Excerpts from Must Read Books & Articles on
Mental Health Topics
Articles- Part XXVII
The Fate of the Ego in Analytic Therapy
Richard Sterba (1934)
That part of the psychic apparatus which is turned towards the outside world and whose business it is to receive stimuli and effect discharge-reactions we call the ego. Since analysis belongs to the external world, it is again the ego which is turned towards it. Such knowledge as we possess of the deeper strata of the psychic apparatus reaches us by way of the ego and depends upon the extent to which the ego admits it, in virtue of such derivatives of the Ucs as it still tolerates. If we wish to learn something of these deeper strata or to bring about a change in a neurotic constellation of instincts, it is to the ego and the ego alone that we can turn. Our analysis of resistances, the explanations and interpretations that we give to our patients, our attempts to alter their mental attitudes through our personal action upon them--all these must necessarily start with the ego. Now amongst all the experiences undergone by the ego during an analysis there is one which seems to me so specific and so characteristic of the analytic situation that I feel justified in isolating it and presenting it to you as the `fate' of the ego in analytic therapy.
The contents of this paper will surprise you by their familiarity. How could it be otherwise, seeing that it is simply an account of what you do and observe every day in your analyses? If, nevertheless, I plead justification, it is because I believe that, in what follows, adequate recognition is given for the first time to a factor in our therapeutic work which has so far received too little attention in our literature. The nearest approach to my theme is to be found in a paper on character-analysis by Reich, in which he talks of `isolating' a given character-trait, `objectifying' it and `imparting psychic distance' to it, referring thereby no doubt to that therapeutic process which I shall now present in a much more general form.
For the purposes of our incomplete description it will suffice if we regard the ego in analysis as having three functions. First, it is the executive organ of the id, which is the source of the object-cathexis of the analyst in the transference; secondly, it is the organization which aims at fulfilling the demands of the super-ego and, thirdly, it is the site of experience, i.e. the institution which either allows or prevents the discharge of the energy poured forth by the id in accordance with the subject's previous experiences.
In analysis the personality of the analysand passes first of all under the domination of the transference. The function of the transference is twofold. On the one hand, it serves to satisfy the object-hunger of the id. But, on the other, it meets with opposition from the repressive psychic institutions--the super-ego, which rejects it on moral grounds, and the ego, which, because of unhappy experiences, utters a warning against it. Thus, in the transferenceresistance the very fact of the transference is utilized as a weapon against the whole analysis.
We see, then, that in the transference a dualistic principle comes into play in the ego: instinct and repression alike make themselves felt. We learn from the study of the transference-resistance that the forces of repression enter into the transference no less than the instinctual forces. Anti-cathexes are mobilized as a defence against the libidinal impulses which proceed from the Ucs and are revived in the transference. For example, anxiety is activated as a danger-signal against the repetition of some unhappy experience that once ensued from an instinctual impulse, and is used as a defence against analysis. Here the repressive forces throw their weight on the side of the transference because the revival of the repressed tendency makes it the more imperative for the subject to defend himself against it and so put an end to the dreaded laying bare of the Ucs.
In order to bring out the twofold function of the transference let me sketch a fairly typical transference-situation such as arose at the beginning of one of my analyses.
A woman patient transferred to the analyst an important object-cathexis from the period of early childhood. It represented her love for a physician to whom she was frequently taken during her fifth year on account of enlarged tonsils. On each occasion he looked into her mouth, without touching the tonsils, afterwards giving her some sweets and always being kind and friendly. Her parents had instituted these visits in order to lull her into security for the operation to come. One day, when she trustfully let the doctor look into her mouth again, he inserted a gag and, without giving any narcotic or local anesthetic, removed the unsuspecting child's tonsils. For her this was a bitter disillusionment and never again could she be persuaded to go to see him.
The twofold function of the transference from this physician to the analyst is obvious: in the first place it revived the object-relation to the former (a fathersubstitute), but, in the second place, her unhappy experience with him gave the repressive forces their opportunity to reject the analyst and, with him, the analysis. `You had much better stay away, in case he hurts you', they warned her, `and keep your mouth shut!' The result was that the patient was obstinately silent in the analysis and manifested a constant tendency to break it off.
This typical example shows how the ego manages in the transference to rid itself of two different influences, though in the shape of a conflict. For the establishment of the transference is based on a conflict between instinct and repression. Where the transference-situation is intense, there is always the danger that one or other of the conflicting forces may prevail: either the analytic enterprise may be broken up by the blunt transference demands of the patient, or else the repressive institutions in the mind of the latter may totally repudiate both analyst and analysis. Thus we may describe the transference and the resistance which goes with it as the conflict-laden result of the struggle between two groups of forces, each of which aims at dominating the workings of the ego, while both alike obstruct the purposes of the analysis.
In opposition to this dual influence, the object of which is to inhibit the analysis, we have the corrective influence of the analyst, who in his turn, however, must address himself to the ego. He approaches it in its capacity of the organ of perception and of the testing by reality. By interpreting the transference-situation he endeavours to oppose those elements in the ego which are focussed on reality to those which have a cathexis of instinctual or defensive energy. What he thus accomplishes may be described as a dissociation within the ego. It may be doubted whether `dissociation' is an appropriate term for non-pathological processes in the ego. This point is answered by the following passage in Freud's New Introductory Lectures on Psycho Analysis, a work which has appeared since this paper was read: We wish to make the ego the object of our study, our own ego. But how can that be done? The ego is the subject par excellence: how can it become the object? There is no doubt, however, that it can. The ego can take itself as object; it can treat itself like any other object, observe itself, criticize itself, do Heaven knows what besides with itself. In such .a case, one part of the ego stands over against the other. The ego can, then, be split; it becomes dissociated during many of its functions, at any rate in passing. The parts can later on join up again' (p. 80).
We know that dissociations within the ego are by no means uncommon. They are a means of avoiding the clash of intolerable contradictions in its organization. `Double consciousness' may be regarded as a large-scale example of such dissociation: here the left hand is successfully prevented from knowing what is done by the right. Many parapraxes are of the nature of `double consciousness', and abortive forms of this phenomenon are to be found in other departments of life as well.
This capacity of the ego for dissociation gives the analyst the chance, by means of his interpretations, to effect an alliance with the ego against the powerful forces of instinct and repression and, with the help of one part of it, to try to vanquish the opposing forces. Hence, when we begin an analysis which can be carried to completion, the fate that inevitably awaits the ego is that of dissociation. A permanently unified ego, such as we meet with in cases of excessive narcissisms or in certain psychotic states where ego and id have become fused, is not susceptible of analysis. The therapeutic dissociation of the ego is a necessity if the analyst is to have the chance of winning over part of it to his side, conquering it, strengthening it by means of identification with himself and opposing it in the transference to those parts which have a cathexis of instinctual and defensive energy.
The technique by which the analyst effects this therapeutic dissociation of the ego consists of the explanations which he gives to the patient of the first signs of transference and transference-resistance that can be interpreted. You will remember that in his recommendations on the subject of technique Freud says that, when the analyst can detect the effects of a transference-resistance it is a sign that the time is ripe for interpretation. Through the explanations of the transference-situation that he receives the patient realizes for the first time the peculiar character of the therapeutic method used in analysis. Its distinctive characteristic is this: that the subject's consciousness shifts from the centre of affective experience to that of intellectual contemplation. The transference-situation is interpreted, i.e. an explanation is given which is uncoloured by affect and which shows that the situation has its roots in the subject's childhood. Through this interpretation there emerges in the mind of the patient, out of the chaos of behaviour impelled by instinct and behaviour designed to inhibit instinct, a new point of view of intellectual contemplation. In order that this new standpoint may be effectually reached there must be a certain amount of positive transference, on the basis of which a transitory strengthening of the ego takes place through identification with the analyst. This identification is induced by the analyst. From the outset the patient is called upon to 'co-operate' with the analyst against something in himself. Each separate session gives the analyst various opportunities of employing the term `we', in referring to himself and to the part of the patient's ego which is consonant with reality. The use of the word `we' always means that the analyst is trying to draw that part of the ego over to his side and to place it in opposition to the other part which in the transference is cathected or influenced from the side of the unconscious. We might say that this `we' is the instrument by means of which the therapeutic dissociation of the ego is effected.
The function of interpretation, then, is this: Over against the patient's instinct-conditioned, or defensive behaviour, emotions and thoughts it sets up in him a principle of intellectual cognition, a principle which is steadily supported by the analyst and fortified by the additional insight gained as the analysis proceeds. In subjecting the patient's ego to the fate of therapeutic dissociation we are doing what Freud recommends in a passage in Beyond the Pleasure Principle (p. 18): `The physician . . . has to see to it that some measure of ascendancy remains [in the patient], in the light of which the apparent reality [of what is repeated in the transference] is always recognized as a reflection of a forgotten past.'
The question now suggests itself: What is the prototype of this therapeutic ego-dissociation in the patient? The answer is that it is the process of super-ego-formation. By means of an identification of analysand with analyst -judgements and valuations from the outside world are admitted into the ego and become operative within it. The difference between this process and that of super-ego-formation is that, since the therapeutic dissociation takes place in an ego which is already mature, it cannot well be described as a `stage' in ego-development: rather it represents more or less the opposition of one element to others on the same level. The result of super-ego formation is the powerful establishment of moral demands; in therapeutic ego-dissociation the demand which has been accepted is a demand for a revised attitude appropriate to the situation of an adult personality. Thus, whilst the super-ego demands that the subject shall adopt a particular attitude towards a particular tendency in the id, the demand made upon him when therapeutic dissociation takes place is a demand for a balancing contemplation, kept steadily free of affect, whatever changes may take place in the contents of the instinct-cathexes and the defensive reactions.
We have seen, then, that in analysis the ego undergoes a specific fate which we have described as therapeutic dissociation. When analysis begins, the ego is subject to a process of 'dissimilation' or dissociation, which must be induced by the analyst by means of his interpretation of the transferencesituation and of the resistance to which this gives rise.
