Chapter 29 Lecture 28 Analytical Therapy

You know what to discuss today.When I admitted that the effectiveness of psychoanalytic therapy depends mainly on transference or suggestion, you asked me why I did not make use of direct suggestion, which aroused the following suspicion: that is, while we admit that suggestion is so important, Does that still guarantee the objectivity of psychological findings?I have allowed you to give a full answer to this matter. Direct cues are cues given directly to resist the symptoms, a struggle between your authority and the motives of the disease.In this struggle you do not question these motives, as long as the patient represses their symptomatic expression.Roughly speaking, it makes no difference whether you put the patient under hypnosis or not.With his keen eyesight, Bernheim has repeatedly believed that suggestion is the essence of hypnosis, and hypnosis itself is the result of suggestion, a situation under suggestion; Hinting achieves the same result.

Should I first talk about the results of experience, or do I first discuss the theory? Allow us to speak from experience first. In 1889 I visited Bernheim in Nancy, and became one of his pupils; translated his book on suggestion into German.For many years I have used suggestion therapy, first with "prohibitory suggestion" prohibitory suggestions, and later in combination with Breuer's method of inquiry into the patient's life; The conclusion of hypnotherapy.According to the ancients' views on medicine, an ideal therapy must have rapid results, reliable results, and not be disgusted by patients; Bernheim's method meets two of these requirements.The effect of this method is faster than that of the analytical method, and it does not make the patient feel unhappy.But from the doctor's point of view, it is too monotonous; because it always uses the same method for everyone to prevent the appearance of various symptoms, but it cannot understand the meaning and importance of the symptoms.This kind of work is mechanical rather than scientific; it smacks of a charlatan, but it doesn't matter if it's for the sake of the patient.As far as the third condition of ideal therapy is concerned, hypnosis absolutely fails; its results are unreliable.For some diseases, this method can be used, but for some diseases, it is not; for some diseases, this method has great effect, and for some diseases, this method has little effect, and the reason is unknown.It is even more regrettable that the results of the treatment cannot last long; after a while, if you talk to the patient again, the old symptoms will relapse or the other symptoms will recur.Hypnosis may then be applied again.However, experienced people behind the scenes will warn the patient and advise him not to lose his independence due to repeated hypnosis, but to become addicted to it, as if taking narcotics.Conversely, after hypnosis is implemented, it can sometimes meet the doctor's expectations; the full therapeutic effect can be achieved with the least effort; but the conditions for achieving the effect are still not understood.Once, I used a short-term hypnotic treatment to completely cure a disease. The patient was a woman. She suddenly became angry with me for no reason, and the disease relapsed. Later, I reconciled with her and cured her. I am sick, but she hates me so much.Another time, I had the following experience: the patient was also a woman, and her disease was very stubborn. I had repeatedly relieved her neurotic symptoms. When I was doing a consultation, she suddenly stretched her arms around my neck. .Like it or not, with this happening, we cannot fail to study the nature and origin of implied authority.

As for the experience, it has been a little like the above; it can be seen that it is not necessarily impossible to replace the direct suggestion with other methods.Now relate these facts for a little explanation.Suggested therapy requires more effort from the doctor than from the patient.This approach is not contrary to the view of neurosis which is agreed upon by the majority of physicians.The doctor said to the neurotic: "You have nothing wrong with it, but nervousness; so I can say a few words in five minutes, and all your ailments can be completely eliminated." However, a minimum effort, without any appropriate A serious disease can be cured with the help of some method, which is too incompatible with our belief in general ability.If the situations of various illnesses could be compared with each other, it seems from experience that this method of suggestion can never cure neurosis.But I also know that the argument is not airtight; there are such things as sudden success in the world.

