Interpersonal Psychoanalytic Theory for the 21st Century: Evolving Self
Sponsored by the City College of New York Alumni Association, September 27, 2023
Includes a slideshow and a Q&A with the authors
Three of the authors are CCNY alumni: Sue Harris ’62, Janet Mayes ’64 and David Singer ’68.
Additional Q&A Answers
Can you explain the difference between anxiety and stress and how it’s explained in your theory?
On page 14, in the Chapter “Basic Concepts,” we write:
“Stress” is differentiated from “anxiety.” Stress may be related to a realistically overwhelming situation, not necessarily from an expansion of the self-system. Anxiety occurs when one attempts to expand functioning, including previously inconceivable perceptions and functions. It is the difference between worrying about getting to a meeting on time (stress) and feelings of disorientation and dysphoria when one is successful at organizing for the first time not to be late.
How do you define the concept of dread? As differing from fear, terror, etc.
Dread is the anticipation of the terror associated with anxiety. It’s the feeling of “Uh-oh, ”I’m gonna die!” It is part of the many aspects of anxiety.
On page 137, in the chapter “The Self-System” we write:
When one expands their self-system, requiring reorganization of their perceptions and behavior, they experience anxiety, feelings of disorientation and uncanny emotions, often including dread and horror, coupled with the temporary loss of functioning involved in struggling to reorganize. The uncanny emotions stem from original experiences of disruption from the parenting figure(s) in the process of coming up against original restrictions.
On page 142, in the same chapter, we write:
Dread associated with challenging the limitations of the parenting one(s) usually goes back to infancy, when things were more precarious, more a life-and-death issue. It comes from the underpinnings of the central paranoia: the infant’s early fear of death, disorganization, and a loss of tenderness with disruption from the mothering figure(s). It has devastating power and is usually in marginal awareness, but becomes more focally conscious in moments when the limits of the self-system are challenged.
On page 154, endnote 19, of the same chapter, we write:
If for whatever reasons in one’s upbringing, a person finds oneself brave enough to try on new experiences, rock the self-system’s boat, one can learn that storms of dread and disorganization can be survived and are worth the positive outcomes of change. One does need a positive audience in or near the person’s rocking boat, either imagined from previous validators, and/or from current people in one’s life. One may think it is better to tough it out on one’s own, but without a previous and/or current cheering squad, the struggle to weather the storm can be too daunting. Each survived boat-rocking can prepare a person for the next one.
On page 220, in the chapter “Interpersonal Theory and Psychotherapy,” we write:
Anxiety arouses uncanny emotions one avoids as if their life depended on it. It can involve disorganization, disorientation, and dysphoria. It can be vaguely disconcerting, or it can induce unnerving dread, fear of death, or fear of insanity. These uncanny emotions might be, for example, particular “mood-memories” stemming back to infancy when the emotional and/or physical disconnection with the original primary caretaker(s) provoked abject visceral terror at a time when a need was pushing for satisfaction.
Is there an anti-capitalist way of treating schizophrenic spectrum disorder, e.g., schizoaffective, bi-polar type?
To begin with, the theory does not deal with diagnoses, which are really labels. The treatment for people labelled ‘schizophrenic’ of any kind is the same as for anyone else. The diagnosis you mention is usually applied to people who find their current life insupportable, because they have not been getting crucial needs met due to various inner restrictions in their self-system. When they are on the cusp of breaking through those restrictions, they may experience extreme anxiety and terror, become paralyzed, unable to function and/or have wild mood swings.
The treatment involves finding out the nature of the restrictions, what needs must be validated and support the person’s functioning at the new, interpersonally expanded level. Then, crucially, it’s necessary to support their reintegration into society. The Cubans have been doing this very well with a high rate of success. In the United States, the infrastructure for this kind of treatment and reintegration hardly exists. Instead, people are given a diagnosis, medicated, and thrust back into society to cope with little or no support that would ultimately allow them to function with satisfaction and emotional growth.
