Chapter 28 Lecture 27 Empathy

Our discussion is now coming to an end, so you must have an expectation, but don't cause a misunderstanding because of this.You may think that after discussing all the complex problems of psychoanalysis, I would not end without a word about therapy, since the work of psychoanalysis ends up in therapy.In fact, I must not omit this aspect; for in connection with the phenomenon of healing there is a new fact to tell you.Without knowledge of this new fact, no deep understanding of diseases previously studied can be gained. I know that you do not want me to tell you the technique of carrying out analytic treatment; you just want to know the outline of psychoanalytic treatment and its achievements.It is your right to know this, and no one can deny it; but I don't want to tell you—you'd better find out for yourself!

Think about it, you already know all the important facts, from the conditions that cause the disease to the factors that operate in the patient's heart.At what point can the effects of treatment be accepted?First, the hereditary predisposition--I don't often mention heredity, because the subject is so well emphasized in other sciences that we have nothing new to say.But don't let that lead you to think that we underestimate it; we are analyses, and of course we are well aware of its power.We cannot in any way alter heredity; this is a predetermined material in the problem which may limit the scope of our efforts.Next, there are the influences of childhood experiences, which are often the most important material in analysis; they belong to the past and of course render us useless.The second is all the misfortunes in life, that is, the deprivation of real happiness, which leads to the loss of all love elements in life-such as poverty, family disharmony, marriage failure, bad social situation, and moral excess. Oppression etc.It is true that there is a great possibility of effective treatment in this respect; but it must be modeled on the way of Kaise Joseph in the legend of Vienna. , and the difficulties are all eliminated; but what kind of people are we, can we spread the grace of healing to everyone?We have no money and no power in society, and we only rely on medical skills to make a living. Of course, we can't perform surgery on poor people like other doctors; because our treatment takes a lot of time and labor.Yet you may still insist that one of the many aforementioned factors must be treatable.If the traditional morality of society acts to deprive patients of their happiness, they may be encouraged and exhorted in therapy to break down these barriers, and to obtain satisfaction and health at the expense of an ideal which is so dearly admired but which the world disregards. There are also many people here.However, since the acquisition of health is due to "free living", the analysis must be stained with the stain of violating general morality: because it benefits the individual and harms the society.

Who gave you this false impression about analysis?Part of the analytic treatment includes, of course, exhortations to live more freely—if for no other reason than because the patient feels a tension between libidinal desires and sexual repression, or sensual and ascetic tendencies. contradiction.This kind of contradiction cannot be resolved by helping one side to overwhelm the other side.In the case of neurotics, it is true that asceticism prevails for a while; the result is that repressed sexual impulses find outlet in symptoms.If we turn to the possibility of victory in the sensual side, the neglected forces that suppress sexual life will have to seek compensation in symptoms.Neither of these methods can stop the inner conflict; there is always one aspect that cannot be satisfied.As for the cases where the contradictions are not so severe that the doctor's advice is effective, there are very few cases, and these cases do not need analytical treatment.Those who are susceptible to the doctor's influence must find their own way without this influence.In fact, you always know that if a desperate man decides to engage in illicit sexual intercourse, or if a dissatisfied wife seeks compensation from a lover, they would never seek permission from a doctor or analyst first, and then Just do whatever you want.

When people discuss this question, they tend to miss the whole point—namely, that the paradox that causes the neurosis is different from the normal balance of contradictory impulses, because the two impulses of the normal balance exist in the same psychology. In the sphere of disease, as far as the pathogenic contradiction is concerned, one of the two forces enters the plane of the preconscious and conscious, and the other is confined in the region of the subconscious.Therefore, their contradictions must not have a final outcome; the difficulty of meeting the two forces is no different from the fact that one is in the south of the sky and the other is in the north of the earth.To solve it, the two must meet in the same place.I think this is the main work of psychoanalysis.

Besides, you are mistaken again if you imagine that analysis also has as its point the counseling of life or the direction of conduct.In fact, when we try to avoid playing the role of mentor; we just want the patient to figure it out on his own.In order to achieve this goal, we advise him not to make important life decisions, such as career, marriage choice, or divorce, while he is undergoing treatment, until after the treatment is completed.This may be beyond your imagination.We do not insist on such restrictions only for young or helpless people.For them, we had to be doctors and educators at the same time; we knew that our responsibilities were heavy at that time, so we had to be cautious.