According to the experience of psychoanalysis, there is a slight difference between hypnotic suggestion and psychoanalytic suggestion as follows: hypnotic therapy wants to whitewash the hidden things in the heart, while the analytical method exposes the hidden things and eliminates them.The former is seeking appeasement, while the latter is seeking thoroughness.The former counteracts the symptom by suggestion, which only increases the force of the repressive effect, without altering the whole process of symptom formation.The latter seeks the source of the disease in the contradictions that cause symptoms, and uses hints to change the consequences of these contradictions.Hypnotherapy leaves the patient in a state of inactivity and invariance, so that he becomes irresistible to new triggers of attack.Analytical therapy requires the patient to work as hard as the doctor to eliminate inner resistance.If the resistance is overcome, the patient's psychological life will undergo lasting changes, he will have a higher level of development, and he will have the ability to resist the recurrence of the old disease.The overcoming of resistance is the chief achievement of the analytical method; the patient must have it, and the doctor assists the patient by an instructive suggestion.So we can say that psychoanalytic therapy is a kind of re-education.

I hope I have now made you aware of the difference between the use of suggestion in analysis and the use of suggestion in hypnosis;Since we have traced the influence of suggestion back to the transference, you will better understand why the results of hypnotherapy are so insecure, and why the results of analytic treatment are more durable.The success of hypnotism depends entirely on the conditions of the patient's transference, but these conditions cannot be influenced by us.A hypnotized patient's transference may be passive, most commonly bipolar, and special attitudes may be adopted to prevent his transference; we are not sure of these.As for psychoanalysis, the transference is dealt with directly, leaving it free to develop as a therapeutic aid.We therefore use suggestion as much as possible and control it; the patient then no longer has his suggestion-receptivity at will as he pleases, and we guide his suggestion-receptivity if it is possible for him to be affected by it.

Now you may think that the impetus behind the analysis is either transference or suggestion, but our influence on the patient makes the objective validity of our findings dubious.The benefits of treatment can be the detriment of research.These are the words most frequently raised against psychoanalysis; and though they are unreasonable, we cannot dismiss them as unreasonable.If it were justified, psycho-analysis would be only a particularly effective variant of suggestion therapy; and all its conclusions about the patient's past-life experiences, psychic dynamics, and unconsciousness would be disregarded.Our opponents really think so; they think that we first conceive the so-called sexual experiences for ourselves, and then "inject the meaning of these experiences, if they are not the experiences themselves, into the patient's mind." It is more satisfactory to be refuted by empirical evidence than by the aid of theory.Anyone who has practiced psychoanalysis knows well that we cannot suggest to the patient in this way.It would not be difficult for us to make a patient a believer in a certain theory, and make him believe in the doctor's false beliefs, and he behave like everyone else, like a disciple.However, we can only affect his sanity with this method, not his illness.Only when we tell him that what he seeks in himself does correspond to what actually exists in himself does he resolve the contradiction and overcome the resistance.Errors in the physician's conjectures will gradually disappear as the analysis proceeds, and more correct opinions will take their place.Our aim is to guard against temporary success by suggestion, by a very deliberate technique; but it does not matter if we have this success, since we are not satisfied with the first curative effect.We think that the analytic study is not complete until the problems of the disease are explained, the memory gaps are not filled, the causes of the repressions are not uncovered.If there are results before the time is ripe, we must see these results as obstacles to analytical work rather than as progress in analytical work, and we must continue to expose the empathy from which these results arise, rather than The curative effect obtained is denied.This basic last feature is sufficient to distinguish analytic therapy from pure suggestion therapy, and to make the curative effects obtained by analysis different from those obtained by suggestion.In every other form of suggestion the transference is carefully preserved; but in analysis the transference itself is the object of treatment, and is constantly studied in its various forms.As a result of the analysis, the transference itself must thereby be destroyed; and if it is then accompanied by success and persistence, this success must not be based on suggestion, but is due to a change that has taken place in the patient, because the patient's inner resistance has been borrowed. overcome with the help of suggestion.

