“Basic Concepts,” lays the groundwork by defining terminology, including the “self-system” and anxiety. It also introduces aspects of personality structure, including cognitive development and the process of learning.
The subsequent chapters are organized so that readers can move smoothly from very fundamental concepts to the more complex intricacies of interpersonal theory. The next group of chapters covers the human developmental eras, delineating how growth takes place in an orderly sequence involving interactive experiences with people. The following section, “Personality and How it Works,” delves deeper into specific concepts, including despair, cognitive development, learning and envy. Although practical applications are discussed throughout, along with short case illustrations, the next section specifically addresses psychotherapy itself, including dream analysis from an interpersonal perspective. The final section brings the theory into the larger sociopolitical sphere.
The chapters following “Basic Concepts” need not be read in sequence. Nonetheless, reading the book in the presented order is likely to offer the best understanding of interpersonal theory and practice. Because each subsequent chapter can stand on its own, there is some repetition. Since some of the issues can arouse discomfort, even for seasoned practitioners, repetition using different words and phrases can allow readers to “hear” better.
Chapter One: Introduction
A person’s first deep connection is with those responsible for their very survival. They are completely dependent on their interpersonal environment. To the extent their primary parenting one(s) can validate experiencing people and phenomena outside their immediate orbit, as children develop, they are also influenced by the wider world. This interpersonal blending defines their humanness, their unique personalities, and organizes lives that vary in degree of satisfaction. Evolving Self examines how repetitive patterns of interactions with significant others and the wider world, particularly but not exclusively in the formative years, are primarily responsible for one’s ever-expanding personality, and how some repetitive patterns can also create debilitating “problems in living.”
Subhead: Logic of organization
Chapter Two: Basic Concepts
Human growth involves a complex and ever-changing interaction between people, in a developmental sequence from infancy onward. This chapter briefly introduces the basic concepts of interpersonal theory as elucidated in this volume, including the self-system, integral personality, the dissociated and central paranoia, as well as other explanatory concepts, including anxiety, envy, depression, deterioration, point of fixation, empathy, tenderness, cherishing and validation. Personality is the interaction between the self-system, the integral personality, the central paranoia and the dissociated, utilizing the mental phenomena described above in repetitive patterns. The chapter includes illustrative case examples.
Subheads: The interpersonal framework; The self-system; The central paranoia and despair; The dissociated; The integral personality; Anxiety; Security operations; Validation; Envy; Point of fixation; Growth/deterioration/regression; Empathy; Primary relationships, productive and restrictive; Summary.
Section One: Developmental Eras
From the moment of conception, the human organism can build upon itself, each cluster of cells growing out of earlier ones. Starting with the fetus, each integration of a capacity relies on earlier integrations of capacities, the way a blastula doubles and then doubles again in the womb. “It spreads out over the course of a lifetime in a fanlike direction, to include more specific and more elaborate functions” (Pearce & Newton, 1963, p. 29). As discussed in Chapter Three, interpersonal validation from the person or people most intimately responsible for the neonate’s very survival is essential for the integration of functions, including digestion and skin integrity. The integration of new functions, from developmental era to developmental era, is also based on validation from the ones who matter. What happens next depends upon the quality of essential intimate communication. Interpersonal theory posits that all functioning, starting in utero, depends upon the quality of the two-way communication between the caretaker(s) and the growing individual.
In the beginning, communication is purely empathic. Babies in the first hours after birth “wish to imitate, and with astonishing discrimination and skill. Indeed they are happy to negotiate exchanges of imitation, taking their turn and inventing new messages” (Nagy & Molnár, 2004). This attentive aiming of the baby’s sense organs is imaginative and creative using the wisdom of a body feeling its movements intentionally. It is not reflexive, triggered and “conditioned” by stimuli. Thus a blind baby can look, a deaf baby can listen, making the required movements “as if” they had sight or hearing, expecting new experience. Books for parents with eloquent photographs show how rich infant sociability normally is in intimate communication (Murray & Andrews, 2005) and (Nugent & Morell, 2011).
As the individual grows, from era to era, so does the mode of communication from idiosyncratic between the infant and the mothering one(s) to articulation in childhood that is understandable by an ever-expanding interpersonal milieu. Likewise, as the child develops motility and other capacities, understanding the world beyond the bassinet widens exponentially, to varying degrees of satisfaction, depending upon the quality and quantity of interpersonal validation.