Although I argue that analytical therapy does not encourage free living, don't let this lead you to think that we advocate traditional morality.Neither is our purpose.We are not reformers, but observers; however, if we want to observe, we cannot do without criticism. Therefore, we cannot support traditional sexual morality or approve of society's handling of sexual issues.It is not difficult to prove that the so-called moral law in the world requires sacrifices that often exceed its own value;We never hide these criticisms from our patients; make sure that they are accustomed to unbiased consideration of sexual problems as well as other problems; If we choose a moderate solution between abstinence, no matter what the result is, we will not be blamed by our conscience.Anyone who has completed his training and has come to know the truth increases his strength against the dangers of immorality, even if his moral standards differ in some respect from the average person.Nor should we overestimate the importance of abstinence in the development of neuroses; only a small number of diseases caused by deprivation and accumulation of libido can be cured by easily induced sexual intercourse.

You cannot, therefore, assume that the explanation of the therapeutic effects of psychoanalysis must be due to the permission of the patient to indulge in an indulgent sex life; you must seek some other explanation.I remember that when I refuted your speculation, I once said a word, which may set you on the right path.Perhaps our success comes from substituting something conscious for something subconscious, transforming subconscious thoughts into conscious ones.If you do, you've hit home.The unconscious is enlarged into the conscious, the repression is removed, the symptoms are eliminated, and the paradoxical contradiction becomes a normal contradiction which must be resolved sooner or later.Our job is only to enable patients to have this kind of psychological transformation. To the extent that this matter can be achieved, they can also benefit to the extent that they can.If there are no repressed or repressed-like psychic processes waiting to be undone, then our treatment is done.

The purpose of our endeavors can be expressed in different formulas—to make the unconscious conscious, to remove repression, or to fill in the absence of memory; they all refer to the same thing.You may not be satisfied with this sentence; you think that the recovery of a neurotic is very different. After receiving psychoanalytic treatment, he may become a completely different person, and you only hear that the whole process is just to make the subconscious The material of consciousness is slightly reduced, while the material of consciousness is only slightly increased.You may not understand the importance of this inner transformation.A cured neurotic is a different character, though at heart he remains the same person—that is to say, he has become the best personality that can be formed under the best circumstances.This is no longer a trivial matter.If you could know all our achievements, and the best efforts we have made to bring about this seemingly trivial transformation of the psyche, you would be able to understand the importance of the differences in the various psychic planes.

I will leave this question for a moment now, and ask you whether you know the meaning of the so-called "causal therapy" a ca-usal therapy.If a kind of treatment abandons the manifestation of the disease and seeks a breakthrough to eradicate its cause, it is called cause therapy.Is psychoanalysis a cause therapy?It is by no means a simple matter to answer this question, and yet we may be convinced of the impracticality of such questions.Psychoanalytic treatment, when it is not directly aimed at the elimination of the symptoms, proceeds in much the same way as the treatment of causes.In other respects it is different, for we seek causes much more than repression down to instinctive tendencies and their considerable intensity in their structure, up to aberrations in the development of these instincts, etc.Now if we could modify the mechanism of the psyche by some chemical method, or increase or decrease the libido at any time, or increase the force of one impulse at the expense of another—it would be a real cause treatment, and our analysis becomes an indispensable first step in detecting the cause.But at present there is no process by which this influence can reach the libido, as you know; our psychotherapy attacks on another point, not above the symptoms, but relatively far below the symptoms. Places are accessible to us only under very peculiar circumstances.

So, what exactly do we have to do to bring the patient's subconscious into consciousness?We used to think it was a simple matter; we just had to find out this subliminal material and tell the patient, and that was it.But we now know that this is a myopic fallacy.Our knowledge of his subconscious is not the same thing as his knowledge of his own.We told him what we know, he can't achieve assimilation to replace his own subconscious thoughts, but only inclusive, in fact, there is little change.We are therefore obliged to still approach the unconscious material from the point of view of the situation; but to seek it at the point in his memory where the repression first occurred.This repression must be removed before the work of substituting conscious thoughts for subconscious thoughts can be done immediately.But how is this repression to be removed?Our work then enters the second stage; first, the discovery of repression, and secondly, the elimination of the resistance on which this repression depends.

