Contemporary Growth Therapies
by Howard J. Clinebell, Jr.

Chapter 3: Growth Resources in Traditional Psychotherapies, Erich Fromm. Karen Horney, Harry Stack Sullivan

Resources from Erich Fromm

Erich Fromm was born in Frankfurt, Germany, in 1900. He studied sociology and psychology at the universities of Frankfurt and Munich and Heidelberg, and was trained in psychoanalysis at the Psychoanalytic Institute in Berlin. He came to the United States in 1934 and was affiliated with the International Institute for Social Research in New York until 1939. In 1941 he joined the faculty of Bennington College. In 1951 he became a professor at the National University of Mexico. For a number of years Fromm lived and wrote in Cuernavaca, Mexico. His death in March, 1980, at his home in Muralto, Switzerland, ended the career of one of the most creative thinkers and prolific psychoanalytic writers of our times.

When I was a student at Columbia University in the late 1940s, Fromm was a resource person for a small cross-discipline group of faculty and graduate students who met regularly to discuss papers on the relationship of religion and health. I recall the excitement that I experienced when he presented his ideas and interacted with members of our group on two occasions. Through the years, my thought and practice have been influenced repeatedly by the insights of this therapist-theoretician.

Fromm's major contributions to growth-oriented teachers, counselors, and therapists are his understanding of the ways in which cultures constrict or nurture human individuation (Fromm's term for potentializing) and his discussion of the importance of existential- philosophical -religious factors in all human growth. Fromm gives psychoanalysis a broad philosophical and cross-cultural orientation that provides a fresh context for growth work.

His discussion begins with a description of the existential dilemma that we human beings face. Humans are animals who have lost our instincts (our fixed, inborn patterns of response) and have developed reason, self-awareness, and autonomy to replace them. We are freaks of nature. Deep within us there is a nostalgia for our "lost Edens," the primitive unity with nature and the herd that we have lost in our evolutionary development. Thus there is a two-way pull within us -- toward autonomy and individuation, on the one hand, and toward conformity and merging our identity with the group on the other. This creates a continuing conflict between the need to become our autonomous selves and the need to feel a part of the larger whole.  

In Fromm's thought, as in Adier's, Horney's, and Sullivan's, human beings are essentially social. Our culture molds our basic personal pattern and determines our degree of wholeness. Each society tends to produce what Fromm calls a "social character," a common personality core that is required to cope with that society. This pattern is created in individual children by the way they are reared.

Our self-awareness, though it helps define what is unique and precious about being human, also renders us prey to guilt and to the anxiety stemming from our existential aloneness and our mortality. The inherent dichotomies of the human situations -- e.g., autonomy vs. belonging, life vs. death -- are bearable only within a sense of meaning and a sense of community with others who share our existential fate. When people are alienated from a community of shared meanings, as countless millions now are, the inescapable human dichotomies become unbearable. They produce a variety of destructive problems and nonproductive life orientations. Many people try to escape from the existential dichotomies by embracing one side and rejecting the other. When the mass insecurities fostered by a society in rapid transition reinforce the feeling of vulnerability derived from personal autonomy, people tend to "escape from freedom"; they lose their anxiety but also their freedom by overidentifying with some authoritarian ideology, leader, or system, political or religious. Fromm analyzes the social psychology of Nazi Germany (from which he fled) and of Reformation Calvinism to illustrate how people escape from freedom when it becomes too threatening.(1)

The goal of growth and of therapy is what Fromm calls the productive person. Such persons develop their unique potentialities and thus become capable of genuine love, creativity, productive work, and participation in a community of shared meanings. In this way, the productive person is able to cope constructively with the inescapable existential dilemmas. If this maturing does not occur, four types of nonproductive life-orientations (and character structures) develop in the attempt by persons to defend themselves from feelings of existential insignificance and aloneness. Receptive type persons require constant approval and reassurance from others. Exploitative type people take what they want or need from others. Hoarding type people center their lives on defensively saving and owning. They try to possess others by behavior that is often disguised as love. Marketing-oriented people experience themselves as commodities whose value is limited to their value for use by others. They say, and mean, "I had to sell myself to that prospective employer." The marketing orientation is the pervasive social character produced by a capitalist society like ours. All four of these nonproductive personality types represent an alienation from our potential for real love, self-esteem, and creative living.

Fromm provides important resources for facilitating spiritual growth. With Jung and Assagioli, he sees religion (broadly defined) as a fundamental need of all human beings. He points to the crucial distinction between growth-inhibiting and growth-enabling religion: "There is no one without a religious need, need to have a frame of orientation and an object of devotion. . . .The question is not religion or not but which kind of religion, whether it is one furthering man's [sic]

development, the unfolding of his specifically human powers, or one paralyzing them."(2) He describes neurosis as a. private religion (which reverses Freud's view that religions are a collective childish neurosis of humankind); he sees neurosis as a regression to primitive forms of religion. Fromm's critique of authority-centered religions as inherently growth-limiting is a valuable contribution to the spiritual growth work of individuals and to their development of growth-enabling religious beliefs:

Fromm sees clearly that for many people Christianity is a thin veneer over the idolatrous worship of power, success, and the authority of the marketplace; or it is a cover masking their idolatrous fixation on their clan, religious or ethnic group, or nation-state. Fromm's insights about the dynamics of our modern idolatries illuminate many of the growth-blocking religious beliefs, practices, and institutions one encounters both in doing therapy and in society.

