulation responses, 212-213, 215
during adolescence, 106, 109, 127 Confidence in rating, 207n3
opportunity for, 170 Conflict resolution, 34, 35
therapeutic. See Therapeutic change(s) Confucian culture, 23
Chewong culture, 23 Congruency hypothesis, 151
Child development, 91-92. See also Infant Conscience, 83
development Constancy
Child rearing, 35 affect, 250
Christianity boundary, 250, 253
freedom through Christ in, 18 evocative object, 245, 248-251
free man in early, 17 levels of, 123
self-discovery in, 19 self-, 45, 251, 253
Chumship, 89, 102, 104 Constructive action scripts, 94
CIT (coordinated interpersonal timing), 50 Contamination responses, 212, 213n9, 215
Clannishness, 111 Contingencies, detection of, 48
Classic psychoanalytic theory, 25-27, 44 Contingent coordination, 52, 53, 61-63
Clinical case records, rating of, 207—208 Continuity of existence, sense of, 53, 58
Clinical symptoms, rating of, 208 Cooperation, 89, 90, 109, 110
CL (conceptual level) of descriptions, 255 alienation vs., 102
Closeness, 174 behavioral evolution of, 37-39
Cognitive activity, 276nlO and collaboration, 104
Cognitive-affective schemas, 119, 245-249, with family/peers, 102
252 Cooperative peer play, 102
Cognitive behavior therapy (CBT), 225, 235 Cooperative system, 33
Cognitive capacities, 51, 64, 65 Coordinated interpersonal timing (CIT), 50
Cognitive-developmental theories, 249 Copernican revolution, 18-19
Cognitive functioning, 182-183 COR. See Concept of Object on the Ror-
Cognitive schemas, 249 schach
Collaboration, 89, 90, 104 Counteractive defenses, 141,143,144,180-
Collectivism, 23 181
Collectivist cultures, 34-35 Cronbach, L. J., 204
Communalism, 23 Culture
Communal society, 34 and individualism, 16-22
SUBJECT INDEX 389

and interpersonal relatedness, 22-24, Diagnostic and Statistical Manual of Mental
90-91 Disorders, Fourth Edition (DSM-JV),
of relatedness vs. separateness, 34 5-6, 170, 171, 196, 198
Diagnostic classificatory system, 198
Darwin, C., 37, 78 Diagnostic formulations, 281
DAS. See Dysfunctional Attitudes Scale Diathesis-stress model of psychopathology,
Deci, E. L., 31 166, 253n4
Defense mechanisms, 141-144 Didactic prototype, 63-65
avoidant, 141,143, 144, 174, 177 Differential impairment, 253n4
counteractive, 141, 143, 144, 180-181 Differentiation-Relatedness (D-R) scale,
nature of, 167 221, 255-259
obsessive-compulsive, 180, 182 Dionysian personality organization, 134- See
Deferred action, 166, 253n4 also Anaclitic personality organiza-
Delusional ideation, 183 tion
Democracy, 75-76 Disengagement, 44^45, 49, 142
Denial, 141, 143, 177 Dismissive attachment
Dependability, of caregiver, 55 precursors of, 292
Dependency, 103 of therapist, 239
as depression factor, 141,145,147-149, treatment difficulties of, 239
153-154 Dismissive avoidant attachment
and feminist theory, 85 descriptions of parents in, 259
mother's level of, 53 emotion-engagement strategies with,
and relatedness, 86 237, 238
of women, 153 Kortenberg-Leuven Study (K-LS) of,
Dependent (sociotropic) depression, 8, 157- 220
158 organization of, 68-69
Dependent personality disorder, 160, 174, and psychodynamic therapy, 236
175 Disorganized attachment
Depression. See also Treatment of Depression and coordinated interpersonal timing,
Collaborative Research Program 50
and attachment style, 157 and separation, 66
as disruption of personality develop- Disoriented attachment, 66
ment, 155-160 Displacement, 177
introjective, 179, 181 Disruptions of personality development,
research on, 7-8 154-162
subtypes of, 226-227 depression, 155-160
types of, 8, 155, 188 personality disorders, 160-162
Depressive experiences Disruptive introjects, 282
types of, ix Docility, 39
of women vs. men, 7 Dominant goal (type of depression), 157
Depressive Experiences Questionnaire Dominant other (type of depression), 157
(DEQ), 7, 53-54, 134, 144-154, D-R scale. See Differentiation-Relatedness
159, 205 scale
Deprivation, 52 DSM-IV. See Diagnostic and Statistical Manual
DEQ. See Depressive Experiences Question- of Mental Disorders, Fourth Edition
naire Dysfunctional Attitudes Scale (DAS), 146,
Descartes, Rene, 18, 19 205, 227
Descriptions of self and others, 253-259
Despair, 128 EAC (enhanced adaptive capacities), 235
Developmental levels, 146-154 Early development, 48-51
of interpersonal relatedness, 147-149 Eastern cultures, 23
of self-definition, 149-154 Efficacy, 31, 145, 146, 149-150, 153
390 SUBJECT INDEX