Basic assumptions underlying this process are the universality of human needs and the resilience and adaptability of human beings.
In discussing how one function is a prerequisite for the next, such as crawling is essential before walking, it is necessary, as it is with any child, to keep in mind how its needs are met and the extent to which they are met. A caretaker with a deaf child or a child born with cerebral palsy benefits from an understanding of what all children need. Figuring out how to provide appropriate opportunities for the satisfaction of the needs of a differently abled child or one born under the most unfortunate conditions, in most instances, depends, mainly, on who the caretakers are and what opportunities are or could be made available in a particular community or society.
Some human needs are more complex than others. Consider the need to communicate with others. If an infant is born deaf, for example, a major adaptation is required on the part of the parents and others , as well as on the part of the infant (the physiology of the infant may be able to compensate for the deficit) in order to meet that infant’s need to communicate and feel emotionally connected to others – a vital need across the life span that is intertwined with the need to communicate. Under the most fortunate circumstances, throughout this adaptive process, the caregiver(s) and others never forget that a deaf child is, most importantly, a child with the same needs that every other human being has.
Likewise, when discussing the necessity for “articulate” speech to develop in childhood as a prerequisite to mutually satisfying relatedness with the wider world, the concept of “articulate” must include all modes of communication, such as sign language, or, for people like Hellen Keller, a reliably different way to communicate. It all depends upon how related the particular caretaker or caretakers are to the need for the child to develop the capacity to interact with mutual satisfaction with the wider world.
In a sense then, all humans are differently abled as soon as they have been placed in the arms of their significant, yet imperfect, parenting one(s). The degree and kind of differently abled matters but “we are all more simply human than otherwise” (Sullivan, 1968, p. 32).1
 With this principle, radical for his time, Sullivan was emphasizing that homosexuals and people diagnosed schizophrenic must be not be placed in a category of “other” and treated as such. In the current social climate, not only must his one-genus postulate be reasserted, it must particularly call attention to “recently acknowledged complexities in gender identity, development, and both the vulnerability and resilience of transgender communities; in other words, a greater understanding of the diversity in the human condition” (Taffel, 2020, p. 17). This applies to all peoples who are oppressed, whose common humanity must be emphasized.
Murray, L., & Andrews, L. (2005). The social baby: Understanding babies’ communication from birth. Richmond, Surrey, UK: CP Publishing.
Nagy, E., & Molnár, P. (2004). Homo imitans or homo provocans? Human imprinting model of neonatal imitation. Infant Behavior and Development, 27, 54–63.
Nugent, K., & Morell, A. (2011). Your baby Is speaking to you: A visual guide to the amazing behaviours of your newborn and growing baby. New York: Houghton Mifflin.
Pearce, J., & Newton, S. (1963). The conditions of human growth. Secaucus, NY: Citadel Press.
Sullivan, H. S. (1968). Interpersonal theory of psychiatry. New York: W.W. Norton & Company.
Taffel, R. (2020). Preface. In G. J. Jacobson, J. C. Niemira, & K. J. Violeta (Eds.), Sex, sexuality and trans Identities; Clinical guidance for psychotherapists and counselors (pp. 15-18). Philadelphia: Jessica Kingsley Publishers.
Chapter Three: Early Infancy, The Development of Initial Blueprints for Later Experience
Early Infancy describes the initial stage of a person’s development from possibly pre-birth (Goodrich, 2010) to approximately eight months, when the infant is more able to relate to the object world and to issues of mobility (Stern D. , 2018). Physiological, perceptual-cognitive and motor functioning is organized into the infant’s burgeoning self-system through essential interaction with the infant’s primary caretaker(s) or mothering-figure(s). These early developmental functions must be validated by one or more of these early primary figures, the initial audience for the infant’s functioning. The relationship between the infant and the mothering figure(s) is the primary force for the development of the self-system.