To prevent the one-sided effects of therapeutic suggestion is a constant struggle against resistances which disguise themselves as negative, hostile transferences.There is another argument, which we must also pay attention to: namely, that there are many results of analysis which may be suspected of being suggestive, but which can be proved otherwise by other reliable data.Dementias and paranoiacs, for example, are by no means susceptible to suggestion.However, the fantasies and symbol transformations reported by these patients are consistent with the results of our research on the subconscious of transference neurotic patients. It can be seen that our explanation, although often doubted, does have objective evidence.I think you will not be much mistaken if you rely on analysis in these respects.

We shall now complete the account of therapeutic effects in libidinal terms.The neurotic has neither the capacity for pleasure nor the capacity for action—the former because his libido is not originally attached to objects, the latter because the faculties at his disposal serve both to maintain the libido rather than to repress it. Now, there is no spare energy to express yourself.If his libido and his ego were no longer in conflict, and his ego could control the libido, he would no longer be sick.So the job of therapy is to liberate the libido from its former fetishes, which were out of reach of the ego, and to serve the ego repeatedly.Where, then, is the libido of a neurotic?It is easy to find: it clings to the symptoms, and the symptoms give it a vicarious satisfaction, making it possible to satisfy all the demands of the status quo.Therefore, we must control the patient's symptoms and relieve them-this is the job that the patient asks of us.But to eliminate the symptoms, one must first go back to the starting point of the symptoms, examine their previous contradictions, and then lead the contradictions to a new solution with the help of a driving force that has not been used before.For this investigation of repression, it is necessary to use the memory clues that caused the repression, so as to obtain a partial effect.It is especially important that in the patient-physician relationship or in the transference, those early conflicts are repeated, the patient tries to behave in the same way as before, and we enable him to call upon all the available energies of his psyche to seek Have another solution.Transference is thus the dueling field in which all competing forces meet.

All forces pertaining to the libido and opposing to it converge on one point: the relationship with the physician; symptoms must therefore be deprived of their libido; the patient thus appears to use this artificially acquired transference. Emotional or transference disturbances, instead of the original illness; and his libido seems to substitute the doctor, the "fantasy" object, for various other non-real objects.The new struggle arising from this object is thus raised above the surface or higher psychic planes with the help of the analyst's suggestion, and turns out to be a constant psychic contradiction.Because new repression is avoided at this time, the resistance of the ego and libido is ended; the patient's inner unity is restored.When the libido is freed from its temporary object, the doctor, it cannot return to its former object, and is therefore now at the disposal of the ego.In therapy, the resistance we encounter in this struggle is, on the one hand, the ego's distaste for libidinal tendencies, expressed as a repressed tendency; The object it was previously attached to.

The work of therapy can therefore be divided into two aspects: first, forcing the libido away from the symptoms and concentrating on the transference; second, aggressively attacking the transference and restoring libido's freedom.If we are to bring this new contradiction to a successful conclusion, the repression must be eliminated so that the libido no longer escapes into the unconscious and out of the ego.And this is possible again because the patient's ego has been altered with the help of the analyst's suggestion.The work of interpretation not only introduces the material of the subconscious into the consciousness, so the ego gradually expands its scope due to the disappearance of the subconscious; it also achieves reconciliation with the libido through education, so the ego is also willing to give the libido a certain degree of satisfaction; Since the ego can sublimate a small amount of libido, the fear of libido demands gradually weakens.The closer the treatment process is to this ideal description, the greater the effect of psychoanalytic treatment.If there are obstacles, it is: 1. libidinal inflexibility, unwillingness to leave the object, and 2. rigidity of the patient's narcissism, which does not allow a certain degree of object transference to develop.The dynamics of the healing process may perhaps be more clearly outlined as follows: that is, having attracted a portion of the libido to us through transference, we have to enlist the full strength of the libido that has been freed from ego control.