In addition, medical and psychiatric care in Cuba starts, in the form of preventive medicine, in neighborhoods from birth with constant monitoring of any problems individuals may have and attempts to support them. If there is a need for hospitalization, the approach is to immediately determine an interpersonal way to validate the forbidden needs and reintegrate the newly functioning person back into society, usually by finding activities and a group in which a person can function. Gradually, though “work therapy,” the process helps the person find an occupation that allows for a feeling of independence and worth.
On page 114, in the Chapter “Adolescence,” we write:
Harry Stack Sullivan practiced, wrote and lectured between the 1920s and 1950s. His most famous clinical work was with people perceived by the larger society as a breed apart. He practiced at Shepherd and Enoch Pratt in Washington, DC, and then at Chestnut Lodge, a psychiatric facility in Maryland. Those on his caseload were often fairly young, diagnosed with schizophrenia after the emergence of puberty. They were incommunicative, enigmatic in speech and difficult to manage, behaving in irrational and often dangerous ways that required separation and restraint. Sullivan’s approach to them was from a sociocultural perspective unusual for his time (currently as well). He achieved markedly successful results, primarily using verbal psychotherapy and social manipulation of the treatment environment.
On page 6, endnote 9, in the “Introduction,” we write:
At Sheppard and Enoch Pratt Hospital in Baltimore in the 1920s, Sullivan organized a closed, long-term, non-judgmental and caring therapeutic community for inpatient schizophrenics that made use of his interpersonal approach. It is known for having approximately an 86 percent “cure” rate.
If a person is hearing voices, what is your approach?
Voices are data, information about a person’s thoughts and feelings, conscious and unconscious. They can be used by a therapist to understand a person’s mood, motivation and history. The therapist needs to understand how voices are integrated into the rest of the person’s life. This may sound like blasphemy, but hearing voices is not simply a diagnosis of schizophrenia; it’s a way of thinking that varies from one culture to another and must be seen in that context. The same goes for hallucinations.
A beautiful example of how a therapist uses voices is in the semi-autobiographical book I never Promised You a Rose Garden, by Hannah Green (pen name). There she chronicles how Frieda Fromm-Reichmann (fictionalized as Dr. Fried) made therapeutic use of the battling voices to clarify the person’s inner struggle. In real life, after hospitalization, Joanne Greenberg (Hannah Green) became a professor of anthropology and an award-winning novelist.
How has your book added, changed Sullivan and/or Pearce & Newton?
On page ix of the Preface, we write:
Evolving Self is a reintroduction, exposition and elaboration of interpersonal psychoanalytic theory, developed by Harry Stack Sullivan in the early 20th century. It focuses on and modernizes his original theoretical constructs as interpreted and enhanced at The Sullivan Institute for Research in Psychoanalysis in the mid-20th century. Jane Pearce, a founder of the Institute, was a student of Sullivan as well as interpersonal theorists Frieda Fromm-Reichmann and Clara Thompson. In the spirit of Sullivan and the Institute, our book reinterprets the theory, rendering it applicable to the 21st century.
We humbly assert that the theory espoused in Evolving Self stands on their shoulders. They stand on the shoulders of and depart from the original teachings of Sigmund Freud. We make use of neurological and observational research on infancy and empathy over the past 40 years to bring the theory up to date. Our volume represents another chapter in the evolution of psychoanalytic theories.
In addition to making use of concepts coined by Sullivan and Pearce & Newton, we provide contemporary “case” examples to illustrate the theory. Further, we try to depict a more positive view of parenting than presented by those theorists, focusing, without blame, on the reality that all people are raised by people and impacted by events in their socioeconomic and ecological milieu. There are no perfect parenting ones. In therapy, the emphasis is on helping people retain what was positive in their upbringing; reevaluating and changing assumptions that impede wider satisfaction in life; and organizing and validating interpersonal projects that facilitate that process.
We also simplify the prose.
This has been great! thanks!
Thank you so much for this panel.
Thanks so much, I hope your book gets widely used!
Sorry to have sent this at the end. Thanks so much for the presentation.