In his books Psychoanalysis and Religion and Psychoanalysis and Zen Buddhism,(4) he spells out his understanding of growth-enabling religion. This is essentially a religion in which people do not give their power and freedom away to external deities or to idolatries such as those mentioned above. It is a rational, nonauthoritarian religion. Fromm's analysis of authority-centered religions and of their ethical systems is a critique that all religious leaders and pastoral counselors need to take seriously and use to exorcise the growth-inhibiting beliefs and practices of their own religious systems. One can learn from his critique without necessarily agreeing with his underlying nontheistic metaphysical assumption.

In a time when more and more people are rejecting old authority-centered standards of right and wrong, truth and falsehood, Fromm's contributions to a humanistic, psychologically informed ethic (in Man for Himself) offer valuable resources for growth work. In contrast to approaches to the good life which derive their criteria from external sources of authority, Fromm looks for criteria in the depths of persons and in society. He asks the key question for any growth-centered ethic -- which ethical guidelines contribute to the growth of creative, loving, productive people? The good is defined as that in individuals and in social institutions which makes for the unfolding of full human possibilities. The bad is whatever blocks growth toward full humanness. The massive collapse of old authority-centered value systems provides humankind today with an unprecedented opportunity and necessity to grow up morally. This can happen only as we develop self-validating ethical guidelines to help us maximize the full potentialities of persons. Fromm's understanding of ethics can offer valuable insights concerning how a planetary ethic-of-growth can be developed. He makes it clear that our moral problem today is that we have become alienated from our real selves, that we treat ourselves, and therefore others as things. Ethically speaking, our period of history is "an end and a beginning, pregnant with possibilities."(5) The outcome of this period of transition will depend on whether human beings have the courage to become their potential selves -- loving, creative, and productive.

Fromm's understanding of human evil provides an approach that can help human potentials approaches to education and therapy avoid superficial optimism. In The Heart of Man and subsequently in The Anatomy of Human Destructiveness he rejects both sentimental optimism and the view that human beings are inherently evil. He sees our greatest problem as our individual and collective destructiveness and points to the crucial importance of discovering ways to resolve it. He identifies a variety of types of destructiveness in persons and in society. There is playful aggressiveness motivated by the display of skill, not by destructiveness per se. There is reactive or defensive violence motivated by fear when individual or collective life, freedom, property, or dignity are threatened. Much destructiveness of this type results from our incestuous tribal ties to family, clan, culture, and nation. If the collective narcissism of such limited circles of concern is threatened or wounded, defensive violence results.

Another contemporary form of violence which is very prevalent results from the shattering of old faith systems. Another form of violence is compensatory. A person "who cannot create wants to destroy. He thus takes revenge on life for negating him."(6) Compensatory destructiveness is a negative substitute for making a creative impact on the world. The only cure for this form of evil is the fuller development of love and reason, autonomy and creativity.

Destructiveness and violence can also be malignant, as in sadism. We human beings apparently are the only animals who become driven by the lust to hurt, torture, and kill others of their own species. This form of violence today is threatening the very survival of humankind. It is motivated, according to Fromm, by a distorted religious need, the passion to have absolute, unrestricted control over another being, as a way of attempting to overcome existential anxiety. "The experience of absolute control over another being, of omnipotence so far as he, she or it is concerned, creates the illusion of transcending the limitations of human existence, particularly for those whose lives are deprived of productivity and joy. Sadism . . . is the transformation of impotence into the experience of omnipotence; it is the religion of psychical cripples."(7) The extreme forms of malignant destructiveness are labeled "necrophilous" by Fromm. The necrophile is a lover of death and destructiveness. Hitler is an example of a pure necrophile who was passionately fascinated by force, mechanical things, killing, and death.

More than any other therapist, Fromm has brought the searchlight of depth psychology to bear on the historical and societal roots of individual problems. In The Sane Society and elsewhere, he describes factors in our society which make for widespread alienation of persons from their powers and potentials. He shares his vision of a sane society in which human possibilities will be maximized. The road to such a society is the creation of an economic system in which "every working person would be an active and responsible participant, where work would be attractive and meaningful," where every worker would participate in management and decision-making.(8) The sane society would be one that is organized to serve the basic need of all human beings -- for relatedness and love, for a sense of inclusive identity, for creativeness, for a

frame or meaning, and for a satisfying object of devotion.

From the growth perspective, there are several weaknesses in Fromm's approach. His nontheistic belief system renders his religious orientation two-dimensional. He lacks awareness of a Source of inspiration and creativity that is both beyond and within human beings. Only such an awareness can give depth and height dimensions to what Fromm calls one's "frame of orientation and object of devotion." Although I find his critique of authority-centered ethics convincing in the sense that it is clear that we must find moral criteria that are self-validating in human experience, his orientation here also seems two-dimensional. There is no sense that what is best for human potentializing is somehow undergirded by ultimate spiritual Reality.

Fromm has a tendency to demonize authority in general. This tendency is partially offset by his recognition of the need for "rational authority," the authority of competence, to replace the attributive authority of status or position in a more humanizing society. Although I agree that the maximum distribution of power and decision-making is desirable and growth-producing, it is clear that some structured authority is also essential in all social systems. Such authority need not be oppressive provided there are strong checks on its exercise, built into the system.

From a feminist therapy perspective, Fromm, like most therapists, lacks a full appreciation of the centrality of sexism as a fundamental form of human oppression. From the viewpoint of radical therapies he does not emphasize the ways in which empowerment and involvement in changing institutions can be profoundly healing and growth-enabling for oppressed persons. His therapeutic theory is essentially individualistic in spite of his brilliant insights into the societal roots of pathology.