As the analyst proceeds, the state of 'dissimilation' in the ego is set up again whenever the unconscious material, whether in the shape of instinctual gratification or of defensive impulses, fastens on the analyst in the transference. All the instinctual and defensive reactions aroused in the ego in the transference impel the analyst to induce the therapeutic process of ego-dissociation by means of the interpretations he gives. There is constituted, as it were, a standing relation between that part of the ego which is cathected with instinctual or defensive energy and that part which is focussed on reality and identified with the analyst, and this relation is the filter through which all the transference-material in the analysis must pass. Each separate interpretation reduces the instinctual and defensive cathexis of the ego in favour of intellectual contemplation, reflection and correction by the standard of reality.
However, once the analyst's interpretations have set up this opposition of forces--the ego which is in harmony with reality versus the ego which acts out its unconscious impulses--the state of 'dissimilation' does .not last and a process of `assimilation' automatically begins. We owe to Hermann Nunberg our closer knowledge of this process, which he calls `the synthetic function of the ego'. As we know, this function consists in the striving of the ego, prompted by Eros, to bind, to unify, to assimilate and to blend--in short, to leave no conflicting elements within its domain. It is this synthetic function which, next to therapeutic dissociation of the ego, makes analytic therapy possible. The former process enables the subject to recognize intellectually and to render conscious the claims and the content of his unconsciousness and the affects associated with these, whilst when that has been achieved, the synthetic function of the ego enables him to incorporate them and to secure their discharge.
Since there are in the transference and the transference-resistance two groups of forces within the ego, it follows that the ego-dissociation induced by the analyst must take place in relation to each group, the ego being placed in opposition to both. At the same time the interpretations of defensive reactions and instinctual trends become interwoven with one another, for analysis cannot overcome the defence unless the patient comes to recognize his instinctual impulses, nor put him in control of the latter unless the defence has been overthrown. The typical process is as follows: First of all, the analyst gives an interpretation of the defence, making allusion to the instinctual tendencies which he has already divined and against which the defence has been set up. With the patient's recognition that his attitude in the transference is of the nature of a defence, there comes a weakening in that defence. The result is a more powerful onslaught of the instinctual strivings upon the ego. The analyst then has to interpret the infantile meaning and aim of these impulses. Ego-dissociation and synthesis ensue, with the outcome that the impulses are corrected by reference to reality and subsequently find discharge by means of such modifications as are possible. In order that all these interpretations may have a more profound effect, it is necessary constantly to repeat them; the reason for this I have explained elsewhere (`Zur Dynamik der Bewaltigung des Ubertragungswiderstandes,' Internationale Zeitschrift fur Psychoanalyse. Bd. XV, 1929).
Now let us return to the case I cited before and see how it illustrates what I have just said. The patient's resistance, which began after a few analytic sessions, took the form of obstinate silence and a completely negative attitude towards the analyst. Such meagre associations as she vouchsafed to give she jerked out with averted head and in obvious ill-humour. At the close of the second session an incident occurred which showed that this silence and repellent attitude were a mode of defence against a positive transference. At the end of the hour she asked me if I had not a cloakroom where she could change her clothes as they were all crumpled after she had lain on the sofa for an hour. The next day she said to me in this connection that, after her analysis, she was going to meet a woman friend, who would certainly wonder where the patient had got her dress so crushed and whether she had been having sexual intercourse. It was clear that, as early as the second session, her ego had come under the influence of the . transference and of the defence against it. Of course, she herself was completely unconscious of the connection between her fear of being found out by her friend and the attitude of repudiation which she assumed in analysis.
The next thing to do was to explain to the patient the meaning of her defence. As a first step, the defensive nature of her attitude was made plain to her, for of this, too, she was unconscious. With this interpretation we had begun the process which I have called therapeutic ego-dissociation. When the interpretation had been several times repeated the patient gained a first measure of `psychic distance' in relation to her own behaviour. At the start her gain was only intermittent and she was compelled almost at once to go on acting her instinctual impulses out. As, however, the positive transference was sufficiently strong, it gradually became possible to enlarge these islands of intellectual contemplation or observation at the expense of the process of acting the unconscious impulses out. The result of this dissociation in the ego was that the patient gained an insight into the defensive nature of her attitude in analysis, that is to say, she now began to work over preconsciously the material which had hitherto been enacted unconsciously in her behaviour. This insight denoted a decrease in the cathexis of those parts of the ego which were carrying on the defence.
Some time afterwards there emerged the memory of her visits to the kind throat-specialist and of the bitter disillusionment in which they had ended. This recollection was in itself a result of the synthetic function of the ego, for the ego will not tolerate within itself a discrepancy between defence and insight. The effect of the infantile experience had, it is true, been felt by the ego, but this effect had been determined from the unconscious; it now became incorporated in the preconscious in respect of its causal origin also. It is hardly necessary for me to point out that the discovery of this infantile experience of the patient with the physician was merely a preliminary to the real task of the analyst, which was to bring into consciousness her experiences with her father and especially her masochistic phantasies relating to him.
In overcoming the transference-defence by the method of therapeutic ego-dissociation we were not merely attacking that part of the ego which was using the patient's unhappy experience with the physician in her childhood to obstruct the analysis; we were, besides, counteracting part of the super-ego's opposition. For the defensive attitude was in part also a reaction to the fear that her friend might find out the patient had been having sexual intercourse. Now she had developed an obvious mother-transference to this particular friend, and the mother was the person who had imposed sexual prohibitions in the patient's childhood. By means of the therapeutic egodissociation a standpoint of intellectual contemplation, a `measure of ascendancy', had formed itself in her mind, in opposition to her defensive behaviour: in that dissociation the `reality' elements in the ego were separated not only from those elements which bore the stamp of that unhappy experience and signalled their warning, but also from those other elements which acted as the executive of the super-ego.
In the case we are considering, the next result of the analysis was that the positive transference began to reveal itself, taking more openly possession of the ego and manifesting itself in the claims which the patient made on the analyst's love. Once more, dissociation had to be induced in the ego, so as to separate out of the processes of dramatic enactment an island of intellectual contemplation, from which the patient could perceive that her behaviour was determined by her infantile experiences in relation to her father. This, naturally, only proved possible after prolonged therapeutic work.
I hope that this short account may have sufficed to make clear what I believe to be one of the most important processes in analytic therapy, namely, the effecting of a dissociation within the ego by interpretation of the patient's instinctually conditioned conduct and his defensive reaction to it. Perhaps I may say in conclusion that the therapeutic dissociation of the ego in analysis is merely an extension, into new fields, of that self-contemplation which from all time has been regarded as the most essential trait of man in distinction to other living beings. For example, Herder expressed the view that speech originated in this objectifying process which works by the dissociation of the mind in self-contemplation. This is what he says about it: `Man shows reflection when the power of his mind works so freely that, out of the whole ocean of sensations which comes flooding in through the channel of every sense, he can separate out, if I may so put it, a single wave and hold it, directing his attention upon it and being conscious of this attention.... He shows reflection when he not only has a vivid and distinct perception of every sort of attribute, but can acknowledge in himself one or more of them as distinguishing attributes: the first such act of acknowledgment yields a clear conception; it is the mind's first judgement. And how did this acknowledgment take place? Through a characteristic which he had had to separate out and which, as a characteristic due to conscious reflection, presented itself clearly to his mind. Good! Let us greet him with a cry of "eureka"! This first characteristic due to conscious reflection was a word of the mind! With it human speech was invented!' (Uber den Ursprung der Sprache.)
In the therapeutic dissociation which is the fate of the ego in analysis, the analysand is called on 'to answer for himself and the unconscious, ceasing to be expressed in behaviour, becomes articulate in words. We may say, then, that in this egodissociation we have an extension of reflection beyond what has hitherto been accessible. Thus, from the standpoint also of the human faculty of speech, we may justly claim that analytic therapy makes its contribution to the humanizing of man.
Some Queries on Principles of Technique
M. Nina Searl (1936)
The title will already have told something about the relation of this paper to the subject of technique. Unless we adhere to principles of technique we either sacrifice their elasticity for the narrow rigidity of rules, or we are outside the realm of law and order and limited to that of shifting expediency. Most papers on technique give us the opportunity of feeling our way toward such principles in a variety of analytical situations, or give a limited number of rules adapted to a limited number of typical situations. Of English papers James Strachey's1 brought us nearest to consideration of principles, but only Freud himself has given us principles of technique.
A recent stimulus and help has been Hellmuth Kaiser's paper on Problems of Technique.2 This paper seems to me to grasp the nettle of difficulty both firmly and promisingly. To whatever extent I differ on some of the side-issues, its main theme, reliance on the analysis of resistances, is in complete and, to me, welcome accord with my own previous conclusions, and is stated with much clarity. As Kaiser has pointed out, Freud has, so far at least, left us with little more than a clear indication that the most promising way to pursue is that of the analysis of resistances. Yet Kaiser's paper, following Reich's in some points, is the first to deal specifically and thoroughly with this subject, however much it may be implicit and occasionally explicit in other work on technique.3
Before we come to any conclusions about correct technique it seems worth while to clear our minds a little about--
(I) the criteria of correct technique. For this purpose we have to ask not only what are (a) the objective, but also (b) the subjective criteria.
(2) Then comes the question of aim: what exactly do we want our technique to do ?
(a) If we answer this question in terms of the analysis of resistances, what attitude (b) to the patient and (c) to his material does this imply?
(3) After some instances of what (a) the analysis of resistances is not, we should be in a better position to answer a previous question more exactly formulated. i.e. (b) What the analysis of resistances is, and finally to ask (c) Whether it forms the whole or part of our work with our patients.
(I) Our first query, then, is this: What are the criteria (a) objective, (b) subjective of correct technique?
