Isr J Relat Sci Vol 44 No. 4 (2007) 251–254

Editorial: Matters: A Special Issue in Honor of Sidney J. Blatt

Golan Shahar, PhD, 1,2 Ada Zohar, PhD,3 and Alan Apter, MD4

1 The Personality, Risk and Resilience Research Group (Director), Ben-Gurion University of the Negev, Beersheba, Israel 2 Department of Psychiatry, School of Medicine, New Haven, Conn., USA 3 Department of , Ruppin Academic College, Emek Hefer, Israel

4 Department of Psychiatry, Schneider Child Study Center, Petach Tikva, Israel.

Abstract: This special issue in honor of Sidney J. Blatt includes a collection of articles written by his Israeli friends, col- leagues and former students. Blatt, a professor of Psychology and Psychiatry at Yale University, a senior psychoanalyst at the Western/New-England Psychoanalytic Institute in New Haven, , and a world-renowned clinician, theoretician, and investigator, has made an invaluable contribution to the understanding of personality processes in development, , and the therapeutic process, as well as to Israeli and psychiatry. Articles in this special issue relate Blatt’s work to the author’s findings regarding mental representations of self-and- others, suicide and self-destructive behavior, depressive personality styles, adolescent development, personality as- sessment, and evidence-based treatment. An interview with Blatt, and his response to the articles in his honor, con- clude this special issue.

There are two good reasons to launch this special on basic personality processes purports to increase issue in honor of Sidney J. Blatt: one is more concep- markedly our understanding of the multi-causal na- tual in nature, the other particularly pertinent to the ture of psychopathology, and to the employment of Israeli situation. The more conceptual reason is that person(ality)-sensitive procedures for assessment the theoretical and empirical work of Blatt, extended and treatment. over more that five extremely productive decades, teaches us about the formidable role of personality In particular, Blatt’s theory and research promise processes in normal development, psychopathology, to sensitize the clinical practitioner-researcher to the and the outcome, and process, of mental health key role played by mental representations of self and treatment, both psychological and pharmacological. others in the (dis)regulation of cognition, affect and behavior, as well as to individual differences in the In an era in which biological psychiatry on the one emphasis people place on interpersonal relatedness hand, and the focus on brief, manualized psycho- vs. self-definition and self-esteem. As compellingly therapies on the other hand, dominate our profes- demonstratedinahostofresearchfindings(see,for sion, Blatt’s legacy serves as a crucial reminder that it instance, 1), maladaptive and incoherent mental rep- is the person, with her particular way of making resentations of self-and-others, or object relations, sense of herself and the work around her, who suf- predisposeindividualstoahostofadaptationprob- fers, is the one who needs help, and is the one who lems and to severe psychopathology, and restrict will ultimately respond — or not — to our interven- these individuals’ ability to gain from treatment. tions. Without taking the person into account, our Conversely, essentially positive, albeit realistic, co- conceptualization of mental suffering and its treat- herent, and psychologically flexible representations ment runs a serious risk of being highly bolster normal development and serve as a resource reductionistic, and therefore erroneous and ineffec- during treatment (2). Related to his theory and re- tive. In contrast, incorporating theory and research search on mental representations, Blatt’s theory of

