Freud - Complete Works (422 page)

  
¹
Much might be said about our experiences
with the fundamental rule of psycho-analysis. One occasionally
comes across people who behave as if they had made this rule for
themselves. Others offend against it from the very beginning. It is
indispensable, and also advantageous, to lay down the rule in the
first stages of the treatment. Later, under the dominance of the
resistances, obedience to it weakens, and there comes a time in
every analysis when the patient disregards it. We must remember
from our own self-analysis how irresistible the temptation is to
yield to these pretexts put forward by critical judgement for
rejecting certain ideas. How small is the effect of such agreements
as one makes with the patient in laying down the fundamental rule
is regularly demonstrated when something intimate about a third
person comes up in his mind for the first time. He knows that he is
supposed to say everything, but he turns discretion about other
people into a new obstacle! ‘Must I really say everything? I
thought that only applied to things that concern myself.’ It
is naturally impossible to carry out analysis if the
patient’s relations with other people and his thoughts about
them are excluded.
Pour faire une omelette il faut casser des
oeufs
. An honourable man readily forgets such of the private
affairs of strangers as do not seem to him important to know. Nor
can an exception be made in the case of names. Otherwise the
patient’s narratives became a little shadowy, like the scenes
in Goethe’s play
Die natürliche Tochter
[
The
Natural Daughter
], and do not lodge in the doctor’s
memory. Moreover, the names that are withheld screen the approach
to all sorts of important connections. But one may perhaps allow
names to be left on one side until the patient has become more
familiar with the doctor and the procedure of analysis. It is very
remarkable how the whole task becomes impossible if a reservation
is allowed at any single place. But we have only to reflect what
would happen if the right of asylum existed at any one point in a
town; how long would it be before all the riff-raff of the town had
collected there? I once treated a high official who was bound by
his oath of office not to communicate certain things because they
were state secrets, and the analysis came to grief as a consequence
of this restriction. Psycho-analytic treatment must have no regard
for any consideration, because the neurosis and its resistances are
themselves without any such regard.

On Beginning The Treatment

2489

   Patients who date their illness
from a particular moment usually concentrate upon its precipitating
cause. Others, who themselves recognize the connection between
their neurosis and their childhood, often begin with an account of
their whole life-history. A systematic narrative should never be
expected and nothing should be done to encourage it. Every detail
of the story will have to be told afresh later on, and it is only
with these repetitions that additional material will appear which
will supply the important connections that are unknown to the
patient.

   There are patients who from the
very first hours carefully prepare what they are going to
communicate, ostensibly so as to be sure of making better use of
the time devoted to the treatment. What is thus disguising itself
as eagerness is resistance. Any preparation of this sort should be
disrecommended, for it is only employed to guard against unwelcome
thoughts cropping up.¹ However genuinely the patient may
believe in his excellent intentions, the resistance will play its
part in this deliberate method of preparation and will see to it
that the most valuable material escapes communication. One will
soon find that the patient devises yet other means by which what is
required may be withheld from the treatment. He may talk over the
treatment every day with some intimate friend, and bring into this
discussion all the thoughts which should come forward in the
presence of the doctor. The treatment thus has a leak which lets
through precisely what is most valuable. When this happens, the
patient must, without much delay, be advised to treat his analysis
as a matter between himself and his doctor and to exclude everyone
else from sharing in the knowledge of it, no matter how close to
him they may be, or how inquisitive. In later stages of the
treatment the patient is usually not subjected to temptations of
this sort.

   Certain patients want their
treatment to be kept secret, often because they have kept their
neurosis secret; and I put no obstacle in their way. That in
consequence the world hears nothing of some of the most successful
cures is, of course, a consideration that cannot be taken into
account. It is obvious that a patient’s decision in favour of
secrecy already reveals a feature of his secret history.

  
¹
Exceptions may be made only for such data
as family relationships, times and places of residence, operations,
and so on.

On Beginning The Treatment

2490

   In advising the patient at the
beginning of the treatment to tell as few people as possible about
it, we also protect him to some extent from the many hostile
influences that will seem to entice him away from analysis. Such
influences may be very mischievous at the outset of the treatment;
later, they are usually immaterial, or even useful in bringing to
the fore resistances which are trying to conceal themselves.

   If during the course of the
analysis the patient should temporarily need some other medical or
specialist treatment, it is far wiser to call in a non-analytic
colleague than to give this other treatment oneself. Combined
treatments for neurotic disorders which have a powerful organic
basis are nearly always impracticable. The patients withdraw their
interest from analysis as soon as they are shown more than one path
that promises to lead them to health. The best plan is to postpone
the organic treatment until the psychical treatment is finished; if
the former were tried first it would in most cases meet with no
success.

