Pioneers of Interpersonal Psychoanalysis

Donnel B. Stern, Carola Mann, Stuart Kantor, Gary Schlesinger, Donnel B. Stern, Carola Mann, Stuart Kantor, Gary Schlesinger

• Publisher: Routledge
• Year: 2015
• Print ISBN: 9780881631777
• eBook ISBN: 9781317714583
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This volume brings together 14 classic papers by interpersonal pioneers. Collectively, these papers not only demonstrate the coherence and explanatory richness of interpersonal psychoanalysis; they anticipate the emphasis on relational patterns and analyst-analysand interaction that typifies much recent theorizing. Each paper receives a substantial introduction from a leading contemporary interpersonalist.

The pioneers of interpersonal psychoanalysis are: H. Sullivan, F. Fromm-Reichmann, J. Rioch, C. Thompson, R. Crowley, E. Schachtel, E. Tauber, E. Fromm, H. Bone, E. Singer, D. Schecter, J. Barnett, S. Arieti, and J.Schimel.

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1

THE DATA OF PSYCHIATRY

HARRY STACK SULLIVAN

[1938]

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INTRODUCTION

John Fiscalini

As a contemporary perspective in psychoanalysis, the American school of interpersonal relations draws from the diverse contributions of several generations of interpersonal theorists. Constellatory, however, have been the seminal conceptions of Harry Stack Sullivan, who, more than any other theorist of his generation, laid the foundation for the development of an interpersonal school of thought. Though Sullivan did not invent interpersonal psychoanalysis single-handedly, he did provide a central theoretical armature upon which successive generations of interpersonal theorists could shape their own unique and diverse visions of interpersonal thought and practice. All contemporary interpersonal analysts, however they may differ from one another, have been profoundly influenced by Sullivan’s seminal ideas.

Sullivan developed a psychological theory of human experience and behavior that in its comprehensiveness, elegance, and originality rivals Freud’s. Sullivan’s lifework—the development of an interpersonal theory of human nature and of human psychic disorder and its therapy—was a full meta-psychological effort that has profoundly influenced not only all subsequent generations of interpersonalists but also the wider post-Freudian therapeutic community, often in ways that have remained invisible. Thus, such writers as Leston Havens have proclaimed that Sullivan almost secretly dominates American psychiatry and, one might add, all of contemporary psychoanalytic praxis.

Sullivan was one of the seminal figures in the “interpersonal turn” in psychoanalysis, that profound paradigmatic shift, beginning in the 1920s and 1930s and continuing to this day, from drive theory to interpersonal, or object relations, theory and from an impersonal to an interpersonal or personal model of psychoanalytic inquiry. The American school of interpersonal relations, like British object relations and contemporary Freudian ego psychology, has focused on the study of the self, adaptation, character analysis, and the widening of analytic technique to accommodate therapeutic work with the severely disturbed. Unlike these cognate schools, however, interpersonal theory, guided by the democratic, pragmatic, pluralistic, and open-ended spirit of Sullivan and other American analysts, did not retain close ties, either in language or spirit, with orthodox metapsychology.

Though Sullivan did not identify himself as a psychoanalyst, his thinking and sensibility was clearly psychoanalytic, and he developed a psychoanalytic system of the first rank. Sullivan’s theory of interpersonal relations deviated from Freud’s libidinal metapsychology and proposed a radically new concept of the human as communal being—inextricably linked to others in a series of interpersonal fields from cradle to grave. For Sullivan, the communal human, first as infant and then as child and adult, can only be studied and known psychoanalytically through his or her nexus of interpersonal relations—this central idea is implicit in all of his interpersonal concepts of personality and praxis.

Two generations removed from the direct influence of Sullivan, I studied him largely through his posthumously published lectures and writings. From the beginnings of my study of psychoanalysis, I was drawn to Sullivan’s ideas. Perhaps because I, like Sullivan, grew up on a relatively isolated farm, I understood intuitively his emphasis on the human need for social attachment—on the centrality of loneliness as a motivating force in human experience—and his concept of the self as socially formed. In the way that we always bring ourselves to our reading or understanding of others, I brought my own sense of personal loneliness and anxiety to my reading of Sullivan. Reading Sullivan was more than simply an intellectual adventure, for, in studying his ideas, I came to understand my own experience in new and deeper ways. Though I have evolved in my own way, and moved from traditional interpersonal ism to what I think of as a radical empiricist perspective in interpersonal relations theory, I continue to find Sullivan’s interpersonal concepts robust, evocative, and helpful. I continue to find, for example, new meanings in his simple, but profound, one-genus postulate that we are all more simply human than otherwise. I have always found Sullivan’s writing filled with human insight and truth, a telling of human experience the way it is, in fact, lived. Sullivan’s psychoanalytic concepts always seemed closer to what humans were about than Freudian ideas did. Thus such core concepts as dynamism, self-system, zones of interaction, tension, selective inattention, referential process, somnolent detachment, empathy, anxiety, personification, uncanny experience, and integrating tendency captured for me the dynamic, ever-moving quality and interpersonal complexity of human experience and motivation, and its functional, ever-emerging, developmental nature.