Egocentric, 24 mother-infant, 55, 63
Ego energy, 127 with primary caregiver, 45
Ego function disturbances, 167 Face-to-face play, 49, 61
Egoistic individualism, 21 Facial expression, 61
Ego style, 127 Facial mirroring, 51-52
Eliciting and responding style, 49 Failure, feelings of, 184
Emde,R.N., 112 Fairweather Ward Behavior Rating Scale,
Emerson, Ralph Waldo, 75 208
Emotional vigilance, 292 Family
Empathic contingent responsiveness, 52 child's realization of, 57, 89
Empathy child's relationships with, 86
evolution of, 38 in collectivist vs. individualist cultures,
in psychoanalytic process, 264-265 35
and therapist's attachment style, 239 cooperation with, 102
Empedocles, 16 Fantasies, 183
Empirically supported treatments (ESTs), Father
235 child's relatedness with, 91-92
Engagement, 44-45, 49, 142 communicating feelings of, 107
Enhanced adaptive capacities (EAC), 235 and identification/self-definition, 186
Enlightenment, 20, 75 working model of, 246
Enmeshment, 92 Fear
Ensembled individualism, 81-82, 84-85 of abandonment/neglect, 174
Entitlement, 80 of annihilation, 178
Environmental factors, in psychopathology, Fearful avoidant attachment, 68, 259
167 Felt Safety, 221
Epigenetic psychosocial model, 73-74, 100, Feminine development, 26
101-116 Femininity, 24
Erikson, E. H., 73-74,96,99-107,109,110, Feminist theories/theorists, 83-85, 103
113-117, 124-126, 128 Flattened affect, 208
Esprit de corps, 111 Flexibility, lack of, 170
"Essential other," 73 Foster, Vincent, 156n2
ESTs (empirically supported treatments), 235 Freedom, 81
Evaluation of psychological test protocols, Free enterprise system, 77
209-213 Free will, 17
Evocative object constancy, 245, 248-251 Freud, Anna, 73, 167
Evolutionary biology, 37-40 Freud, Sigmund, 25-26, 37, 72, 73, 87, 114,
Evolutionary theory, 78 121, 133, 134, 155, 166, 176, 181,
Evolving configuration, 101 253n4, 264-265, 268, 272
Experienced incompatibility, 120-121, 124, Friendship, 89, 102, 104
245, 268-274 Fusion, 174
Exploratory visual-tactile skills, 65
Expression of affection, 174 GAS (Global Assessment Scale), 261
Expressive mode of self, 104-109, 125, 127 Gaze, 49, 61, 62
Expressive society, 34 Gemeinschaft, 34
External perspective, 264 Gender differences
Extrinsic motivation, 31 in interpersonal relatedness, 90-92
Extroverts, 140 in personality development, 286-287
Eysenck Neuroticism Scale, 141 in psychopathologies, 186-187
Gender-incongruent individuals, 186
Fabulized combination responses, 213, 215 Generativity, 96, 114-116
Face-to-face interactions Geometric coordinate system, 18, 19
guiding principles of, 46 Geselhchaft, 34
SUBJECT INDEX 391

Gilligan, C., 85 Klein's concept of, 111
Global Assessment Scale (GAS), 261 self-, 95-96, 104,110
Goal(s) sexual, 92
dominant, 157 Identity formation, 96
group, 34-35 clear/effective, 187
personal, 35 Erikson's concept of, 101
of therapeutic change mechanisms, Ideological individualism, 21
279-280 Idiocentrism, 35
God, 17, 78 IIP (Inventory of Interpersonal Problems),
Good-enough mother, 117-118, 125 205nl
Grandiosity, 183 Illusions, 59
Gratifying involvement, 117-120, 124, 125, Imipramine, 225, 226
245, 263-264, 267-274 Imitation, 61
Greece, ancient, 17 Immunocompetence, 82
Greed, 290 Implicit relational knowing, 123
Grieving, 59 Inadequacy, feelings of, 178, 184
Group violence, 111 Incorporation, 117
Growth Independence, 57
opportunity for, 170 Individualism. See also Self-definition
in therapeutic internalization, 266 in American society, 75, 78
Guilt, 101-102,104, 105, 158, 178,182 and dependence on society, 22
Guntrip, H., 88 ensembled, 81-82, 84-85
Gutmann, D., 127 primary views of, 20-21
self-contained, 80, 81
Hallucinations, 59 in Western culture, 16-22
Happiness, 25 Individuality
Harmony, 46, 84, 88-89 antecedents of, 51-60
Hedonic mode, 36, 39, 40 mature sense of, 79-80
Helping behavior, 82 and separation, 74
Helplessness, 52 in United States, 75
HFDs (Human Figure Drawings), 206 Individuation, 65-66
Hierarchical spirality, 122 Industry, 74, 75, 80, 102, 105, 109
Hierarchical view of clinical disorders, 289 Ineffectiveness, 52
Hindu culture, 23 Infant-caregiver bond, 245
Histrionic character style, 143 Infant development, 48-51
Histrionic personality disorder, 160, 174- Infantile (dependent) personality disorder,
175, 184, 186 174, 175
Hobbes, Thomas, 21 Infant-initiated activity, 63, 65
Homeostatic functions, 52 Inferiority, feelings of, 102, 105, 178
Homey, Karen, 28 Information-processing system, 65
Human docility, 39 Initiative
Human figure, 210, 214 capacity for, 102, 104, 107, 109
Human Figure Drawings (HFDs), 206 guilt vs., 101-102, 104, 105
Initiatory infant activity, 45
"I, me, mine," 55, 113, 251 "Inner certainty" of mother, 55
Identification, 117 Insecure attachment. See also specific Insecure
with caregiver, 86 attachments; e.g. Dismissive attach-
with father, 186 ment
mechanism of, 125-126 and contingent coordination, 61
with peers, 86 and coordinated interpersonal timing,
Identity 50
Erikson's concept of, 100, 101 descriptions of parents in, 257
392 SUBJECT INDEX