Here we must know that the distribution of the libido resulting from the analysis does not allow us to infer directly from the nature of the libidinal tendency in the previous illness.Suppose a patient is cured because he transfers his affection for his father to the doctor. We cannot think that his illness is due to an unconscious libidinal attachment to his father.The father transference serves only as a dueling arena where we subdue the patient's libido; its source is elsewhere.The arena does not have to be one of the enemy's most important fortifications; and the enemy's defense of the capital does not necessarily mean fighting in front of the city gates.Only after the transference has been dissolved again can we infer in imagination the libidinal tendencies behind the disease. Now we can talk about dreams again in libidinal terms.The dreams of a neurotic, as well as his faults and free associations, enable us to seek the meaning of symptoms and discover libidinal tendencies.The form which the desire-fulfillment takes in these tendencies shows what kind of desire-impulse is repressed, and to what object the libido attaches itself after separation from the ego.The interpretation of dreams therefore occupies an important place in psychoanalytic treatment, and in most cases it is the most important tool of long-term analysis.We already know that the condition of sleep itself causes some relaxation of repression.The weight of the repression is somewhat lessened, so that the repressed desires are more clearly expressed in dreams than in diurnal symptoms.The study of dreams is therefore the most convenient method of studying the repressed unconscious, which is the lodging of the libido detached from the ego. But the dreams of neurotics are essentially the same as those of normal people; there is simply no difference between the two.It would be illogical to say that the interpretation of the dreams of neurotic patients cannot be used to explain the dreams of normal people.We are therefore compelled to conclude that the distinction between neurosis and health is only as far as the day is concerned; it cannot be established with regard to the dream-life.We are therefore again compelled to transfer to healthy persons the conclusions we have drawn concerning the relationship between dreams and symptoms of neurotic patients.We must admit that healthy people also have those factors that form dreams or symptoms in their spiritual life; we must even think that healthy people can also form repression, and it takes a certain amount of energy to maintain the power of repression, and their subconscious mind also stores The repressed impulse is powerful, and part of the libido is not at the mercy of the ego.So a healthy person can be regarded as a neurotic in essence, but the only symptoms he seems to be able to develop are dreams.In fact, if you make a critical study of his waking life, you will also find facts that contradict this conclusion; for this seemingly healthy life also has many trivial and unimportant symptoms. Thus the difference between neurotic health and neurotic sickness, neurosis, can be reduced to a practical difference, and can be determined by practical results—for example, how far the person can enjoy and be active.This difference may perhaps be traced to a ratio between the capacity for free disposition and the capacity for being trapped in repression; that is to say, it is a quantitative rather than a qualitative difference.It goes without saying that this point of view provides a theoretical basis for our belief that neuroses, although founded on constitutional tendencies, are in essence curable. Therefore, we can infer the attribute of health from the consistency of the dreams of neurotic patients and healthy people.But as far as the dream itself is concerned, we can also make the following inferences-namely, 1. Dreams cannot be separated from the symptoms of neurosis; 2. We do not believe that the importance of dreams can be reduced to "translation of thoughts into ancient expressions" Such a formula is exhaustively referred to in Book II; 3 We have to use dreams to reveal the tendencies of the libido, as well as the objects of desire that were actually active at the time. Our presentation is now coming to an end.You may be disappointed that I took psychoanalytic therapy as the subject, but it turned out that I only talked about the theory, without mentioning the situation and efficacy of the treatment.But I also have reasons: the case of healing is not mentioned because I never intended you to be practically trained in the practice of analysis; and the effects of healing are not mentioned because of several motives.At the beginning of my lecture I stated repeatedly that we, under the right circumstances, can reap no less results than the most glorious achievements in medical therapy in other fields; owned.If I exaggerate beyond this, some people will inevitably suspect that I am advertising myself to offset the depreciation of my opponents.The friends of medicine, even in public meetings, have frequently intimidated psycho-analysis, declaring that publicizing the failures and harmful results of the analysis