(a) Objective criteria. I think that any attempt to answer this query should subdivide objective criteria into those applying to (i) a general survey of an analysis, and (ii) current or particular details of analytic technique.
(i) The only satisfactory objective criterion of a finished analysis seems to me to be that of a marked improvement of the total personality, and not of one part at the expense of another it involves the capacity to retain or quickly regain that total improvement, when tested by the independent facing of difficulties subsequently encountered. But much has to be taken into account, such as the severity of the previous illness and of the subsequent environmental difficulties, before we can well base on the post-analytical state and behaviour of the patient a decision about the general correctness or otherwise of the technique employed in the course of the analysis. It is in some ways still less easy to apply such a criterion during the course of the analysis, before its upheavals have had time to 'settle', although we have the advantages of closer and more prolonged observation.
(ii) It is also difficult to find simple and conclusive objective criteria for details of technique. Quick and superficial improvement often conflicts with a more fundamental change for the better, and the analyst, no less than the patient, has often to do without objective reassurance and trust to the wider-reaching reality principle instead of the more hasty pleasure-pain principle. Even the two generally recognized and often valuable signs of correct technique, the production of more material and increased relaxation, cannot be relied on in all circumstances: and in individual work we cannot expect that this should be so. General applicability would naturally indicate a sphere from which individual variation was excluded. I have known increased production of material due to predominantly unsatisfactory motives, though it is true that such a form of apparent improvement never takes one very far or lasts very long--any more than on the surface do some of the more satisfactory forms of improvement. For example, after I had answered some question to which some other form of response was expected, I have known a patient to settle down easily and begin to talk with comparative volubility and warmth after long periods of hard silence broken only by occasional remarks. But it soon became apparent that the patient was in fact encouraging me to conduct pleasing to her immediate demands, and apparently saving her from the need to encounter the very difficulty which was standing in the way of her progress--the danger of the unsatisfied person. She was saying in effect ' See what I will do to please and satisfy you if only you will please and satisfy me in my own way and at once', implying also, ' I will do nothing you want unless you quickly please me.' But reliance on such a method was two-edged, and left her unable to hope that I would wish to satisfy her unless she satisfied me--and retrospectively that had its difficulties. It took me a little time to see that in the long run anxiety was rather increased than diminished. This is no argument against the answering of questions in analysis--a point that must be judged on its merits in particular situations. Possibly but for failure to deal suitably with previous questions my answering of this one would have had less significance one way or another. At the moment I only want to illustrate the point that apparent improvement along recognized lines may be deceptive. Among other unsatisfactory motives for marked increase of material may be the desire to divert attention and make a substitute offering. Also the feeling that the analyst has shifted some threatening responsibility to himself away from the patient may be signalized by the production of significant information. In the latter case it is often accompanied by pronounced relaxation.
(b) We see, then, that if our immediate judgement of the correctness of technique depends upon behaviouristic observations, and even if it includes the patient's more obvious emotional attitudes, we may be led astray because other essential objective criteria are not immediately available, and may be long delayed. I think all will agree that we can gain the most from our analytical experience for this purpose after long willingness to delay our judgements based on such criteria, or at least to recognize their temporary and ad hoc character, and to take the span of months rather than of moments. None-the-less we can and do develop an ability to form immediately correct judgements; and not only so, but some of that capacity must have been there from the beginning, or we should have been in a state of mental chaos not only occasionally, but every time objective data left us uncertain about the state of affairs in the patient's mind. The capacity of intuition to arrive at conclusions apart from and in addition to a conscious valuation of objective data--or, in analytic terminology, the free working of the analyst's unconscious with his conscious mind, and of these with the unconscious and conscious mind of the patient--has perhaps tended to fall into some disrepute in the outlook of the intellectual and practical man towards such subjects as the one under discussion. This state of affairs cannot, I think, be at all fully accounted for by a high valuation of the conscious compared with the unconscious mind, and of intelligence, which must stand or fall with that valuation--many analysts, indeed, rank consciousness comparatively low in the scale of importance. The disrepute is rather the result of the frequent distortions of intuition by emotional disturbance, and, for analysts in particular, of the understandable concentration of their attention on the repressed and anxiety-laden part of the unconscious. Therefore it seems to me worth while to spend a few moments in asking when we can trust our intuition on the correctness or incorrectness of our technique, or in other words, ' what are our subjective criteria of correct technique ? ' The first and obvious answer is, again, Considerable experience and frequent confirmation of the trustworthiness of our intuitions on the subject. But even so, we need to be sure that such a delicate and easily disturbed instrument as intuition is maintained in good working order. And of this we can, I think, have a more rapid means of determination than by waiting for the subsequent confirmation of experience. We may safely trust ourselves if we find that we are readily able to recognize our mistakes and the effect of them, to experience the pain of proportionate regret and to shoulder the burden of doing what we can to repair the harm resulting from them.
(2) In order that our intuitive judgement should be in accord with purposive intelligence, we must try to determine what correct technique aims at accomplishing. We need an aim which relates with sufficient elasticity to our pre-conceived ideas, or to our past, and to our own and the patient's future.
Is it the aim of our technique, then, to free the patient's instinctual impulses? I do not see how the most expert analyst can have such full and precise knowledge of his patient's psyche that he is fitted to decide, against the decision of the patient's own mind, that this can be done in such a way as to better his total position. If our aim were to be the freeing of instinctual impulse we should need to know all the factors arrayed against it in order to be sure that our aim was a wise one; and our closest approximation to such knowledge comes at. the end and not at the beginning of an analysis. Obviously too, the need of many patients is to achieve a non-threatening control of instincts which have an apparent autonomy, and in such a case the aim of freeing them is clearly beside the mark, unless, contrary to general parlance, it includes the aim of freeing them from their compulsive drive.4
Is it not nearer the truth, then, to say that the aim of our technique is to show the patient himself, to unmask5 what lies in the depth of his mind? I think it is, because it leaves with the patient the decision of what he does as a result of his increased vision.6 Ultimately and fundamentally we can never make anyone with the whole of his mind, of himself, do anything against his own wish and will: some part of him always remains in a state of refusal: and it is in accordance with this knowledge which analysis has so definitely impressed on us that we should leave the decision to the patient as part of our deliberate aim, and not make any vain attempt to decide for him.
But even this statement of aim, the unmasking of the mind, leaves, I think, something to be desired. Is it not still nearer the truth to say that we aim at helping the patient to understand not so much even the mask itself as those forces which produce it?--that is, to understand the dynamics of a situation which prevent him from knowing as much of himself as he needs to know ?
(a) In other words the aim of our technique is that analysis of resistances which Freud has recommended to us.
'Finally the present day technique evolved itself, whereby the analyst abandons concentration on any particular element or problem, contents himself with studying whatever is occupying the patient's mind at the moment, and employs the art of interpretation mainly for the purpose of recognizing the resistances which come up in regard to this material and making the patient aware of them. A rearrangement of the division of labour results from this: the physician discovers the resistances which are unknown to the patient; when these are removed the patient often relates the forgotten situations and connections without any difficulty.'7
This method Freud contrasts with 'divining from the patient's free associations what he failed to remember'. We cannot therefore doubt that Freud wished to substitute interpretation of resistances for interpretation of absent content.8
(b) The analysis of resistances seems to me, then, to imply that the knowledge of 'what ' is subservient to the understanding of ' why? ', or 'why not? '; and close adherence to this simplifying principle can alone gradually bring clarity and order into confusing varieties of attempts to deal with the patient's material, and can ultimately give us a firm basis from which to proceed. Among the most important of those advantages with which we have long been familiar is the possibility it gives the patient of 'living through' other experiences in a less ill-defined and massive form than in ordinary life, in order that the analyst's understanding may help to define still further and localize them into the form of memory. One may perhaps say that instead of the past situation controlling the patient and re-living him,9 the patient can in this way regain his capacity to re-live his past in this more controllable form of memory. The analysis of resistances interferes with the re-living process only to help substitute this better form of it. Too literal adherence to the 'blank sheet ' attitude of the analyst, as well as the difficulties in the way of gaining the best from it, have perhaps tended to its discredit. But in so far as we believe in the ' transference ' situation, and in its value as a ' living through ' process previous to the correct sorting out of experiences, phantasies and affects, it is clearly of small advantage to forestall this second part by proving to the patient that, for example, the analyst has not some bad quality ascribed to him--though, indeed, to prove that he has it to any serious extent is much worse. Whatever advantages there may be in the analyst's revelation of himself and his qualities, good and bad, to the patient otherwise than in his interpretations10--and there may certainly be advantages as well as disadvantages in such a situation--it is obviously impossible to believe that the ' transference situation ' and the ' re-living ' phases can be as clearly distinguished and demonstrated as in the case of reliance on psycho-analytical technique alone. That is, the analysis of resistances makes it easier to distinguish re-living from living, and neither to miss the 'transferred' situations between the patient and the analyst, nor to extend them to include that part of their relation which is the adequate outcome of the actual situation and occasion.
