HARRY STACK

SULLIVAN, 1892–1949

Important concepts
Interpersonal psychoanalyst
Needs, safety, satisfaction
Self system with safety operations & parts, personifications
Dynamism
Cognitive theory of development of personality
Prototaxic
Parataxic
Syntaxic
Social theory of development of personality (called these epochs)
Infancy
Childhood
Juvenile era
Preadolescence
Adolescence

Interpersonal psychotherapy
Participant observer
Face to face interview
Inception
Reconnaissance
Detailed enquiry
Termination
Most original and distinctive American-born theorist in dynamic
psychiatry

Interpersonal psychoanalyst

Initiated the first of what would now be called therapeutic

communities

Editor of the journal Psychiatry

Founder & director of Washington school of psychiatry

Wrote a number of papers on schizophrenia, later collected in

Schizophrenia as a Human Process

Sullivan & Freud:

Agreed on:
Presence of unconscious
Dream interpretation
Defense mechanisms

Disagreed:
Freud Sullivan
Used terms id, ego, superego Abandoned all Freudians frames
of reference
Behavior motivated by instincts By need for satisfaction & security
Development of personality in Personality grew thru out life
childhood
Stages of infantile sexuality in Stages of social & cognitive
development development

Rejected Freud’s theories as increasingly rigid and dogmatic

Developed his own working theory of personality, psychopathology,
and therapy
Sullivan:

“Man is biologically rooted but a socially interacting being”

“Person we refer to as an individual is an interaction between

physiology, psychobiology & situational factors”

“The relatively enduring patterns of recurrent interpersonal

situations which characterize a human life characterize
personality”

Rejected the Kraepelinian dogma that dominated psychiatric thinking

about schizophrenia

He would elucidate the meaning of passages of patient speech that

Kraepelin presented as nonsensical.

Emphasize the psychiatrist as participant-observer in the clinical

situation.

He sought to keep observations as objective as possible, although he

recognized the difficulty this presented in dealing with private
emotional experience.

What can be observed is the social interaction of patients

Defined personality as the "relatively enduring pattern of

interpersonal relations which characterize a human life"

Focus was very different from the intrapsychic emphasis of

psychoanalysis.
Needs, satisfaction & safety:

NEEDS

Satisfied without Danger of being

anxiety not met

Security Anxiety

Competence in Lack of security

interpersonal incompetence
relations
 Needs Anxiety
When needs are in
danger of not being
met

Satisfaction security

Physical emotional

Formation of

Self system
(To avoid/ ↓anxiety)

Mechanisms Parts
Security operations
 Good me
 Apathy  Bad me
 Somnolent detachment  Not me
 Selective inattention
Needs
Needs for satisfaction
Physical: air, water, food, warmth,
Emotional: human contact and for expressing one's talents and
capacities
Needs for security

Satisfaction: when needs are fulfilled

Anxiety:
Anxiety occurs when fundamental needs are in danger of not being
met.
Caused by frustration of needs
It is the primary motivator of human behavior & personality
development.
Because infants are utterly unable to meet their own needs,
interpersonal relationships are a central concern.
Spoke of the "empathic linkage" between caretaker and infant,
strongest between 6-25 months of age.
Failure to meet needs results in loneliness and anxiety.
(Similar to later describe by Mahler symbiotic stage)
Anxiety is inevitable, because there is no such thing as a perfect
mother or parent
Severe anxiety produces serious psychopathology in later life
Mild forms of anxiety—child learns to modify behavior according to
social approval.

Security:
Love & acceptance of the mothering figure produces security
It is absence of anxiety

Needs for security are

Need to avoid, prevent, or reduce anxiety.
Development of self system:
The dynamism that is responsible for avoiding or reducing anxiety.
Involves the protective mechanisms developed by the child to avoid
anxiety
Exists purely within an interpersonal framework

Security operations
Mechanisms developed by self system to deal with anxiety
== defense mechanisms in psychoanalysis
defined interpersonally.
Based on observing the way infants and young children reacted to
painful interactions, such as scolding, with their parents.

Important security operations:

 Apathy
 Somnolent detachment
 Selective inattention

Parts of self system:

good set of images, experiences, and behaviors associated with an

me unanxious, tender, empathic, and approving on accepting
response from the environment.
bad associated with ideas, actions, and perceptions that provoke
me anxiety and disapproval from caretakers.

not Some situations, however, provoke such intense anxiety that

me they are entirely disavowed and disowned;

Self system isolates one from ones real self

Prevents a person from making objective observations of own
behavior
Self system is a product of irrational aspects of society.
Personifications

Through social interactions and our selective attention or inattention,

we develop what Sullivan called Personifications of ourselves and
others.

While defenses can often help reduce anxiety, they can also lead to a
misperception of reality.

Personifications are mental images that allow us to better understand

ourselves and the world.

There are three basic ways we see ourselves that Sullivan called the
bad-me, the good-me and the not-me.

The bad me
Represents those aspects of the self that are considered negative
and are therefore hidden from others and possibly even the self
The anxiety that we feel is often a result of recognition of the bad part
of ourselves, such as when we recall an embarrassing moment or
experience guilt from a past action.

