Freud - Complete Works (423 page)
But at this point an objection
will be raised. Is it, then, our task to lengthen the treatment and
not, rather, to bring it to an end as rapidly as possible? Are not
the patient’s ailments due to his lack of knowledge and
understanding and is it not a duty to enlighten him as soon as
possible - that is, as soon as the doctor himself knows the
explanations? The answer to this question calls for a short
digression on the meaning of knowledge and the mechanism of cure in
analysis.
On Beginning The Treatment
2493
It is true that in the earliest
days of analytic technique we took an intellectualist view of the
situation. We set a high value on the patient’s knowledge of
what he had forgotten, and in this we made hardly any distinction
between our knowledge of it and his. We thought it a special piece
of good luck if we were able to obtain information about the
forgotten childhood trauma from other sources - for instance, from
parents or nurses or the seducer himself - as in some cases it was
possible to do; and we hastened to convey the information and the
proofs of its correctness to the patient, in the certain
expectation of thus bringing the neurosis and the treatment to a
rapid end. It was a severe disappointment when the expected success
was not forthcoming. How could it be that the patient, who now knew
about his traumatic experience, nevertheless still behaved as if he
knew no more about it than before? Indeed, telling and describing
his repressed trauma to him did not even result in any recollection
of it coming into his mind.
In one particular case the mother
of a hysterical girl had confided to me the homosexual experience
which had greatly contributed to the fixation of the girl’s
attacks. The mother had herself surprised the scene; but the
patient had completely forgotten it, though it had occurred when
she was already approaching puberty. I was now able to make a most
instructive observation. Every time I repeated her mother’s
story to the girl she reacted with a hysterical attack, and after
this she forgot the story once more. There is no doubt that the
patient was expressing a violent resistance against the knowledge
that was being forced upon her. Finally she simulated
feeble-mindedness and a complete loss of memory in order to protect
herself against what I had told her. After this, there was no
choice but to cease attributing to the fact of knowing, in itself,
the importance that had previously been given to it and to place
the emphasis on the resistances which had in the past brought about
the state of not knowing and which were still ready to defend that
state. Conscious knowledge, even if it was not subsequently driven
out again, was powerless against those resistances.
On Beginning The Treatment
2494
The strange behaviour of
patients, in being able to combine a conscious knowing with not
knowing, remains inexplicable by what is called normal psychology.
But to psycho-analysis, which recognizes the existence of the
unconscious, it presents no difficulty. The phenomenon we have
described, moreover, provides some of the best support for a view
which approaches mental processes from the angle of topographical
differentiation. The patients now know of the repressed experience
in their conscious thought, but this thought lacks any connection
with the place where the repressed recollection is in some way or
other contained. No change is possible until the conscious
thought-process has penetrated to that place and has overcome the
resistances of repression there. It is just as though a decree were
promulgated by the Ministry of Justice to the effect that juvenile
delinquencies should be dealt with in a certain lenient manner. As
long as this decree has not come to the knowledge of the local
magistrates, or in the event of their not intending to obey it but
preferring to administer justice by their own lights, no change can
occur in the treatment of particular youthful delinquents. For the
sake of complete accuracy, however, it should be added that the
communication of repressed material to the patient’s
consciousness is nevertheless not without effect. It does not
produce the hoped-for result of putting an end to the symptoms; but
it has other consequences. At first it arouses resistances, but
then, when these have been overcome, it sets up a process of
thought in the course of which the expected influencing of the
unconscious recollection eventually takes place.
It is now time for us to take a
survey of the play of forces which is set in motion by the
treatment. The primary motive force in the therapy is the
patient’s suffering and the wish to be cured that arises from
it. The strength of this motive force is subtracted from by various
factors - which are not discovered till the analysis is in progress
- above all, by what we have called the ‘secondary gain from
illness’; but it must be maintained till the end of the
treatment. Every improvement effects a diminution of it. By itself,
however, this motive force is not sufficient to get rid of the
illness. Two things are lacking in it for this: it does not know
what paths to follow to reach this end; and it does not possess the
necessary quota of energy with which to oppose the resistances. The
analytic treatment helps to remedy both these deficiencies. It
supplies the amounts of energy that are needed for overcoming the
resistances by making mobile the energies which lie ready for the
transference; and, by giving the patient information at the right
time, it shows him the paths along which he should direct those
energies. Often enough the transference is able to remove the
symptoms of the disease by itself, but only for a while - only for
as long as it itself lasts. In this case the treatment is a
treatment by suggestion, and not a psycho-analysis at all. It only
deserves the latter name if the intensity of the transference has
been utilized for the overcoming of resistances. Only then has
being ill become impossible, even when the transference has once
more been dissolved, which is its destined end.