This chapter integrates research demonstrating that infants demonstrate a high level of responsiveness to their interpersonal environment from even before birth, along with the concepts of empathy and mood and their functions in the development of the interactions between the infant and primary caretaker(s). It briefly covers the development of physiological functioning during Early Infancy, how deficits during this developmental period might show up in later malfunctioning, and how those deficits can be addressed. This chapter also discusses the potentially debilitating experience of anxiety that occurs when the person responsible for care is unresponsive in some way to the infant’s needs. From the very beginning, perhaps even before birth, the caretaker(s)’ validating and anxiety producing moods initiates, via the empathic connection between caretaker(s) and infant, the formation of the person’s self-system. Finally, this chapter focuses on the study of observable and inferred interactions between the infant and early caretaker(s) to understand their impact on a person’s later functioning. The chapter includes illustrative case examples.
Subheads: Physiological development in the interpersonal milieu; Perceptual development in early infancy; Empathy; Beginning the development of foresight; Anxiety; Residuals and treatment; Summary.
Chapter Four: Late Infancy: Exploring Beyond the Self
Late Infancy begins as the infant moves from total dependency on the primary caretaker(s) to involvement with the wider world, including alternate validators. The major areas of functioning that begin to develop during this stage of development include relatedness to the object world, increased mobility and communication, each of which develops in sequence, at the same time as the late infant begins to learn to relate to a wider world of people. The chapter includes illustrative case examples and ramifications of obstacles to development in Late Infancy.
Subheads: Exploration of the object world; Mobility; Training and “socializing” the toddler; Communication; The development of object constancy; Modes of learning; The organization of the self-system; The development of the personifications of the self; Continued development of self-system; Late Infancy functions and residuals in later life; Summary.
Chapter Five: Childhood: The Widening World
The Childhood era of human development (from approximately two and a half to four years) begins with the need for communicative speech and extends to the conscious need for playmates. The primary caretaker(s) remains the most significant relationship(s) in the child’s life as they continue to learn to be a person according to what is expected by the caretaker(s). Other major areas of development during this time include relationships to people, objects, pets and authority. Mobility and physical coordination continue to develop rapidly. The child’s continuous experience is focused on learning to adapt within the family environment while simultaneously being introduced to various aspects of the culture into which they were born. The chapter includes illustrative case examples and ramifications of obstacles to development in the Childhood Era.
Subheads: Development of communicative speech; Learning and anxiety; Self-image; Relating to authority; Relatedness to objects; Need for playmates and parallel play; Summary.
Chapter Six: The Juvenile Era: Group Experience and the Political Arts of Relating
The Juvenile Era marks the introduction of the young person to the wider world of strangers beyond the family constellation. The juvenile begins relating to peer groups and learns the political arts of managing the relationships within those groups, such as cooperation, competition, compromise and consensually validated communication. The major focus of the juvenile is group membership. It starts at approximately four and continues throughout life. The chapter includes illustrative case examples and ramifications of obstacles to learning from the experiences of the Juvenile Era.
Subheads: Storing “unacceptable” experiences for later; Cooperation, competition and compromise; Identification with the juvenile group; Moving into The Juvenile Era as a natural interpersonal need; Consensual validation; Role-playing; Ostracism; Mastery of information; Obstacles to successful integration of the Juvenile Era; The burgeoning shift of primary audience; What happens next; Summary.
Chapter Seven: Preadolescence: Falling in Love with a Peer
The major preadolescent interpersonal project is to learn how to love a world of people wider than the world of the primary caretaker(s). The development of the capacity for intimacy, along with the capacity for empathy, is a complex process that begins in infantile experience with the primary caretaking one(s) and builds from there, from developmental era to developmental era. In each developmental era there are limits set due to the limitations of the parental relationship(s), poorly consolidated earlier functions, and lack of opportunity. The accumulating residuals affect how one experiences later eras, that is, how people are able to continue to grow in preadolescence, adolescence and adulthood. So in spite of all these complicating factors, how does one develop the capacity for true peer intimacy between people who are not the primary parenting one(s)? How does one learn to love an ever-widening world of people? The chapter includes illustrative case examples and ramifications of obstacles to development in Preadolescence.
Subheads: Moving from the Juvenile Era into Preadolescence; Sullivan’s “same-sex chum”; Heightening self-esteem and expanding awareness of others; Major changes in the self-system; Timing of preadolescent chumship; “Homosexual panic”; Summary.
