Orchestrating Anxiety

Leston Havens: Participant Observation New York: Jason Aronson 1976.

LESTON HAVENS, IN THE CONSERVATIVE sanctuary of Boston psychoanalysis and Harvard Medical School, has rediscovered Harry Stack Sullivan, and with great skill and clarity has accomplished the task, long spoken of, but heretofore never completed, of explicating Sullivan for the sophisticated, dynamic psychotherapist.

In the first chapter, practically entitled Sullivan's Fine Disregard he confronts the reader immediately with the almost awesome respect and painstaking regard Sullivan had for the patient's self esteem, while at the same time (and in the service of this painstaking care) Sullivan was sarcastic, mocking and offhand. He shows how Sullivan daringly operates on his inferences of what sort of fantastic projection of interpersonal relations the patient is experiencing, imagining in himself, the subjective reality of the patient's world. He precisely expresses himself in attitude, gesture and words to counter the patient's projection and expected behavior of the other. In this respect, Sullivan could be strategic and manipulative, lulling the patient into going out much farther than originally intended, so that the patient is, as it were, hoisted in his own petard. Sullivan is presented as the conductor orchestrating himself and the patient with the imaginary significant others, increasing and decreasing the volume of anxiety to a code of relief, and enhanced well-being for the patient.

What we read here reflects Havens' fine sense of humor and dramatic insight into the heart of Sullivan's innovations: The Other People in the Room; Managing Conflict; Two Illustrations; An Interview; The Interpersonal Perspective and Techniques; Therapeutic Rationale and Termination.

Havens by no means touts these innovations as panacea for all mental illness. He makes it quite clear, as he did in his earlier book,