Similarly, Sullivan’s interpersonal conceptions of clinical inquiry, his concepts of participant-observation and detailed inquiry caught, for me, the inherently dyadic and dynamically complex, always shifting nature of the psychoanalytic situation, in which the presumed certainty, anonymity, and absolute authority of the impersonal analyst, so characteristic of pre-Sullivanian psychiatry and psychoanalysis, proved mythic. Sullivan provided an alive alternative to what I felt to be the artificial and authoritarian constraints of orthodox technique.

Sullivan’s interpersonal theory, in contrast to Freud’s theory of personality, is more open ended and interactive in its concept of mind and more dynamic and process oriented in its understanding of human living. Freud’s theory, with its hydraulic metaphor, libidinal focus, and psychosexual epigenetic scheme, is a more closed, narrowing concept of mind. In contrast, Sullivan’s ideas always seemed to me to provide an expansive view of human personality and possibility. Sullivan’s theory, in its operational ism and pragmatism is, in a way, a sparse one, one that stays close to the empirical and the clinical. The human, as Sullivan strove to understand him or her, was to be understood in the significant details of his or her relations with others and the experience of that relatedness, rather than in terms of a complex assemblage of reified mental structures. Though Sullivan outlined, and to some degree filled in, a comprehensive theory of psychological life, his successors, influenced more by his fruitful clinical ideas and guided by a clinical sensibility, have tended, with some major exceptions, to leave aside the development of a fuller, more complete, metapsychology in order to mine the clinical richness of Sullivan’s thinking.

Sullivan’s contributions to the human sciences are not limited solely to psychoanalytic science or praxis. An important figure in modern American intellectual history, Sullivan’s influence has reached far beyond psychoanalysis or psychotherapy. His seminal ideas, particularly his revolutionary concept of empirical inquiry as participant observation, have had a profound impact on several disciplines of thought and continue to influence the nature of empirical methodology in the social sciences of anthropology, sociology, and political science. A complex, multi-faceted man with a broad range of interests in the society of his day, Sullivan was interested in applying his psychiatric and psychoanalytic understanding of human anxiety and disorder to the diagnosis and amelioration of various social evils, including such social and political problems as racial prejudice, international political tensions, and war. Even within the more narrow field of psychotherapy, Sullivan’s influence has been extensive, if often unrecognized or unacknowledged. His interpersonal ideas have profoundly shaped contemporary conceptions of family therapy, milieu therapy, hospital psychiatry, social learning therapy, cognitive-behavior therapy, and group therapy, as well as modern psychoanalytic therapy.

Sullivan’s mind was active and far-reaching; it was, at once, theoretical, clinical, political, intellectual, and organizational in its scope and interest. Sullivan was talented and multi-faceted in his interests and ambitions—he applied himself to editorial, organizational, and political, as well as to theoretical and therapeutic, developments in his field, and to its political and organizational implementation in related fields of inquiry and practice, for example, national and international politics. This urbane and complex man lived at the intellectual center of an America undergoing vast and complex social, economic, and political upheavals and changes. Sullivan’s most enduring legacy, certainly for psychoanalysis, however, lies in the profound impact of his revolutionary interpersonal conceptions of the human psyche or “interpsyche” all, in one way or another, expressing his central view of humankind as irreducibly communal, homo communis.

“The Data of Psychiatry,” published in 1938 in the first issue of the journal Psychiatry , is one of several papers published during the last decade of Sullivan’s life that outline his central interpersonal conceptions. In these papers, Sullivan discusses his seminal theoretical and therapeutic concepts of dissociation, selective inattention, self-system, personification, anxiety, empathy, parataxis, “me–you” relations, participant-observation, and detailed inquiry.

Sullivan’s concept of the interpersonal situation as the unit, the primary datum of psychoanalytic, or psychiatric study forms a central theme of the “Data of Psychiatry.” As Sullivan states in this paper, psychiatry or psychoanalysis inevitably becomes “the study of interpersonal phenomena,” for “personality is made manifest in interpersonal situations, and not otherwise ” In this article, Sullivan clinically illustrates his concept of the interpersonal situation as the unit of psychoanalytic study by presenting a detailed study of the complex and shifting parataxic “me-you” relations of a married couple.

