For better or worse: interpersonal relationships and individual outcome

At a time of strong biological emphasis in psychiatry, it is important to emphasize that relationships with important others may play a crucial role in individual outcome. Psychoanalytic theories in the form of object relations, self psychology, and relational psychoanalysis reflect this emphasis, and at a broader level, the interpersonal school of psychiatry focuses selectively on the role of relationships in health and illness. Ten central premises of the interpersonal school are presented, followed by brief, selective reviews of three bodies of empirical data: studies of well-functioning marriages and families, the role of adult relationships in undoing the adult consequences of destructive childhood experiences, and the relationship of marital variables to the onset and course of depressive disorders. Clinical experience and research findings suggest that clinicians treating couples and families may be helpful by using techniques designed to both increase the intensity of affective bonds and repair the inevitable disruptions of those bonds. It is also noted that recent psychophysiologic studies suggest that derivatives of intense affective bonds and their disruptions, in the form of confiding and conflict, may influence both vascular reactivity and cellular immune competence. These studies suggest that "for better or worse" may have physiologic as well as psychological implications.