Again, the analysis of resistances, or otherwise and perhaps more clearly stated, the analysis of conflicting processes, is of far wider and more effective reach than any analysis of static content. The answer to the 'why not ' is always applicable to many ' whats ', that is, to a variety of other situations, whereas the interpretation which gives absent content alone does not itself apply to anything but that content, whatever the patient's mind may do about it and whatever changes may result from such an interpretation. Thus one may be able to say to the patient 'This is why you cannot get further with such and such a subject ', or 'This is why you are in difficulties about such and such a situation. You are trying to prevent any results from the very things you are doing or wishing to do', or' You are trying to manage the difficult emotions of a particular situation by repeating it with a reversal of roles. But that leaves the total situation with its difficulties and emotions exactly where it was'; or 'Your fear of one extreme of feeling drives you to the opposite extreme, not because you want it, but from fear of the other', or 'You are in difficulty because you have so far been unable to find a better way than the one you could not tolerate, and have been misled by the feeling," anything must be better than this" '; or ' Your dread of guilt has not yet enabled you to find a satisfactory substitute for guilt', and so on. The dynamics of the particular situation with which we are dealing have been and are active in many other situations too, and therefore in affecting one we affect many. And one has brought to his notice the fact that we recognize his difficulty and that we can offer a reason not only for it, but for his incapacity to emerge from it; also one has implicitly indicated the belief that there is a more satisfactory way. Not until he finds a good reason for rejecting the way or ways he has hitherto taken by believing in the possibility of better ways,
hitherto untried or abandoned, can he desire to find such, or can he be ready to meet difficulties in the way of finding them. The use of the positive transference and the most important element of dependence on the analyst in this case, is to establish an interim trust in the possibility of more efficacious and satisfactory ways of dealing with difficulties. It is no longer necessary when such a way has been found. If on the other hand, we say to a patient, ' You are thinking so and so ', ' You have such and such a phantasy', and so on, we give him no help about his inability to know that for himself, and leave him to some extent dependent on the analyst for all such knowledge. If we add
'The nature of this thought or phantasy explains your difficulty in knowing it for yourself ', we still leave the patient with increased understanding related to a particular type of thought and phantasy only, and imply 'One must know the thought or phantasy first before one can understand the difficulty about knowing it'. The dynamics of the patient's disability to find his own way have been comparatively untouched if the resistance was more than the thinnest of crusts, and will therefore still be at work to some extent and in some form whatever the change brought about by the interpretation of absent content. I remember how a most important and explanatory early memory was once given by a patient much sooner than I could have expected. After a certain amount of talk on his part about his lack of explosive or stormy feelings, I queried, ' What about other kinds of storms and explosions ? ' This brought references to immediate and past stormy weather, and evidence in various forms that he must be biggest or smallest. Therefore I said, 'I think you are in difficulties about emotional storms because if you have them at all, they must be the biggest of all, and you find yourself in competition with the most tremendous of thunder and other storms'. After a a moment's pause --obviously one of reflective acceptance--he said 'Why do they have to be biggest of all ? Perhaps because they must be bigger than any they could call out'. I said, 'Perhaps so. You have found at least one reason for yourself'. Immediately and with apparent irrelevance, he began the recall of a previously very dim memory of an experience in his third year, which with its mixture of reality and phantasy (particularly of the apparent threat in loud noise11) had very considerably altered his life both materially and psychically. It proved entirely relevant and most explanatory. There was an element of competition with the analyst, but it found satisfactory expression during the hour and in co-operation with the work of analysis. The content came classically after the solution of the resistance, and continued to come for some time, leaving the analyst the work of sorting out the effects of remembered earlier situations on later ones, including the present, so that one was able to do a surprising amount of work in a short time.
A somewhat similar example in another case was the sense of wide applicability in an interpretation of the feeling that a little bad had much power to spoil and bring about the rejection of much good--that the patient was applying observations and feelings about the effect of a maggot in food and of spots on clean clothes, table-cloths, etc., to other and psychical situations, where their validity was at the very least not as obvious. Clearly, the analysis of resistances should be much more fruitful than any analysis of absent content.
Another pronounced advantage in the analysis of resistances is that it removes from the analyst the difficult and precarious business of 'dosing' in determining the amount of anxiety to be aroused.12 That is left to the working of the patient's own mind in conjunction with circumstances extraneous to the analysis itself, and the test of the amount of anxiety he can bear is--for adult patients--the amount of anxiety-laden thought he has been able to put into words. A correct interpretation about the reason why he has not been able to put more into words still leaves the option with him. But to put his thought or feelings into words for him is to interfere with the action of a kind of mental sieve, depriving both the analyst of a sure guide about the integrating power of the ego, and the patient of the best form of defence he has been able to adapt to a particular difficulty; it is therefore one that should be left to him until he has found a better method. By telling him what he has not put into words, whatever the subsequent result, one has not increased but has rather provided a substitute for his own power of verbal expression in the particular instance under consideration. One is saying to him in effect 'You see what your sieve was keeping back--how harmless, indeed how helpful, this piece of knowledge, how unnecessary such rigid sieving ', and one may indeed do much for the patient by such methods. But in addition to its use as an anxiety mechanism the process of discriminatingly sieving his thought may be very useful to him in other circumstances, and we do not want to injure it. In other words, one wants to further a power
of reasonable choice and control rather than either rigid censorship or lack of control between conscious thought and speech as well as between the conscious and the pre-conscious, and the pre-conscious and the unconscious. And the quickest and surest way to this end is to show good reason, however misapplied, for its previous use rather than unreason.
(c) To carry a little further our enquiry into the analysis of resistances, we may usefully ask what attitude this implies towards the patient and his material. Some part of the answer one would give to such a question must be conveyed in every reference to the subject, but we may well be more explicit.
In the first place I find something to regret in the technical term resistance, even though it may on the whole be the best shorthand for the purpose. It puts the emphasis on the negative strength exerted by the patient rather than on the cause. Analysis depends for its success on co-operation with that part of the patient's mind which, however mistakenly and ineffectively, seeks a better solution. In that sense, then, what we call analysis of resistances is really an analysis of ineffectual capacities, or of conflicting and mutually damaging processes. If we centre our activities as analysts on the aim of restoring his full capacities to the patient, we are constantly asking ourselves such questions as ' Why can he not . .. ? ' ' Why is there a difficulty? ' Then we are able to limit our activities to explaining those difficulties when and as we see them. The analyst does not then need to take any stand for or against any action, feeling, thought, attitude or belief of the patient's. He does not even need to decide how much of any given situation is reasonable or unreasonable. If there is a difficulty in connection with it which the patient cannot solve in a way which reasonably satisfies the whole of him, that fact shows that at least some part of it is in need of elucidation. And it is that part, and that alone, about which the analyst need, or indeed can, do anything to help the patient. The indication for analysis is not what the analyst may think about any given subject or situation, but the evidence given by the patient that he finds something unsatisfactory about it, and also that he is not able to improve the situation without the analyst's help. With regard to the latter point, one remembers that the patient already has some capacity to deal with difficulties, a capacity which we want to increase and not lessen either by unnecessary attempts to help, or by help delayed to the point of discouragement and despair. Also, it is evident that one cannot force help on anyone who is explicitly or implicitly disclaiming his need of help with such emphasis as temporarily to silence his desire for it. Further we would not claim that our interpretations are always correct and helpful. It is equally true that the patient may refuse to accept what we offer in the way of real help, demanding instead quicker and immediately easier forms, which however, may do little to reduce his subsequent difficulties. But regarded from the point of view of a capacity to tolerate and deal with difficulties, the mind will always do as much in that direction as it both can and wishes to at any particular time. Therefore solution of one difficulty leaves it free to exercise its capacity on another; and we need never doubt but that freedom from a pre-conscious difficulty will bring an unconscious difficulty just so much nearer to consciousness. Kaiser says, in effect, 'Interpret only conscious material. Do not try to got behind or beneath the resistance. You leave it still functioning and can never hope to exhaust the material against which its functioning is directed'. I would add to that 'Make it clear both to yourself and to your patient that even with regard to conscious material you do not pretend to do more than help him with his difficulties'.
Those considerations lead us to three indications affecting our attitude to the patient and his material. (1) Because the patient's difficulties or resistances are our one reason for helping him, and because his own recognition of them provides our best opportunity of doing so, we should by neither word nor action seek to avoid them or to mitigate them, otherwise than by analysis and an attitude consistent with it, if he has any capacity for expression of them. Otherwise we reduce both our own and the patient's opportunities of understanding and dealing with them more fundamentally. (2) The most perfectly conducted analysis cannot be an easy matter for any patient. On the contrary, it is his opportunity of developing his psychical muscles by meeting and overcoming just those hard parts of his life which have hitherto been too much for him. This opportunity is given by the helpful understanding of the analyst, which reduces or counteracts some of the earlier adverse factors, but can neither remove the hardships and struggles to the point of ease, nor compel the patient to undertake them. It needs determination on his part not to try for an immediately easier way, which may ultimately prove as hard or harder than the one rejected. Therefore, it seems to me we do no kindness to the patient if we give him any kind of encouragement to hope for an easy way out of his troubles. It only makes it harder for him to take the difficult way of meeting them fairly and squarely. Apparent kindness may in these circumstances sometimes prove to be unkindness. For both these reasons, then, because to hide the patient's difficulties is to reduce his opportunity of help, and because it encourages him to trust to other means than the more thorough ones of analysis, we should, I think, look very carefully indeed at the question of reassurances
There is much less need to query the rights and wrongs of increasing resistances, or adding to the patient's difficulties--not, of course, the same thing as giving them the opportunity of putting in an appearance. Although we all do it at times unwillingly and sometimes unwittingly, no one can think it correct to add difficulties. From the patient's outlook, adding to resistances generally seems a much more serious mistake than avoiding them. From the analyst's standpoint, difficulties avoided or glossed over are still there and will re-appear in another form, although with an added tendency to take the way of avoidance, and can still be dealt with; while it is a more obvious mistake to increase resistances, and the bad results are more quickly seen.
It is clear that if we limit ourselves to the direct analysis of conscious and pre-conscious difficulties we must be prepared to show increased understanding of pre-conscious material and processes. Often the best use we can make of the patient's material when his own difficulties are not obvious to him is to show him that just what he condones or upholds in himself, he dislikes, attacks, or fears in another. Much work may have to be done in preparing the way for the patient's toleration of internal conflict. In this, as we know, the attitude of the analyst is of the greatest importance, and long understanding receptiveness of the patient's conflict with the analyst instead of with himself may be a necessary preliminary. Help and enlightenment received from the analyst must be to some degree suspect unless or until the relation to the analyst from whom it comes is clarified. And this can obviously only become possible very gradually while the patient needs to fight with the analyst rather than with himself.