The good me
Is everything we like about ourselves
It represents the part of us we share with others and that we often
choose to focus on because it produces no anxiety

The not-me
Represents all those things that are so anxiety provoking that we can
not even consider them a part of us
Doing so would definitely create anxiety which we spend our lives
trying to avoid
Kept out of awareness by pushing it deep into the unconscious
Dynamism & transformation of energy:

Smallest unit that can be employed in the study of the individual

Relatively enduring pattern of energy transformations, that is,
recurrent interpersonal behavior patterns

Transformation of energy:
Is any kind of behavior
Overt - - like talking
Covert - - like thinking
THEORIES OF DEVELOPMENT OF PERSONALITY

COGNITIVE DEVELOPMENT:
3 modes
There degree of persistence into adulthood would be important in
understanding psychopathology

Prototaxic Characteristic of infancy and early childhood,

mode Involves a series of disconnected, brief states
experienced as totalities with no temporal relationship.
No difference b/w self & reality
Necessary for the other two processes to emerge
Persistent prototaxic experiences --- mystical
experiences and schizophrenic fusion

Parataxic Early in childhood

mode Self-system begins its more independent functioning.
Involves a series of momentary experiences;
Seeing causal relation b/w events that occur at the same
time but not logically connected e.g. Superstitions
Coincidence plays a major role in how the world is
perceived.
Used this mode to explain transference, slips of the
tongue, and paranoid ideation.
Syntactic Highest mode of thinking
mode Based upon the development of language
The world and the self is perceived within rules of logic,
temporal sequencing, external validity, and internal
consistency.
Thinking about oneself as well as others becomes
testable and modifiable based upon rigorous analysis of
experiences in a variety of different situations.
Maturity may be defined as extensive predominance of
the syntactic mode of experiencing.
Enables people to communicate with one another

Disturbed interpersonal relationships may cause persistence of the

more primitive (prototaxic or Parataxic) ways of experiencing the world.
SOCIAL DEVELOPMENT
Characterized by the satisfaction needs which are fulfilled in the
interpersonal sphere
Each stage is characterized by the primary "zone of interaction"—
bodily areas through which the individual channels needs, anxiety,
and relief—in interactions with the environment.
DEVELOPMENTAL EPOCHS

Infancy Birth to the onset of language

Characterized by the primary need for bodily contact and
tenderness
Prototaxic mode predominates
Primary zones of interaction are oral and, to some extent,
anal.
As needs are fulfilled with a minimum of anxiety, the infant
experiences euphoria and a sense of well-being
With moderate anxiety: apathy and somnolent detachment
are used as security operations which persist into adult life
as basic detached & passive stance
With severe anxiety, intense experiences of dread will
persist, presenting in later life as the eerie, uncanny,
bizarrely disruptive internal states seen in individuals with
schizophrenia.
Childhood Onset of usable language to 5 years (beginning of school)
Parataxic mode
Common zone of interaction is anal
The child needs an approving adult audience.
This leads to a variety of learning—of language, behavior,
self-control, and so on.
Can also be observed in a variety of trial-and-error efforts by
the child to find what pleases.
Gratification associated with the "good me" and positive
self-esteem.
Moderate anxiety leads to chronic anxiety, uncertainly, and
insecurity.
Extreme anxiety results in giving up known successful
behavior in favor of self-defeating patterns that fulfill others'
expectations.
Juvenile era 5 to 8 years
Shift to syntactic cognitive modes begins
Interpersonal focus spreads to the peer group and
outside authority figure
Period of becoming social
Interpersonal cooperation, competition, play, and
compromise become the gratifying experiences.
Differentiates more clearly between fantasy &
reality
Preadolescence 8 to 12 years
Need for an intimate relation with a peer of same
sex
Important stage in which the give and take of the
special friend could repair and undo distortions
that resulted from excessive anxiety at earlier
stages. Point at which the individual truly moves
outside the family and engages in a free give and
take with another person unfettered by the same
dynamics.
Major shift towards syntactic thinking takes place,
although some distortions may persist into
adolescence.
Capacity for attachment, love, and collaboration
develop
Sexuality not a central element
Early Ages 13 to 17
Adolescence The onset of puberty changes this need for
friendship to a need for sexual expression.
Self worth will often become synonymous with
sexual attractiveness and acceptance by
opposite sex peers.
Late Ages 18 to 22 or 23
Adolescenc The need for friendship and need for sexual
e expression get combined during late adolescence.
In this stage a long term relationship becomes the
primary focus.
Conflicts between parental control and self-
expression are commonplace and the overuse of
selective inattention in previous stages can result
in a skewed perception of the self and the world.

Adulthood Ages 23 on
The struggles of adulthood include financial
security, career, and family.
With success during previous stages, especially
those in the adolescent years, adult relationships
and much needed socialization become easier to
attain. Without
a solid background, interpersonal conflicts that
result in anxiety become more commonplace.
Theory of Psychopathology

 Psychopathology as resulting from excessive anxiety arresting

development of the self-system and thereby limiting both
opportunities for interpersonal satisfaction and available
security operations

 Psychiatric patients struggle to maintain their self-esteem with

very limited means.

 The level of anxiety at particular developmental stages could

lay the groundwork for a developmental arrest.

 To understand psychopathology, the developmental stage at

which patient operates should be understood
Interpersonal Psychotherapy

Therapist is a participant observer

By interacting actively (face to face interview) with patients, verbal

and nonverbal expressions of recurrent interpersonal patterns
become apparent. These observations then inform the therapist's
further behavior, thereby creating the opportunity for change.

This process occurs over seconds and over months and years as the
psychotherapy unfolds.

Viewed psychotherapy as divided into four distinct stages:

INCEPTION Very beginning

Part of the first interview, during which the
contract and roles are stipulated
RECONNAISSANCE for as many as 10 to 15 sessions,
Therapist identifies the patient's recurring
patterns and assesses their adaptive and
maladaptive qualities
DETAILED INQUIRY Very lengthy process
Of exploring the patient's thoughts, feelings,
and memories; evaluating and re-evaluating
data from earlier stages seeking to recognize,
clarify, and change persistent parataxic
distortions.
The recurrent patterns are discussed
TERMINATION Product of the evolving contract and
understanding between the patient and
therapist and may reflect either extensive or
limited goals.

The ultimate goal of psychotherapy

Develop syntactic mode and to broaden the repertoire of the self-
system.