Resources in the Therapy of Karen Homey

Karen Horney was born in Hamburg, Germany, in 1885. Her father was a stem Norwegian sea captain; her mother was Dutch and much more open in her thinking and attitudes than was her father. Horney's medical education was received at the University of Berlin and her psychotherapeutic training at the Berlin Psychoanalytic Institute, where she subsequently became a lecturer. She was analyzed by two of the best-known training analysts in Europe -- Karl Abraham and Hans Sachs. At the invitation of Franz Alexander she came to the United States in 1932 and became associate director of the Chicago Institute of Psychoanalysis. She moved to New York in 1934 and taught at the New York Psychoanalytic Institute. Becoming increasingly dissatisfied with orthodox psychoanalysis, she joined with persons of similar views in founding the American Institute of Psychoanalysis. She was the dean of this institute until her death in 1952.

In spite of her orthodox Freudian training, Homey became remarkably growth-oriented in her understanding of human beings and of therapy. Horney's writings influenced my thinking significantly during my years of training as a counselor-therapist. I agree with this evaluation of her contemporary relevance: "Her ideas and understanding of the human person are as alive and fresh today as they were when she first shared them through her writings."(9) Paul Tillich (for whom Horney was a therapist) described the dynamic quality of her personhood in a moving statement at her funeral: "Few people whom one encountered were so strong in the affirmation of their being, so full of the joy of living, so able to rest in themselves, and to create without cessation beyond themselves."(10)

Horney's search for deeper understanding of the distortions and possibilities of human personality was linked with the willingness to challenge many of Freud's ideas. In April, 1941, she walked out of the New York Psychoanalytic Society singing "Go Down, Moses," having been told that her views were utterly out of keeping with psychoanalytic theory. There is something winsome about a person who had the courage to defy the rigidities of the psychoanalytic establishment in this

way.

Karen Horney's writings include a wealth of insights of value to growth-oriented counselors, therapists, and teachers. Along with Erich Fromm (with whom she was associated at the Berlin Psychoanalytic Institute and later in New York City) and with Adler, Rank, and Sullivan, she rejected Freud's compartmentalized conflict-centered, biologically reductionistic model of human personality in favor of an emphasis on the functioning of the self as whole in its relational context. She saw that the concept of a unifying, active center of personality is essential to the view that persons possess some freedom to respond intentionally to their situation. Both Horney and Fromm understood personal growth as being centered in the interaction of persons with their particular familial and cultural context. Both therapists shared an interest in understanding how sociological factors create growth-blocking or growth-enabling environments. Both saw their systems as falling within the general framework of psychoanalytic thought, but both rejected Freud's fundamental assumption that the essence of human development is the working out of biological drives and impulses.

Horney saw human beings as possessing the essential resources for wholeness:

Therapy, according to Horney, aims at enhancing self- awareness and self-knowledge. Thus, insight is not an end in itself but "a means of liberating the forces of spontaneous growth"(12) toward one's full potential. Healthy persons are spontaneous in their feelings, actively assume responsibility for their own lives, accept mutual obligations in interdependent relationships, are without emotional pretense, and are able to put themselves wholeheartedly into the work, beliefs, and relationships that are important to them. She saw that growth toward wholeness occurs in relationships of love and respect and that neurotic character patterns are learned by children when their relationships lack these essential qualities.  

Horney uses the term real self to mean the potential self -- all that one has the capacity to become. In contrast, the actual self is the way one is at present. In even sharper contrast, the idealized self is the exaggerated self-image by which people seek to maintain feelings of worth. Maintaining this perfectionistic self-picture wastes enormous energy, which could be used for growth toward actualizing the real self. This idealized image functions as a substitute for real self-esteem, creates self-idolatry, demands a pattern of rigid relationships, and makes it necessary to constantly compare oneself with others.

In her understanding of human growth, Horney shared with other analysts an emphasis on the lasting influence of the relationships of the first six years. But she regarded these formative experiences as determinative only in persons who have suffered severe emotional deprivation. A deeply hurt and therefore disturbed child, will turn school experiences as well as later relationships into reenactments of their pathology-fostering family relationships. In contrast, relatively healthy children tend to respond appropriately to the actual quality of the school relationships and of later experiences. Like Adler, Horney emphasizes the importance of growth experiences after as well as before age six. A reasonably growthful childhood leaves a person free to respond directly and appropriately to the pressures and possibilities of later life. The primary focus in Homey's therapy is on the situation one is now facing and on the current function of behavior, rather than on the discovery of the infantile roots of the problem. For those of us who lead growth groups and do education and therapy mainly with adults, this is a valuable and useful emphasis. Horney's insights about how excessive anxiety and low self-esteem stifle growth are relevant when working with painfully blocked growth. She uses the term "basic anxiety" to mean the deep feeling that is at the heart of severely truncated growth (neuroses). Basic anxiety is "the feeling a child has of being isolated and helpless in a potentially hostile world."(13) Neurotic patterns of relating are desperate attempts to prevent oneself from being overwhelmed by this most painful of feelings.

Horney identified three major neurotic personality patterns, which both stem from and produce further diminishing of growth. Each of these is a defense against feelings of threat, isolation, and helplessness. I find this simple schema useful in identifying the major ways we human beings block our growth in relationships. The first type of defense is that employed by the "moving toward" type persons(14) (comparable to Fromm's receptive type). Such individuals are compliant, dependent, and submissive. They seek to defend themselves against basic anxiety by seeking constant approval from others. Their fear of aggressiveness prevents them from satisfying their need for autonomy and assertiveness. They are pleasant, ingratiating, and easy to get along with as long as their exaggerated need for acceptance and love are met. They become very anxious when these needs are not met. Such persons tend to control others subtly by their "weak" submissiveness. In our sexist society, many women are conditioned to use the moving-toward defense.

