Sullivan is chiefly noted for his “interpersonal theory,” an approach to personality and psychotherapy based on the crucial importance of interactions with other people.Sullivan defines personality as “the relatively enduring pattern of recurrent interpersonal situations which characterize a human life.” If we say a man is “an angry person” we are using a shorthand expression for the fact that he has reacted with anger in a large number of dealings with other people. In simpler terms, our relations with people determine what we are. They also determine our emotional security. If these relationships—especially with the “significant others” in our lives—are based on satisfying experiences, we feel secure; if they are based on experiences which have produced anxiety, we feel insecure and have probably developed defensive measures, or “security operations,” that distort our relationships with other people and with ourselves as well. In the latter case, Sullivan (1953) proposes a therapeutic approach aimed at understanding and then altering those interpersonal relationships.Sullivan presents a highly systematic approach which tends to be obscured by his use of special terms. Perhaps the clearest way of presenting his views is to outline his account of the development of the individual, since he contends that the process of becoming a human being is equivalent to the process of socialization, the process in which the values of the culture are gradually absorbed by the child from his parents and others in his environment. Moreover, personality is not “set” at an early age but is considered extremely malleable. The various stages of development—infancy, childhood, pre- adolescence, early adolescence, and late adolescence—are therefore viewed in the light of social patterns and interpersonal relations, not primarily as a sequence of biological, psychosexual drives, as in Freud. Biological needs are not ruled out, however, since both the “pursuit of satisfactions” (the biological needs) as well as the “primitive security operations” (avoidance of anxiety and attainment of “good feeling”) are motivating forces at every stage. But the achievement of these satisfactions is always dependent on our relationships with other people and our ability to understand and manipulate our social environment.In sketching Sullivan’s account of personality development, three basic principles must be borne in mind. First, in his view, interpersonal relations include not only interactions with actual individuals and groups but with imaginary people such as fairy-tale figures (Paul Bunyan), idealized figures (a dream girl or childhood sweetheart), or personifications such as the government. If disturbed relationships to actual people or to personifications of illusory ideals dominate the life of the individual, they produce distorted perceptions, or “parataxic distortions” of the self and others; and in some cases these misconceptions become extreme enough to produce mental illness. Second, the unit of personality study is the “dynamism,” a habitual reaction, attitude or feeling toward one or more persons. The term not only applies to part-dynamisms such as the way we tend to satisfy a basic drive like lust, but also to the entire emerging self, or self-dynamism which determines the way we utilize our available experience and carry on our relationships at any point in life. Third, the forces behind the evolution of our self-dynamism are the attempt to preserve self-esteem and security, and to ward off anxiety. In this process we ignore experiences that might arouse anxiety or have no value to our growing self (“selective inattention”), and exclude from awareness people and events that threaten our security and therefore arouse anxiety (“dissociation”).The infant’s basic drives, or “satisfactions”—the need for sleep, food, etc. —create internal tensions which can only be dispelled by other people, and particularly by “the mothering one.” The way these needs are met determines the kind of self-system he develops. If the mother feels tender and meets his needs without arousing anxiety, he will feel “euphoric” and secure. But if she feels threatened and responds to his signals with anxiety, this feeling will spread to the child by “empathy,” and he will feel anxious and insecure.Communication plays a major part in the development of the self. Interpersonal communication by empathy, or “emotional contagion” is termed “proto- taxic”; communication by gesture and symbol, which comes next, is called “parataxic”; and the final stage of communication in which “consensual validation” occurs—that is, ideas expressed in commonly accepted language—is termed “syntaxic.” All three modes, and especially the last two, come into play in socializing the child, for they enable him to know how his parents appraise him and what they expect of him. Impulses that arouse their disapproval and anxiety are gradually organized into the “bad-me”; those that are acceptable give rise to the “good-me,” and others are ignored by the process of selective inattention. Still other activities may provoke so much anxiety and anger in others that they are dissociated from conscious awareness—but may reveal themselves in dreams and fantasies. All these responses determine the child’s “self-system.” If, however, the child feels totally disapproved and unwanted, the boundaries of the self may be eliminated and a state of “not-me” characterized by overwhelming anxiety may be experienced in nightmares, emotional crises or the onset of schizophrenia.As the child learns to communicate through speech, he gradually acquires social patterns and becomes a civilized person. Denial of his desires, often accompanied by punishment, is an important factor