Age-Old Wisdom, with a Contemporary Distillation
Harry Stack Sullivan
Therapeutic Inquiry
Exploring the Depths of Understanding
My approach is a continuously evolving blend of classical and modern influences, with its bedrock being the detailed inquiry. As the name implies, the concept of the detailed inquiry signifies that in order to clearly apprehend the nature of your difficulties, how they have arisen and evolved over time, and how they may have become self-perpetuating, we need to inquire into them in a detailed and probing manner.
In this inquiry, both of us are on the same side. I’m not one-sidedly probing you in a traditional doctor-patient relationship. Rather, we’re both probing your difficulties in a collaborative relationship. The key to this probing process is that when our questions yield answers that contain gaps or non-sequiturs, as they must, we follow them up with further questions, which yield slightly clearer answers, and so on and so forth in an iterative process.
This is what so markedly distinguishes a therapeutic conversation from a polite, commonplace conversation. In the latter, we tend to politely avert our gaze from the non-sequitur and avoid probing it too deeply, whereas in the former, we consciously turn our gaze towards the non-sequitur in search of greater understanding.
In this inquiry, both of us are on the same side. I’m not one-sidedly probing you in a traditional doctor-patient relationship. Rather, we’re both probing your difficulties in a collaborative relationship. The key to this probing process is that when our questions yield answers that contain gaps or non-sequiturs, as they must, we follow them up with further questions, which yield slightly clearer answers, and so on and so forth in an iterative process.
This is what so markedly distinguishes a therapeutic conversation from a polite, commonplace conversation. In the latter, we tend to politely avert our gaze from the non-sequitur and avoid probing it too deeply, whereas in the former, we consciously turn our gaze towards the non-sequitur in search of greater understanding.
Psychopathology Unveiled
The Classical Perspective on Psychological Conflict
So much, then, for the modern, enlightened idea of psychotherapy as a collaborative, two-way conversation. Let us now turn our attention to the concept of psychopathology (or problems in living, if you will) as it is described in the classical tradition. The essential observation of the classical theorists, beginning with Freud and continuing on into the present day, is that problems in living are borne out of unresolved or maladaptively resolved psychic conflict. This conflict takes place among three basic elements: feelings, anxiety, and defenses.
In brief, certain feelings can be distressing to tolerate; they cause us anxiety. This is not dissimilar to how certain situations in our external environment can cause us anxiety. In any event, this anxiety motivates us to employ defenses. These defenses often succeed at assuaging the anxiety, but at a price: they cause secondary problems in the form of symptoms or general life impoverishment. These secondary problems, in turn, are what motivate the patient to seek psychotherapy. Often, the patient is only partially aware of the conflict that has given rise to the secondary problem. This is what is meant when it is said that the roots of our problems are often unconscious.
In brief, certain feelings can be distressing to tolerate; they cause us anxiety. This is not dissimilar to how certain situations in our external environment can cause us anxiety. In any event, this anxiety motivates us to employ defenses. These defenses often succeed at assuaging the anxiety, but at a price: they cause secondary problems in the form of symptoms or general life impoverishment. These secondary problems, in turn, are what motivate the patient to seek psychotherapy. Often, the patient is only partially aware of the conflict that has given rise to the secondary problem. This is what is meant when it is said that the roots of our problems are often unconscious.
Integrative Psychotherapy
These two ideas, then, are the pillars of my blended approach; a classically informed conceptualization of psychic conflict as lying at the root of much human suffering, and a collaborative, interactive style of doing psychotherapy with you, instead of on you, in order to help you more adaptively resolve the conflict.
Embracing Flexibility in Therapy
Adapting to the Evolving Nature of Your Struggles
Finally, a note on flexibility. In my work with your, I try to avoid becoming rigidly attached to any one fixed idea of what may be causing your difficulties. For example, although psychic conflict plays an important role in the genesis of many difficulties, its role in maintaining those difficulties may be less significant. In many cases, a problem in living may have become self-perpetuating over time, with the original conflict that gave rise to it having receded in importance.
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