would convince the aggrieved public of the worthlessness of the therapy.Putting aside the malice of this method, the collection of failure materials may not be an effective evidence, so that it can be used to make a correct estimate of the analysis results.Analytic therapy, you know, is still very young; many years of experience are still needed to improve its technique.Owing to the difficulties of teaching this therapy, the novice, more than the other specialists, has to try to develop his faculties, and the results of his early years can by no means serve as a measure of the full success of the analytical therapy. At the beginning of psycho-analysis many attempts at treatment failed, because analysts then had to treat diseases for which analytic treatment was unsuitable, while we now see certain characteristics that lead us to treat them. These diseases are excluded.Traits are also only available through exploration.We did not know at first that when paranoia and praecox were fully developed, analysis was ineffective; and that we could of course treat all kinds of deranged phenomena in this way.But the failure in the early years is not due to the fault of the doctor, or the careless choice of the disease, but due to the unfavorable external circumstances.I have only spoken of the inescapable but overcomeable resistances of the patient.All the external resistance against psychoanalysis in the patient's environment is of little academic interest but is of practical importance.Psychoanalytic treatment, like surgical operations, must be carried out within the most appropriate circumstances before it can have any hope of success.You know that before a surgeon can perform an operation, he must have all kinds of arrangements—for example, a suitable room, sufficient light, skilled assistants, and the avoidance of the patient's relatives and friends.May I ask, if all surgical operations are performed in front of the patient's whole family, and the family members surround and watch, how many times will it be effective?As far as psychoanalysis is concerned, the interference of relatives and friends is an active danger, which we just don't know how to deal with.We believe that the patient's internal resistance must be induced and should be strictly guarded against; however, how can we defend against these external resistance?Those relatives and friends are neither persuasive by any kind of explanation, nor can we persuade them to stand aside; let alone lead them as confidantes and tell the truth, because in doing so, we will inevitably lose the patient's faith in us, and the patient will demand ——Of course this is justified—we think that since we trust his relatives and friends, there is no need to treat him as an object of treatment.Anyone who knows the inside story of family divisions, as an analyst, will not be surprised that the relatives of the patient often do not want the patient to recover, but prefer his condition not to improve.If neurosis arises from family conflicts, the healthy members of the family will regard their own interests as more important than the restoration of the sick person's health.It is no wonder that a husband, who thinks that his wife is bound to expose his guilt when he is cured, takes no pleasure in it; the resistance of the husband is added to the resistance of the sick wife, and there is no guilt for the failure and interruption of our efforts. Because what we were going to do at that time was actually an impossible job. I don't want to give more examples, but now I will only give one case. In this case, for the sake of professional ethics, I also had to suffer.Many years ago, I gave an analytical treatment to a young girl; she had been afraid for a long time, and she dared not go out of the house, nor did she dare to live alone in the house.After a long hesitation, she admitted that she had seen her mother express affection to a rich man by chance, and had been deeply troubled by it afterwards.She untactfully—or subtly—hinted the discussion of the analysis to her mother by: 1 changing her behavior towards her, and 2 claiming that no one but her mother could undo it. Her fear when she was alone, 3 and her mother's refusal to open the door when she wanted to go out.Her mother, who had been suffering from neurosis, had been cured for many years after visiting the spa—or, to put it more clearly, she had met a man in the hospital and became intimate with him, and felt relieved.Suspicion aroused by her daughter's vehement hints, she suddenly understood the true meaning of her daughter's fear.The meaning is to put the mother under house arrest and deprive her of the freedom to communicate with her lover.So her mother made up her mind to end the harmful treatment.She sent her daughter to a house for mental patients, and for many years referred to her as an "unfortunate victim of psychoanalysis;" and I was vilified for it.The reason why I don't defend myself is because I am bound by professional ethics and cannot announce this secret.A few years later, a colleague of mine visited this space-phobic woman and told me that her mother's close friendship with the rich man had become an open secret, and that her