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Harrystack sullivan dr mo ali

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  • 1. Presenter Dr Mohd Osman Ali Chairperson Dr P Himakar Prof of Psychiatry
  • 2. Scheme of Presentation •Introduction • Personality theory • Developmental theories •Theory of psychopathology (psychiatric implications) • Interpersonal psychotherapy •Summary
  • 3. Introduction •Brief biography •His works •His main contribution
  • 4. generally acknowledged as the most original and distinctive American-born theorist in dynamic psychiatry
  • 5. • Sullivan graduated from medical school in Chicago in 1917. • He made his reputation based on his experimental treatment ward for schizophrenics at the Sheppard Pratt Hospital, between 1925-29.
  • 6. Works • The Interpersonal Theory of Psychiatry (1953) • "The Psychiatric interview”(1954) • Conceptions of Modern Psychiatry (1947/1966) • and" Schizophrenia as a Human Process (1962)
  • 7. • Sullivan's work on interpersonal relationships became the foundation of interpersonal psychoanalysis • a school of psychoanalytic theory and treatment that stresses the detailed exploration of the nuances of patients' patterns of interacting with others.
  • 8. Personality theory •Interactional approach •Needs and anxiety •Security operations •Self system
  • 9. For many years the primary theoretical dispute within dynamic psychiatry circles was between Classic freudians Sullivanians
  • 10. In his words, one must pay attention to the "interactional“, not the "intrapsychic“.
  • 11. • He emphasized the psychiatrist as participant/observer in the clinical situation • seeking to keep observations as objective as possible, • What can be observed is the social interaction of patients
  • 12. • This search for satisfaction via personal involvement with others led Sullivan to characterize loneliness as the most painful of human experience
  • 13. • thus, he defined personality as the “relatively enduring pattern of interpersonal relations which characterize a human life.” • Sullivan defined a “dynamism” as “the relatively enduring pattern of energy transformations,” that is, recurrent interpersonal behavior patterns.
  • 14. Sullivan's theory is fundamentally one of Needs and Anxiety.
  • 15. Needs • needs for satisfaction(e.g., air, water, food, warmth), • and needs for securityneed to avoid, prevent, or reduce anxiety. • emotional needs for human contact and for expressing one's talents and capacities Anxiety • occurs when fundamental needs are in danger of not being met • and is the primary motivator of human behavior.
  • 16. • Decades before Mahler wrote of a symbiotic stage in infant development, Sullivan spoke of the “empathic linkage” between caretaker and infant • and described the complicated interaction of infants communicating tension and anxiety, arousing anxiety in the caretaker, leading to tender responses to the infant's needs.
  • 17. • The tension of anxiety, when present in the mothering one, also induces anxiety in the infant.
  • 18. • Eventually, the empathic linkage becomes unnecessary and the self-system operates autonomously within the individual, developing ever more subtle and complex ways to manage the person's anxiety. • Failure to meet these needs results in loneliness and anxiety. • Because there is no such thing as a perfect mother or parent, anxiety is inevitable and becomes the primary driver for personality development.
  • 19. Security operations • Sullivan defined security as the absence of anxiety • The self-system develops a set of mechanisms, called security operations, which effect this goal. • function within Sullivan's theory much as defense mechanisms do within psychoanalytic theory. • Some bore the same labels and definitions as Anna Freud's, but Sullivan is best known for three contributions that bore his distinct stamp: – Apathy, – somnolent detachment, – and selective inattention.
  • 20. Self System • a configuration of the personality traits • developed in childhood and • reinforced by positive affirmation and the security operations developed in childhood to avoid anxiety and threats to self-esteem. • and is the outgrowth of interpersonal experiences, rather than an unfolding of intrapsychic forces
  • 21. • Sullivan equated the self, identity, or ego with the individual's developed patterns for avoiding the discomforts – that arise from the inability of others to meet one's fundamental needs. – It exists, like all else, purely within an interpersonal framework.
  • 22. Develop mental theories •cognitive •social
  • 23. The Prototaxic mode • undifferentiated thought that cannot separate the whole into parts or use symbols. • It occurs normally in infancy • and also appears in patients with schizophrenia, mystical experiences The Parataxic mode The Syntaxic mode • events are causally related because of temporal or serial connections. • Logical relationships, however, are not perceived • Begins early in childhood • explain transference, slips of the tongue, and paranoid ideation. • the logical, rational, and most mature type of cognitive functioning of which a person is capable. • based on the development of language and consensual validation
  • 24. • These three types of thinking and experiencing occur side by side in all persons; – it is the rare person who functions exclusively in the syntaxic mode. • Maturity may be defined as extensive predominance of the syntactic mode of experiencing.