What does Sullivan mean by “interpersonal situation”? What, for example, does he mean when he states that personality is that “hypothetical entity” that is posited to account for “interpersonal fields”? Are individual personalities, thus, nonexistent, simply constructs? Is the interpersonal situation, or field, simply the concrete sum of the external, behavioral actions of two or more people? Does Sullivan, as many assume, deny the intrapsychic, or “inner life”?

A close look at Sullivan’s definition of “situation” or “personality” indicates, however, the centrality of personal experience and its internal organization—the “intrapsychic”—in his theoretical system. As Sullivan makes clear in his clinical discussion in “The Data of Psychiatry,” he had developed a theory of an internal representational world, an “inner life” of reflected appraisals, personifications, “conceptual me–you” relations, and dynamic “mental” operations—what he, in his latest theoretical statement, the posthumously published Interpersonal Theory of Psychiatry, referred to as “the functional interplay of persons and personifications, personal signs, personal abstractions, and personal attributions—which make up the distinctly human.” The interpersonal field, in other words, always involves experience and imagination—the “inner workings” of the mind. As Sullivan notes in the “The Data of Psychiatry,” interpersonal situations represent “configurations made of two or more people all hut one of whom may be more or less completely illusory” For Sullivan, the distinction between the interpersonal and the intrapsychic, made by many theorists, is a mythic one. The intrapsychic is always interpersonal, an indivisible amalgam of event and self. Sullivan’s internal world, however, in contrast to the closed intrapsychic world of Freudian and post-Freudian metapsychology, is an open one, interactively born and interpersonally dynamic.

Sullivan’s theory of the intrapsychic, however, is incomplete, and along with other aspects of his theoretical system—most notably his theory of intimacy (the realm of the relational self) and his theory of sensuality (sexuality)—awaits further development by today’s interpersonalists.

Sullivan’s theory of experience is focused on the reactive, rather than proactive, aspects of the psyche. Consistent with his field orientation and positivist sensibility, Sullivan, in his interpersonal formulations of the mind, emphasized the communal, observable, and communicable, rather than the innate, private, and idiosyncratic. True to his interest in the communal and the consensual, Sullivan focused on the developmental vicissitudes of the adjusting person in adaptive response to his or her interpersonal surround. Sullivan emphasized how human experience and behavior are shaped (or misshaped) by one’s acculturating social environment. He focused, in other words, on the representational self and how it is structured by the play of interpersonal factors, rather than on the organizing self (self as organizing and initiating process), or the creative self (self as spontaneous and a procreative agency). Although Sullivan himself notes in “The Data of Psychiatry” that a “selecting and organizing factor determines what part of … observed judgments of one’s personal value … and which of the deductions and inferences that occur in one’s own thinking, shall be incorporated into the self,” he did not develop the implications of this and similar notions of a personal self. A theory of man as personifier, organizer, doer, or creator remained an unelaborated theme in Sullivan’s system.

Sullivan, in his clinical and theoretical focus on the interpersonal self—the reactive, reflected “me,” rather than on the personal self—the active or proactive “I,” thus presented a truncated study of the self. Sullivan, like Kohut and many of the object-relations theorists years later, focused on the study of the self-object aspects of human striving, to the relative neglect of its selfssubject aspects. Sullivan’s focus was not on the uniquely individual self, but rather on its shaping interpersonal context. The interpersonal self, the reflected appraisals of significant others, the self shaped by anxious experience, is the dimension of human experience whose study Sullivan found most compelling. And in this area he made a signal contribution. Sullivan’s unique view of anxiety is that it is wholly interpersonal in origin, that it springs from our communal humanness—originally “caught” empathically from one’s significant caretakers. For Sullivan, anxiety, or social disapproval, plays a central role in human socialization, shaping much of anyone’s living and awareness of that living. He, perhaps more than any other psychoanalytic theorist, understood the crippling power of social anxiety and its analytic significance. Sullivan, in his focus on the primary human need for social approval and affirmation, anticipated what has become the central clinical theme in contemporary, post-Freudian psychoanalysis—the inquiry into narcissism, the study of self esteem, and man’s search for interpersonal security.

The dimension of anxiety, or the interpersonal self, as Sullivan profoundly understood, forms a central dimension of the human psyche. But this is only part of the story. In addition to the powerful shaping force of interpersonal anxiety, of the need for social affirmation, there are other powerful human yearnings equally formative in their influence on human living. There is, as interpersonalists of a more individualistic strain have pointed out, the equally crucial realm of the self-generative striving for personal fulfillment—a full and free living-out of one’s uniquely individual psychic capacities and interests.