organization of, 68-69 Interpersonal reciprocity, 187
precursors of, 292 Interpersonal relatedness, 85. See also Com-
and separation, 66 munion
of therapist, 239 antecedents of, 60-69
treatment difficulties with, 238 aspects in development of, 15
Instinctual development, 167 capacity for, 61
Instrumentalism, 91 development of, 4
Instrumental society, 34 levels of, 147-149
Integrated development, 280-281 in psychological development, 87
Integration, 126-128 in Western culture, 22-24
balance between internalization and, Interpersonal relationships, 3
128 as developmental challenge, 3
of integrity, 126 psychopathologies of, 4-5
in late adolescence, 110 rating of, 208
of psychological awareness/reorganiza- Interpersonal responsibility, 32
tion, 127 Interpersonal schemas, 248-254
Integrative theories of psychological devel- Interpersonal therapy (IPT), 225, 235
opment, 92-97 Intersubjective relatedness, 122
and identity, 95-96 Intersubjectivity theory, 255
and intimacy development, 96 Intimacy, 30, 89-90, 96, 114-116, 176
and search for one's true self, 95 Intimate relationships, 89-90
self-determination model of, 94 Intrinsic motivation, 31
Integrity, 110, 115-116, 126 Introjection, 117
Intellectualization, 141 Introjective (term), 134
Intelligence, 65 Introjective borderline personality disorder,
Intentionality, 110 8
Interactive regulation, 47 Introjective depression, 8, 155-157, 181-
Interactive schema, 59 184, 188
Interactive styles, 63 Introjective development, 169
Interiorization, 117 Introjective disorders, 8
Internalization, 31, 58, 106-110, 117-126 Introjective patients
balance between integration and, 128 later treatment focus of, 280
experienced incompatibility in, 120- PSA (psychoanalysis) with, 237
121, 124 therapeutic change mechanisms in,
gratifying involvement in, 117-120, 278-280
124, 125 therapeutic focus of, 278-279
of intersubjective relatedness, 122 therapeutic response of, 9
levels of, 117 treatment of, 230-231
and levels of constancy, 123 Introjective personality organization, 4,134-
and procedural aspects of representa- 138. See abo Self-definition
tions, 123-124 Introjective psychopathology, 172-173,177-
of role relations, 95 187, 287
and superego formation, 121-122 cognitive functioning in, 182-183
in therapeutic process, 263-274 common features of, 195
Internal perspective, 264 complex balance of features in, 182-184
Internal psychological experiences, 127 counteractive defenses in, 180-181
Internal working models, of attachment re- depression, 179
lationships, 245-248 gender differences with, 186-187
Interpersonal Communication Scale, 208 model of development of, 185
Interpersonal interpretive mechanisms, narcissistic, 179-180
275n9 obsessive-compulsive, 179
Interpersonal knowledge, 58-59 paranoid, 179
SUBJECT INDEX 393

progression/regression in, 184, 186 Male chauvinism, 92
Introverts, 140 Maori culture, 23
Intrusive maternal style, 49nl Masculine development, 26
Intrusiveness, 81 Masculinity, 24
Inventory of Interpersonal Problems (IIP), Maslow, A. H., 88-89
205nl Maternal acknowledgment, 61
Inventory of Personality Organization, Maternal play, 63, 65
222nl5 Maternal reciprocity, 63
IPT. See Interpersonal therapy Maternal relatedness, 64
Islamic culture, 23 Maternal responsiveness, 63, 64
Isolation, 80, 178 Maternal scaffolding, 51
I-You development, 33 Maternal style, 49nl, 63
McAdams, Dan, 30, 140
James, William, 21, 55 McClelland, D. C., 32
Japanese culture, 23 Mechanism of identification, 125-126
Jung, C. G., 140 Medication, 225, 226, 233, 235
Melancholia, 155. See also Depression
Kagitcibasi, C., 34-36 Men
Kin selection, 37-38 depressive experiences of, 7
Klein, George, 111-112, 120 as egocentric, 24
K-LS. See Kortenberg-Leuven Study and interpersonal relatedness, 90-92
Kohut, Heinz, 28, 73 introjective psychopathology in, 178
Kortenberg-Leuven Study (K-LS), 205,220- Menninger Psychotherapy Research Project
224 (MPRP), 205, 216-220, 224, 274,
evaluation of extent of therapeutic 275
change, 221-222 assessment of therapeutic change, 218
patterns of therapeutic change, 222-224 differentiation of anaclitic-introjective
relationship among different measures configurations of psychopathology,
of therapeutic change, 222 218
therapeutic change, 218-220
Labile affect, 208 Mentalization, 270
Language, 90 Mental representations, 59, 60, 66
Latent Difference Score (LDS), 234 Merger, 109, 174
Leary, M, 79 Meyer, B., 238
Libido, 26 Middle Ages, 17
Lichtenberg, J. D., 112-113 Mindfulness, 270
Loewald, H. W., 26 Mirroring, facial, 51-52
Loneliness, 82 MOA Scale. See Mutuality of Autonomy
Loss, 52 Scale
Love Mob behavior, 111
ability to give/receive, 174-175 Modell, H., 93
and attachment, 68, 87 Mother
being in, 88-89 attachment style of, 291
as motivation, 30 child's relatedness with, 91, 92
for other, 176 communicating feelings of, 107
and status, 32 personality organization of, 54,291-292
Low agreeableness, 136 working model of, 246
Loyalty, 111 Mother-infant relationship, 44-48, 51
Luther, Martin, 18 Mother's heartbeat, 52
Motivation, 30-31, 76-80
Madeline (case study), 189-193 Motivational forces, 290
Mahler, M. S., 72, 73 Motivational systems, 158-159
394 SUBJECT INDEX

