Freud - Complete Works (419 page)

The Dynamics Of Transference

2461

   After it has been overcome, the
overcoming of the other portions of the complex raises few further
difficulties. The longer an analytic treatment lasts and the more
clearly the patient realizes that distortions of the pathogenic
material cannot by themselves offer any protection against its
being uncovered, the more consistently does he make use of the one
sort of distortion which obviously affords him the greatest
advantages - distortion through transference. These circumstances
tend towards a situation in which finally every conflict has to be
fought out in the sphere of transference.

   Thus transference in the analytic
treatment invariably appears to us in the first instance as the
strongest weapon of the resistance, and we may conclude that the
intensity and persistence of the transference are an effect and an
expression of the resistance. The
mechanism
of transference
is, it is true, dealt with when we have traced it back to the state
of readiness of the libido, which has remained in possession of
infantile imagos; but the part transference plays in the treatment
can only be explained if we enter into its relations with
resistance.

   How does it come about that
transference is so admirably suited to be a means of resistance? It
might be thought that the answer can be given without difficulty.
For it is evident that it becomes particularly hard to admit to any
proscribed wishful impulse if it has to be revealed in front of the
very person to whom the impulse relates. Such a necessity gives
rise to situations which in the real world seem scarcely possible.
But it is precisely this that the patient is aiming at when he
makes the object of his emotional impulses coincide with the
doctor. Further consideration, however, shows that this apparent
gain cannot provide the solution of the problem. Indeed, a relation
of affectionate and devoted dependence can, on the contrary help a
person over all the difficulties of making an admission In
analogous real situations people will usually say: ‘I feel no
shame in front of you: I can say anything to you.’ Thus the
transference to the doctor might just as easily serve to
facilitate
admissions, and it is not clear why it should
make things more difficult.

The Dynamics Of Transference

2462

   The answer to the question which
has been repeated so often in these pages is not to be reached by
further reflection but by what we discover when we examine
individual transference resistances occurring during treatment. We
find in the end that we cannot understand the employment of
transference as resistance so long as we think simply of
‘transference’. We must make up our minds to
distinguish a ‘positive’ transference from a
‘negative’ one, the transference of affectionate
feelings from that of hostile ones, and to treat the two sorts of
transference to the doctor separately. Positive transference is
then further divisible into transference of friendly or
affectionate feelings which are admissible to consciousness and
transference of prolongations of those feelings into the
unconscious. As regards the latter, analysis shows that they
invariably go back to erotic sources. And we are thus led to the
discovery that all the emotional relations of sympathy, friendship,
trust, and the like, which can be turned to good account in our
lives, are genetically linked with sexuality and have developed
from purely sexual desires through a softening of their sexual aim,
however pure and unsensual they may appear to our conscious
self-perception. Originally we knew only sexual objects; and
psycho-analysis shows us that people who in our real life are
merely admired or respected may still be sexual objects for our
unconscious.

   Thus the solution of the puzzle
is that transference to the doctor is suitable for resistance to
the treatment only in so far as it is a negative transference or a
positive transference of repressed erotic impulses. If we
‘remove’ the transference by making it conscious, we
are detaching only these two components of the emotional act from
the person of the doctor; the other component, which is admissible
to consciousness and unobjectionable, persists and is the vehicle
of success in psycho-analysis exactly as it is in other methods of
treatment. To this extent we readily admit that the results of
psycho-analysis rest upon suggestion; by suggestion, however, we
must understand, as Ferenczi (1909) does, the influencing of a
person by means of the transference phenomena which are possible in
his case. We take care of the patient’s final independence by
employing suggestion in order to get him to accomplish a piece of
psychical work which has as its necessary result a permanent
improvement in his psychical situation.

The Dynamics Of Transference

2463

   The further question may be
raised of why it is that the resistance phenomena of transference
only appear in psycho-analysis and not in indifferent forms of
treatment (e.g. in institutions) as well. The reply is that they do
show themselves in these other situations too, but they have to be
recognized as such. The breaking out of a negative transference is
actually quite a common event in institutions. As soon as a patient
comes under the dominance of the negative transference he leaves
the institution in an unchanged or relapsed condition. The erotic
transference does not have such an inhibiting effect in
institutions, since in them, just as in ordinary life, it is
glossed over instead of being uncovered. But it is manifested quite
clearly as a resistance to recovery, not, it is true, by driving
the patient out of the institution - on the contrary, it holds him
back in it - but by keeping him at a distance from life. For, from
the point of view of recovery, it is a matter of complete
indifference whether the patient overcomes this or that anxiety or
inhibition in the institution; what matters is that he shall be
free of it in his real life as well.