Chapter Eight: Adolescence: A Precursor to Independence, Emergence of Sexuality, Need for Partnership, Intimacy—a Work in Progress
With the possible exception of Early Infancy, Adolescence in many cultures is the stormiest developmental era. Early Infancy encompasses the transition from the womb to the outside world and the beginning of life. Adolescence marks the transition from the family of origin to the world at large. If there is to be continuous expansion of personality, the adolescent’s primary validators by necessity become those people who can provide experience and support for what has not yet been learned in the home. Unless the parent(s) is also growing, they are no longer the primary validator(s) for their offspring’s growth. At the same time, parenting one(s) can often be crucial in helping to organize practical aspects of an adolescent’s life even though unable to remain the primary validator(s). Parenting an adolescent is usually an extremely tough job. The chapter includes illustrative case examples and ramifications of obstacles to development in Adolescence.
Subheads: Preliminary comments; Partnerships, sexuality and intimacy; The emergence of sexual urgings; Anxiety about sex; Barriers to consolidation of learning about sex; Some restrictions based on interpersonal deficits in development; Intimacy and partnerships; Partnerships and other intimate relationships; Independence; Leaving home; Leaving home, but not really; Supporting the parent; Postscript on Sullivan, with sub-subheads: The one-genus postulate; Homosexual panic; Summary.
Chapter Nine: Adulthood: A New Interpersonal Challenge
The crucial difference between pre-adulthood and adulthood is that the person is now responsible for organizing their own growth experience. Up until puberty, validation for functions that satisfy needs comes from the parent(s) and alternate validators who are acceptable to the parent(s). Once puberty is reached, despite their inexperience and dependent financial and legal status, the adolescent needs interpersonal validation of functions the parenting one(s) could not conceive of, that is, from beyond the parental relationship(s). The functions could even include physiological-motor skills, the world of objects or social skills the person did not yet learn during the first 10 or 12 years (the formative years).
By the time the offspring reaches puberty, the parent(s) has imparted to their offspring, by empathic communication, direct instruction or simply by example, their full repertoire of relatedness as well as their repertoire of limitations, given their own self-systems, including how far relatedness can go. At that point, if the young adult wishes to grow beyond the limits of what is conceivable to the parent(s), that validation must come from people who function beyond those limits. The chapter includes illustrative case examples and ramifications of obstacles to further development in Adulthood.
Subheads: Validation in Adulthood; Relationship between the parent(s) and the young adult; The process of growth in adulthood; Projects of young adulthood with sub-subheads: Leaving home; Financial independence; Productive work, Intimate partnerships; Having children. Summary.
Section Two: Personality & How it Works
Chapter Ten: The Self-system
The self-system is the theoretical construct in interpersonal theory that includes all conscious experience. It functions both productively and restrictively. There are two major functions of the self-system. One is the organization of a person’s perceptual/cognitive functioning: The self-system governs the ability to focus attention in order to do anything at all. However, this same capacity to focus attention is also affected by the second function, the self-system’s restrictive apparatus, which uses “selective inattention” to avoid awareness of anything that disrupts the historical connection with the central parenting figure(s). This process starts in the context of the relationship between the primary caretaking figure(s) and the newborn. The chapter includes illustrative case examples.
Subheads: Recall and foresight; Self-image; Marginal and focal awareness; Roots of resistance to change; Underpinnings of the restrictive aspects of the self-system; Opportunities for expansion of the self-system; Logical fallacies; The integral personality; The self-system and the struggle to grow beyond it. Summary.
Chapter Eleven: Despair and the Central Paranoia
The newborn is eager to relate to whoever is available. The primary caretaker(s) provides the nurturing interaction with the infant necessary for survival and promotes the infant’s growth and development. The interaction is reciprocal, the mothering figure(s) gaining in empathic relatedness and satisfaction as the infant’s needs are satisfied. Despair has its origins in lapses of relatedness in the caretaker-infant relationship. The chapter includes illustrative case examples.
Subheads: The Central Paranoia with sub-subheads: The fear of disorganization; The fear of death; Dissociation of the need for tenderness with sub-sub-subheads: Preoccupation with rejection; Fear of being alone vs loneliness; Summary.