MPRP. See Menninger Psychotherapy Re- Opiates, 197
search Project Opportunity, for growth and change, 170
Murray, H. A., 77 Orality, 176
Mutual gaze, 49, 61 Organization
Mutual influence, 49 capacity for, 48
Mutuality, 114, 187 caregiver's contribution to sense of, 53
Mutuality of Autonomy Scale (MOA), 211- of insecure attachment, 68-69
212, 219nl2, 224 of interpersonal schemas, 248-254
Mutually shared reciprocal relationships, levels of anaclitic personality, 176
54n3 of personality. See Personality organi-
Myers-Briggs Personality Inventory, 141 zation
of representations, 60
Narcissism, 28, 80, 178-184 self-, 84-85
Narcissistic choice, 26 ORI. See Object Relations Inventory
Narcissistic personality disorder, 161 "Other" schema, 59
Narrative response, 274 Overcompensation, 141, 179-181
National Institute of Mental Health
(NIMH), 205 Paranoia, 178-184, 186
Natural selection, 37-38 Paranoid ideation, 182
Need for approval (NFA), 227, 228 Paranoid personality disorder, 161
Neediness facet, 148, 149, 154 Parental care, 38
Needs, of others, 89 Parental figures, 152, 195
Neglect, fear of, 174 Parent-child relationship, 159
Negotiation of status, 35 Parsons, Talcott, 34, 91
Neoplastic immunological disease, 197 Patient-outcome (P-O) interaction, 226
Neopsychoanalytic theory, 27-28 Patient-therapist congruence, 236-240
Neurosis, 27, 208 Patient-treatment (P-T) interaction, 226
Neuroticism, 136 Patient variables, 204-206
NFA. See Need for approval Paul (apostle), 18
Nietzsche, Friedrich, 20 Peacemaker, 140
NIMH (National Institute of Mental Peer play, 102
Health), 205 Peers
Nonpsychoanalytic personality theory, 28- identifying with, 86
33 involvement with, 89
"No," saying, 49 Perfectionism (PFT), 227-232, 234-235. See
Nurturance, 86 also Self-critical perfectionism
Perloff, R., 75
Object choice, 26, 27 Personal goals, 35
Object relations, 267 Personal happiness, 25
Object Relations Inventory (ORI), 190-192, Personality development, 71-98, 285-287
221, 224 integrative theories of, 92-97
Object relations theory, 28, 44, 88, 246, 255 relatedness theories of, 82-92
Object representation, 60 separation theories of, 72-82
Obsessive-compulsive defenses, 180, 182 Personality disorders, 160-162
Obsessive-compulsive disorder, 143, 161, Personality organization, 133-163
179, 181, 182 anaclitic, 138-141
Obsessive-compulsive personality, 186 assessment of, 144-154
Obsessive-compulsive symptoms, 178 and defense mechanisms, 141-144
Ocnophilic tendency, 28 developmental levels of, 146-154
Oedipal phase, 102nl disruptions of, 154-162
Omnipotence, 183 introjective, 134-138
Operational thinking, 57, 251-253 of mother, 54, 291-292
SUBJECT INDEX 395