How can this resistance be eliminated?Still: first find out where the resistance is, and then tell the patient.Resistance arises either from a repression which we are trying to get rid of, or from a repression which has been active earlier; both are resistances to unpleasant impulses.So what we have to do now is the same as before; that is, explain it, verify it and tell the patient; but this time it is done right.Resistance or resistance does not belong to the subconscious mind but to the ego, which must cooperate with us even if it is not conscious.We know that the word "subconscious" seems to have two meanings here, one is a phenomenon, the other is a system.This may sound vague, but it is really just a restatement of what was said earlier.is not that right?We have already said this before—if we could recognize the place of resistance by explaining it, we might hope that this resistance and resistance would thereby be annihilated.But what instinctive drive do we have at our disposal to make this possible?First, it is the patient's desire to restore health that makes him willing to cooperate with us, and second, the help of his reason, which is strengthened by our interpretation.If we can give him some hints, it will of course be easier for the patient to recognize the resistance with his intellect, and to obtain an idea corresponding to this resistance in the subconscious.If I tell you: "Look up at the sky, you will see a light balloon," or if I just ask you to look up at the sky and ask what you can see, it is of course under the former condition that it is easier to see the light balloon .When a student looks at a microscope for the first time, the teacher must tell him what to look at; otherwise, although there is something visible under the microscope, he cannot see anything. Now tell the truth!In all forms of neuroses, hysteria, anxiety phenomena, obsessive-compulsive neuroses, etc., our hypothesis is sound.If we use this method to find out the repression, resistance, and the location of the repressed ideas, then we can overcome the resistance, break the repression, and turn the subconscious material into conscious material.When we do this, we feel clearly that at the very moment when every resistance is overcome, there is a violent duel going on in the patient's psyche--two tendencies in the same area are engaged in the normal psychological struggle, one is to help. The motive of resistance, one is the motive of dispelling resistance.The first are old motives which originally established the repression; the second are newly aroused motives which are expected to help us resolve our contradictions.We have thus repeated a previous struggle, temporarily reconciled by repression, as a new contribution to the matter, first, to show the patient that the old solution was enough to cause illness, and that the new solution can restore health, and, second, to tell He has been very different since those impulses were originally repelled.Because the ego at that time was weak and naive, afraid of the danger of libido oppression, and tried to retreat, while the ego now is stronger, more experienced, and can obtain the assistance of doctors.We may, therefore, hope that the reintroduced contradictions will have a more complete result than the repression; if you do not believe it, please testify to our success in the treatment of hysteria, anxiety neuroses, and obsessional neuroses. But there are other diseases in which our remedies have failed, although the situation is similar.In these cases, a contradiction arises between the ego and the libido, resulting in repression—although this contradiction differs in situation from the conflict in the transference neurosis; to the point where the repression occurred; we give him the same help in the same way, with the same assurance, and tell him what he wants; Contradictions have better endings.However, after all, we have not been able to overcome a resistance and eliminate a depression.Such patients as paranoid, depressed, and dementia praecox are probably not affected by psychoanalytic treatment.What is the reason for this?This is not due to a lack of intellect; a certain degree of intellect is necessary to be analyzed, but is it not, say, the most intelligent and deductive paranoiac?There is no lack of any other motivating force; for example, the depressed person, unlike the paranoid person, is also well aware of the suffering of his illness;Here again we encounter a fact that we are ashamed to understand, and we have to wonder whether we really have the healing power to understand other neuroses. If we now discuss hysteria and obsessive-compulsive neuroses exclusively, we immediately encounter a second and unexpected fact.After the patient has been treated a little, he has a special behavior for us.We thought that having given due attention to all the motives which might have influenced the treatment, and had taken adequate account of the situation between ourselves and the patient, we had drawn a most reliable conclusion; but beyond what we had estimated, It seemed that something unexpected had suddenly invaded.This unexpected new phenomenon itself is extremely complicated; I will briefly describe the more common and simple ones as follows. The patient should only pay attention to the resolution of his own mental conflicts, but suddenly he gradually develops a special interest in the doctor himself.Everything about the doctor seemed to be more