Harry Stack Sullivan was a bit of a trailblazer and rebel in the field of psychoanalysis. He went against Freud’s intrapsychic concepts–that conflict is primarily happening inside your own mind-and forwarded a more generous vision of us as interpersonal creatures with ‘problems in living.’
All of us need each other in order to be ourselves, and in needing others, we lose ourselves too.
Relationships carry prized and essential sides of self we can’t neatly separate. It’s the standing and running paradox that makes all of us “more simply human than otherwise be we happy and successful, contented and detached, miserable and mentally disordered, or whatever.”
Like Sullivan rebelled against and revolutionized Freud’s work, I’d like to challenge and awaken the state of OCD treatment which is steeped not in an intrapsychic process but a cognitive-behavioral one. Most of the time, OCD treatment centers on thoughts and behaviors. There’s hardly a glancing interest or curiosity about feelings and relationships. And not only is that such a pity, it’s a bit of a problem too.
Sullivan has a wonderful concept known as selective inattention. It is the situation in which a mother or father has difficulty being with a certain aspect of themselves. Let’s say they are challenged by being too close to their own anger, sadness, power and the child picks this up. They can tell it’s too anxiety-provoking for the parent to even entertain this, so they learn to block it out.
Just as the parent becomes selectively attentive to these sides of self-experience, so does the child. Notice it’s selective to the particular areas that are unbearable for the parent to experience comfortably and label both affectively and effectively.
As a result of the anxiety that the caretaker witnessing, containing, and expressing these sides of self, they become ‘bad me’ or ‘not-me’, aspects that either feel shameful and conflicted or even worse, completely unformulated.
OCD hits at that level, where these things can’t be formulated, as writer Michael J Greenberg astutely points out in his version of Rumination-Based ERP. The individual learns that the experience of anger, sadness, or power (or a host of other possible experiences) is problematic and must be defended against. Ironically, the symptom of OCD comes in unconsciously to ‘take care’ of this by expressing and concealing the fuller story.
And here’s why relationship is so central even to the treatment of OCD. It removes that selective inattention, and allows the experiences and feelings to be labelled, contained, and expressed so they don’t have to be communicated through a symptom itself.
Notice the irony here. CBT as a treatment is becoming a selectively inattentive parent.
You are not allowed or supposed to talk about your feelings, relationships, or meaning in here because that goes against protocol. Interpersonally, this communicates, you are not allowed to talk about certain aspects of yourself because it makes us feel anxious and complicates the picture in ways we don’t know how to deal with.
In our world, only evidence matters, and if there’s no evidence in some kind of test, it’s not worth spending time on. Unfortunately, evidence will not carry the day for what is missing in relationship.
In relationship, everything is about presence and energy, which can’t easily or precisely be measured but are palpably felt. And this is even more so the case with OCD sufferers who have an emotional sixth sense about who they are dealing with on the other side.
So, the problem currently with CBT is that it doesn’t address this selective inattentive elephant in the room. It tries to justify its own lack of relationship focus in treatment as if people themselves were only operating internally.
Ironically enough, the CBT treatment for OCD of today is in precisely the same place where classical psychoanalysis failed and disappointed OCD sufferers in the past. In a strange twist of fate, the rescuers of the ineffective pseudoscience of psychoanalysis have now become as dogmatic and obsessed as what they tried to correct. ‘
But this isn’t a dig, it’s another iteration of the human process of being imperfect in relationship. Unfortunately, if the treatment itself doesn’t talk about or look at the relationship, there’s no way to even speak to it or repair it.
It doesn’t have to be this way, which was precisely Sullivan’s innovation. The attentiveness to the relationship and the capacity to become closed off or conflicted about issues requires the interpersonal relationship to be front and center in all treatment.
It’s not enough to presume that issues are merely intrapsychic or just behavioral, Sullivan paved the way for us to see how the problems of living were found in the possibilities of being more connected, curious, and creative. We must be as open to seeing ourselves as part of the problem as we are part of the solution.
Then, and only then, might we find ourselves freed from chains like Houdini, grateful for the relationship that both holds the key and the lock to our newfound freedom.
Another insightful article. "In relationship, everything is about presence and energy, which can’t easily or precisely be measured but are palpably felt."
I am curious - in your book "the upside of OCD" and in your articles, I do not see a mention of "meditation" as a tool/method be calm, assured, staying in the present, and improving the relationships. Nobel prize winner Elizabeth Blackburn has quoted a number of studies that prove the efficacy of meditation.
Your thoughts? Thanks