This guest post by James Barnes is a counterpoint article to In Defense of Psychoanalytic Diagnosis by Mark L. Ruffalo.
The “relational” approach—whether in its original form in relational psychoanalysis or in the later “relational turns” across other psychotherapies—rests on a core premise: that our minds and mental lives are not confined within the bounds of our skulls, as traditional psychological and psychiatric models have long assumed. The prevailing view, that mental life is internal, individual, and self-contained—what we might call the “atomistic” conception of mind—has given way to an understanding of mind as fundamentally shaped by and embedded within interpersonal dynamics and intersubjective experience.
This represents a “paradigm shift” from what is often termed a “one-person” to a “two-person” psychology. The one-person model, rooted in Cartesian dualism and its modern heirs, imagines the mind as a private, enclosed system, separated from others and the world outside. This philosophy served as the foundation of Freud‘s original psychological model, and it continues to underpin mainstream psychiatric and clinical psychological models. The two-person model emerged from a confluence of object relations theories (e.g., Fairbairn, Winnicott, Balint), attachment research, and existential-phenomenological thought. It decisively rejects the Cartesian mythology of the isolated individual, arguing that the mind is—we are—fundamentally open to and interwoven with the fabric of human relationships and social experience.
While “two-person psychology” and the “relational model” are relatively modern terms, their roots can be traced back to the work of Freud’s colleague-turned-heretic, Sándor Ferenczi, who was among the first to place relational dynamics at the heart of psychic life. Since the very beginning, it has had an uneasy relationship with the psychiatric status quo, which has been thoroughly invested in the diagnosis of “individual mental disorders” owing to its medical foundation.
I argue that not only is the one-person, Cartesian model philosophically obsolete—a view widely accepted in the social sciences outside psychiatry and psychology—but also that it has been empirically discredited. We now know that infants do not come into this world as private, self-involved beings, as Descartes, then Freud, and later others such as Piaget had assumed and built their models around. Infant research over the past 50 years has conclusively shown that we are interpersonally open, sensitive, and attuned to primary others and the immediate environment from birth. Neuroscience corroborates this: The limbic system and prefrontal cortex, critical to our emotional and psychological lives, emerge through attachment experiences with caregivers over time and are dependent for their functioning on proper interpersonal relations thereafter. The science shows, in other words, that we are not solitary minds that merely relate; we are fundamentally relational beings.
This causes a fundamental problem for models of individual “mental disorder” and the diagnoses which follow from them. Such diagnoses are constrained, by definition, to experiences within individuals—to internal mental or physiological states, or to behaviors taken to result from such states. The DSM, for instance, describes mental disorders as “dysfunctions in the individual.” This is not a scientific conclusion but a presupposition imported from the outside. From a two-person standpoint, this is fundamentally in error, as the experiences in question extend beyond the individual and incorporate others and aspects of the personal world. There are only persons-in-relations—interpersonal, familial, societal relations—so the “disorder,” if we still call it that, must include these within it. This is vital.
The shift to a two-person psychology involves a shift from a “biopsychosocial” model to what we might call a “sociopsychobio” model. Rather than beginning with individual functioning and extending outward, the sociopsychobio model starts with relational and social experience and understands psychological and biological functioning within that context. What is dysfunctional, then, or what is to be “diagnosed,” is not primarily the failure of an isolated system but of interpersonal dynamics and/or systems that cause harm and distress. This follows directly from a view of mind as a private, closed system to mind understood as fundamentally open and relational in nature. As a different paradigm, it cannot be explained away by rehearsing the beliefs and assumptions of the existing (one-person) paradigm.
This isn’t, of course, to deny that people have internal experiences or relevant biological processes. It is to say that if we diagnose social-relational processes as internal states and treat them individually, we have got things back to front. While it is entirely valid to speak of internal states, dysfunctions, disorders, or pathologies when describing the biology of a person, it is a “category error” when applied to mental life, which is open to and incorporates others and the world outside.
Consider, for instance, the experience of depression. In the standard, one-person account, this arises from some kind of neurochemical or brain-circuit dysfunction, faulty cognition, or maladaptive internal emotional process. If a person speaks of feeling worthless, “worthlessness” is presumed to be a private, internal state—perhaps triggered by external circumstances but ultimately located within the individual. By contrast, in the two-person account, “worthlessness” is not an internal state at all but a relational event. The person feels worthless in relation to how they are seen, treated, or neglected by others. Significant others—family, partners, peers, bosses—as well as broader societal structures, values, and expectations, are directly and inescapably involved. Even if it starts in the past, it is played out with and by others in the present, and it is in such dynamics, not inside the person, that the remedy is found because that is where the problem is.
Mislocating relational problems inside individuals is not just a theoretical error but an ethical one. By denying the constitutive role of others and the world, psychiatric diagnosis effectively isolates individuals and places the burden of dysfunction within them. This not only obscures the true nature of psychological and emotional distress but also turns the individual into a scapegoat for broader relational and social failings. That’s why such diagnoses pose a serious problem, and why, from the relational perspective, they do more harm than good. They not only reflect the one-person paradigm; they reproduce it, over and over, and they entrench it. And from a relational standpoint, this happens at great cost.
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James Barnes MSc., MA, is a psychotherapist in private practice as well as faculty and lecturer at Iron Mill College, Exeter. You can find him on X @psychgeist52 or his website jamesbarnes52.co.uk.