The "moving against" type persons (comparable to Fromm's exploitative type) attempt to defend against anxiety by being hyper-independent, competitive, and aggressive, and by demanding power and prestige. They use others, including then-spouses and children, in status seeking and power games. They deny their underlying dependency needs. Our competitive society conditions many men to adopt this growth-inhibiting defense.

"Moving away" type persons are detached and aloof. They have great fear of intimacy and therefore must deny their need for the warmth of human contact. Such persons are essentially loners, who defend against anxiety by distancing. Often they are very conscientious in their work. Many are intellectualizers who keep distance from feelings -- their own and others -- by chronic :"head trips."

According to Horney, all three of these relational trends are present in everyone. But the relatively healthy person can move among the three flexibly as appropriate in different situations. In contrast, the severely growth-diminished person is frozen into one type of response in all situations. Most people have one trend that is stronger than the others. For example, when I feel threatened I most often use the moving-against defense (a favorite with many of us white, upward-striving males). But I also find myself using unproductive distancing and ingratiating compliance on other occasions.

Horney describes the dynamics of inner conflicts in a way that illuminates the nature of the growth work that many people need to do in therapy or in growth groups. She believed that in our conflicted society, inner conflicts are inescapable. In severely growth-diminished persons these conflicts paralyze creative living. Such persons are like soldiers under fire in a trench. They can live with some safety and even comfort as long as they stay within their defenses, but this position constricts their mobility and freedom severely. So-called neurotic persons seek to resolve conflicts between two sides of their needs (e.g., dependency and autonomy) by ignoring one side and exaggerating the other. Mary, a thirty-two-year-old secretary, adopted the moving-toward defense particularly in relating to men, denying her need for autonomy and assertiveness. But the exaggerated and unrelenting quality of her constant need for male reassurance and approval actually pushed men away. This deprived her of the approval and love that she was attempting to get. Her growth work in therapy focused on learning to recognize, value, and use her repressed assertiveness and to balance her need for love with greater autonomy.

As a practicing therapist, Horney was intimately acquainted with human destructiveness but rejected Freud's view that human beings are inherently destructive. Narcissism is not an inevitable or instinctual phenomenon but results from disturbed early relationships with authoritarian, rejecting, overambitious, or self-sacrificing parents.

If we want to injure and kill, we do so because we feel endangered, humiliated, abused; because we feel rejected and treated unjustly; because we are or feel interfered with in wishes which are of vital importance to us. That is, if we wish to destroy, it is in order to defend our safety or our happiness or what appears to us as such. Generally speaking, it is for the sake of life and not for the sake of destruction.(15)

Reflecting on her experiences as a therapist, Horney observed that the most powerful forms of anger and guilt that she had encountered were the anger and guilt of unlived life -- i.e., of diminished growth.

Horney criticized Freud for his lack of any clear vision of the constructive forces in human beings, his reduction of creativity and love to sublimated libido, and his misunderstanding of strivings toward self-realization as narcissism. Drawing on Albert Schweitzer's use of the terms "optimistic" and "pessimistic" (to mean "world and life affirmation" and "world and life negation") Horney described her own philosophy as follows: "With all its cognizance of the tragic element in neurosis, [it] is an optimistic one."(16)

In contrast to Freud's model of the therapist as detached and impersonal, Horney sees the therapist as a friendly, active person who shows personal concern and sympathy, liking, and respect for the patient. In this way the therapist helps the individual "retrieve his faith in others" (17) by discovering that his fears and hatreds are inappropriate with at least one person.

During Horney's adolescence, turn-of-the-century feminists were emphasizing education for women as a rallying point. With the support of her mother and several of her women friends, the resistance of Horney's father to her going to the gymnasium and on to medical school was overcome. She went on to become a pioneering foremother of contemporary feminist therapists. Three decades before the current writing by feminist therapists, she was publishing papers challenging the blatantly patriarchal presuppositions of Freud. Using the tools and many of the concepts of Freud, she identified his sexist blind spots and pointed to the need for a new psychology of women, understood from the viewpoint of women. She pointed out that Freud had drawn his theory of penis envy entirely from neurotic women and that he had ignored the fact that many men suffer from womb envy. She saw that women are a disadvantaged group in our society and that this cultural reality contributes significantly to their individual psychological problems. In examining the widespread distrust between the sexes, she showed how the patriarchal religion of the Old Testament provided justification for distrust of women and for male dominance. She rightly saw the distrust between men and women as being rooted in the unequal distribution of power between them: "At any given time, the more powerful side will create an ideology suitable to help maintain its position and to make this position more acceptable to the weaker one. . . .It is the function of such an ideology to deny or conceal the existence of a struggle."(18)

In her discussion of the problems of marriage, she shows that many of the difficulties that make good marriages so rare result from the unresolved conflicts people bring to marriage from the ways they are reared as boys and girls -- e.g., the unresolved dependency on mothers by the men and the anxiety and low self-esteem produced in women by being trained to respond as submissive and inferior to men.(19) She points to the actual physiological superiority possessed by women in their ability to carry, birth, and nurture new life, showing how many men are envious of this power. (20)

In my work as a pastoral counselor, I find many of Horney's concepts to be valuable for facilitating spiritual growth. She illuminates the dynamics of pathogenic, growth-stifling, guilt and fear-enhancing religion -- the type of beliefs, values, and religious practices that negate joy, freedom, and spiritual creativity. Many people are attracted to such rigid, authoritarian religious orientations because they seem to offer a defense against basic anxiety. Superego religion, which aims at controlling people (oneself and others) through guilt and fear of punishment, helps to create the paralyzing perfectionism of the ideal image. It helps keep people captive of what Homey calls the "tyranny of the oughts and shoulds."