important than his own, and he no longer focused on his illness.The relationship between him and the doctor also became very kind for a while; he especially obeyed the doctor's wishes, expressed his gratitude to the utmost, and showed unexpected virtues.Analysts therefore have a good impression of patients; Shenqing is lucky to have such a kind personality as a cure.If the doctor has the opportunity to see the relatives of the patient, he will also be happy to hear the patient's respect for him; the patient praises the analyst endlessly at home, thinking that he has various virtues.The relatives said: "He admires you very much; he trusts you very much; what you said seems to him to be the truth of revelation." At this time, someone with a discerning eye may insert a sentence: "He will not say anything except you. Anything else, it's kind of tiresome to keep talking to you." Of course the doctor was very humble at that time, thinking that the reason why the patient respected him was firstly because he hoped that he could recover his health, and secondly because the influence of the treatment made the patient unheard of and increased his knowledge.Under these conditions, too, analysis has progressed astonishingly. The patient understands the doctor's suggestions and concentrates his attention on the work of treatment. The materials needed for analysis-such as his memories and associations-are everywhere available; Even the analysts are surprised that these new psychological concepts were originally refuted by healthy people outside, but patients are so willing to accept them, which cannot but be happy.As a result of this rapprochement in the analysis, the patient's condition gradually improved in practice. However, this kind of good weather will not last, there will always be a day covered by dark clouds.As a result, difficulties began to arise in the analysis, and the patient declared that he could say nothing more.We doubtless felt that he was no longer interested in this kind of work, and sometimes he would not listen if you asked him to say what came to his mind at any time, without having to refute it.His behavior was not governed by the therapeutic situation; it was as if he had never entered into a contract of cooperation with the doctor; and even on the surface it was evident that he was now distracted by other secret matters. .This is the situation where therapy is not easy.The reason is that a strong resistance has developed again.How did it go? If such a thing were possible to understand, the cause of the disturbance would be a strong feeling of fraternity transferred by the patient to the doctor, which cannot be explained by the relationship between the doctor's behavior and the treatment.The manner in which this affection is expressed and the object to be achieved will of course vary with the circumstances between the two persons.If one is a girl and the other is a young man, the impression is normal; a woman both meets alone and talks about her intimate affairs with a man who occupies the position of director, Then her admiration for him seems to be natural - but the fact that a crazy woman's ability to love is inevitably slightly abnormal can be ignored for the time being.The more the situation between two people differs from this hypothetical example, the more inexplicable their admiration becomes.If a young woman is unloved and the doctor is not yet in love, if she has a strong affection for him, she is willing to divorce and commit herself to him, or if this is not possible, to have a secret love with him. Still comprehensible.This kind of thing is also common outside of psychoanalysis.But under such circumstances, women and women often make such amazing confessions, which shows that they have a special attitude towards the problem of healing: they already know that there is no other way to cure them except love, And from the beginning of the treatment, they have expected that from this relationship, they will finally get the comfort that they lack in actual life.It is only because of this hope that they endure the trouble of analysis and disclose their thoughts.We might add: "That's why it's so easy to understand things that are often hard to accept." But this confession really horrifies us, and all our estimates come to naught.Can we go so far as to ignore this most important element in the whole problem? This is true; the more experience we have, the less likely it is to deny this new element, which changes the whole question and shames our scientific estimates.For the first few times we may have thought that the analytic treatment had just encountered an unexpected obstacle.But this kind of affection for doctors is inevitable even in the most inappropriate or ridiculous situations-such as between an old woman and a gray-haired doctor, in fact there is no so-called temptation at all-so we It is no longer necessary to regard this matter as an accident, but must admit that it is indeed closely related to the nature of the disease. This new fact that we have to admit is called transference.The implication is that the patient empathizes with the doctor, since the situation at the time of treatment cannot be used to explain the origin of this emotion.We even suspect that this emotion originated from another side; that is, it was first formed in the patient's heart, and then transferred to the doctor at the opportunity of treatment.The expression of empathy can be a passionate