variations in normal, 134-144 PSI (Personal Style Inventory), 146
Personality styles, 4 Psychoanalysis (PSA)
Personality theory, 24-33 with introjective patients, 237
classic psychodynamic, 25-27 Lichtenberg on, 112-113
neopsychoanalytic, 27-28 in Menninger Psychotherapy Research
nonpsychoanalytic, 28-33 Project, 216-220
psychodynamic, 25-33 therapeutic effects of, 274-277
Personal Style Inventory (PSI), 146 Psychoanalytic psychotherapy, 217
Perturbations, 119 Psychoanalytic theory, 72-73
Petrarch, 18 Psychodynamic theory, 25-33
PFT. See Perfectionism classic psychoanalytic, 25-27
Pharmacotherapy, 233-234n20 neopsychoanalytic, 27-28
Philobatic tendency, 28 nonpsychoanalytic personality, 28-33
Physical senses, 265 Psychological awareness, 127
Physiological homeostasis, 51 Psychological development, 3-4
Physiological regulation, 46, 52 integration process of, 126-128
Pilkonis, P., 238 internalization process of, 117-126
Planetary system, 18-19 mature, 187
Play behavior, 47 processes of, 108, 116-128
P-O (patient-outcome) interaction, 226 products of, 100-101
Point of view, 57 Psychological reorganization, 127
Points of vulnerability, 166 Psychological sense, 265
Polarization, 181 Psychological test protocols evaluation, 209-
Post hoc analyses, 291 213
Postpartum depression, 138, 154 Concept of Object on the Rorschach,
Power 209-211
levels of, 32 Mutuality of Autonomy Scale, 211-212
mature form of, 94 thought disorder, 212-213
as motivation, 30-31 Psychopathology(-ies), 4-6, 26, 165-199
Predestination, 17 anaclitic configuration of, 173-177
Predictability, 55 biological/environmental factors of,
Preoccupied attachment 166-168
cognitive interventions with, 238 classification of, 287-290
descriptions of parents in, 259 configurations of, 170-187
and dismissive therapists, 239 diathesis-stress model of, 166
precursors of, 292 etiologically-based, dimensionally-orga-
and psychotherapy, 237 nized taxonomy of, 193-198
of therapist, 239 introjective configuration of, 177-187
Prerepresentational schemas, 118, 245, 293 later development of, 173
Prerepresentational self, 46 Madeline case study, 189-193
Preservation of other, 158 mixed features of, 187-189
Presymbolic representations, 45, 49 symptoms of, 169
Pride, 107, 109, 115 Psychosexual theory, 105
Primates, 36 Psychosis factor, 208
Prisoner's dilemma game, 38 Psychotherapy, 233, 235
Productivity, 77, 78 Psychotic depression, 181
Projection, 179, 188 P-T (patient-treatment) interaction, 226
Prosocial behaviors, 37, 82
Protestantism, 75 Rank, Otto, 28
Protestant work ethic, 75-77 Rating
Prototype theory, 59 of clinical case records, 207-208
PSA. See Psychoanalysis of clinical symptoms, 208
396 SUBJECT INDEX

of interpersonal relations, 208 object relations model of, 88
of social behavior, 208 and perceived harmony, 88-89
Reality, pretend and, 56 Relational knowing, 123
Receptivity, 86 Renaissance, 17-19
Reciprocal alliances, 35 Reparation of disruptions, 62
Reciprocal altruism, 38 Repetition, 46
Reciprocal force of confrontation, 44 Representational development, 245-259
Reciprocal process, 62 descriptions of self/others in, 253-259
Reciprocal regulatory functions, 52 and internal working model, 245-248
Reciprocal relatedness, 187 structural organization of schemas in,
Reciprocity, 90, 115 248-254
Recursive interactions, 291 Representations, 48
Referential activity, 275 adaptive, 282
Referential thinking, 275-276 mental, 59, 60, 66
Reflection on affective experiences, 54n3 of parental figures, 152
Reflective function (RF), 221, 275 procedural aspects of, 123-124
Reflective self-awareness, 57, 58 revised, 282-283
Reflectivity, 127 of self/other, 46
Reflexive self-awareness, 55-56 therapeutic changes in, 260-263
Regression, 266 Repression, 142, 143, 177
Regulation, 45, 46 Resilience, 150, 153
interactive, 47 Resistant attachment
physiological, 46, 52 and coordinated interpersonal timing,
self-. See Self-regulation 50
stimulus, 51 and love in adults, 68
Relatedness, 31 organization of, 69
and attachment, 85-87 over time, 67
as basic need, 31 and separation, 66
culture of, 34 therapeutic relationship with, 276
expressions of, 45 Responsibility, 32
mature, 80 in ensembled individualism, 81
Relatedness developmental line, 106-110, and rights, 78
115-116 and separateness, 75
gratifying involvement in, 125 Responsiveness
integration of, 126-128 child's, 86
integrity in, 115—116 empathic contingent, 52
interaction of self-definition and, 105 maternal, 63, 64
internalization of, 117-126 RF. See Reflective function
intimacy/generativity in, 114-116 Rhythmicity, 46, 52
in psychological development, 108 Riggs-Yale Project (R-YP), 205-216, 224,
"we-ness" in, 111-115 274
Relatedness development levels, 103 evaluation of anaclitic-introjective dis-
Relatedness facet (of dependency factor), tinction, 207
148, 149, 154 evaluation of psychological test proto-
Relatedness theories of psychological devel- cols, 209-213
opment, 82-92 ratings of clinical case records, 207-208
biological basis, 82-84 therapeutic change in seriously dis-
and child development, 91-92 turbed inpatients, 213-216
and development of attachment, 85-87 Rights, responsibility and, 78
feminist models of, 84-85 Risk, 150, 153
of intimacy, 89-90 Risk-related environment, 152
and love, 87 Rogers, Carl, 231
SUBJECT INDEX 397