In her early life Horney reacted against her father's stern, dogmatic religion. But she was a spiritual searcher even at seventeen. At that age she wrote a poem in her diary about her struggles to discover inner freedom, the purpose of her life, and knowledge of the All. Her daughter, Marianne Homey Eckardt, also a psychoanalyst, describes the poem in this way:

The poem begins with a restless longing for freedom, and an image of her digging herself out of an old masonry stronghold that a thousand years had built for her. The masonry gives way and buries her. But then her strength stirred, and as the poem continues, "an all-powerful longing. . .drove me forth to wander in order to see, to enjoy, and to know the All. And I wandered -- restlessly driven. . . . Released from the dungeon, I joyfully sing in jubilant tones the old song of life, to freedom, to light. But ever so often a question haunts me: What goal am I striving for? . .

. And I believe to hear the answer in the murmer of the woods: Rest exists only in the prison's walls. . . . Watchful searching, without complaining; restless striving, but no weary resignation: That is life. Dare to accept."(21)

This same free spirit characterized Horney throughout her life. Paul Tillich shared something of her spiritual journey in this last tribute to her:

Karen Horney became more and more aware that you cannot listen intensively to people who speak to you, that you cannot even listen to yourself if you do not listen to the voices through which the eternal speaks to us. It was not the voice of traditional religion to which she listened, it was the voices of people, the inner experiences, of nature, of poetry. And in the last year it was the voice from the eastern religion which grasped her heart and made her feel that the limits of an earthly existence are not the limits of our being, that we belong to two orders, although we can only see one of them with our senses. And it was an expression of her indomitable affirmation of life that she chose "reincarnation" as her symbol for the invisible order. More distinctly than in the earlier parts other life, she heard the sound of the eternal in these last years. But the power of the eternal was always working in her. For the manifestation of the eternal light and love worked in her and through her in all periods of her life. She knew the darkness of the human soul . . . but she believed that the soul can become a bearer of light. . . .She believed in the light and she had the power to give light to innumerable people. . . . Eternity works in time only if it works in love. And eternity worked love in her. . . . You can heal through insight only if insight is united with love. Therefore, many people who felt the light which radiated from her, from her insights and from her love, were healed in soul and body.(22)

Robert Coles, author and child psychiatrist at Harvard, met and had several conversations with Karen Horney when he was a medical student and she was hospitalized in New York City, a few days before her death. Homey knew she was dying. She asked how many women were in his medical school class, and he replied that there were only three out of a hundred students. She asked why that was the case, and they talked about the problems of combining marriage, motherhood, and training in medicine (which she had experienced personally), the resentment of women that many doctors have, and the irony that a profession dedicated to caring for people was so overwhelmingly composed of men. As he left her the last time, she was cordial and hopeful, thanking him for their talk. She spoke of the future: "You are young, and maybe when you reach my age the world will be quite different."(23)

Horney contributed in major ways to making psychoanalytic thought more growth-oriented. Yet, from the growth perspective, there are several limitations in her approach. Although she was keenly aware of the relational and societal roots of individual pathology and health, her therapeutic focus seemed to have remained intrapsychic and individualistic. She explored the intrapsychic factors that contribute to problems in marriages but did not emphasize equally crucial interpersonal dynamics that reinforce and perpetuate the intrapsychic patterns. As far as I know, she did not work directly with interpersonal systems (such as marriages or families) as such. Her awareness of the societal factors in personal problems apparently did not lead her to emphasize the importance of social and political action to change the pathogenic institutional context in which personal and relational problems proliferate. Although as an analyst she was radical for her times in her feminist views, she lacked the explicit emphasis of radical feminist therapists today on the therapeutic necessity of empowering people in therapy to change the social-political causes of their personal problems. Finally, although the spiritual awareness other thought increased, particularly in her latter years, the centrality of spiritual-value issues in all human growth was not emphasized explicitly in her therapeutic system.

Resources in the Therapy of Harry Stack Sullivan

Harry Stack Sullivan, founder of the interpersonal school of psychiatry, was born in upstate New York in 1892. During his lonely childhood on his parents' farm, his mother told him tales of their Irish past. One that fascinated him was that one of his ancestors was the West Wind, depicted as a

horse running toward the sunrise to meet the future.(24) Sullivan received his M.D. from Chicago Medical College in 1917. He received his psychiatric training with Adolf Meyer at Johns Hopkins and with William Alanson White at Saint Elizabeth's Hospital in Washington, D.C. When Horney and Fromm immigrated to New York, Sullivan discovered that his thought had much in common with theirs. They all shared a strong interest in how cultures affect personal development. The three joined forces for several years. Eventually each developed a distinctive approach while retaining many similarities. Sullivan worked closely with anthropologists Ruth Benedict and Margaret Mead, and with Fromm and Horney as they together challenged classical psychoanalytic theory because of its inadequate instinctual and biological presuppositions. In 1923 Sullivan began teaching and doing research at the University of Maryland Medical School. In 1936 he became a founder of the Washington School of Psychiatry, out of which the William Alanson White Institute of Psychiatry in New York City grew. One of his passionate interests was the application of psychotherapeutic insights to the resolution of social problems. He was active in the formation of the World Federation of Mental Health. He died in 1949 while he was in Paris on a UNESCO project exploring the psychological roots of international conflict.