Chapter Twelve: Cognitive Development, an Interpersonal Phenomenon
Within interpersonal theory, cognitive functioning (thought, perception, communication, levels of consciousness, memory) develops in the context of the self-system, the construct that contains all conscious experience and functions both productively and restrictively. This chapter is a theoretical attempt to describe cognition as it develops in interaction with significant others. This chapter does not cover how neurological systems produce cognitive thought, definitively covered by the neuroscientist Antonio Damasio and his associates (2018). It is, instead, an attempt to describe how human social interaction develops, creating its own processes that continue to elaborate into widening social realms, interacting reciprocally with both the neurological and the broader social world. The chapter includes illustrative case examples and ramifications of obstacles to cognitive development.
Subheads: Audience; The interpersonal relationship in early development; Symbolism and foresight; Selective inattention and substitutive operations; Alternate validation and expanded audiences; Stages of development of consciousness; Initial infantile experience; Mood-memory; Hierarchy of perception; Parataxic experience; Dramatization; Syntaxic mode of communication; Latent awareness; Memory as an aspect of consciousness; Earliest memories; The relationship between communication and perception; Summary.
Chapter Thirteen: The (Essential) Interpersonal Context of Learning
Interpersonal validation is essential for learning. The embryo, neonate and infant require validation from caretakers in order to thrive. Later, the individual’s self-system incorporates learning according to the particular self-system(s) of the primary caretaker(s). Expansion of the roster of important validators is essential if the individual is to recognize and make us of opportunities to integrate learning beyond the purview of the original primary caretaker(s)’ own self-systems. Since the quality of validation is on a continuum, the learning process is extremely complex. In addition to environmental (including natural and human-made catastrophes) and physiological and genetic issues faced by the differently-abled, the larger interpersonal atmosphere all contribute to the quality of learning: the extended family, the school, the play yard, the neighborhood, the community, the socio-economic organization of a nation, books, movies, TV, the internet, social media, famous people, socio-economic conditions, racism, classism, wars, displacement, holocausts/diasporas, pandemics, man-made disasters—the list is infinite.
Of most importance, nothing in the learning and ever-changing brain is “hard-wired.” Given validating opportunities, “late bloomers” do bloom. Poorly consolidated skills are revisited and honed if opportunities for alternate positive validators arise later in life—but only to the extent that the individual is open to those alternate validators. The chapter includes illustrative case examples and ramifications of obstacles to learning functions and skills.
Subheads: Expanding the roster of validators; Learning by imitation; Learning because of competition and the desire to be admired or get ahead; Rote learning; Breaking down the learning process; Learning while anxious; Academic learning; Sexism, classism, and racism: the larger interpersonal sphere; Summary.
Chapter Fourteen: The Interpersonal Theory of Envy
Envy has its roots in the unsatisfied and often unrecognized (unconscious) needs of the envious person. The envious person typically behaves with some form of rejection of the other person, such as disapproval, disparagement, discouragement, disgust or dismissal. It may be expressed by simply—although it is far from a “simple” operation—not noticing, or as Sullivan explained, by selectively inattending (1970, p. 270) to the other person (or some particular aspect of the other person). Instead, the envious person responds, unwittingly, in a way that is antagonistic to that person’s need at the time. The chapter includes illustrative case examples.
Subheads: Jealousy vs. envy; Summary.
Section Three: Practical Applications
Chapter Fifteen: Interpersonal Theory and Psychotherapy
The underlying assumptions in the interpersonal theory of psychotherapy are profound in their simplicity: people are brought up by people and “we are all much more simply human than otherwise” (Sullivan, 1953, p. 18). The therapeutic goal is to increase “a patient’s skill in living” (Sullivan, 1953, p. 175). The therapist’s driving paradigm is to forge an alliance with their analysands’ integral personalities, to understand their problems in living in relation to their interpersonal histories, to challenge their own and the others’ security operations, to ward off their own and the others’ despair and to not be afraid of their own and the others’ anxiety.
The practice of therapy involves a life-long commitment to growing their analysands’ and their own self-systems, which means struggling to be open to self-evaluation and change, learning genuine humility and patience, as well as finding satisfaction in their chosen career, even if some of their analysands are decidedly uncooperative in the therapeutic collaboration. The therapist needs to respect their analysands and their struggles, no matter how they present themselves, even if they seem impossibly stuck, which implies developing the same amount of respect for themselves in their own struggles. The chapter includes illustrative case examples.