Romantic individualism, 20-21 Self-critical perfectionism, 79, 136-138
Romantic period, 20 Self-criticism, 54, 145-146, 149-153, 159-
Romantic relationships, 68 160, 197
Rome, ancient, 17 Self-defeating personality disorder, 161
Rorschach test, 206, 209-213, 224 Self-definition, 3, 30. See also Individualism
Concept of Object on the, 209-211 aspects in development of, 15-16
Mutuality of Autonomy Scale with, as developmental challenge, 3
211-212 development of, 4, 177
responses to, 191-193, 213n9, 274 and father, 186
and thought disorder, 212-213 levels of, 149-154
Rousseau, Jean Jacques, 20 psychopathologies of, 5
Ryan, R. M, 31 in Western culture, 16-22
R-YP. See Riggs-Yale Project Self-definitional developmental line, 103-
110, 115-116
Sage (personality type), 140 adolescent changes in, 127
Sampson, E. E., 80, 81, 84 expressive mode of self in, 104-109
SAS. See Sociotropy-Autonomy Scale gratifying involvement in, 125
Saying "No," 49 integration of, 126-128
Schizoid personality disorder, 161 integrity in, 115-116
Schizophrenia, 174, 253 interaction of relatedness and, 105
SCID-II (Structural Clinical Interview for internalization of, 117-126
DSM-IV Axis II personality disor- intimacy/generativity in, 114-116
ders), 222 in psychological development, 108
SDT. See Self-determination theory self-feelings in, 104, 106-110
Second-order representations, 275n9 and "we-ness," 111-115
Secure attachment Self-determination theory (SDT), 31-32,94
and coordinated interpersonal timing, 50 Self-doubt, 184
and dependability of caregiver, 55 Self-esteem, 64, 107
descriptions of parents in, 257, 259 Self-expression, 45. See also Expressive mode
early, 64 of self
and love in adults, 68 Self-feelings, 104, 106-110, 125, 127
over time, 67 Self-identity, 95-96, 104, 110
precursors of, 292 Self-inquiry, 271-272
and self, 69 Self-in-relation, 85, 109-111, 115
and separation, 66 Self-interest, 37, 75-76
and social adaptability, 60-61 Self-observation, 56
therapeutic alliance with, 238 Self-organization, 84-85
and therapeutic gain, 236 Self-preoccupation, 79
of therapist, 239 Self-preservation, 158
in well-functioning individuals, 144 Self-reflection, 79
Self Self-reflective capacity, 184
and anaclitic psychopathology, 176 Self-reflective evaluation, 95
development of, 169 Self-reflectivity, 110
inner nature of, 19 Self-reflexivity, 55, 56
working model of, 246 Self-regulation, 45-48
Self-awareness, 110 capacity for, 48, 51
Self-concept, 91 and caregivers, 45-46
Self-constancy, 45, 251, 253 caregiver's contribution to, 53
Self-contained individualism, 80, 81 Self-reliance, 75, 157
Self-control, 183 Self-representations, 46
Self-critical depression, 8, 156-157. See also Self-respect, 95
Introjective depression Self-schema, 59
398 SUBJECT INDEX

Self-sustaining regulatory styles, 62 Social mode, 64, 65
Self-system, 112 Social obligation, 17
Self-versus-other, 46 Social prototype, 63
Self-with-other, 46, 112, 113 Social reciprocity, 58
Self-worth, 115, 179 Social relationships, 22, 153
SEM (structural equation modeling), 152 Social rules and roles, 83
Sense of self, 49, 60 Social skills, 137-138
and sharing experiences with caregiver, Social support, 152, 153, 230
53 Social systems, 33-37
woman's, 84 agonic vs. hedonic, 36-37
Senses (physical and psychological), 265 collectivist vs. separateness, 34-36
Sensitivity, to criticism, 184 communal vs. associational, 34
Sensitization, 142-143 competitive vs. cooperative, 33-34
Sensorimotor experiences, 55 expressive vs. instrumental, 34
Sensory deprivation, 52, 59 level of structure, 34
SEP. See Supportive-expressive psycho- in primates, 36
therapy Social values and norms, 110
Separateness, 28 Socioemotional functioning, 64, 65
of body/mind, 56 Sociotropic depression, 8, 157-158
culture of, 34, 35 Sociotropy, 157
sense of, 49 Sociotropy-Autonomy Scale (SAS), 8,134,
Separation, 52 146, 159, 205
and individuation, 65-66 Solar system, 18-19
maternal, 52 Spence, Janet, 75, 77-79
sense of, 102 Splitting, 179, 181
and therapeutic relationship, 269-270 St. Augustine, 18
Separation—individuation, 72, 73 Status, 32, 35
Separation theories of personality develop- Stern, D. N., 113
ment, 72-82 Stimulation, 46, 62
achievement motivation in, 76-80 Stimulus regulation, 51
and ensembled individualism, 81-82 Stress, 293
epigenetic psychosocial model of, 73- Stressful life events, 137, 235
74 Stressors, 197
in nonpsychodynamic models, 74-77 Stress reactivity, 235
psychoanalytic model of, 72-73 Structural Clinical Interview for DSM-IV
Settlage, C. F., 72 Axis II personality disorders (SCID—
Sex-role stereotypes, 24, 92 II), 222
Sexual identity issues, 92 Structural equation modeling (SEM), 152
Sexuality, 176 Structural organization of interpersonal
Sexual relationship, 89, 176 schemas, 248-254
Shame, 101, 104, 105, 178 in adolescence, 252-253
Shared experiences, 52-54, 61, 90, 95, 102 affect constancy, 250
Shyness, 92 boundary constancy, 250
Simultaneous vocalizations, 61 evocative object constancy, 248-251
Smiles, 250 levels of, 254
Social absorption, 79 self-constancy, 251
Social adaptability, 60 therapeutic changes in, 260-263
Social anxiety, 26 Structure, levels of societal, 34
Social behavior, 208 Subjective perspectives, 58
Social context, 153 Subjectivity, 58
Social fittedness, 46 Sublimation, 144, 281
Socialization, 74 Substance abuse, 196-197
SUBJECT INDEX 399