Sullivan was a kind of remote grandfather figure at the White Institute of Psychiatry when I trained there in the late forties. He still lectured occasionally, and my teachers there reflected the influence of his thought. As a result, his ideas had a considerable impact on the direction of my developing understanding of persons and of therapy. Sullivan was regarded as brilliant and eccentric. (He had five dogs that were in and out of his office most of the time.) Throughout his life he struggled with emotional difficulties and problems in relationships. Awareness of his own problems apparently increased his insight, empathy, and almost maternal compassion for deeply troubled persons. He was known for his remarkable effectiveness in treating young schizophrenics. It is indicative of the esteem in which Sullivan was held that his colleagues assembled his lectures and saw that they were published after his death.

As a therapeutic system-builder, Sullivan is second only to Freud. He was essentially a clinician who wrote for other therapists to communicate what he had learned about his primary concern -- how to help deeply troubled people. As I recall from his lectures, his language was very technical and his thought compressed and complicated. It was only when he was describing his work with particular patients that his communication style was dynamic and moving. Since the publication of his lectures (1953-56), appreciation of his contributions has increased. He is now recognized as having made significant contributions to field theory, sociology, and social psychology, as well as to the practice of psychotherapy.(25) His theories seek to show how particular cultures create the

warp and woof of personality within them. As a pioneer theoretician he was a foreparent of what eventually became relational and systems approaches to psychotherapy. His understanding of persons offered a fresh, innovative perspective when he introduced it. His primary focus was on blocked growth (pathology) in people he described as "inferior caricatures of what they might have been." But, from his clinical experience, he developed a theory of personality that provides resources which are useful for facilitating growth in people all along the continuum of wholeness.

The central motif of Sullivan's thought is his interpersonalism ùthe conviction that personality is essentially and inescapably interpersonal. All human experiences, even those which seem most solitary, are actually interpersonal in their essence. A man fishing alone in a boat, when he catches a big one, thinks immediately of whom he will tell or he fantasizes the response of persons to his success as a fisherman. Sullivan saw that what goes on within people is always intertwined with what goes on between them and others. Except on the most abstract level, the within and the between are inseparable. In Sullivan's view it is unproductive to try to define the psychological attributes of individuals (drives, impulses, and such) as though they existed in isolation. To do so simply reflects the inadequacies of our individualistic thought patterns and language. What we refer to as the psychology of individuals is actually a description of persons' patterns of interactions with others -- past, present, and future (in fantasy). The most effective way to understand or help people change is to approach them as selves-in-relationships. Constructive changes can best be facilitated in individuals by perceiving them in this interpersonal way.

When individuals come for counseling or therapy, it often is illuminating to see them through the interpersonal perspective. This perspective reminds one that persons are the organizing center of their interpersonal network; that who they are is an expression of the quality of their most significant relationships, past and present; that they still carry within them hurts from past relationships; that their present relational system sustains and reinforces their diminished growth; that their hurt will be healed only if they can establish more growthful relationships as they move into the future. As systems therapies emphasize more than did Sullivan, intrapsychic growth is best sustained by constructive interpersonal change.

As was true of Adler, Horney, Fromm, and Assagioli, Sullivan saw the self as having a central role in the organization of all behavior. The "self system," as Sullivan called it, develops out of the child's experiences of the reflected appraisals of need-fulfilling or need-depriving adults in early life. The self system plays a powerful role in enabling persons to meet the two sets of basic human needs -- the need for bodily satisfaction (food, sleep, sex, closeness to people) and interpersonal security (esteem, belongingness, acceptance, the power to meet one's needs). Self-esteem is derived both from the internalized appraisals of significant others in early life and from developing the power to satisfy one's basic needs. In working with persons suffering from damaged self-esteem, Sullivan's insights are particularly useful. Such persons still bear the burden of negative appraisals by adults in their early lives. Their feelings of self-worth will be enhanced both by experiencing and internalizing esteem from significant others (e.g., the therapist or growth group members) and from increasing their competence and power to meet their basic needs.

Sullivan, like Horney, uses anxiety as a key working concept. Anxiety is always an interpersonal phenomenon. Its essence is fear of disapproval. An infant absorbs parental values automatically and empathetically in order to reduce this painful fear. Anxiety is the force by which, for better or worse, the personality's basic contours are molded in early childhood. Children feel anxiety when they go against the culturally approved values as these are embodied in the values of their parents. Children learn to organize their behavior to meet their needs according to culture's values and thereby feel the security of a deeply felt sense of well-being and belonging. Sullivan's insights about anxiety, cultural values, and self-esteem are particularly useful in parent training and growth experiences. Most parents would like to rear children with constructive values and sturdy self-respect. It often helps them implement this desire to see how their children's esteem is deeply influenced by the evaluations they as parents communicate continually to them and how their children's values are determined, to a considerable degree, by the real values of themselves as parents.

Sullivan understood disordered behavior such as schizophrenia as a pattern of inappropriate and ineffective responses that aim at coping with an overload of anxiety. This is caused by confused and inconsistent relationships in which children cannot learn to avoid overwhelming anxiety.

Ineffectively coping with this overload of anxiety produces severely distorted perceiving, thinking, feeling, and relating.