   The negative transference
deserves a detailed examination, which it cannot be given within
the limits of the present paper. In the curable forms of
psychoneurosis it is found side by side with the affectionate
transference, often directed simultaneously towards the same
person. Bleuler has coined the excellent term
‘ambivalence’ to describe this phenomenon.¹ Up to
a point, ambivalence of feeling of this sort seems to be normal;
but a high degree of it is certainly a special peculiarity of
neurotic people. In obsessional neurotics an early separation of
the ‘pairs of opposites’ seems to be characteristic of
their instinctual life and to be one of their constitutional
preconditions. Ambivalence in the emotional trends of neurotics is
the best explanation of their ability to enlist their transferences
in the service of resistance. Where the capacity for transference
has become essentially limited to a negative one, as is the case
with paranoics, there ceases to be any possibility of influence or
cure.

  
¹
Bleuler, 1911, 43-4 and 305-6. - Cf. a
lecture on ambivalence delivered by him in Berne in 1910, reported
in the
Zentralblatt für Psychoanalyse
,
1
, 266. -
Stekel has proposed the term ‘bipolarity’ for the same
phenomenon.

The Dynamics Of Transference

2464

   In all these reflections,
however, we have hitherto dealt only with one side of the
phenomenon of transference; we must turn our attention to another
aspect of the same subject. Anyone who forms a correct appreciation
of the way in which a person in analysis, as soon as he comes under
the dominance of any considerable transference-resistance, is flung
out of his real relation to the doctor, how he feels at liberty
then to disregard the fundamental rule of psycho-analysis which
lays it down that whatever comes into one’s head must be
reported without criticizing it, how he forgets the intentions with
which he started the treatment, and how he regards with
indifference logical arguments and conclusions which only a short
time before had made a great impression on him - anyone who has
observed all this will feel it necessary to look for an explanation
of his impression in other factors besides those that have already
been adduced. Nor are such factors far to seek: they arise once
again from the psychological situation in which the treatment
places the patient.

   In the process of seeking out the
libido which has escaped from the patient’s conscious, we
have penetrated into the realm of the unconscious. The reactions
which we bring about reveal at the same time some of the
characteristics which we have come to know from the study of
dreams. The unconscious impulses do not want to be remembered in
the way the treatment desires them to be, but endeavour to
reproduce themselves in accordance with the timelessness of the
unconscious and its capacity for hallucination. Just as happens in
dreams, the patient regards the products of the awakening of his
unconscious impulses as contemporaneous and real; he seeks to put
his passions into action without taking any account of the real
situation. The doctor tries to compel him to fit these emotional
impulses into the nexus of the treatment and of his life-history,
to submit them to intellectual consideration and to understand them
in the light of their psychical value. This struggle between the
doctor and the patient, between intellect and instinctual life,
between understanding and seeking to act, is played out almost
exclusively in the phenomena of transference. It is on that field
that the victory must be won - the victory whose expression is the
permanent cure of the neurosis. It cannot be disputed that
controlling the phenomena of transference presents the
psycho-analyst with the greatest difficulties. But it should not be
forgotten that it is precisely they that do us the inestimable
service of making the patient’s hidden and forgotten erotic
impulses immediate and manifest. For when all is said and done, it
is impossible to destroy anyone
in absentia
or
in
effigie
.

2465

RECOMMENDATIONS TO PHYSICIANS PRACTISING PSYCHO-ANALYSIS

(1912)

2466

Intentionally left blank

2467

RECOMMENDATIONS TO PHYSICIANS PRACTISING PSYCHO-ANALYSIS

The technical rules which I am putting forward
here have been arrived at from my own experience in the course of
many years after unfortunate results had led me to abandon other
methods. It will easily be seen that they (or at least many of
them) may be summed up in a single precept. My hope is that
observance of them will spare physicians practising analysis much
unnecessary effort and guard them against some oversights. I must
however make it clear that what I am asserting is that this
technique is the only one suited to my individuality; I do not
venture to deny that a physician quite differently constituted
might find himself driven to adopt a different attitude to his
patients and to the task before him.

   (
a
) The first problem
confronting an analyst who is treating more than one patient in the
day will seem to him the hardest. It is the task of keeping in mind
all the innumerable names, dates, detailed memories and
pathological products which each patient communicates in the course
of months and years of treatment, and of not confusing them with
similar material produced by other patients under treatment
simultaneously or previously. If one is required to analyse six,
eight, or even more patients daily, the feat of memory involved in
achieving this will provoke incredulity, astonishment or even
commiseration in uninformed observers. Curiosity will in any case
be felt about the technique which makes it possible to master such
an abundance of material, and the expectation will be that some
special expedients are required for the purpose.