   To return to the beginning of the
treatment. Patients are occasionally met with who start the
treatment by assuring us that they cannot think of anything to say,
although the whole field of their life-history and the story of
their illness is open to them to choose from. Their request that we
should tell them what to talk about must not be granted on this
first occasion any more than on any later one. We must bear in mind
what is involved here. A strong resistance has come to the front in
order to defend the neurosis; we must take up the challenge then
and there and come to grips with it. Energetic and repeated
assurances to the patient that it is impossible for no ideas at all
to occur to him at the beginning, and that what is in question is a
resistance against the analysis, soon oblige him to make the
expected admissions or to uncover a first piece of his complexes.
It is a bad sign if he has to confess that while he was listening
to the fundamental rule of analysis he made a mental reservation
that he would nevertheless keep this or that to himself; it is not
so serious if all he has to tell us is how mistrustful he is of
analysis or the horrifying things he has heard about it. If he
denies these and similar possibilities when they are put before
him, he can be driven by our insistence to acknowledge that he has
nevertheless overlooked certain thoughts which were occupying his
mind. He had thought of the treatment itself, though nothing
definite about it, or he had been occupied with the picture of the
room in which he was, or he could not help thinking of the objects
in the consulting room and of the fact that he was lying here on a
sofa - all of which he has replaced by the word
‘nothing’. These indications are intelligible enough:
everything connected with the present situation represents a
transference to the doctor, which proves suitable to serve as a
first resistance. We are thus obliged to begin by uncovering this
transference; and a path from it will give rapid access to the
patient’s pathogenic material. Women who are prepared by
events in their past history to be subjected to sexual aggression
and men with over-strong repressed homosexuality are the most apt
thus to withhold the ideas that occur to them at the outset of
their analysis.

   The patient’s first
symptoms or chance actions, like his first resistance, may possess
a special interest and may betray a complex which governs his
neurosis. A clever young philosopher with exquisite aesthetic
sensibilities will hasten to put the creases of his trousers
straight before lying down for his first hour; he is revealing
himself as a former coprophilic of the highest refinement - which
was to be expected from the later aesthete. A young girl will at
the same juncture hurriedly pull the hem of her skirt over her
exposed ankles; in doing this she is giving away the gist of what
her analysis will uncover later: her narcissistic pride in her
physical beauty and her inclinations to exhibitionism.

On Beginning The Treatment

2491

   A particularly large number of
patients object to being asked to lie down, while the doctor sits
out of sight behind them. They ask to be allowed to go through the
treatment in some other position, for the most part because they
are anxious not to be deprived of a view of the doctor. Permission
is regularly refused, but one cannot prevent them from contriving
to say a few sentences before the beginning of the actual
‘session’ or after one has signified that it is
finished and they have got up from the sofa. In this way they
divide the treatment in their own view into an official portion, in
which they mostly behave in a very inhibited manner, and an
informal ‘friendly’ portion, in which they speak really
freely and say all sorts of things which they themselves do not
regard as being part of the treatment. The doctor does not accept
this division for long. He takes note of what is said before or
after the session and he brings it forward at the first
opportunity, thus pulling down the partition which the patient has
tried to erect. This partition, once again, will have been put
together from the material of a transference-resistance.

  
So long as the patient’s
communications and ideas run on without any obstruction, the theme
of transference should be left untouched
. One must wait until
the transference, which is the most delicate of all procedures, has
become a resistance.

   The next question with which we
are faced raises a matter of principle. It is this: When are we to
begin making our communications to the patient? When is the moment
for disclosing to him the hidden meaning of the ideas that occur to
him, and for initiating him into the postulates and technical
procedures of analysis?

   The answer to this can only be:
Not until an effective transference has been established in the
patient, a proper
rapport
with him. It remains the first aim
of the treatment to attach him to it and to the person of the
doctor. To ensure this, nothing need be done but to give him time.
If one exhibits a serious interest in him, carefully clears away
the resistances that crop up at the beginning and avoids making
certain mistakes, he will of himself form such an attachment and
link the doctor up with one of the imagos of the people by whom he
was accustomed to be treated with affection. It is certainly
possible to forfeit this first success if from the start one takes
up any standpoint other than one of sympathetic understanding, such
as a moralizing one, or if one behaves like a representative or
contending party - of the other member of a married couple, for
instance.

On Beginning The Treatment

2492

   This answer of course involves a
condemnation of any line of behaviour which would lead us to give
the patient a translation of his symptoms as soon as we have
guessed it ourselves, or would even lead us to regard it as a
special triumph to fling these ‘solutions’ in his face
at the first interview. It is not difficult for a skilled analyst
to read the patient’s secret wishes plainly between the lines
of his complaints and the story of his illness; but what a measure
of self-complacency and thoughtlessness must be possessed by anyone
who can, on the shortest acquaintance, inform a stranger who is
entirely ignorant of all the tenets of analysis that he is attached
to his mother by incestuous ties, that he harbours wishes for the
death of his wife whom he appears to love, that he conceals an
intention of betraying his superior, and so on! I have heard that
there are analysts who plume themselves upon these kinds of
lightning diagnoses and ‘express’ treatments, but I
must warn everyone against following such examples. Behaviour of
this sort will completely discredit oneself and the treatment in
the patient’s eyes and will arouse the most violent
opposition in him, whether one’s guess has been true or not;
indeed, the truer the guess the more violent will be the
resistance. As a rule the therapeutic effect will be nil; but the
deterring of the patient from analysis will be final. Even in the
later stages of analysis one must be careful not to give a patient
the solution of a symptom or the translation of a wish until he is
already so close to it that he has only one short step more to make
in order to get hold of the explanation for himself. In former
years I often had occasion to find that the premature communication
of a solution brought the treatment to an untimely end, on account
not only of the resistances which it thus suddenly awakened but
also of the relief which the solution brought with it.