On Beginning The Treatment
2495
In the course of the treatment
yet another helpful factor is aroused. This is the patient’s
intellectual interest and understanding. But this alone hardly
comes into consideration in comparison with the other forces that
are engaged in the struggle; for it is always in danger of losing
its value, as a result of the clouding of judgement that arises
from the resistances. Thus the new sources of strength for which
the patient is indebted to his analyst are reducible to
transference and instruction (through the communications made to
him). The patient, however, only makes use of the instruction in so
far as he is induced to do so by the transference; and it is for
this reason that our first communication should be withheld until a
strong transference has been established. And this, we may add,
holds good of every subsequent communication. In each case we must
wait until the disturbance of the transference by the successive
emergence of transference-resistances has been removed.
2496
REMEMBERING, REPEATING AND WORKING-THROUGH
(FURTHER RECOMMENDATIONS ON THE TECHNIQUE
OF PSYCHO-ANALYSIS II)
(1914)
2497
Intentionally left blank
2498
REMEMBERING, REPEATING AND WORKING-THROUGH
(FURTHER RECOMMENDATIONS ON THE TECHNIQUE
OF PSYCHO-ANALYSIS II)
It seems to me not unnecessary to keep on
reminding students of the far-reaching changes which
psycho-analytic technique has undergone since its first beginnings.
In its first phase - that of Breuer’s catharsis - it
consisted in bringing directly into focus the moment at which the
symptom was formed, and in persistently endeavouring to reproduce
the mental processes involved in that situation, in order to direct
their discharge along the path of conscious activity. Remembering
and abreacting, with the help of the hypnotic state, were what was
at that time aimed at. Next, where hypnosis had been given up, the
task became one of discovering from the patient’s free
associations what he failed to remember. The resistance was to be
circumvented by the work of interpretation and by making its
results known to the patient. The situations which had given rise
to the formation of the symptom and the other situations which lay
behind the moment at which the illness broke out retained their
place as the focus of interest; but the element of abreaction
receded into the background and seemed to be replaced by the
expenditure of work which the patient had to make in being obliged
to overcome his criticism of his free associations, in accordance
with the fundamental rule of psycho-analysis. Finally, there was
evolved the consistent technique used to-day, in which the analyst
gives up the attempt to bring a particular moment or problem into
focus. He contents himself with studying whatever is present for
the time being on the surface of the patient’s mind, and he
employs the art of interpretation mainly for the purpose of
recognizing the resistances which appear there, and making them
conscious to the patient. From this there results a new sort of
division of labour: the doctor uncovers the resistances which are
unknown to the patient; when these have been got the better of, the
patient often relates the forgotten situations and connections
without any difficulty. The aim of these different techniques has,
of course, remained the same. Descriptively speaking, it is to fill
in gaps in memory; dynamically speaking, it is to overcome
resistances due to repression.
Remembering, Repeating And Working-Through
2499
We must still be grateful to the
old hypnotic technique for having brought before us single
psychical processes of analysis in an isolated or schematic form.
Only this could have given us the courage ourselves to create more
complicated situations in the analytic treatment and to keep them
clear before us.
In these hypnotic treatments the
process of remembering took a very simple form. The patient put
himself back into an earlier situation, which he seemed never to
confuse with the present one, and gave an account of the mental
processes belonging to it, in so far as they had remained normal;
he then added to this whatever was able to emerge as a result of
transforming the processes that had at the time been unconscious
into conscious ones.
