Sullivan's Participant Observation

SULLIVAN WROTE LITTLE ABOUT his technique as such, focusing instead on the principles and assumptions underlying the words and gestures of the therapist as participant-observer. In 1924 he was already noticing how the "warps" of the psychiatrist affected the psychopathology exhibited by the patient during that session. Henceforth, in all his teaching and writing, he assumed that the psychiatrist is inextricably and inescapably involved with all that is going on in the session. His emphasis, in contrast to most others of his time, was not on eliciting hidden psychopathology, nor upon encouraging a dependent relationship for the uncovering of unconscious fantasies. He explicitly states that clear communication is what he is after. To the extent that a person can clearly articulate and communicate what he is thinking or suffering or whatever-he has a grasp on it. Sullivan stated succinctly, "and no one has grave difficulties in living if he has a very good grasp on what is happening to him."

The notion of participant observation as Sullivan refers to it again and again is as follows: The psychiatrist as a well trained expert, is knowledgeable, about the various fictions or dead weight past figures operating in his present perceptions of other people, so that regardless of how crippled he may be in other human relationships, he nonetheless functions as an effective, skilled participant-observer in enhancing the clarity of the patient's formulation in communication of whatever is ailing him. To do this he must avoid arousing unnecessary anxiety, and must produce some communication before termination of the session that will be beneficial or useful to the patient.

It has always impressed me how much Sullivan emphasizes that in the first interview especially, two strangers are meeting. The patient, regardless of what diagnostic label he has been referred with, is a complete stranger, and hence due all the courtesy, hospitality, and caution due a strange person makin