courtship, or it can be taken in a milder form; if one is a young woman and the other is an old man, she does not want to be his wife or mistress, but she also wants to be his beloved daughter, Libby The desire for more is transformed into an ideal platonic desire for friendship.Some women know how to sublimate their empathy so that it has a reason to exist; others can only show it in crude, primitive and almost impossible forms.But fundamentally they are always the same, and their origins are the same for all who are interested. To ask the extent of this new fact requires an additional explanation.For example, what happened to the male patient?Here, at least, we can hope to be free from the trouble of sex and sexual attraction.But the fundamental situation is the same as that of a woman; he admires the doctor just as much, exaggerates his qualities just as much, obeys his wishes just as much, and envies everyone related to him just as much.The sublimation of empathy is more common between men and men, and the number of direct sexual love is less, just as the same-sex tendency shown by patients can be expressed in other ways.There is another mode of expression which analysts more often see in male patients and which at first appears to be counterproductive to what has just been said—that of rebellious or passive transference. The transference, which takes place in the patient at the beginning of the treatment, is temporarily the most powerful motivator.The result of this dynamic, if it could lead to the cooperation of the patient and thus to the benefit of the treatment, was of course not seen or noticed.On the contrary, once it becomes resistance, it has to attract attention; at that time, there are two different and opposite psychology that change the patient's attitude towards treatment: 1. The attraction of love is too strong, and it has revealed the meaning of sexual desire, so It has to arouse the inner resistance against oneself; 2 The feeling of friendship changes into a feeling of hostility.The feelings of hostility, roughly speaking, often follow and are disguised by the feelings of friendship; if they occur simultaneously, it is a good example of the emotional contradictions that dominate the relationship between human beings. All the closest relationships.Thus the feelings of hostility and friendship express a feeling of attachment, just as rebellion and obedience, though opposite, depend on the presence of the other.The patient's hostility towards the analyst may, of course, also be called transference, since the therapeutic situation is not the cause of this emotion; so the passive transference from this point of view is also consistent with the positive transference mentioned above. the opinion of. Where exactly does empathy originate?What difficulties does it cause us?How can we overcome these difficulties?And what kind of convenience can be obtained because of this?These problems can only be discussed in the special account of the analytical method; here they can only be mentioned briefly.Of course we must comply with the demands which the patient has made of us under the influence of the transference; otherwise it would be foolish to rebuff them angrily.His empathy could be overcome by telling him that his emotion had no origin in the present situation and had nothing to do with the doctor himself, but was merely a repetition of something from his past.Therefore, we asked him to turn repetition into recollection.Then the transference, be it friendly or hostile, which often seems to be the great obstacle to therapy, becomes the most convenient tool of therapy for uncovering the secrets of the mind.However, this unexpected phenomenon will always surprise you, so I have to say a few words to dispel the unpleasant impression it creates on you.We must remember that the condition of the patient we are analyzing is not at an end after all, but continues to develop like a living organism.The beginning of treatment is not enough to stop this development, but as soon as the patient is treated, the whole process of the disease seems to be concentrated in one direction at once-that is, to focus on the relationship with the doctor.Empathy is thus likened to the new layer of a tree between the wood and the bark, whereby new tissue is formed and the radius of the trunk enlarged.Once the transference has developed to this extent, the work on the patient's recollection takes a backseat.At that time we can say that we are no longer diagnosing and treating old diseases, but diagnosing and treating newly created and reformed neurological diseases that have taken their place.For the new version of the old disease, the analyst can trace its beginning, how it developed and changed, and he is especially familiar with this process, because he himself is its central target.All the symptoms of the patient lose their original meaning and are adapted to a new meaning; this new meaning is contained in the relationship of the symptoms to the transference; wipe out.If we can cure this newly acquired neurosis, it is equivalent to curing the original disease, in other words, we have completed the work of healing.If the patient can have a normal relationship with the doctor and get rid of the influence of repressed instinctive tendencies, he can still maintain his health after leaving the doctor. Transference is so absolutely important in the treatment of hysteria, anxiety hysteria, and obsessive-compulsive