At this point I will interpolate
a few remarks which every analyst has found confirmed in his
observations. Forgetting impressions, scenes or experiences nearly
always reduces itself to shutting them off. When the patient talks
about these ‘forgotten’ things he seldom fails to add:
‘As a matter of fact I’ve always known it; only
I’ve never thought of it.’ He often expresses
disappointment at the fact that not enough things come into his
head that he can call ‘forgotten’ - that he has never
thought of since they happened. Nevertheless, even this desire is
fulfilled, especially in the case of conversion hysterias.
‘Forgetting’ becomes still further restricted when we
assess at their true value the screen memories which are so
generally present. In some cases I have had an impression that the
familiar childhood amnesia, which is theoretically so important to
us, is completely counterbalanced by screen memories. Not only
some
but
all
of what is essential from childhood has
been retained in these memories. It is simply a question of knowing
how to extract it out of them by analysis. They represent the
forgotten years of childhood as adequately as the manifest content
of a dream represents the dream-thoughts.
Remembering, Repeating And Working-Through
2500
The other group of psychical
processes - phantasies, processes of reference, emotional impulses,
thought-connections - which, as purely internal acts, can be
contrasted with impressions and experiences, must, in their
relation to forgetting and remembering, be considered separately.
In these processes it particularly often happens that something is
‘remembered’ which could never have been
‘forgotten’ because it was never at any time noticed -
was never conscious. As regards the course taken by psychical
events it seems to make no difference whatever whether such a
‘thought-connection’ was conscious and then forgotten
or whether it never managed to become conscious at all. The
conviction which the patient obtains in the course of his analysis
is quite independent of this kind of memory.
In the many different forms of
obsessional neurosis in particular, forgetting is mostly restricted
to dissolving thought-connections, failing to draw the right
conclusions and isolating memories.
There is one special class of
experiences of the utmost importance for which no memory can as a
rule be recovered. These are experiences which occurred in very
early childhood and were not understood at the time but which were
subsequently
understood and interpreted. One gains a
knowledge of them through dreams and one is obliged to believe in
them on the most compelling evidence provided by the fabric of the
neurosis. Moreover, we can ascertain for ourselves that the
patient, after his resistances have been overcome, no longer
invokes the absence of any memory of them (any sense of familiarity
with them) as a ground for refusing to accept them. This matter,
however, calls for so much critical caution and introduces so much
that is novel and startling that I shall reserve it for a separate
discussion in connection with suitable material.
Remembering, Repeating And Working-Through
2501
Under the new technique very
little, and often nothing, is left of this delightfully smooth
course of events. There are some cases which behave like those
under the hypnotic technique up to a point and only later cease to
do so; but others behave differently from the beginning. If we
confine ourselves to this second type in order to bring out the
difference, we may say that the patient does not
remember
anything of what he has forgotten and repressed, but
acts
it
out. He reproduces it not as a memory but as an action; he
repeats
it, without, of course, knowing that he is repeating
it.
For instance, the patient does
not say that he remembers that he used to be defiant and critical
towards his parents’ authority; instead, he behaves in that
way to the doctor. He does not remember how he came to a helpless
and hopeless deadlock in his infantile sexual researches; but he
produces a mass of confused dreams and associations, complains that
he cannot succeed in anything and asserts that he is fated never to
carry through what he undertakes. He does not remember having been
intensely ashamed of certain sexual activities and afraid of their
being found out; but he makes it clear that he is ashamed of the
treatment on which he is now embarked and tries to keep it secret
from everybody. And so on.
Above all, the patient will
begin
his treatment with a repetition of this kind. When one
has announced the fundamental rule of psycho-analysis to a patient
with an eventful life-history and a long story of illness and has
then asked him to say what occurs to his mind, one expects him to
pour out a flood of information; but often the first thing that
happens is that he has nothing to say. He is silent and declares
that nothing occurs to him. This, of course, is merely a repetition
of a homosexual attitude which comes to the fore as a resistance
against remembering anything. As long as the patient is in the
treatment he cannot escape from this compulsion to repeat; and in
the end we understand that this is his way of remembering.