It is a great help at this stage when one can, for example, show a double and complementary process at work, both psychically and physically, in that because he has sought to separate from himself a part of his actual psychical self, his own problem, affect, responsibility and so on, and to project it into another person, he may also be concerned to restore the threatened unity of his own personality by some type of fusion, mental or physical, with that same person. This is the kind of interpretation that can be given quite early in an analysis. It obviously includes both castration anxiety and compulsive sexual relations, and can help to relieve some of the necessity of both before the patient is able to bring himself to talk openly on the subject.
I believe that only when one abandons the attempt to deal directly with absent content and with truly unconscious material-eor at least when one tries to do so--does one become aware of the wider possibilities of analytical work which lie hidden in the conscious and proconscious material--the re-grouping, the re-arrangement of it, the dissolving of compulsive fusions, the tracing of hidden links, unsuspected connections, etc. This work of putting things in the places to which they belong, making true wholes and separating false ones, can be more effectively carried out, I believe, if the analyst keeps his own work in the place to which the patient allows that it belongs--voluntarily expressed material. It can hardly be necessary to say that one does not abandon one's knowledge of the 'true unconscious' because one makes no attempt to apply it directly. All that is in question is the best way in which the patient himself may reach such knowledge. And it is not to be expected that he can gain the necessary security and confidence for such difficult work until he has plenty of evidence that the lesser emotional distortions and barriers can safely be met and need not be avoided. We know the importance, for this result, of evidence that even his more aggressive emotional reactions can safely be met by the analyst, and that they are not therefore inevitably responsible for all harmful effects on others.
Alexander13 has recently shown that what he calls 'the logic of emotions' brings ready comprehension of emotional reactions which are related to their most appropriate situations; but he also shows clearly the feeling of inevitability accompanying such logic; that is, that it is 'only natural' to feel so and so in such and such a situation; 'of course' one would feel like that if someone behaved to one in such a way, etc. This assumption of the inevitability of emotional results clearly gives to anyone who stimulates emotional reactions entire responsibility, not only for his own emotional state and actions, but also for those of the other person or persons involved in them. It is just this feeling of too heavy responsibility which tends to make people unable to bear the responsibility of even their own moods and actions; and a large part of the analyst's work lies in disposing of it. His silent receptiveness of the patient's hostility does something, but not enough. It is an essential preliminary at a time when all active response may be felt to have a retaliatory aggressive character. But silence can have its menace; and neither silence nor the mere absence of overt hostility on the analyst's part, nor even pronounced friendliness, which, rightly or wrongly, may be understood as a reaction formation, can fully dispose of the dread of full responsibility for 'inevitable' harm done to the analyst. After and in conjunction with silence, only the continued and unimpaired activity of the analyst, of that which is the central reality of the analytical situation, the analyst's capacity to be a friendly understanding analyst, can eventually prove to the patient that he is not responsible for any injury to the analyst's life; that is, to his analytical capacity, without which he no longer exists as an analyst, whatever else he may be. No amount of un-analytical action on the analyst's part can ever put right this central situation, which is the living reality of analysis. But if this is right, and continues to be so, the patient may become less afraid of bearing the responsibility of the effects of his own past affects and actions, less certain that if he bears any at all, he has also to take the responsibility which actually belongs to others for 'inevitable' affects and their effects. It is clear, then, that the example of the analyst who assumes more than his own share of responsibility in the analysis, equally with the example of one who assumes less than that, can act on the patient as a deterrent from shouldering his own due burden, no more and no less.
(3) From consideration of the attitude of the analyst, let us try, using contrast as the means, to come to a more precise understanding of that which the analysis of resistances really is, mentioning more specifically a few of those multifarious methods which it is not.14
(a) It is not, it seems to me, a method of 'breaking' or of 'conquering' or 'melting' resistances or even of showing how 'unreasonable' they are--although it is true that the patient's own recognition of some lack of reason in them is an essential preliminary to the desire for something better. It is simply a method of understanding them. As I have said before, it is only when the analyst can show the reason of them, that the patient can hope to strengthen his more reasonable nature, his ego, through the help of analysis.15
It is not a method of pursuit of a resistance. Only as long as the resistance or the difficulty can be felt and shown can it be accessible to analysis. Variations in circumstances help to bring a quite different kind of difficulty to the fore for the time being, and we do not pursue the one which has temporarily disappeared. It does not, then, place such undue and exclusive reliance on 'transference' interpretations that the analyst has constantly to query 'Where do I come in here? ' I agree with those analysts who believe that transference interpretations have a central importance; but the analysis of resistances does not pursue any one specific resistance or type of resistance; it takes the one which is immediately uppermost, whether of greater or of lesser importance, and relies always on such queries as 'What exactly is the difficulty? ' ' Why can the patient not know and show more of his own mind?'
It is not a way of deciding what the patient ought to think or do or say, or how closely his thoughts and actions should approximate to the analyst's own standards, ego, moral or sexual in order to be 'normal'.
It does not say that because some part of a given attitude or situation is due to or influenced by unconscious factors, or can be explained in terms of positive or negative transference, the analyst claims the ability or the right to judge the whole of it in such terms. The analyst more modestly confines his activities and the judgements involved to that part which is demonstrably defective in some way. He need not say, for example, 'You think me cruel because you are influenced by such and such another situation', but, 'Some part of your thought that I am cruel and of your difficulty about it is determined by a different situation'. That is a different thing from saying indirectly 'I am not cruel, and you are wrong in thinking me so'.
It does not make a frame-work of theory and proceed to fit the patient into it. The function of theory is to help the analyst's weaknesses on extra-analytical occasions, and is of use to the patient in this indirect fashion only. Theory is the hypothetical skeleton on which we seek to re-assemble the array of facts and their relationships which our minds cannot otherwise hold in any ordered cohesion. But we never shall build up a human being in this way, or even create any close resemblance to the living interaction of living psychic tissue. To have theory in our minds in the hours of analytical treatment when we are in actual contact with the individual patient's mind, and when we have the opportunity of learning directly from it, is to barter possible strength for the props of weakness. It blocks that free working of our own unconscious which, as we know, is our one way of understanding the working of the patient's unconscious.
But because this method of analysing thus relies on analytical intuition, it does not therefore undervalue the work of consciousness and intelligence, either in the analyst or in the patient. With regard to the analyst, intuition can only work satisfactorily where it co-operates with intelligence, and is not an alternative to it. With regard to the patient, the attention directed to his conscious and pre-conscious material, and to working in conjunction with and not against his reason, is further proof that his conscious mind and intelligence are not undervalued. It is only in this way that the analysis of more normal people becomes possible. This is a subject to which I will return later.
The analysis of resistances is not, as we know, the analysis of symptoms. The analysis of symptoms limits us to end-results which at one and the same time conceal difficulties and display them obviously because unassailably. It is not even the analysis of states and positions, which are indeed a kind of general and non-localized symptom of less definite form. It is not the analysis of anything which can be stated in general terms, and thus exclude that which is individual to the particular patient. That which is individual is of primary and not of secondary importance in an individual analysis.
And finally, the analysis of resistances abandons reconstructions, however correct, since that which is important is not the extent to which we may be able to impart to the patient our knowledge of his life and psyche, but is the extent to which we can clear the patient's own way to it and give him freedom of access to his own mind. For the same reason, it does not jump over obstacles, leaving them in the way, but securely links the conscious with the pre-conscious and with as much of the unconscious as can at the time become pre-conscious. I have given reasons previously for believing that this is possible even with regard to symbolic interpretation.16
(b) What then is the analysis of resistances? At the risk of repetition let us return to this question. It is the analysis of conflicting processes and of difficulties or disabilities. It relies on principles and on individual work with the individual, and not on theory, rules, plans or standards, beyond the one analytical rule or condition. It helps the patient to help himself, and therefore to meet and not avoid his difficulties. Trusting to the principles of analysis, it gives the patient in his turn a possibility of trusting the work of analysis. It implies one attitude and one only to the patient's material--that of constantly inquiring what understanding it can provide of his disability, or unsatisfactorily employed ability. It gives full value to consciousness and does not disparage it because there is more 'to it' than may at first appear--that is, it does not throw away the baby with the bathwater. We have, for example, come to distrust the patient's conscious desire to got well, because of the mixed motives in it. But then it is, or becomes, mixed largely because he distrusts our way of helping him to satisfy that desire, and because difficulties in the now way make him uncertain whether it really is better than old and familiar and infantile ways, even if these do not lead to real improvement. The analysis of resistances, as I understand it, does not reject any part of consciousness because of its mixed motives; it values the patient's co-operation, and without taking over the full responsibility for resistance instead of co-operation, tries always to find the reason for the resistance, whatover it may be, including the analyst's own mistakes. It therefore gives reasons, and does not work in a sense contrary to the patient's reason. At the very beginning we give him reasons for the one thing we ask of him in analysis--its condition rather than its rule--and explain that the more he can tell us about himself, his thoughts and his feelings, and the less he rejects, the better our chance of helping him. The adult patient then knows that this is his reasonable share in the technique of analysis; while we soon show him, even if we have not already told him, that we will try to help him about it where he does not keep to that condition. To this explicable and explained technique the analyst should try to keep, no loss than the patient, neither of them going beyond it. The patient is less likely to do so if the analyst does not. Naturally the analyst, like the patient, learns much from the action, bearing and expression of the other; but, for the analyst's purposes, the knowledge thus gained is and remains secondary to that from verbal expression, in the sense (i) that his interpretations should be based on and referable to or explicable in terms of what the patient has put into words and that alone; and (2) that our chief concern is with that which prevents him putting more into words. We are taking away the patient's accepted and reasonable responsibility if we in any way shift the importance away from the only, though the very difficult, technique which analysis asks of him; and we encourage him to believe in magic, which is independent of conditions, if we do not evince our belief in the conditions in which analysis can be carried on. How to be firm about it without being harsh or rigid is indeed a problem for the analyst, but an essential one.