neuroses that these neuroses can all be classified as "transferring neuroses."Whoever can get a true impression of the transference fact from analytic experience will never again doubt the nature of those repressed impulses which seek an outlet in symptoms; , no stronger evidence could be found.We can say that it is only after studying the phenomenon of transference that we become more convinced that the meaning of the symptoms is the vicarious satisfaction of the libido. However, we now feel that we should correct the previous concept of the dynamics of the therapeutic effect in order to be consistent with this new discovery.When we use analysis to find that resistance resolves normal conflicts, he needs a strong impetus to help him achieve the resolution we desire, so as to restore health.Otherwise he may repeat the same mistake and bring the ideas already brought into consciousness down under repression.The outcome of this struggle did not depend on his understanding - for his understanding was neither strong nor free enough for this achievement - but only on his relationship with the doctor.If his empathy is positive, he assumes the authority of the doctor and trusts his research and opinions.If there is no such transference, or if the transference is passive, it will be very difficult for the doctor and his arguments to be heard by the patient.Faith originates from love and initially requires no reason.If the reason is put forward by the beloved, it is only later that it is critically examined.A reason without a backing of love is not sufficient to subject the sick or the general population to its influence.Therefore, even intellectually, a person can be influenced by others only if his libido is invested in objects; so we have reason to believe that the best analysis of people with narcissistic tendencies It may not be easy to use the technique. The ability to project one's libido more than others is of course common to normal people; the tendency to empathize in neurotics is but an aggravation of this generality.Isn't it very strange that no one pays attention to and utilizes such an important and universal generality?In fact, someone has noticed and used it.With his keen thinking, Bernheim did use the suggestibility of human beings as the basis for his hypnotic theory.In fact, his so-called "suggestive receptivity" is the tendency to transference, only because he narrowed the scope of this tendency so much that he did not include negative transference.Bernheim, however, never said what the allusion was or how it originated; it seemed to him a self-evident fact, without possibility of explanation.He did not know that suggestive receptivity depends on sexual or libidinal activity.We are obliged to admit that we are abandoning hypnotism in the method, and only try to discover the suggestive nature in the transference. But now I'm going to pause for a moment to give you something to think about.I know that there is already a violent protest in your minds at this time, and if you are not allowed the opportunity to publish, you will inevitably be deprived of your attention.I think you will think: "You have finally admitted that you use the help of suggestion like a hypnotist. We have always thought so. Why do you go after past experiences in a devious way, inventing subconscious materials, explaining All kinds of disguises, wasting infinite time, labor and money, and the result is nothing more than using suggestion as an effective aid? Why do you, like those faithful hypnotists, use suggestion to cure symptoms? If you still think that this detour Who is to justify the many important psychological facts which, with the aid of devious methods, reveal themselves hidden behind direct suggestion? Aren't they also the product of suggestion, or unintentional suggestion? Can't you use Does the patient accept your idea in favor of your opinion?" Your protest is very interesting and has to be answered.But not today; for it is too late.Wait until next time.You know, I am determined to answer as I am told.Today I must conclude what I have begun.I have allowed you to explain why we do not respond to narcissistic neuroses by means of transference. I will suffice in a few words for this explanation; and you will see how easy the riddle is, and how the facts fit together.Experience has proved that narcissistic neurotics do not have the ability to empathize, and even if they do, it is only in a small way.They leave the doctor not because of hostility but because of disinterest.Therefore, they are not under the influence of the doctor; what the doctor says is only indifferent to him, without impression, so that the treatment that can be effective for others, such as the repetition of pathogenic conflicts arising from repression and the overcoming of antagonisms, is not effective for them. has no effect.They are always stuck in their own way, often in automatic attempts to restore health, with morbid results; we just can't help it. From the clinical observations of these patients we have said that they must have abandoned the investment of the libido in the object and transformed the libido of the object into the libido of the ego.These neuroses are thus distinguished from the first group, such as hysteria, anxiety and obsessive-compulsive neuroses.Their behavior during treatment is also sufficient to prove this conjecture.They cannot be affected by our treatment because they have no empathy.