  • 25. Develop mental theories • cognitive •social
  • 26. somewhat based on his three evolving cognitive modes. However, disturbed interpersonal relationships may cause persistence of the more primitive (prototaxic or parataxic) ways of experiencing the world.
  • 27. Social d e v e l o p m e n t • the satisfaction needs, which are predominant, • and the interpersonal sphere in which these and their resulting security needs are sought to be fulfilled. • the primary “zone of interaction”—bodily areas through which the individual channels needs, anxiety, and relief—in interactions with the environment.
  • 28. During infancy • characterized by the primary need for bodily contact and tenderness • the primary zones of interaction are oral and, to some extent, anal. • To the extent that some anxiety is commonly present in the caretakers, apathy and somnolent detachment are regularly used as security operations, persisting into adult life as a basic detached and passive stance.
  • 29. • If anxiety and inconsistency are severe, intense experiences of dread persist, presenting in later life – as the eerie, uncanny, bizarrely disruptive internal states seen in individuals with schizophrenia
  • 30. During childhood-- from 2 to 5 years • The primary mode of experience shifts to the parataxic, and the most common zone of interaction is anal • a child's main tasks are to learn the requirements of the culture and how to deal with powerful adults • Gratification leads to an expansive self-system with many facets of life associated with the “good me” and positive self-esteem.
  • 31. • Moderate anxiety leads to chronic anxiety, uncertainty, and insecurity. • Extreme anxiety results in giving up known successful behavior in favor of self-defeating patterns that fulfill others' expectations
  • 32. As a juvenile, from 5 to 8 years • The shift to syntactic cognitive modes begins • a child has a need for peers and must learn how to deal with them. • Interpersonal cooperation, competition, play, and compromise become the gratifying experiences.
  • 33. • The risks of excessive anxiety are either too great a need to control and dominate social situations or they become an internalization of restrictive, prejudicial social attitudes.
  • 34. In preadolescence, from 8 to 12 years the capacity for love and for collaboration with another person of the same sex develops. This so-called chum period is the prototype for a sense of intimacy. the major shift toward syntactic thinking takes place
  • 35. • In the history of patients with schizophrenia, this experience of chums is often missing. • the give and take of the special friend could repair and undo distortions that resulted from excessive anxiety at earlier stages
  • 36. During adolescence, major tasks include the separation from the family, the development of standards and values, and the transition to heterosexuality
  • 37. Theory of psychopathology •Problems in living •schizophrenia
  • 38. • He saw psychopathology as resulting from excessive anxiety arresting development of the self-system • thereby limiting both opportunities for interpersonal satisfaction and available security operations. • He viewed psychiatric patients as struggling to maintain their self-esteem with very limited means. • To understand them, the developmental phase at which they operate has to be gauged, and the interpersonal needs they express have to be understood. • Finally, the chance occurrence of stresses encountered during life is deemed a factor
  • 39. Problems in living • Sullivan was the first to coin the term "problems in living" to describe the difficulties with self and others experienced by those with so-called mental illnesses. • This phrase was later picked up and popularized by Thomas Szasz, whose work was a foundational resource for the antipsychiatry movement. • "Problems in living" went on to become the movement's preferred way to refer to the manifestations of mental disturbances. • He initiated the first of what are now called therapeutic communities
  • 40. schizophrenia • he sought to understand the fundamental human process within his patients, especially his sickest ones. • Sullivan theorized that anyone might develop schizophrenia, even people with relatively successful developmental histories, should their chosen defenses fail dramatically and their life stresses mount in the extreme
  • 41. Interpersonal psychotherapy • Four steps of therapy process
  • 42. • the very beginning, often only a part of the first interview, Inception • contract and roles are stipulated. • might go on for as many as 10 to 15 sessions, reconna • therapist identifies the patient's recurring patterns and assesses their adaptive and maladaptive qualities issance detailed inquiry • a very lengthy process of seeking to recognize, clarify, and change persistent parataxic distortions and there is often much ongoing interchange between patient and psychiatrist • may reflect either extensive or limited Termin goals. ation
  • 43. • Sullivan emphasized that the psychiatrist is a participant–observer in all interactions with patients. • Ultimately, persons need to see themselves as they really are, instead of as they think they are or as they want others to think they are.
  • 44. • He argued that parataxic distortions emerge in all interactions, not only in the classic analytical situation. – This differing view of transference and of it being a universal human process was among the core debates for decades between classic analysts and interpersonal analysts.
  • 45. References • Kaplan and Sadock’s comprehensive textbook of psychiatry 9th edition
  • 46. Thank You
  • 47. Questions and discussion

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