Further, as I have said, by not confining our interpretation to the patient's verbal expression we leave ourselves without our clearest guide to the state of the patient's defences. Very prolonged and obstinate silence, after one has done all one can to rectify one's previous mistakes in technique, I take to be a sign that the patient's defences are in too precarious and explosive a state for analysis.17 I touch on this question chiefly to show the consistency with which I would try
to follow the principle of making our guide that which the patient is able and willing to tell us.
To finish this section by trying to sum up shortly the contrast between the analysis of absent content and the analysis of resistances, I might put it in this way: the analysis of absent content says in effect : 'We can conclude from what you have said that you are resisting such and such an affect, memory, thought or phantasy; and in order to know why you are resisting we have first to know what you are resisting'; the analysis of resistances says in effect, 'We can conclude why you are resisting from what we already know'; or more fully, 'We can conclude from what you have said that you have taken and are taking such and such a method of dealing with a painful situation. That way may have been the best you could find in some circumstances, but it contained an alteration of a real state of affairs to suit emotional troubles, and therefore, whatever it did for you, it had to leave some of the real difficulty not really dealt with. That is the difficulty you are meeting at the present time, and it is increasing any other difficulty you may have in keeping to the conditions of analytical treatment '.
(c) Following this formulation of principles of technique, we next ask, Does the analysis of resistances form the whole or only part of technique? And if a part, how big a part ? We can at once say that it quite certainly forms a part, and in theory at least, the main every analyst's technique. But my own answer to the question would be this--that the principle underlies the whole of our technique, and that the kind of application of it which I have tried to indicate to you I believe should apply to very nearly the whole. It is true that at one time I planned a whole section on 'Preparation for the Analysis of Resistances', but the more closely I looked into it, the more evident it became that it starts from the beginning. Thus, the very formulation of the conditions under which analysis can take place, asking the patient for free associations or free verbal expression of his thoughts and feelings of whatever kind, already takes the patient a step beyond his customary resistances to uncensored speech. Encouragement to tell more, requests for more information on specific points, the questioning 'Yes? ' are all ways of trying to help the patient to overcome his resistances, and are therefore an integral part of the analysis of resistances. They are part of the question ' Why can he not? ' in the sense of getting the patient to try whether he can and will or not.
There is obviously every reason not to neglect conscious and intellectual resistances. Explanations of particular parts of our technique when they are queried may not take us very far, and yet can prevent the ranging of the conscious resistances against us, enlisting them instead on our side. For example, in explaining my reason for not giving advice when sought, I should tell the patient that while it might possibly solve the immediate trouble for him easily and quickly, yet such means left him dependent on the analysis for such solutions, and no whit better off with regard to other situations which might well supervene when the analyst was not available: that if he would undertake the more immediately difficult way of saying whatever came into his mind, there was a possibility of helping him in a way not limited to a single situation and tending towards increased independence. I do not, of course, think that such explanations, such attempts to deal with the conscious resistances, will do anything very fundamental. But I do think that without them these same conscious resistances will prove a heavy barrier against us. One will count two at least on a division. For the same reason, and always provided that I am confident the conscious desire for information is relatively strong whatever the other motives, I do not now hesitate to enter at times into some discussion and argument on psychological matters, never going outside the realm of one's understanding of the psyche and its processes, and keeping it related to the patient's current problems. One does not then always and inevitably refuse a kind of friendly combat, and this is one in which the analyst is supposed to be the stronger, and in which it is obviously advantageous to the patient that he shall be--but one must be out to help the patient by doing so, and not merely to win in a battle of wits, or it is better to keep quiet. In such ways I believe one may have the reasonable and more normal parts of the patient's minds with one instead of against one--as they certainly will be if they feel unreasonably ignored and unsatisfied.
Again, that long work to which I have earlier referred, the reassembling of conscious material, is also a part of the analysis of resistances, and an important part, though it deals with the slighter
pre-conscious resistances only. It explains difficulties due to some thing correct enough in itself, but incorrectly placed; it relates conscious material to conscious material, and does not involve the
bigger shifts of position connected with the more difficult pre-conscious and the unconscious. One can often deal with the slighter resistances by such queries as 'Always, or in particular circumstances? ', when a patient is laying down some law or giving some abstract example of cause and effect, without giving the particular situation which has troubled him with regard to it. It can be of more immediate help than the mere request for an example, because it at once brings to his mind
the possible advantage of limitation of trouble to its own setting, Similarly one can often query whether something or other is as inevitable as he is indicating. There are innumerable ways of dealing with resistances and bringing them to light which can be developed when our technique is directed to this end, and it is of considerable importance that we should not neglect the minor resistances in searching for the major ones.
I have earlier referred at length to the way in which toleration of conflict and anxiety, a feeling of real difficulty, gives the best opportunity for analysis, whether the conflict is that of ambivalence, of
ideals, of the super-ego with the ego or the id, or of any other combination and arrangement of opposing forces. One does not tunnel to reach either anxiety or its causes in the unconscious. Whatever the defensive strength, the mind is not a rock and tunnelling is risky. But both anxiety and its unconscious causes will surely come to the surface if the minor pre-conscious resistances have been adequately met, and some confidence in forthcoming help has already been established. In other words, the unconscious will become pre-conscious before it becomes conscious. Sometimes, of course, the most obvious conflict and anxiety are there at the beginning. And then only the. calmness of the analyst and his ability to marshal the more reasonable forces of the mind on his side by some other approach than the analysis of the symptom can give the opportunity for working more patiently with material proceeding from the pre-conscious.
With regard to catharsis as contrasted with symptomatic and compulsive affect, the analysis of resistances. should, bring about so much and only so much as would enable the patient to realize, to feel and know as real, the quality and quantity of his emotional reactions, and relate them to the situations in which they have been most appropriate and are therefore most understandable.
The analysis of the resistances involved in conflict, with this amount of catharsis forms, as we know, the most strikingly effective part of the work, even though the long preparation for it has been just as necessary. If the last straw is sometimes given the responsibility belonging also to the other straws, it sometimes receives commendation rightly belonging to the other straws in equal measure.
The influx of material which follows the solving of an important resistance in this way calls for work similar to that correlating, re-assembling of conscious material which has almost certainly preceded it. What we call the 'working through' seems to contain a 'living through' in the analysis after as well as before the emergence of memories, obviously so with obsessional cases; and this plays an important part in filling out the significance and emotional reality of the memory.
The one and only type of situation in which, so far at least, I find no cause at all to regret having given an interpretation of absent content rather than of process is that in which the work of analysing resistances has in some way left not so much a slight resistance as the form of a resistance. At such times a few words suffice to bring the hidden content to light with pleasurable affect and the feeling 'Why, of course'.
Thus I believe that the analysis of resistances should form practically the whole of our analytical work, and that there is still much to hope from it in its further development, particularly in the elastic and individual variations of its application which adherence to such a principle can allow.
1 James Strachey. 'The Nature of the Therapeutic Action of Psycho-Analysis '. This Journal, Vol. XV, p. 127.
2 Hellmuth Kaiser. ' Probleme der Technik', Internationale Zeitschrift fur Psychoanalyse, Band XX, S. 490. Summary in this JOURNAL, Vol. XVI, p. 368.
3 In addition to other papers specifically named, I may mention:
Michael Balint. ' Charakteranalyse and Neubeginn', Internationale Zeitschrift fur Psychoanalyse, Band XX, S. 55.
Michael Balint. ' Das Endziel der psychoanalytischen Behandlung ', Ibid., Band XXI, S. 36.
Edward Glover. 'The Technique of Psycho-analysis'. Supplement No. 3 to this Journal.
Melanie Klein. 'The Psycho-analysis of Children'. International Psychoanalytical Library, 1934.
H. Nunberg. 'The Synthetic Function of the Ego.' This Journal, Vol. XII, p. 123.
Melitta Schmideberg. ' Reassurance as a Means of Analytic Technique '. Ibid., Vol. XVI, p. 307.
Melitta Schmideberg. ' Zur Wirkungsweise der psychoanalytische Therapie ', Internationale Zeitschrift fur Psychoanalyse, Band XXI, p. 46.
Ella Freeman Sharpe. 'The Technique of Psycho-analysis'. This Journal, Vol. XI, pp. 3 and 4 ; Vol. XII, p. 1.
Helen Sheehan-Dare. 'On Making Contact with the Child Patient', Ibid., Vol. XV, p. 435.
Richard Sterba. ' Das Shicksal der Ichs in therapeutischen Verfahren ', Internationale Zeitschrift fur Psychoanalyse, Band XX, S. 66.
4 See Walder. 'The Problem of Freedom in Psycho-Analysis and the Problem of Reality-Testing.' This Journal, Vol. XVII, p. 89.
5 See, among others, Joan Riviere, ' Analysis of the Negative Therapeutic Reaction'. This Journal, Vol. XVII, p. 314.
6 See Freud. Introductory Lectures on Psycho-Analysis, p. 220.
7 Freud. 'Further Recommendations in the Technique of PsychoAnalysis. Recollection, Retention and Working Through', 1914, Collected Papers, Vol. II, p. 366.
8 On this subject see Alexander. 'The Problem of Psychoanalytic Technique', The Psychoanalytic Quarterly, Vol. IV, p. 588; Fenichel. ' Zur Theorie der Psychoanalytischen Technik', Internationale Zeitschrift fur Psychoanalyse, Band XXI, S. 78,; Reik. 'New Ways in PsychoAnalytical Technique', this Journal, Vol. XIV, p. 321.