Suicide attempts progression of, 273-274
and anaclitical personality organization, Therapeutic process, 9, 294-295
140 Therapeutic relationship, 244
and introjective individuals, 156, 157 with anaclitic patients, 276-278
and self-critical perfectionism, 137 experienced incompatibility in, 268-
Sullivan, H. S., 28, 89, 90, 102 274
Superego formation, 121-122 fluctuations in, 266
Supportive-expressive psychotherapy (SEP), gratifying involvement in, 268
216-220, 231, 237, 274-277 and interpersonal schemas, 260-262
Support systems, 82 and patient-therapist congruence, 236-
Surrender, 29 240
Symbolic representations, 46, 48 perceived level of, 231-232
Symptom-based diagnoses, 196-197 and perfectionism, 229-230, 232, 235
quality of, 234
Tarachow, S., 268 and therapeutic change mechanisms,
TAT. See Thematic Apperception Test 283
TDCRP. See Treatment of Depression Col- Therapist
laborative Research Program attachment style of, 239
Termination phase, 272 efficacy of, 232-233
Thematic Apperception Test (TAT), 190, impact of therapy on, 272-273
193, 206, 274-275 personality of, 236
Therapeutic change(s), 203-242 representation of patient by, 271
Menninger Psychotherapy Research Thoreau, Henry David, 75
Project on, 216-220 Thought disorder, 175, 212-215
and patient-therapist congruence, 236- Tocqueville, Alexis de, 22, 75
240 Tonnies, Ferdinand, 34
and patient variables, 204-206 Touch, 54, 292
Riggs-Yale Project on, 206-216 Traumas, 26
in structural organization/content of Treatment of Depression Collaborative Re-
representations, 260-263 search Program (TDCRP), 9, 205,
TDCRP on, 224-236 224-236
Therapeutic change mechanisms, 274-283 differentiation of anaclitic/introjective
in anaclitic patients, 278, 280 dimensions, 226-228
and diagnostic formulations, 281 and empirically supported treatments,
goal of, 279-280 235
in introjective patients, 278-280 impact on therapeutic outcome, 228-
later focus of, 280-281 235
processes of, 281-282 perfectionism, impact on outcome from,
psychoanalysis, 274-277 234-235
supportive-expressive psychotherapy, and stress reactivity, 235
274-277 therapeutic efficacy, impact on outcome
and therapeutic relationship, 276-277, from, 232-233
283 therapeutic relationship, impact on out-
Therapeutic internalization, 263-274 come from, 231-232, 235, 236
achieving new, 267 Triadic interactions, 121
attachment/separation in, 266 Triadic interpersonal matrix, 89
empathy in, 264-265 Triadic interpersonal relationships, 57, 102,
experienced incompatibility in, 268- 252
274 Triadic operational thinking, 83
gratifying involvement in, 263-264, Triandis, Harry, 34-35
267-274 Trust, 86, 89,101, 104, 107, 109, 110, 174
growth/regression in, 266 Trusting relationship, 54
400 SUBJECT INDEX

Ubermensch, 20 Wallerstein, R. S., 217
Unavailable maternal style, 49nl Waterman, A. S., 95
Undersocialized, 39 "We," 252-253
Union, 28 We, sense of, 111-115
Uniqueness, 30 Wechsler Adult Intelligence Scale (WAIS),
United States 206
individualism in, 75, 78 "Wego," 112
individuality in, 75 Western culture
lack of relatedness in, 81 individualism in, 16-22
success orientation of, 76 interpersonal relatedness in, 22-24,90-
Unmitigated agency, 78 91
Unmitigated communion, 78, 85 Wiggins, J. S., 32
Women
Vampire bats, 38 as altercentric, 24
Vanderbilt Therapeutic Alliance Scale, 229 anaclitic psychopathology in, 174
Verbal abilities, 64 dependent, 153
Verbal stimulation, 51 depressive experiences of, 7
Vermote, Rudi, 220-224 and interpersonal relatedness, 90-92
Vocal coordination, 53 self-critical, 138
Vocalizations, 61 Worthiness, feelings of, 109
Voice, 61 Worthlessness, feelings of, 178
WAIS (Wechsler Adult Intelligence Scale),

206
SUBJECT INDEX 401

ABOUT THE AUTHOR
Sidney J. Blatt received his PhD in personality development and psychopa-