Three patterns of self-referent responses ("personifications" of oneself) develop in children out of their relationships during infancy. Good-me feelings are learned in relationships where behavior produces satisfactions and security. Bad-me feelings are learned in anxiety-producing situations. The "good me" and "bad me" personifications belong to the self-system. Which one predominates most of the time depends on the need-satisfying quality of early relationships. Not-rne feelings result from experiences of "primitive anxiety," horror, and loathing, which is beyond verbal description. Not-rne feelings appear in images in nightmares and in schizophrenic episodes. (Sullivan saw "bad dreams" as constructive in that they discharge impulses that otherwise might be overwhelming.) Most of us have experienced the polarity of the good-me, bad-me feelings.

Sullivan's view of wholeness, like Freud's, was essentially developmental. His schema of the sequence of life stages defines them, however, by significant change in relationships rather than in terms of internal instinctual development. His six-stage approach complements and corrects the intrapsychic focus of Freud's developmental schema. Stage 1: Infancy extends from birth to the development of speech (a learning that alters interpersonal relationships profoundly). During this first period one absorbs good-me and bad-rne feelings empathically. Stage 2: Childhood extends to maturation of the need and capacity for peer playmates. Stage 3: Juvenile era extends to the maturation of the need and capacity for intimate relationships with one's age peers. The child goes to school and must learn to compete and cooperate with peers and to relate to 'authorities outside the family. Sullivan believed, as did Adler, Horney, and Fromm, that personality is not fixed in early childhood unless the self-system is so crippled by anxiety as to be largely out of touch with reality. Stage 4: Preadolescence is the same-sex chum period, which extends to maturation of genital sexuality. Stage 5: Adolescence: Early adolescence focuses on the initial patterning of behavior to satisfy sexual intimacy and security needs. Late adolescence extends to the establishment of an intimate love relationship in which the other person is nearly as important as oneself. Stage 6: Adulthood: This is the goal of the developmental process by which one becomes, in this stage, a participant in the adult culture. Sullivan describes the healthy adult who has successfully finished the growth stages through adolescence in almost euphoric terms:

The person comes forth with self-respect adequate to almost any situation, with the respect for others that this competent self-respect entails, with the dignity that benefits the high achievement of competent personality, and with the freedom of personal initiative that represents a comfortable adaptation of one's personal situation to the circumstances that characterize the social order of which one is a part.(26)

Sullivan's descriptions of growth from the interpersonal perspective can provide valuable insights for anyone interested in facilitating optimal development in children and youth. (27)

A serious deficiency in Sullivan's developmental schema is his lack of awareness of the possibilities of continuing to develop throughout the adult stages of life. Like Freud, Sullivan made the fallacious assumption that the die is cast at the end of adolescence and that only intense psychotherapy can effect significant changes.

There was a winsome humanity about Sullivan that emphasized the essential humanness of all persons, including the most disturbed. In discussing the mentally ill, he wrote, "We are all much more human than anything else."(28) His view of the therapist is that of a "participant observer." To facilitate growth one must be there, participating as a full human being in the therapeutic relationship. But one must also be an observer who can see what ordinarily is missed and thus help bring clearer understanding of what is occurring in the person and in the relationship. The therapist must function and communicate on these two levels simultaneously.

Sullivan's trust in the healing-growth elan is clear in this comment about therapy: "If we clear away the obstacles (to effective relationships) everything else will take care of itself. I have never found myself called upon to 'cure' anyone."(29) Apparently Sullivan's awareness of his own inner problems served to prevent him from taking a condescending attitude toward patients. His basic therapeutic attitude seemed to be: "Despite my inescapable emotional difficulties and personality warps, I will work with troubled people to help them achieve better relationships and more inner strength. Hopefully both of us will learn and grow in the process."(30)

Sullivan's commitment to using psychological and psychiatric understanding to help resolve social problems is one of his significant contributions to a growth-oriented "persons- in- relationships- in-society" approach. He lived only a few years into the atomic age, but he had a vivid concern about our new fearsome capacity to end all human history. He worked with a kind of missionary zeal to rally the mental health community behind the work of UNESCO and the World Health Organization. His essay entitled "Remobilizing for Enduring Peace and Social Progress"(31) communicates his sense of the urgency of the task and his conviction that the social sciences and psychotherapy offer important resources that may help us survive and develop a new age for humankind. Sullivan saw persons in the psychological and psychotherapeutic professions as among the builders of the future.

There are several limitations in Sullivan's thought when viewed from the growth perspective. Although he was aware of the positive potentials that are wasted in disturbed people, he did not have a thoroughgoing, explicit growth orientation in his understanding of therapy. His theories, derived mainly from severely disturbed people, have "the odor of the clinic." Although his theory of personality was profoundly inter- personal, he apparently did not move beyond focusing on one individual at a time in therapy. He had a dawning vision that eventually led other therapists who shared it to treat interpersonal systems directly. But he did not take this giant therapeutic step himself. Sullivan tended to overgeneralize on some of his theories, reducing complex human responses to oversimplified explanation. For example, he sees anxiety as derived entirely

from the fear of disapproval. Though this is a major source of anxiety, it is only one of several sources. To my knowledge, Sullivan had no interest in facilitating positive spiritual growth. In spite of these weaknesses, Sullivan's system provides valuable insights on which growth-centered counselors and therapists can build. To his credit he was a therapist who sought to be a builder of the future.

For Further Exploration of Growth Resources in Fromm's Therapy

Fromm, Erich. Escape from Freedom. New York: Rinehart and Co., 1941. Explores the reasons that freedom is so threatening, and the escapes into conformity and authoritarianism.

