Interpersonal Psychoanalysis

“One realizes that human relationships are the tragic necessity of human life; that they can never be wholly satisfactory, that every ego is half the time greedily seeking them, and half the time pulling away from them. In those simple relationships of loving husband and wife, affectionate sisters, children and grandmother, there are innumerable shades of sweetness and anguish which make up the pattern of our lives day by day.”

— Willa Cather

As the ego psychologists were delving deeper into the mechanisms of the mind, particularly into its defensive operations and their supporting structures, the society around them was in a state of dramatic turbulence. The social and political movements of the 1920s and 1930s influenced a number of theorists and practitioners. More narrowly, psychoanalysis was discovering the limitations of a one-person psychology. Clinical problems focused less exclusively on individual concerns and more on reactions to, and interactions with, the people in patients’ environments.

One school of thought that aimed at addressing these limitations included a number of theorists who did not share a defining theory, but whose approaches were far different from mainstream drive and ego psychology, and they were unified by an underlying premise that human thought, emotion, and behavior reflected the influence of the social environment. These contributors are identified as the school of interpersonal psychoanalysis. (Interpersonal psychoanalysis should not be confused with interpersonal psychotherapy or IPT, developed in the 1970s as a specific style of time-limited psychotherapy focusing on interpersonal problems). Although their ideas did not have a profound overt influence on the development of psychodynamic theory, many of their notions were implicitly absorbed into the mainstream theories of object relations and self psychology which followed. The principles and philosophy of interpersonal psychoanalysis also achieved great currency with lay audiences because of their accessibility and social relevance. They will be presented here as a waystation between ego and object relations psychologies, but will not return in our examinations of affect, psychopathology, and therapy since they provided no lasting contributions to clinical practice.

HARRY STACK SULLIVAN AND THE BEGINNINGS OF INTERPERSONAL PSYCHOANALYSIS

Harry Stack Sullivan (1892-1949) was trained in the theories and techniques of Sigmund Freud and put them into practice in the treatment of severely-ill schizophrenic patients. Just as Freud had attributed meaning to the symptoms of the neuroses, Sullivan sought meaning in the psychotic content of schizophrenic thought. Unusually gifted in the art of communicating with such disturbed individuals, he was particularly impressed with their impaired capacity to relate to others. From their histories, he understood the origins of their disorders to be in reactions to their social and interpersonal environments. He took psychotic responses to be the extremes of human reaction and assumed that neurotic and normal reactions were more proximate points on the same axis.

Like Freud, Sullivan was impressed with the sexual content and primitive longings in his patients’ thoughts. He fully accepted drive theory’s ideas of intrapsychic conflict and repression of unconscious
material. He was uneasy, however, with the theory’s dogmatism and with the marginal applicability of its Victorian assumptions to his lower-class American patients. He sought to develop a theory that was more attuned to the individuality of personal experience.

Wary of filling in blank areas of knowledge with supposition, Sullivan made few attempts to imagine the content of the unconscious. By the same token, he rejected the notion of psychic structures (id, ego, and superego) and saw all mental processes as elements of energy transformation. Human motivation could be reduced to the need for satisfaction and the need for security.

Satisfaction for the infant is food, warmth, or relief of physical discomfort. Since the infant cannot provide these elements, he or she requires another person. So, the acquisition of satisfaction entails some sort of exchange between the developing individual and the environment. As the child grows, the needs for satisfaction mature to include personal contact, joy, pleasure, and emotional stimulation. More mature needs demand more sophisticated modes of interpersonal exchange. These exchanges are always imperfect at best, and the failures contribute to varying degrees of loneliness.

Security is the freedom from anxiety, but Sullivan uses anxiety in a specific and idiosyncratic fashion. For him, anxiety is an intense and potentially overwhelming fear. This fear stems not from external threats or internal conflicts. Rather, it is caught or absorbed from caretakers through “empathic linkage.” The anxiety of the parent or other caretaker is conveyed to the child, and a vicious cycle ensues. While the caretaker can satisfy needs, he or she can only perpetuate anxiety, never relieve it. The developing infant can neither control nor resolve the anxiety, and it interferes with his or her ability to integrate other sources of satisfaction. As an adult, he or she retains this anxiety and passes it on as a legacy to the next generation.

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