thology from the University of Chicago in 1957, where he interned at the
Counseling Center with Dr. Carl Rogers. He was a postdoctoral fellow at the
University of Illinois Medical School and Michael Reese Hospital in Chi-
cago. He joined the faculty of the psychology department at Yale University
in 1960, and in 1964 he also assumed the post of chief of the psychology
section in the Department of Psychiatry. Dr. Blatt was a fellow of the Foun-
dations Fund for Research in Psychiatry for psychoanalytic training at the
Western New England Institute for Psychoanalysis, graduating in 1972. He
has also held a Senior Fulbright Research Fellowship and is currently a Se-
nior Specialist for the Fulbright Foundation.
Dr. Blatt has published extensively (over 200 publications) in a wide
range of journals in psychology, psychiatry, and psychoanalysis. He has
authored or coauthored several books—Experiences of Depression (American
Psychological Association, 2004), The Interpretation of Psychological Tests
(1968/1988; with J. Allison & C. N. Zimet), Schizophrenia: A Developmental
Analysis (1976; with C. M. Wild), Continuity and Change in Art: The Develop'
ment of Modes of Representation (1984; with E. S. Blatt), and Therapeutic
Change: An Object Relations Perspective (1994; with R. Q. Ford), and coedited
several volumes—The Self in Emotional Distress: Cognitive and Psychodynamic
Perspectives (1993; with Z. V. Segal), three volumes on psychoanalytic theory
and attachment research (1999, 1999, 2003; with D. Diamond), Attachment
and Sexuality (2007, with D. Diamond & J. P. Lichtenberg), and Theory and
Treatment of Depression: Toward Integration (2005; with J. Corveleyn &
P. Luyten). He has been on the editorial board of several journals in psychol-
ogy, psychiatry, and psychoanalysis and has received citations for distinguished
contributions to research, teaching, and clinical practice, including the highly
coveted award from the Mary S. Sigourney Foundation (in 2006) for distin-
403
guished contributions to psychoanalysis. He has also been a visiting professor
at several universities, including the Hebrew University of Jerusalem, Israel;
University College London, England; Catholic University of Leuven,
Belgium; Bar Ilan University in Ramat Can, Israel; Nova Southeastern Uni-
versity in Ft. Lauderdale, Florida; Ben Gurion University of the Negev in
Be'er Sheva, Israel; George Washington University in Washington, DC; and
the Menninger Foundation when it was in Topeka, Kansas.
404 ABOUT THE AUTHOR

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Polarities of

AMERICAN PSYCHOLOGICAL ASSOCIATION

Typeset in Goudy by Stephen McDougal, Mechanicsville, MD

Printer: Maple-Vail Book Manufacturing, Binghamton, NY

Blatt, Sidney]. (SidneyJules), 1928-

Printed in the United States of America

I. Relatedness and Self-Definition: A Fundamental Polarity

II. Personality Development , 41

III. Personality Organization and Psychopathology 131

Extensive clinical experience in the late 1960s (1965-1970) with two

Every person throughout life confronts two fundamental psychological

This initial part identifies two fundamental psychological dimensions

Establishing meaningful, mutually satisfying, reciprocal interpersonal

HISTORICAL DEVELOPMENT OF SELF-DEFINITION AND

The development of individuality or self-definition and of interpersonal

An emphasis on self-definition or individualism has been predominant

Interpersonal Relatedness or Communion

Alexis de Tocqueville, in the mid-19th century, in Democracy in America

RELATEDNESS AND SELF-DEFINITION IN

Personality development throughout the life cycle, from infancy to se-

Classic psychoanalytic theory as well as many subsequent revisions and

Classic Psychoanalytic Theory

'Wink (1991), in an empirical investigation of a number of well-established measures of narcissism,

RELATEDNESS AND SELF-DEFINITION IN SOCIAL

Chance (1980) further stated that

The integral aspect of social or hedonic relationships is based on construc-

In the agonic mode, the self-system is composed of strategies to defend

From a variety of perspectives and in a wide range of disciplines, the

The infant developmental research literature demonstrates that an ex-

Antecedents of Interpersonal Relatedness

Investigations of early mother-infant face-to-face interaction (e.g.,

A wide range of developmental research, from early infancy to adult-

Research on infant development discussed in chapter 2 (this volume)

SEPARATION THEORIES OF PERSONALITY DEVELOPMENT

Influenced by the predominant emphasis on individuality in Western

On the basis of the epigenetic psychosocial model of personality devel-

RELATEDNESS AND SELF-DEFINITION 73

RELATEDNESS AND SELF-DEFINITION 75

Perloff saw no natural relationship between social responsibility and self-

Achievement enables one to be autonomous and self-fulfilling and to de-

RELATEDNESS AND SELF-DEFINITION 77

RELATEDNESS AND SELF-DEFINITION 79

RELATEDNESS AND SELF-DEFINITION 81

RELATEDNESS THEORIES OF PSYCHOLOGICAL DEVELOPMENT

Parallel to the separation personality theorists discussed earlier is a group

RELATEDNESS AND SELF-DEFINITION 83

RELATEDNESS AND SELF-DEFINITION 85

S. Freud (1930/1961) considered it essential to recognize "love as one of the

RELATEDNESS AND SELF-DEFINITION 87

This emphasis on the importance of interpersonal processes in personality

RELATEDNESS AND SELF-DEFINITION 89

Parsons (1951) noted that in a wide range of societies a relative emphasis on

RELATEDNESS AND SELF-DEFINITION 91

1NTEGRAT1VE THEORIES OF PSYCHOLOGICAL DEVELOPMENT

RELATEDNESS AND SELF-DEFINITION 93

RELATEDNESS AND SELF-DEFINITION 95

Proponents of various theories of personality development have dis-

RELATEDNESS AND SELF-DEFINITION 97

An elaboration and extension of Erikson's (1950) epigenetic psychoso-

THE PRODUCTS OF PSYCHOLOGICAL DEVELOPMENT

In a linear series of hierarchical epigenetic stages, Erikson (1950, 1959,

100 POLARITIES OF EXPERIENCE

Erickson's Epigenetic Development Model Modified