   The technique, however, is a very
simple one. As we shall see, it rejects the use of any special
expedient (even that of taking notes). It consists simply in not
directing one’s notice to anything in particular and in
maintaining the same ‘evenly-suspended attention’ (as I
have called it) in the face of all that one hears. In this way we
spare ourselves a strain on our attention which could not in any
case be kept up for several hours daily, and we avoid a danger
which is inseparable from the exercise of deliberate attention. For
as soon as anyone deliberately concentrates his attention to a
certain degree, he begins to select from the material before him;
one point will be fixed in his mind with particular clearness and
some other will be correspondingly disregarded, and in making this
selection he will be following his expectations or inclinations.
This, however, is precisely what must not be done. In making the
selection, if he follows his expectations he is in danger of never
finding anything but what he already knows; and if he follows his
inclinations he will certainly falsify what he may perceive. It
must not be forgotten that the things one hears are for the most
part things whose meaning is only recognized later on.

Recommendations To Physicians Practising Psycho-Analysis

2468

   It will be seen that the rule of
giving equal notice to everything is the necessary counterpart to
the demand made on the patient that he should communicate
everything that occurs to him without criticism or selection. If
the doctor behaves otherwise, he is throwing away most of the
advantage which results from the patient’s obeying the
‘fundamental rule of psycho- analysis’. The rule for
the doctor may be expressed: ‘He should withhold all
conscious influences from his capacity to attend, and give himself
over completely to his "unconscious memory".’ Or,
to put it purely in terms of technique: ‘He should simply
listen, and not bother about whether he is keeping anything in
mind.’

   What is achieved in this manner
will be sufficient for all requirements during the treatment. Those
elements of the material which already form a connected context
will be at the doctor’s conscious disposal; the rest, as yet
unconnected and in chaotic disorder, seems at first to be
submerged, but rises readily into recollection as soon as the
patient brings up something new to which it can be related and by
which it can be continued. The undeserved compliment of having
‘a remarkably good memory’ which the patient pays one
when one reproduces some detail after a year and a day can then be
accepted with a smile, whereas a conscious determination to
recollect the point would probably have resulted in failure.
Mistakes in this process of remembering occur only at times and
places at which one is disturbed by some personal consideration
(see below) - that is, when one has fallen seriously below the
standard of an ideal analyst. Confusion with material brought up by
other patients occurs very rarely. Where there is a dispute with
the patient as to whether or how he has said some particular thing,
the doctor is usually in the right.¹

  
¹
A patient will often assert that he has
already told the doctor something on a previous occasion, while the
doctor can assure him with a quiet feeling of superiority that it
has come up now for the first time. It then turns out that the
patient had previously had the intention of saying it, but had been
prevented from performing his intention by a resistance which was
still present. His recollection of his intention is
indistinguishable to him from a recollection of its
performance.

Recommendations To Physicians Practising Psycho-Analysis

2469

   (
b
) I cannot advise the
taking of full notes, the keeping of a shorthand record, etc.,
during analytic sessions. Apart from the unfavourable impression
which this makes on some patients, the same considerations as have
been advanced with regard to attention apply here too. A
detrimental selection from the material will necessarily be made as
one writes the notes or shorthand, and part of one’s own
mental activity is tied up in this way, which would be better
employed in interpreting what one has heard. No objection can be
raised to making exceptions to this rule in the case of dates, the
text of dreams, or particular noteworthy events which can easily be
detached from their context and are suitable for independent use as
instances. But I am not in the habit of doing this either. As
regards instances, I write them down from memory in the evening
after work is over; as regards texts of dreams to which I attach
importance, I get the patient to repeat them to me after he has
related them so that I can fix them in my mind.

   (
c
) Taking notes during
the session with the patient might be justified by an intention of
publishing a scientific study of the case. On general grounds this
can scarcely be denied. Nevertheless it must be borne in mind that
exact reports of analytic case histories are of less value than
might be expected. Strictly speaking, they only possess the
ostensible
exactness of which ‘modern’
psychiatry affords us some striking examples. They are, as a rule,
fatiguing to the reader and yet do not succeed in being a
substitute for his actual presence at an analysis. Experience
invariably shows that if readers are willing to believe an analyst
they will have confidence in any slight revision to which he has
submitted his material; if, on the other hand, they are unwilling
to take analysis and the analyst seriously, they will pay no
attention to accurate verbatim records of the treatment either.
This is not the way, it seems, to remedy the lack of convincing
evidence to be found in psycho-analytic reports.