Remembering, Repeating And Working-Through
2502
What interests us most of all is
naturally the relation of this compulsion to repeat to the
transference and to resistance. We soon perceive that the
transference is itself only a piece of repetition, and that the
repetition is a transference of the forgotten past not only on to
the doctor but also on to all the other aspects of the current
situation. We must be prepared to find, therefore, that the patient
yields to the compulsion to repeat, which now replaces the
impulsion to remember, not only in his personal attitude to his
doctor but also in every other activity and relationship which may
occupy his life at the time - if, for instance, he falls in love or
undertakes a task or starts an enterprise during the treatment. The
part played by resistance, too, is easily recognized. The greater
the resistance, the more extensively will acting out (repetition)
replace remembering. For the ideal remembering of what has been
forgotten which occurs in hypnosis corresponds to a state in which
resistance has been put completely on one side. If the patient
starts his treatment under the auspices of a mild and unpronounced
positive transference it makes it possible at first for him to
unearth his memories just as he would under hypnosis, and during
this time his pathological symptoms themselves are quiescent. But
if, as the analysis proceeds, the transference becomes hostile or
unduly intense and therefore in need of repression, remembering at
once gives way to acting out. From then onwards the resistances
determine the sequence of the material which is to be repeated. The
patient brings out of the armoury of the past the weapons with
which he defends himself against the progress of the treatment -
weapons which we must wrest from him one by one.
We have learnt that the patient
repeats instead of remembering, and repeats under the conditions of
resistance. We may now ask what it is that he in fact repeats or
acts out. The answer is that he repeats everything that has already
made its way from the sources of the repressed into his manifest
personality - his inhibitions and unserviceable attitudes and his
pathological character-traits. He also repeats all his symptoms in
the course of the treatment. And now we can see that in drawing
attention to the compulsion to repeat we have acquired no new fact
but only a more comprehensive view. We have only made it clear to
ourselves that the patient’s state of being ill cannot cease
with the beginning of his analysis, and that we must treat his
illness, not as an event of the past, but as a present-day force.
This state of illness is brought, piece by piece, within the field
and range of operation of the treatment, and while the patient
experiences it as something real and contemporary, we have to do
our therapeutic work on it, which consists in a large measure in
tracing it back to the past.
Remembering, Repeating And Working-Through
2503
Remembering, as it was induced in
hypnosis, could not but give the impression of an experiment
carried out in the laboratory. Repeating, as it is induced in
analytic treatment according to the newer technique, on the other
hand, implies conjuring up a piece of real life; and for that
reason it cannot always be harmless and unobjectionable. This
consideration opens up the whole problem of what is so often
unavoidable - ‘deterioration during treatment’.
First and foremost, the
initiation of the treatment in itself brings about a change in the
patient’s conscious attitude to his illness. He has usually
been content with lamenting it, despising it as nonsensical and
under-estimating its importance; for the rest, he has extended to
its manifestations the ostrich-like policy of repression which he
adopted towards its origins. Thus it can happen that he does not
properly know under what conditions his phobia breaks out or does
not listen to the precise wording of his obsessional ideas or does
not grasp the actual purpose of his obsessional impulse. The
treatment, of course, is not helped by this. He must find the
courage to direct his attention to the phenomena of his illness.
His illness itself must no longer seem to him contemptible, but
must become an enemy worthy of his mettle, a piece of his
personality, which has solid ground for its existence and out of
which things of value for his future life have to be derived. The
way is thus paved from the beginning for a reconciliation with the
repressed material which is coming to expression in his symptoms,
while at the same time place is found for a certain tolerance for
the state of being ill. If this new attitude towards the illness
intensifies the conflicts and brings to the fore symptoms which
till then had been indistinct, one can easily console the patient
by pointing out that these are only necessary and temporary
aggravations and that one cannot overcome an enemy who is absent or
not within range. The resistance, however, may exploit the
situation for its own ends and abuse the licence to be ill. It
seems to say: ‘See what happens if I really give way to such
things. Was I not right to consign them to repression?’ Young
and childish people in particular are inclined to make the
necessity imposed by the treatment for paying attention to their
illness a welcome excuse for luxuriating in their symptoms.