Though Sullivan, given his strict operationalist philosophy, deemphasized these aspects of the psyche in his interpersonal studies, and eschewed what he called the delusion of unique individuality, other post-Sullivanian interpersonalists have studied this more personal aspect of the human psyche, thus contributing to an expanded interpersonal theory of the self. These contemporary interpersonalists, incorporating personalistic and humanistic concerns in their interpersonal orientation, have developed latent themes in Sullivan’s work, and have thus contributed to the development of a more rounded interpersonal psychoanalytic psychology—one built upon Sullivan’s insights, but expanded to fulfill their creative potential—that has radical implications for the interpersonal theory of analytic participation and curative action.

Though Sullivan was a major contributor to the development of psychoanalytic theory, perhaps his most enduring and pervasive legacy lies in his contributions to psychoanalytic praxis. His revolutionary conception of the analytic situation as an “interpersonal field”—the notion that the analyst’s interpersonal participation forms an integral aspect of the data of psychoanalysis, formulated in terms of the clinical principle of participant observation—has influenced all modern post-Freudian conceptions of psychoanalytic inquiry.

The radical implications of Sullivan’s principle of participant observation, particularly for analysis of transference and countertransference, have occupied the clinical attention of several generations of post-Sullivanian analysts who, in various ways, have developed and extended this concept of interpersonal psychoanalytic inquiry. Sullivan’s clinical focus, like his theoretical emphasis, was on the study of the interpersonal self. For Sullivan, as for those contemporary interpersonalists who might be termed traditional preservationists, the detailed psychoanalytic inquiry into the interpersonal self focuses on how the interactive analytic dimension affects patients’ narrative reports of historical or extratransference experiences. More radically, however, many post-Sullivanian analysts, who could be called radical preservationists, preserve Sullivan’s clinical focus on the interpersonal self, but have extended his participant-observer model with a new emphasis on the interpersonal analysis of the here-and-now transference-countertransference matrix as the center of their work, often emphasizing radical diagnostic and expressive uses of countertransference experience. Building upon and extending the implications of Sullivan’s concept of participant-observation in a different way, other contemporary interpersonalists, the radical empiricists, focus, like the radical preservationists, on the analysis of transference and countertransference in the interpersonal field, but with a greater clinical emphasis on immediate experience and first-personal processes. This contemporary view of Sullivan’s participant-observer model of psychoanalytic inquiry as a coparticipant process emphasizes, in Ferenczian manner, the patient’s role as a full copartner in the analytic inquiry. This extension of Sullivan’s field principle, in its emphasis that both analyst and patient are participant observers and observed participants, calls for a radical individuation of psychoanalytic metapsychologies and methodologies.

All contemporary interpersonalists, though they apply Sullivan’s field principle in many different and individual ways, are alike in that they emphasize the transactive, interactive, and intersubjective nature of the analytic process. Transference and countertransference are seen as mutually created by both analytic participants, rather than as exclusively endogenous expressions of either’s closed intrapsychic world. The analytic expressions of transference and countertransference are, in this contemporary interpersonal view, variable amalgams of the unconscious of both patient and analyst. A central technical implication of this modern interpersonal approach is that understanding of the patient’s personality inevitably involves an understanding of the analyst’s personality. Countertransference analysis thus becomes an integral aspect of transference analysis. Interpersonal analysts focus variably on both their patients’ and their own experiences of their analytic relatedness, often inviting the patient to do the same. Particularly for those post-Sullivanian analysts who embrace a more coparticipatory view of the analytic situation, this forms the interpersonal pathway to the understanding of patients’ unconscious lives. From this point of view, a monadic and non interactive approach to transference, even if relational in metapsychology, inevitably limits and often distorts the analyst’s understanding of the patient and himself or herself. As Sullivan pointed out long ago, if analysts believe they can study their patients in some detached manner, their “data is incomprehensible.”

The American school of interpersonal relations has evolved over the several decades since Harry Stack Sullivan’s pioneering contributions. It has grown increasingly complex and now encompasses a rich and broadly diverse group of practitioners representing a variety of different viewpoints and clinical practices. Sullivan developed a new and radica...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Preface
• 1 The Data of Psychiatry
• 2 Transference Problems in Schizophrenics
• 3 The Transference Phenomenon in Psychoanalytic Therapy
• 4 Some Effects of the Derogatory Attitude Toward Female Sexuality
• 5 Human Reactions of Analysts to Patients
• 6 The Development of Focal Attention and the Emergence of Reality
• 7 Exploring the Therapeutic Use of Countertransference Data
• 8 Remarks on the Problem of Free Association
• 9 The Inter-Personal and the Intra-Personal
• 10 The Patient Aids the Analyst: Some Clinical and Theoretical Observations
• 11 Attachment, Detachment, and Psychoanalytic Therapy
• 12 Interpersonal Processes, Cognition, and the Analysis of Character
• 13 Cognition in Psychoanalysis
• 14 Psychotherapy with Adolescents: The Art of Interpretation
• Index