   (
d
) One of the claims of
psycho-analysis to distinction is, no doubt, that in its execution
research and treatment coincide; nevertheless, after a certain
point, the technique required for the one opposes that required for
the other. It is not a good thing to work on a case scientifically
while treatment is still proceeding - to piece together its
structure, to try to foretell its further progress, and to get a
picture from time to time of the current state of affairs, as
scientific interest would demand. Cases which are devoted from the
first to scientific purposes and are treated accordingly suffer in
their outcome; while the most successful cases are those in which
one proceeds, as it were, without any purpose in view, allows
oneself to be taken by surprise by any new turn in them, and always
meets them with an open mind, free from any presuppositions. The
correct behaviour for an analyst lies in swinging over according to
need from the one mental attitude to the other, in avoiding
speculation or brooding over cases while they are in analysis, and
in submitting the material obtained to a synthetic process of
thought only after the analysis is concluded. The distinction
between the two attitudes would be meaningless if we already
possessed all the knowledge (or at least the essential knowledge)
about the psychology of the unconscious and about the structure of
the neuroses that we can obtain from psycho-analytic work. At
present we are still far from that goal and we ought not to cut
ourselves off from the possibility of testing what we have already
learnt and of extending our knowledge further.

Recommendations To Physicians Practising Psycho-Analysis

2470

   (
e
) I cannot advise my
colleagues too urgently to model themselves during psycho-analytic
treatment on the surgeon, who puts aside all his feelings, even his
human sympathy, and concentrates his mental forces on the simple
aim of performing the operation as skilfully as possible. Under
present-day conditions the feeling that is most dangerous to a
psycho-analyst is the therapeutic ambition to achieve by this novel
and much disputed method something that will produce a convincing
effect upon other people. This will not only put him into a state
of mind which is unfavourable for his work, but will make him
helpless against certain resistances of the patient, whose
recovery, as we know, primarily depends on the interplay of forces
in him. The justification for requiring this emotional coldness in
the analyst is that it creates the most advantageous conditions for
both parties: for the doctor a desirable protection for his own
emotional life and for the patient the largest amount of help that
we can give him to-day. A surgeon of earlier times took as his
motto the words: ‘Je le pansai, Dieu le
guérit.’¹ The analyst should be content with
something similar.

   (
f
) It is easy to see upon
what aim the different rules I have brought forward converge. They
are all intended to create for the doctor a counterpart to the
‘fundamental rule of psycho-analysis’ which is laid
down for the patient. Just as the patient must relate everything
that his self-observation can detect, and keep back all the logical
and affective objections that seek to induce him to make a
selection from among them, so the doctor must put himself in a
position to make use of everything he is told for the purposes of
interpretation and of recognizing the concealed unconscious
material without substituting a censorship of his own for the
selection that the patient has forgone. To put it in a formula: he
must turn his own unconscious like a receptive organ towards the
transmitting unconscious of the patient. He must adjust himself to
the patient as a telephone receiver is adjusted to the transmitting
microphone. Just as the receiver converts back into sound waves the
electric oscillations in the telephone line which were set up by
sound waves, so the doctor’s unconscious is able, from the
derivatives of the unconscious which are communicated to him, to
reconstruct that unconscious, which has determined the
patient’s free associations.

  
¹
[‘I dressed his wounds, God cured
him.’]

Recommendations To Physicians Practising Psycho-Analysis

2471

   But if the doctor is to be in a
position to use his unconscious in this way as an instrument in the
analysis, he must himself fulfil one psychological condition to a
high degree. He may not tolerate any resistances in himself which
hold back from his consciousness what has been perceived by his
unconscious; otherwise he would introduce into the analysis a new
species of selection and distortion which would be far more
detrimental than that resulting from concentration of conscious
attention. It is not enough for this that he himself should be an
approximately normal person. It may be insisted, rather, that he
should have undergone a psycho-analytic purification and have
become aware of those complexes of his own which would be apt to
interfere with his grasp of what the patient tells him. There can
be no reasonable doubt about the disqualifying effect of such
defects in the doctor; every unresolved repression in him
constitutes what has been aptly described by Stekel as a
‘blind spot’ in his analytic perception.

   Some years ago I gave as an
answer to the question of how one can become an analyst: ‘By
analysing one’s own dreams.’ This preparation is no
doubt enough for many people, but not for everyone who wishes to
learn analysis. Nor can everyone succeed in interpreting his own
dreams without outside help. I count it as one of the many merits
of the Zurich school of analysis that they have laid increased
emphasis on this requirement, and have embodied it in the demand
that everyone who wishes to carry out analyses on other people
shall first himself undergo an analysis by someone with expert
knowledge. Anyone who takes up the work seriously should choose
this course, which offers more than one advantage; the sacrifice
involved in laying oneself open to another person without being
driven to it by illness is amply rewarded. Not only is one’s
aim of learning to know what is hidden in one’s own mind far
more rapidly attained and with less expense of affect, but
impressions and convictions will be gained in relation to oneself
which will be sought in vain from studying books and attending
lectures. And lastly, we must not under-estimate the advantage to
be derived from the lasting mental contact that is as a rule
established between the student and his guide.