Address for Correspondence: , PhD, The Personality, Risk and Resilience Research Group (Director), De- partment of Psychology, Ben-Gurion University of the Negev, Beersheba 84105, Israel. E-mail: [email protected]. 252 EDITORIAL: PERSONALITY MATTERS: A SPECIAL ISSUE IN HONOR OF SIDNEY J. BLATT interpersonal relatedness and self-definition demon- and their colleagues, which reviews and interprets strates compellingly that our lives are woven around previous studies that utilized Blatt’s conceptualiza- the need to secure warm, close, stable and supportive tion of mental representations of significant others interpersonal relatedness, combined with the need in researching parental representations in children. to establish a positive, clearly delineated sense of self. This review is carried out through looking at the dy- An overemphasis on one of these psychological vec- namics between actual interpersonal experiences tors at the expense of the other leads to anaclitic-de- and intrapersonal processes as well as cultural influ- pendent and introjective-self-critical personality ences. The various studies reviewed used a children’s organizations, which in turn predispose individuals version of the Object Relations Inventory (ORI) by to specific psychopathological constellations and Blatt and colleagues (6) to assess parental mental distinct responses to treatment (3–5). representations (7). The authors emphasize the ur- The second reason to launch a special issue in gent need for systematic studies of continuity and honor of Sidney J. Blatt is his steadfast support of Is- change of mental representations, in order to en- rael in general and of Israeli clinical psychology and hance the understanding of the roles of interpersonal psychiatry in particular. At a time in which Israeli and intrapersonal factors in the formation of mental universities and academics are being boycotted and representations in children. ostracized, particularly in Europe, Blatt’s intense Israel Orbach from the Department of Psychol- connection to Israel and his support of Israeli schol- ogyofBar-IlanUniversitythenpresentshisvolumi- ars’ career development is nothing less than moving. nous work on self-destructive processes and suicide, Indeed, this connection is not new. Ever since his and links it to findings by Blatt and colleagues on service as the Freud Chair at the Hebrew University self-criticism. Orbach delineates the self-destructive in 1988–9, has been working very internal processes involved in suicidal behavior from closely, mentoring, advising and publishing with nu- three perspectives: theoretical, empirical and clini- merous Israeli psychologists and psychiatrists, some cal. From a theoretical point of view, different think- of whom now occupy leading position in Israeli aca- ers and their contribution to the understanding of demia and its mental health establishment. It is suicide are reviewed. Among them is Blatt and his therefore only fitting that we in Israel would be eager concepts of self-critical and destructive to find a way to thank one of our greatest champions. perfectionism. The empirical aspects of suicidal in- As guest editors, we would like to thank Prof. David ternal processes are also outlined, among them the Greenberg, IJP editor, for allowing us, indeed en- implementation in suicidal behavior of Blatt’s two couraging us, to do so by means of launching this types of depression: self-critical and introjective. The special issue in honor of Sid Blatt. negative suicidal outcomes of perfectionism can also As per Editor Greenberg’s request, this special beseeninclinicalcasedescriptions.Itisofimpor- issue constitutes not only a tribute, but also an op- tance that while some researchers in the field empha- portunity to get immersed in some of the most cen- size specific external adversities in forming the tral questions occupying international and Israeli circumstances that lead to suicidal behavior, Orbach mental health. To that aim, we solicited articles from stresses the significance of self-destructive internal senior Israeli mental health researchers, all of whom processes of which the eroding effects create intoler- are closely familiar with Blatt’s writings, and encour- able mental pain that eventually leads to suicide. aged these authors to discuss their own work and to Next, Hadas Wiseman, Alon Raz and Ruth link it to theory and research on mental representa- Sharabany investigate the way Blatt’s personality tions, the anaclitic and introjective configurations, prototypes may account for the interpersonal prob- psychological development, psychopathology and lems of young adults with difficulties in establishing mental health treatment. Each of the articles submit- long-term romantic relationships. This was executed tedwasthenreviewedbyoneofus,aswellasbya by means of a two-dimensional model of interper- blindinternationalreviewerwhoisanexpertinthe sonal problems, comprised of affiliation and domi- topic addressed by the putative article. Opening this nance. These young adults, as well as young adults special issue is an article by Beatriz Priel, Avi Besser, who were successful in achieving long-term intimate GOLANSHAHARETAL. 