---Man for Himself: An Inquiry into the Psychology of Ethics. New York: Rinehart and Co., 1947. A discussion of the possibilities and problems of a psychoanalytically based humanistic ethic.  

---Psychoanalysis and Religion. New Haven: Yale University Press, 1950. He sets forth his views on the universal human need for religion, Freud's and Jung's views of religion, and the psychoanalyst as physician of the soul.

---The Sane Society. New York: Rinehart and Co., 1955. Examines the pathology of normalcy in our society and the creation of a society in which human needs will be fulfilled.

---The Art of Loving. New York: Harper, 1956. A popular discussion of the nature and practice of life in a society in which love has disintegrated.

---The Anatomy of Human Destructiveness. New York: Holt, Rinehart and Winston, 1973. A depth exploration of the major theories of human destructiveness and a presentation of Fromm's conceptions of the various types of aggression.

For Further Exploration of Growth Resources in the Therapy of Karen Horney

Horney, Karen. Our Inner Conflicts, A Constructive Theory of Neurosis. New York: W. W.

Norton, 1945. An exposition of her major theories, including the three defensive ways of relating and the idealized image.

---Neurosis and Human Growth. New York: W. W. Norton, 1950. A restatement and refinement of her earlier works, emphasizing the motif of human growth.

---Feminine Psychology. New York: W. W. Norton, 1967. A collection of Horney's pioneering papers on the psychology of women and our sexist society.

Kelman, Harold. Helping People: Karen Horney's Psychoanalytic Approach. New York: Science House, 1971. A systematic presentation of Horney's therapeutic concepts and methods; begins

with two biographical chapters.

For Further Exploration of Growth Resources from Sullivan's Therapy

Chapman, A. H. Harry Stack Sullivan, His Life and His Work. New York: Putnam's, 1976. Includes a biography and chapters on Sullivan's views on personality development and psychotherapy, and the relevance of Sullivan to current social dilemmas.

Mullahy, Patrick, ed. The Contributions of Harry Slack Sullivan. New York: Science House, 1967. A symposium on interpersonal theory in social science and psychiatry, including papers by Clara Thompson and Gardner Murphy.

Sullivan, Harry Stack. Collected Works, 2 vols. New York: W. W. Norton, 1965.

---The Interpersonal Theory of Psychiatry. New York: W. W, Norton, 1953. Sullivan's description of the developmental epochs.

---The Psychiatric Interview. New York: W. W. Norton, 1954. Describes the structuring and process of psychiatric interviews.

---Schizophrenia as a Human Process. New York: W. 'W. Norton, 1965. Sullivan's insightful exploration of schizophrenia.

NOTES

1. See Escape from Freedom (New York: Rinehart and Co., 1941), pp. 103-35; 207-39.

2. Psychoanalysis and Religion (New Haven: Yale University Press, 1950), pp. 25-26.

3. Ibid., pp. 50-51.

4. Written with D. T. Suzuki and Richard de Martino (New York: Harper & Row, 1964).

5. Man for Himself (New York: Rinehart and Co., 1947), p. 250.

6. Fromm, The Heart of Man (New York: Harper & Row, 1964), p. 31.

7. The Anatomy of Human Destructiveness (New York: Holt, Rinehart and Winston, 1973), p. 290.

8. Fromm, The Sane Society (New York: Rinehart and Co., 1955), p. 284.

9. Ralph Hyatt, "Karen Horney, A Tribute," Journal of Marriage and Family Counseling, October, 1977, p. 39.

10. Tillich, "Karen Horney, A Funeral Address," Pastoral Psychology, May, 1953, p. 12.

11. Neurosis and Human Growth (New York: W. W. Norton, 1950), p. 17.

12. Ibid., p. 15.

13. Horney, Our Inner Conflicts (New York: W. W. Norton, 1945), p. 41.

14. For a fuller discussion of these three defensive modes, see ibid., chaps. 3, 4, and 5.

15. Gerald Sykes, The Hidden Remnant (New York: Harper, 1962), p. 100.

16. Neurosis and Human Growth, pp. 377-79.

17. Our Inner Conflicts, p. 45.

18. Feminine Psychology (New York: W. W. Norton, 1967), p. 116.

19. Ibid., p. 126.

20. Ibid., p. 60.

21. "Horney's Daughter Shares Mother's Early Diaries." William A. White Institute Newsletter, Fall 1975. p. 12.

22. Tillich, "Karen Homey, A Funeral Address," pp. 12-13.

23. Robert Coles. "Karen Horney's Flight from Orthodoxy." in Women and Analysis, Jean Stouse, ed. (New York: Grossman, 1974), p. 189.

24. Ralph M. Crowley, "Harry Stack Sullivan: The Man," William A. White Institute Newsletter, Fall 1970, p. 2.

25. See Mullahy. The Contributions of Harry Stack Sullivan (New York: Science House, 1967), chaps. 5, 6, 7.

27. For a fuller discussion of the life eras see Patrick Mullahy. Oedipus, Myth and Complex, A Review of Psychoanalytic Theory (New York: Grove Press, 1948), pp. 301-11; and A. H. Chapman, Harry Stack Sullivan, His Life and His Work (New York: Putnam's, 1976), chaps. 4 and 5.

28. Donald H. Ford and Hugh B. Urban, Systems of Psychotherapy (New York: Wiley, 1963), p. 521.

29. The Psychiatric Interview (New York: W. W. Norton. 1954), p. 242.

30. Chapman, Harry Stack Sullivan, p. 17.

31. This paper is in The Fusion of Psychiatry and Social Sciences, Collected Works, II (New York: W. W. Norton. 1965), 273-89.