9 Cf. the id of Groddeck's formulation. ' Das Buch vom Es', Int. Psychoanalytische Verlag, 1920.
10 See Alice Bailint. ' Handhabung der Ubertragung auf Grund der Ferenczischen Versuche ', Internationale Zeitschrift fur Psychoanalyse, Band XXII, 1936, S. 49-54•
11 In passing, I might remark that this phantasy was a reality in other settings.
12 Cf. Freud. 'An Autobiographical Study', International Psychoanalytical Library, 1935, P. 74. ' But it is not only in the saving of labour that the method of free association has an advantage over the earlier method. It exposes the patient to the least possible amount of compulsion and never allows of contact being lost with the actual current situation ; it guarantees to a great extent that no factor in the structure of the neurosis will be overlooked and that nothing will be introduced into it by the expectations of the analyst. It is left to the patient in all essentials to determine the course of the analysis and the arrangement of the material ; any systematic handling of particular symptoms or complexes thus becomes impossible.'
13 Alexander. 'The Logic of Emotions and its Dynamic Background ', this Journal. Vol. XVI, p. 399.
14 We may, however, remind ourselves that other ways are not made worse than they were by an attempt to find better ways. Unfortunately we all find ourselves often enough in a situation in which we are unable to find the best way and need the help of one which is not so good. It is no question of the best or nothing. Therefore, while, for the sake of the sharper definition of contrast I mention other ways which I think not so good in varying degrees, I do not and would not detract from the good many of them can do and have done.
15 The first example of the technique of the analysis of resistances which Kaiser gives seems to me to tend in this direction of showing the patient how unreasonable he is, so that his subsequent burst of anger was in part directed against the analyst on this account, and was probably not the simple instinctual expression Kaiser appears to have thought it. Op.cit.. P. 494.
16 A Note on Symbols and Early Intellectual Activity', this Journal, Vol. XIV, p. 291.
17 We have more to fear from too weak than from too strong defences.
Ego Development and Psychoanalytic Technique
Ralph M. Loewenstein (1950)
For many years scientific interest in psychoanalysis was mainly concerned with the instinctual aspects of pathogenic conflicts. These studies culminated in the discovery of childhood sexuality, its development, and its impact on adult life.
Although from the beginning Freud stressed repeatedly the importance for therapy of analyzing the patient's resistances, the study of these resistances was not systematically undertaken until the 1920S. This became possible through the introduction of the structural point of view.
It was to Anna Freud's work that we owe the practical application of the structural concept to psychoanalytic therapy. We observe in every patient what types of defense mechanisms exist in him, whether repression, projection, identification, etc. We study patients' motives and their aims; we analyze what they achieve and what consequence their presence has for a given individual. We also observe in the history of each patient the various types of dangers that the ego tries to avert.
It is indeed possible to discern, in conflicts, anxiety centered around the fear of loss of love, the fear of loss of an object, castration anxiety, and so-called superego anxiety, which is best known as guilt feeling.
A frequent symptom of compulsion neurotics is anxiety that something dreadful might happen to someone close to them. We know that these fears are generally based on warded-off unconscious aggressive tendencies toward the person concerned. The aim of psychoanalytic treatment is the patient's gaining of insight into these aggressive tendencies, because this leads to the disappearance of the symptom. One possible way of achieving this result would be to tell the patient that his anxiety is based on aggressive and hostile feelings toward the person concerned. Usually such an interpretation would do more harm' than good. Indeed, the symptom is based on the fact that the patient's ego is unable to tolerate the existence of such tendencies. An interpretation of the kind we have just mentioned does not make the ego more capable than before of solving the conflict between the warded-off tendency and the powerful forces that oppose it.
Long ago Freud established this important rule of psychoanalytic technique: namely, that the resistances should be analyzed first, that is, those forces that the ego opposes to the repressed drives. However, for a long time there existed no detailed and systematic study of how to proceed to analyze these resistances. Nowadays we are better equipped.
I remember the case of a girl in her twenties, who presented the symptom just mentioned-the anxiety that some harm might occur to her beloved mother. The analysis went through a prolonged, circuitous route, through various aspects of the patient's complicated relationship toward her mother, before the girl was able to become aware of strongly warded-off hostile feelings toward her. In the analysis gradually the at first vague content of the anxiety became more concrete, more precise. First we encountered the fear of being punished by her mother's disappearance or death, with which the patient was threatened in childhood when she misbehaved. The patient as a girl and adolescent was afraid not only of being abandoned by the beloved mother, but also of being left unprotected against her own sexual desires, which the mother's presence helped to ward off. The dreaded danger also meant something else: it represented the terrible, mysterious sexual things that the father would do to the mother, and that the jealous little girl frantically wished to prevent from happening. Only then was it possible to approach the other side of this patient's feelings toward her mother: namely, that in all these situations there was not only love for her mother, fear of losing her, but also the opposite feeling: resentment for standing in the way of gratification of the various instinctual drives connected with the situations just mentioned.
This extremely brief summary of various steps in the analysis of a patient is an example of the way we gradually achieve a greater tolerance of the patient's ego toward the warded-off drives.
Now, as a matter of fact, the example just cited shows that there has been no fundamental change in the analytic technique. The increase in the tolerance of the patient's ego to his unconscious drives has always been sought for. It is now, however, being achieved with greater security and greater ease. This also makes accessible to analysis certain patients or certain of their symptoms that hitherto were not. Moreover, the example described reveals a shift of emphasis as compared to the past. Indeed the area of interest of the psychoanalyst is widened; it is not exclusively concerned with the uncovering of the earliest forms of pathogenic conflicts. The interest of the analyst dwells for a long time on all the intermediates between the original conflict and its present manifestations. That is actually no fundamental change in the psychoanalytic technique either. Freud formulated the relationship of the past and the present in the pathogenesis of neurosis by comparing it to a damage wrought by fire to a building. The original source of the fire does not always cause the greatest damage. This might very well result from a secondary site of the fire. The therapist has to take this into account.
The scientific interest in the importance of very early stages of instinctual development formerly led some analysts to concentrate their interest, even during treatment, exclusively on them. We do not nowadays minimize their importance, but we know better that the neglect of later events and phases is not only unwarranted but might even have unfavorable therapeutic consequences. Let me give you another example:
Many years ago I saw a patient in a state of violent anxiety. This man in his early fifties, when first entering my office, started by repeatedly asking me, with tears in his eyes, what it meant to be castrated and what castration was. I learned that this man had been in analysis for many years in another country. The symptoms that had led him to treatment five years before were obsessional preoccupations with sensations in the rectum in the presence of other men. During the years of his previous treatment his anxiety did not diminish; on the contrary, it seemed to worsen. His previous analyst had explained to him that his rectal sensations were based on passive homosexual desires, originating in early childhood. He told the patient that in order to overcome his symptom, he had to recall the wish to be castrated and to relive feminine sexual desires of an anal nature toward his father, which he was supposed to have experienced at the age of two. The poor patient could never remember having had wishes or sensations of that kind. However, when we talked about his conflicts of a moral and religious nature, centering around masturbation and sex life in puberty, he soon told me of an event that apparently had been completely neglected by the other analyst. The patient, having in adolescence struggled for years vainly against masturbation, went to a big city and had intercourse with a prostitute. Immediately after intercourse, he thought he had contracted gonorrhea. He soon consulted a so-called "specialist," whose advertisement he had read in a paper. The doctor told him that he did have gonorrhea, and added that he would give the patient a massage, during which he would experience a special sensation in the rectum. The patient underwent a very painful prostatic massage, and, terrified, left the city. Fortunately, he was able to consult another doctor in his home town, who found him in perfect health. This event at the age of seventeen was essential in the structure of his later symptom, consisting of rectal sensations in the presence of men. They appeared years later, when the patient for the first time had satisfactory heterosexual activity. To the patient this traumatic event unconsciously meant that rectal sensations inflicted by another man were punishment for forbidden heterosexual activity. The later obsessional symptoms, indeed, were not just a break-through of passive homosexual tendencies. The patient's anxiety rather expressed his guilt feelings, the fear of punishment for prohibited heterosexual gratifications, so that one could speak in this patient of a partial regression that served as a defense against the danger of castration.
What we have been dealing with up to now was mainly the shift of emphasis in the understanding of the structure of neuroses, which has been brought about by the introduction of ego psychology. We would now like to emphasize that it also led to improvements in the details of the technical procedure itself. Psychoanalysis brings about insight in patients by means of various interventions. Among the interventions, interpretations are characteristic and specific for the psychoanalytic technique.
Webster's Dictionary defines interpretation as the act of explaining, elucidating, telling the meaning of, translating orally into intelligible language. In analysis we apply this term to those explanations we give patients that add to their knowledge about themselves from elements contained and expressed in the patient's own thoughts, feelings, words, and behavior.
The analyst uses interpretations in order to produce those dynamic changes that we call insight. Interpretations are given to patients in analysis to produce insight into thoughts and feelings of which the patient is not aware. Among other things, the patient must gain insight into the resistances that he opposes to his treatment.
This might seem paradoxical. Are not resistances due to defenses of the ego, and is not the ego something essentially conscious? This is not so; indeed patients have only a very incomplete awareness of their resistances. A patient might at a certain time be reluctant to continue his treatment. Of this he may be perfectly aware. It is the analyst's task to show him that this sudden reluctance to continue is, for instance, due to the fact, concealed by the patient at first, that he would have to tell the analyst some unpleasant thought he had about him. When we speak of resistances, we mean to have the patient gain insight into the connection between his reluctance to continue and the fear of revealing a hostile thought. And at a later stage this resistance will be linked to other instances in the patient's life in which he would choose to remain sick rather than express hostility and competition with another man.
Since resistances are in themselves partly unconscious, one must take into account that a very important part of the ego remains unconscious, so that an important part of the analyst's interpretations aim at bringing to consciousness unconscious ego phenomena. As we know,
bringing to consciousness is not merely an intellectual process; it presupposes and implies dynamic changes that are prerequisites for what we call analytic insight.