253 relationships, completed the Depressive Experiences ment’s relative neglect of the role of patients’ pre- Questionnaire (8) as well as questionnaires tapping treatment personality in the outcome and process of onto mental health and interpersonal problems. In- psychotherapeutic and pharmacological interven- terpersonal problems were also measured by a tions. As argued by Soffer and Shahar, this neglect is friend’s evaluation. As hypothesized, the authors particularly alarming given the impending mental found that both self-criticism and dependency were health reform in Israel, with its focus on economic, related to greater self-reported interpersonal dis- cost-containment consideration and what appears to tress, while controlling for psychological distress be its disregard for the role of the person in treat- (depression and anxiety), and that efficacy moder- ment. To illustrate this role, Soffer and Shahar de- ated the effects of these vulnerabilities. In addition, scribe research findings from three evidence-based self-criticism contributed to the friend’s report of in- mental health trials. The first is the National Insti- terpersonal distress only for those without difficul- tute of Mental Health (NIMH) sponsored Treatment ties in long-term romantic relationships. The for Depression Collaborative Research Program findings are discussed in terms of Blatt’s theory on (NIMH-TDCRP), in which state-of-the-art psycho- interpersonal relatedness and self-definition in therapies, as well as a then prevalent tricyclic antide- young adults’ personality development and the com- pressant pharmacotherapy, for unipolar depression plementary ways the personality styles influence the were compared to a placebo plus clinical manage- interpersonal world. ment condition in the context of a Randomized Clin- Ada Zohar’s article comes next, and focuses on ical Trial. The second is the Partnership Project, a the comparison between Blatt’s model of personality community-based Randomized Clinical Trial exam- and that of Robert Cloninger, as well as their rela- ining the effectiveness of a partnership-based reha- tionship to depression and psychopathology. The bilitation for people with severe, and largely two theories arose in different contexts and disci- psychotic, mental illness. The third was a naturalistic plines: The Blatt theory is known mainly to psycho- comparison between classical and analysts, clinical psychologists and research supportive-expressive , which was psychologists with interests in depression and in de- conducted as part of the now classic Menninger Psy- velopment. The Cloninger theory is known mostly chotherapy Research Project. As reviewed by Soffer to psychiatrists, and to psychologists and researchers and Shahar, findings from these trials, including who are interested in the interface between biology those produced by Blatt, Zuroff, Davidson, Shahar and behavior. However, they provide interesting and their colleagues, clearly implicate individuals’ contrasts and surprising commonalities. Each of the personality as a paramount predictor of outcome, theories is outlined, the theoretical foundations of it often more so than the specific treatment modalities presented, as well as some central aspects for com- employed. parison: the theory’s view on personality stability Following Soffer and Shahar’s article is a unique and it’s relation to psychopathology, the theory’s effi- document: Lilly Dimitrovsky’s interview with Sidney cacy at predicting depression from personality mea- J. Blatt. The interview, conducted as part of Prof. sures, the theory’s explanation for sex differences in Dimitrovsky’s qualitative research on master thera- depression, the measures derived from the theories, pists, enables a first hand access to Blatt’s work as a and clinical implications as well as overall theory clinician, inspired by his unique training in human- productivity. The paper concludes with an analysis istic and psychoanalytic approaches. This interview of correspondences and divergences between the is then followed by Blatt’s response to the various ar- two theories, and a suggestion for future research. ticles in this special issue. ThenextarticleisbyNiritSofferandGolan In the course of this process, we were heartened Shahar from Ben-Gurion University, and its focus is bytheauthors’eagercooperation.Wewouldliketo on the role of personality and individual differences thank these authors, and also to re-thank Editor in evidence-based mental health practice. While Greenberg for his diligence and persistence in the generally supportive of the evidence-based move- course of putting forth this special issue, as well as on ment, Soffer and Shahar do point out this move- his insistence of maintaining the high standards of 254 EDITORIAL: PERSONALITY MATTERS: A SPECIAL ISSUE IN HONOR OF SIDNEY J. BLATT the IJP throughout this process. We are very happy standing and treatment of depression. J Am Psychoan- with the final product, which, we believe, construes alytic Assoc 1998;46:723–752. as a major avenue for mental 4. Blass R B, Blatt S J. Attachment and separateness in the health theory, research and practice. We hope that experience of symbiotic relatedness. Psychoanal Q 1996;65:711–746. the reader concurs and enjoys. 5. Blatt S J, Zuroff D C. Interpersonal relatedness and self- definition: Two prototypes for depression. Clin Psychol Rev 1992;12:527–562. References 6. BlattSJ,WeinSJ,ChevronES,QuinlanDM.Parental representations and depression in normal young 1. Blatt S J, Auerbach J S, Levy K N. Mental representa- adults. J Abnorm Psychol 1979;88:388–397. tions in personality development, psychopathology, 7. Priel B, Myodovnick E, Rivlin-Beniaminy N. Parental and the therapeutic process. Rev Gen Psychology 1997; representations among preschool and fourth-grade 1:351–374. children: Integrating object relational and cognitive 2. Shahar G, Blatt S J. Benevolent interpersonal schemas developmental frameworks. J Personal Assess 1995;65: facilitate therapeutic change: Further analysis of the 372–388. Menninger Psychotherapy Research Project. 8. Blatt S J, D’Afflitti J P, Quinlan D M. Experiences of de- Psychother Res 2005;15:345–349. pression in normal young adults. J Abnorm Psychol 3. Blatt S J. Contributions of psychoanalysis to the under- 1976;85:383–389.