Interpersonal psychoanalysis and detailed inquiry

Domain I · Psychodynamic & depth psychology · Harry Stack Sullivan · 1953

What it is

Interpersonal psychoanalysis is a clinical tradition and method, not a manualised therapy. No session-by-session manual exists. What the founders describe is (a) a structured way of interviewing (Sullivan), (b) a stance, participant observation, and (c) a style of inquiry that asks for concrete…

Format

• A. Sullivan's four stages of the interview. These apply to a single interview, to an assessment over several sessions, and, in rough form, to a whole course of treatment. Sullivan calls them hypothetical stages that help the interviewer use the time.
• Session count and format. Sullivan gives no fixed number. One interview may be a single consultation or the start of intensive psychotherapy. In WAWI-tradition interpersonal psychoanalysis, treatment is open-ended, often at 1–4 sessions a week, and may be face-to-face or on the couch.

Who practises it, and how they are trained or regulated

• How change happens. For Sullivan, anxiety in relationships drives "security operations". These are manoeuvres that protect self-esteem but blur what the person notices about their own dealings with others. Selective inattention is the main one. Change comes when a careful, anxiety-regulated inquiry with an expert makes those patterns of living clear. The aim is the patient's "success in living". For Levenson,…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• The patient caretaking you, or the session becoming about you. It is working if the disclosure opens new material about the patient's experience.
• Losing the manifest content by jumping to "deeper" meaning too soon. It is working if the dream links to a concrete interaction you can then explore.
• Using vocal cues as accusations. Offer them as observations. It is working if the patient connects the change to a feeling or to something left unsaid.
• Gaps, blurred periods, and abrupt changes of tone. These are leads for the detailed inquiry. It is working if a sketch emerges and you can state two or three hypotheses.
• Leaving without a summary, which wastes the consolidation, or overloading the patient. It is working if the patient can restate the gist and the next step in their own words.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.