Ego psychology had deep effects on the special criteria that analysts try to establish for the correctness and effectiveness of their interpretations. If one compares the character of interpretations as they were given in the early phases of psychoanalysis with those used more recently, one is struck by one obvious difference: formerly, symbolic interpretations played a much greater part in the analyst's everyday work than they do nowadays. This change is not due to the fact that we consider symbolism less true than before. It is not the frequency of symbolic expressions that has changed; it is the frequency of the use that the analyst makes of symbolic interpretations of the patient's material. If a girl has a phobia of being run over by cars, the car as a symbol for a man is as true now as it was thirty years ago. Our interest, however, is centered not only on this fact, but equally on the motive and the reasons for this patient's fear.
Nowadays analysts are very much concerned with what one might call the hierarchy of interpretations. In the cases I have described earlier, there are examples in point. Indeed, I have stressed in one example the importance of analyzing defenses before analyzing the id derivatives--the motives for the fear of hurting a beloved person before analyzing repressed hostility against this person. In the other example, the one in which it was so essential for the cure of the patient to relate his symptoms to the prostatic massage, it was a concern with another aspect of the hierarchy of pathogenic events and consequently of interpretations. Analytic interpretations now follow -more deliberately the general rule enunciated by Freud, in which he advised the analyst to follow the patient's material from the surface to the so-called depth. In this respect, what we call the surface of the patient's material has various meanings. It relates to what is conscious to the patient, as opposed to what is unconscious. It relates to the present or the recent past, inasmuch as it is influenced by the patient's past; and the interpretations must take into account this specific relationship between the past and the present. One might say that in respect to all these various aspects, which we call the psychological surface, interpretations in order to be effective must be at an optimal distance from the surface. Their effectiveness is impaired if they are too close to the surface, or if they are too far removed from it. This notion of optimal distance or range of interpretations for their effectiveness is a direct result of what we know now about the ego's defensive functions.
The wording of interpretations is sometimes an essential factor in promoting insight. The importance of wording is due to the fact that interpretations must deal with concrete psychological realities of a given individual. The interpretation must also take into account the same conflict in one and the same patient, varied in its significance from one moment in life to another, so that the interpretations have to take into account the specific relationship of the conflict between the ego, superego, and the id, at a given moment.
Tact is an important factor in the way interpretations are given in analysis. Timing, which is part of the problem of tact, is essential because the therapeutic procedure, like the neuroses itself, is not a static phenomenon but a dynamic process. And you know that in this dynamic process, which is the psychoanalytic therapy, a complex relationship develops between the patient and the analyst, of which transference phenomena are the core. Interpretations, consequently, have to take into account the fact that, in the transference, ego defenses, superego, and id functions operate. This explains the fact that frequently patients react to interpretations in a way not directly connected with the actual meaning of an interpretation: lack of psychoanalytic tact in the sequence of interpretations brings about quite unexpected results, sometimes. If a patient's aggressive reactions are being interpreted before his defensive reactions to them have been analyzed, certain patients respond not to the actual meaning of an interpretation, but react as though the analyst were reproaching them for their alleged nastiness. This might have a bearing on certain types of patients who are being analyzed for psychosomatic disturbances. If their psychosomatic symptoms are being interpreted as expressing their unconscious tendencies, they sometimes react with a serious intensification of their symptoms. For these patients it means that they are not only sick but that they are made responsible-that means blamed--for their illness.
One important consequence of the impacts of ego psychology on the psychoanalytic technique, introduced by Anna Freud, is the analysis of defenses against emotions. Pathogenic conflicts between instinctual drives and defenses do not stop there. They are being carried on to conflicts about emotions. Anna Freud pointed out that in certain cases it is impossible to achieve any therapeutic result, to reach the deeper pathogenic conflict, without first having overcome defenses against emotions connected with the past. Sometimes this process, takes the form of what I proposed calling "reconstruction upwards." A beautiful example of it is from a case history written by Mrs. Berta Bornstein.
The patient, a young boy, had severe phobic states related to the birth of a sibling. In the treatment the boy's fantasies centered around an imagined scene of a lonely boy, sitting in a hospital that took fire, during which all the babies and most of the mothers were burned to death. Mrs. Bornstein chose, among many possible interpretations, to tell the boy that he must have been very sad when his mother left for the hospital, where she had the little baby.
Nowadays, when one sees so many patients who have read psychiatric or psychoanalytic books, this procedure of reconstructing upwards is sometimes essential. These patients indeed start by talking about their Oedipus complex, their unconscious homosexuality, they interpret their dreams symbolically, and evade by this very fact all the so-called more superficial but actual psychological realities of their emotional life. The task of the analyst then is to bring the patient's attention to this part of his life, which is the only real and relevant part. Reconstructions upwards are a most helpful type of interpretation in those cases.
We know that the ego develops gradually, and we assume now that both ego and id develop gradually through differentiation from a previous common, undifferentiated stage. However, it has not been possible to find as yet specific correlations between the formation of defense mechanisms and specific stages of instinctual development.
It is striking that certain types of defense mechanisms are, as it were, preferred by certain individuals and not by others. These defense mechanisms can be found at work in them again and again at various periods and in various situations in their lives. The predominance of certain types of defense mechanisms is probably not so much the question of individuals as of neurotic types. One knows, for instance, that 'isolation, undoing, and regression are found particularly among obsessional neurotics, and that in neuroses of the hysterical type repression seems to play a predominant role. However, repression is never absent in compulsive neurotics either. One knows the intimate relationships that exist between projection and paranoid symptoms, and the frequency of introjection in depressive states. Unfortunately, it does not seem possible for the time being to make a nosological classification of mental illnesses on the basis of distribution of defense mechanisms. As a matter of fact, in adults one hardly ever observes isolated defense mechanisms, but groups of them working together. So it might well be worthwhile to look in given patients for certain characteristic "patterns of defense used against certain patterns of instinctual drives."'
In successful psychoanalytic treatment of neurotic patients we know what happens to their warded-off instinctual drives. Some of these drives, hitherto repressed, are being made available to the individual. Another part is supposed to remain unsatisfied, but instead of being repressed is being consciously suppressed. We imply thus that at least to a certain extent the defensive mechanism of repression is being replaced by another defensive mechanism, conscious suppression. We also know that sometimes the defense through repression is being partly replaced by sublimation. One might hope that studies will be made of what happens to the other defensive mechanisms during the psychoanalytic treatment. It will certainly be a worthwhile object of research. However, one might already state that psychoanalysis does not result in doing away with them. The existence of all mechanisms of defense--even repression and projection--are necessary functions of the normal human mind. Here, as in all other areas of medical research, it can be found that the difference between normal and pathological is not one of essence but only one of degree. It is certain that those ego mechanisms that function as defense mechanisms exist also in the normal functions of the ego for the very reason that conflict is not identical with mental illness. For this very reason, further research on the vicissitudes of these mechanisms in psychoanalytic treatment will also be important in a study of what Hartmann called various forms of mental health.
The functions of the ego are not limited to defense mechanisms. Among the authors who have made important contributions to normal ego psychology, I should like to name: Paul Federn, Thomas M. French, Edward Glover, Heinz Hartmann, Ives Hendrick, Ernst Kris, Herman Nunberg, Robert Waelder. More recently Heinz Hartmann introduced the important concept of the conflictless sphere of the ego, or of autonomous ego functions, and studied their role in problems of adjustment.
Psychoanalysis, since its inception, has always had a two-fold function: If on the one hand it was a therapy, on the other hand it was a method of scientific research, which has had a tremendous influence on other psychotherapeutic procedures and on general psychopathology. The study of the ego development has enriched the psychoanalytic therapy. It has widened the area of its application; it has considerably improved its results. That this progress in psychoanalysis will have an equally stimulating influence in psychiatry, there can be no doubt.
Alexander, F. (1930). Psychoanalysis of the Total Personality. New York and Washington: Nervous and Mental Disease Publ. Co.
Bornstein, B. (1949). The analysis of a phobic child. Psychoanal. Study Child, 3/4.
Breuer, J., & Freud, S. (1936). Studies in Hysteria. New York: Nervous and Mental Disease Publ. Co.
Fenichel, O. (1941). The Problem of Psychoanalytic Technique. Albany: Psychoanal. Q.
-----(1945). The Psychoanalytic Theory of Neurosis. New York: Norton.
Freud, A. (1942). The Ego and the Mechanisms of Defense. London: Hogarth Press.
Freud, S. (1947). The Ego and the Id, London: Hogarth Press.
-----(1948). Inhibitions, Symptoms, and Anxiety. London: Hogarth Press. (1933). New Introductory Lectures. New York: Norton.
-----(1920). General introduction to Psychoanalysis. New York: Boni and Liveright.
Fragment of a case of hysteria. Coll. Papers 3.
-----Notes upon a case of obsessional neurosis. Coll. Papers 3.
(1922). The Interpretation of Dreams. London: Allen & Unwin.
The dynamics of transference. Coll. Papers 2.
-----Recommendations for physicians on the psychoanalytic method of treatment. Coll. Papers 2.
-----Further recommendations in the technique of psychoanalysis. Coll. Papers 2.
-----Turnings in the ways of psychoanalytic therapy. Coll. Papers 2. (1949).
The Question of Lay Analysis. New York: Norton.
-----(1937). Analysis terminable and interminable. Int. J. Psychoanal., 18:373.
-----(1938). Constructions in analysis. Int. J. Psychoanal., 19:377 and Coll. Papers 5.
Glover, E. (1947). The Basic Mental Concepts. London: Imago Publ. Co.
Hartmann, H. (1947). On rational and irrational action. In Psychoanalysis and the Social Sciences, ed. Geza Roheim.
-----The Relationship between the Theory of Analysis and Psychoanalytic Technique, in press.
Hartmann, H., Kris, E. & Loewenstein, R. M. (1946). Comments on the formation of psychic structure. Psychoanal. Study Child, 2.
-----(1949). Notes on the theory of aggression. Psychoanal. Study Child, 3/4,
Loewenstein, R. M. (1951). The problem of interpretation. Psychoanal. Q., 20.
Reich, W. (1945). Character Analysis. New York: Orgone Institute.