in teaching him what society demands. If he feels that the enforcement of authority is just and fair he will accept it without bad effects, but if punishment is irrational, arbitrary, and degrading, a “malevolent transformation” may occur, and he will become convinced that he lives among enemies and must trust no one. This, too, may lay the foundation for future mental illness.When the child reaches grammar school age, he has his first real opportunity to compare the attitudes and behavior of his own family with significant persons in the outside world. He begins to question the infallibility of his family, and not only revises his conception of his parents but of himself as well. He also learns to compete and to compromise through activities with the gang—and if he does not have these opportunities he will invent imaginary playmates. However, if the patterns he has learned at home deviate greatly from the acceptable behavior in the community, or if his parents disparage his companions, he will lose the opportunity for realistic, corrective experience with his peers, and may come to feel that he is thrust into a world that is not right for him. This will tend to weaken rather than strengthen his personality.In the preadolescent period a powerful need for personal intimacy appears, and the young person develops an exclusive one-to-one relationship with a close friend. This relationship gives him the experience of love uncomplicated by the “lust dynamism,” and also enables him to see himself through the eyes of another who is like him and yet does not represent the authorities of society. Through this association he not only learns collaboration, but gradually corrects the “parataxic distortions,” or fantastic ideas, about himself which he may have developed. The less intimate but equally potent relationship with a gang or group also teaches cooperation and helps to correct his ideas about himself. If he does not have the opportunity for any of these relationships, he may retreat into loneliness and become schizophrenic.Adolescence brings with it a great need for security, a shift from a need for intimacy with a member of the same sex to intimacy with the opposite sex, and a need for “lustful satisfaction.” If these three needs are satisfied, the personality continues to develop and interpersonal competence increases. But if the individual finds himself rejected or treated with disdain, or if he is fearful of intimacy of any kind, he may turn inward and seek satisfaction through masturbation. And if he does not grow out of his preadolescent attachment to a member of his own sex, he may develop homosexual fantasies, embark on a lifelong search for the “ideal” woman or man, or begin to lead a homosexual way of life.The adult who has passed through each of these developmental periods successfully will achieve effective interpersonal relationships, and will find little need for security operations and dynamisms—that is, defensive measures aimed at protecting himself from anxiety. On the other hand, if defects have developed along the way he may become extremely dependent on one or another of the following dynamisms: ob- sessionalism, sublimation, selective inattention, hypochondria, algolagnia (masochism, sadism), paranoid conditions, “emotion” (fear, anger, conceit, envy, etc.), dissociation, and schizophrenic withdrawal.For Sullivan, the therapeutic process is viewed—like the rest of life—as an interpersonal relationship. The therapist is not a detached observer, as in Freudian analysis, but a participant observer who plays an active part in the situation that confronts the patient. He identifies with the patient’s anxiety or anger or delusions, and his own emotional reactions give him clues to the patient’s faulty ideas and security operations. But in the main he tries to discover what went wrong at each period of the patient’s life, using his own sensitivity to the presence of anxiety as his guide. He may, for example, note a sudden shift from one line of thought to another, and use this as an indication that the patient is fending off anxiety. He then follows up this lead to discover what the patient is screening out through selective inattention or dissociation. In this way he gradually discovers the patient’s entire self-system, and in collaboration with the patient makes a direct attack on the distortions he has developed.This whole procedure, or “psychiatric interview,” divides itself into four stages: first, the “formal inception,” in which the therapist quietly observes the patient as he explains why he is seeking help, noting his manner of speech, facial expression, bodily position, etc. He also allays some of the patient’s anxieties by telling him what he already knows about him from other sources. Second, the “reconnaissance,” in which the therapist collects all the information he can about the patient and his family through intensive interrogation. Third, the therapist examines areas or periods of the patient’s life in which anxiety was particularly acute. In this process he tries to discover the characteristic security operations the patient has used in dealing with such situations as difficulty in playing with other children, in forming intimate relationships during adolescence, or in taking initiative in adult life. At the same time the therapist formulates hypotheses regarding the patient’s problem, and tests them in two-way communication with him. Finally, he terminates the therapy by restating the difficulties which have brought the patient to treatment, and by summarizing what this collaborative process has revealed about the patient’s interpersonal relationships and the probable effect of the patient’s altered attitudes on his future relationships.