Subheads: The goals of therapy; The therapeutic alliance; Initial sessions; Symptoms and diagnoses; Organizing and using a historical interpersonal developmental timeline; Ongoing therapy; Memories and mood-memories; Resistance; The therapeutic relationship as a primary integration; The therapeutic interpersonal field; interpersonal psychotherapy and anxiety; Hope and despair; The well defended self-system: stops and starts, sputters; The importance of repetition; The usefulness of dissociation in therapy; Taking notes; What about “transference” and “countertransference”?; Summary.
Chapter Sixteen: Dreams: Their Origin, Development and Use Therapeutically
Dreams are a source of data for the therapist and the person in the long-term study of a person’s life. It is a symbolic communication to some audience, real or imagined, about the most pressing issues in a person’s life. A dream has a context because it expresses the developmental level of the dreamer; it utilizes historical experience as well as the current experience of the day. It can be utilized in therapy to: delineate aspects of therapeutic analysis that warrant further exploration; help dreamers recognize their dissociated needs and how they create obstacles to meeting those needs; or formulate a summary of where the person has evolved in their interpersonal development. The chapter includes illustrative case examples.
Subheads: Common views about dreams; The interpersonal view of dreams; Nightmares; The developmental process of dreams; Dreams in childhood; How dreams are used in therapy; Listening to dreams; Symbols in dreams; Associations; Nightmares and psychotic experience; Summary.
Section Four: Issues
Chapter Seventeen: LGBTQ2S+ Issues and Interpersonal Theory
Interpersonal Theory maintains that the development of the capacity for adult compeer intimacy is crucial, not a person’s gender identity and expression. If, willy-nilly, young people learn, despite whatever has gone wrong in their lives, to incorporate the experience of love, they can do so with any other human being depending on how much the capacity to love has been developed as they were growing up. What’s the problem with being LGBTQ2S+? No Problem—except people live in an extremely problematic society.
Subheads: Making up for unfinished business; Summary.
Chapter Eighteen: The Current Context of “Mental Disorders,” “Diagnosis,” and Their Treatment
The goals of the therapy explicated in this volume differ vastly from symptom suppression, dissociation, adjustment and stabilization. At their center is helping the person to organize the forces for growth, a dynamism oriented toward the progressive expansion of satisfaction and of experience (Pearce & Newton, 1963, p. 443). It is our view, that by promoting more satisfactory life experiences, interpersonal therapy can alter patterns of organization that stifle growth and (Pearce & Newton, 1963, p. 441). Altering stifling patterns of organization is clearly not a task that can be addressed by one or more medications or a brief series of appointments oriented primarily toward changes of behavior.
Chapter Nineteen: The Political Economy of Psychotherapy
In the United States today, psychotherapy, or for that matter any study of the psychodynamics or interpersonal processes involved in mental and emotional difficulties in living, is on the wane. The cause of the decline is the subject here, but to understand it, it must be viewed in the context of the changes to health care in general that have taken place in the past several decades in the U.S. These changes amount to a transformation from care being provided by many more or less independent providers and institutions to it being sold by a corporate-run industry driven by a lust for profits.
Subheads: The current condition of psychotherapy; Some historical background; The results: drug company dominance of the mental health field; The economic context of these developments; Technological innovation and scientific research; The commodification of care; Turning the tide; Summary.
Chapter Twenty: A Comparison of Revolutionary and Interpersonal Theories
When we talk about changes in a society and how they come about, we are talking about changes in people and how they organize their way of life. People, who are raised by other people, create the processes that produce social change. Social change also has to do with the satisfaction of human needs or their thwarting. If a person develops in an expansive way to satisfy more of their own needs, they are increasing in their capacity for relatedness with more intimacy with more and more people. If this expansion goes beyond the limits of a person’s early training, they can be said to be personally expanding in a revolutionary way. In parallel fashion, social change that satisfies an increasing number of human needs for more and more people becomes revolutionary when it moves beyond the social restrictions set up to limit that change. Counterrevolution restricts that satisfaction. This chapter describes the parallels between theories of individual human development and social development, in particular the parallels between interpersonal theory as developed by Harry Stack Sullivan and his followers and revolutionary theory as developed by Karl Marx, Friedrich Engels and their followers. The chapter includes illustrative case examples.
Subheads: Sullivan’s one-genus postulate: “Everyone is much more simply human than otherwise”; Development in an orderly sequence; The integral personality—guerrilla fighter for personal growth; Summary.