husband and father had acquiesced.Yet her daughter's treatment has been sacrificed to this "secret." In the first few years of the war, patients from all over the world came to seek medical treatment one after another, so I didn't care what others said about my hometown.So I made a rule that anyone who is under the legal age and unable to be independent in an important relationship in life will not be diagnosed and treated on his behalf.The psychoanalyst need not be able to make this determination.Because of my warning about the relatives of patients, you may think that I want to remove patients from the family for analytical purposes, or that only people who have left home and friends can be treated.But this is not necessarily true; the patient—at least not the exhausted one—is far more in the best interest of treatment if he still has to resist the demands that ordinary life imposes upon him.As for the relatives of the patients, they should also pay attention to their behavior so as not to damage this favorable condition, let alone slander the doctor's professional efforts.But how do we get this attitude among people beyond our reach?You also naturally think that the social atmosphere and level of cultivation of the patient's immediate surroundings have a great influence on the hope of treatment. Although our failure can be explained by these external interference factors, it has already diminished the efficacy of psychoanalytic therapy a lot!Proponents of analysis have advised us to tally up our analytic successes to offset our failures.I can't agree.The reason is: if the units to be compared are too far apart, and the diseases to be treated are different, the statistics will be worthless.Moreover, the time available for statistical study is too short to prove whether the effect is durable; in most cases, it is almost impossible to record it.Because patients keep their disease and treatment a secret, and they don't want to tell others when they recover.The most important objection against psychoanalysis is that human beings are the most irrational in matters of treatment, and hardly susceptible to rational argument.New treatments sometimes arouse fervent admiration, such as Koch's first published research results on tuberculosis; sometimes they cause fundamental doubts, such as Jena's vaccination, which is actually a blessing from heaven, but is still opposed by people.There is no greater prejudice against psychoanalysis than the following example.After we cure a difficult disease, people say: "It's nothing, after all this time, the patient will get better." After a period of depression, he came to me for treatment, and after three weeks, mania broke out again, so his relatives and the famous doctors they invited thought that this mania must be the result of analysis and treatment .There is really nothing that can be done to oppose prejudice. Did you not see that during the Great War, no matter what kind of bloc was biased and hated other blocs?The smartest way at this time is to endure temporarily, and wait for these prejudices to gradually disappear with time.Perhaps one day these people will judge the same event with different eyes; and why they thought differently before remains an unknowable mystery. Perhaps the prejudice against psychoanalytic therapy has now begun to moderate.The continuing spread of the analytic doctrine is evidenced by the increasing number of physicians in many countries who practice it.When I was young, the treatment of hypnotic suggestion was being glared at by the medical world with exactly the same intensity as the refutation of psychoanalysis by "sane" people today.Hypnotism as a therapeutic tool has indeed failed to live up to our expectations; we psychoanalysts may claim to be its legitimate heirs, and we should not forget its encouragement and theoretical inspiration.The harmful results of psychoanalysis reported by people are basically limited to the temporary symptoms of the patient's aggravation of contradictions, and the aggravation of contradictions is either caused by too rigid analysis or because the analysis stops suddenly.You have known our methods of dealing with the sick, and you will be able to judge for yourself whether our efforts have perpetually harmed them.There are several possible misuses of analysis: especially in the hands of absurd doctors, transference is a dangerous tool.However, it is inevitable that some people will misuse medical treatment; if a knife cannot cut, should a surgeon still use it? My lecture can now end.I should say that I am deeply ashamed that these speeches have been too flawed, and that is by no means merely a matter of courtesy.I am especially sorry that I accidentally mentioned a problem and often promised to explain it in detail elsewhere, but then I never had the opportunity to practice the previous appointment.The problem I am talking about is not yet closed but is developing, so my brief description is also incomplete.There are many places where I am ready to draw conclusions, but I have not summarized them.However, my purpose is not to make you an expert in psychoanalysis; I just want to make you understand and arouse your interest.