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Articles- Part XX
The Nature of the Therapeutic Action of Psycho-Analysis
James Strachey (1934)
INTRODUCTORY
It was as a therapeutic procedure that psycho-analysis originated.
It is in the main as a therapeutic agency that it exists to-day. We
may well be surprised, therefore, at the relatively small proportion
of psycho-analytical literature which has been concerned with the
mechanisms by which its therapeutic effects are achieved. A very considerable
quantity of data have been accumulated in the course of the last thirty
or forty years which throw light upon the nature and workings of the
human mind; perceptible progress has been made in the task of classifying
and subsuming such data into a body of generalized hypotheses or scientific
laws. But there has been a remarkable hesitation in applying these
findings in any great detail to the therapeutic process itself. I
cannot help feeling that this hesitation has been responsible for
the fact that so many discussions upon the practical details of analytic
technique seem to leave us at cross-purposes and at an inconclusive
end. How, for instance, can we expect to agree upon the vexed question
of whether and when we should give a `deep interpretation', while
we have no clear idea of what we mean by a `deep interpretation',
while, indeed, we have no exactly formulated view of the concept of
`interpretation' itself, no precise knowledge of what `interpretation'
is and what effect it has upon our patients? We should gain much,
I think, from a clearer grasp of problems such as this. If we could
arrive at a more detailed understanding of the workings of the therapeutic
process we should be less prone to those occasional feelings of utter
disorientation which few analysts are fortunate enough to escape;
and the analytic movement itself might be less at the mercy of proposals
for abrupt alterations in the ordinary technical procedure-proposals
which derive much of their strength from the prevailing uncertainty
as to the exact nature of the analytic therapy. My present paper is
a tentative attack upon this problem; and even though it should turn
out that its very doubtful conclusions cannot be maintained, I shall
be satisfied if I have drawn attention to the urgency of the problem
itself. I am most anxious, however, to make it clear that what follows
is not a practical discussion upon psychoanalytic technique. Its immediate
bearings are merely theoretical. I have taken as my raw material the
various sorts of procedures which (in spite of very considerable individual
deviations) would be generally regarded as within the limits of `orthodox'
psycho-analysis and the various sorts of effects which observation
shows that the application of such procedures tends to bring about;
I have set up a hypothesis which endeavours to explain more or less
coherently why these particular procedures bring about these particular
effects; and I have tried to show that, if my hypothesis about the
nature of the therapeutic action of psycho-analysis is valid, certain
implications follow from it which might perhaps serve as criteria
in forming a judgment of the probable effectiveness of any particular
type of procedure.
RETROSPECT
It will be objected, no doubt, that I have exaggerated the novelty
of my topic. (1) `After all', it will be said, `we (to understand
and have long understood the main principles that govern the therapeutic
action of analysis'. And to this, of course, I entirely agree; indeed
I propose to begin what I have to say by summarizing as shortly as
possible the accepted views upon the subject. For this purpose I must
go back to the period between the years 1912 and 1917 during which
Freud gave us the greater part of what he has written directly on
the therapeutic side of psycho-analysis, namely the series of papers
on technique (2) and the twenty-seventh and twenty-eighth chapters
of the Introductory Lectures.
'RESISTANCE ANALYSIS'
This period was characterized by the systematic application of the
method known as `resistance analysis'. The method in question was
by no means a new one even at that time, and it was based upon ideas
which had long been implicit in analytical theory, and in particular
upon one of the earliest of Freud's views of the function of neurotic
symptoms. According to that view (which was derived essentially from
the study of hysteria) the function of the neurotic symptom was to
defend the patient's personality against an unconscious trend of thought
that was unacceptable to it, while at the same time gratifying the
trend up to a certain point. It seemed to follow, therefore, that
if the analyst were to investigate and discover the unconscious trend
and make the patient aware of it--if he were to make what was unconscious
conscious--the whole raison d'etre of the symptom would cease and
it must automatically disappear. Two difficulties arose, however.
In the first place some part of the patient's mind was found to raise
obstacles to the process, to offer resistance to the analyst when
he tried to discover the unconscious trend; and it was easy to conclude
that this was the same part of the patient's mind as had originally
repudiated the unconscious trend and had thus necessitated the creation
of the symptom. But, in the second place, even when this obstacle
seemed to be surmounted, even when the analyst had succeeded in guessing
or deducing the nature of the unconscious trend, had drawn the patient's
attention to it and had apparently made him fully aware of it--even
then it would often happen that the symptom persisted unshaken. The
realization of these difficulties led to important results both theoretically
and practically. Theoretically, it became evident that there were
two senses in which a patient could become conscious of an unconscious
trend; he could be made aware of it by the analyst in some intellectual
sense without becoming `really' conscious of it. To make this state
of things more intelligible, Freud devised a kind of pictorial allegory.
He imagined the mind as a kind of map. The original objectionable
trend was pictured as being located in one region of this map and
the newly discovered information about it, communicated to the patient
by the analyst, in another. It was only if these two impressions could
be `brought together' (whatever exactly that might mean) that the
unconscious trend would be `really' made conscious. What prevented
this from happening was a force within the patient, a barrier once
again, evidently, the same `resistance' which had opposed the analyst's
attempts at investigating the unconscious trend and which had contributed
to the original production of the symptom. The removal of this resistance
was the essential preliminary to the patient's becoming `really' conscious
of the unconscious trend. And it was at this point that the practical
lesson emerged: as analysts our main task is not so much to investigate
the objectionable unconscious trend as to get rid of the patient's
resistance to it.
But how are we to set about this task
of demolishing the resistance? Once again by the same process of investigation
and explanation which we have already applied to the unconscious trend.
But this time we are not faced by such difficulties as before, for
the forces that are keeping up the repression, although they are to
some extent unconscious, do not belong to the unconscious in the systematic
sense; they are a part of the patient's ego, which is co-operating
with us, and are thus more accessible. Nevertheless the existing state
of equilibrium will not be upset, the ego will not be induced to do
the work of re-adjustment that is required of it, unless we are able
by our analytic procedure to mobilize some fresh force upon our side.
What forces can we count upon? The patient's
will to recovery, in the first place, which led him to embark upon
the analysis. And, again, a number of intellectual considerations
which we can bring to his notice. We can make him understand the structure
of his symptom and the motives for his repudiation of the objectionable
trend. We can point out the fact that these motives are out-of-date
and no longer valid; that they may have been reasonable when he was
a baby, but are no longer so now that he is grown up. And finally
we can insist that his original solution of the difficulty has only
led to illness, while the new one that we propose holds out a prospect
of health. Such motives as these may play a part in inducing the patient
to abandon his resistances; nevertheless it is from an entirely different
quarter that the decisive factor emerges. This factor, I need hardly
say, is the transference. And I must now recall, very briefly, the
main ideas held by Freud on that subject during the period with which
I am dealing.
TRANSFERENCE
I should like to remark first that, although from very early times
Freud had called attention to the fact that transference manifested
itself in two ways--negatively as well as positively, a good deal
less was said or known about the negative transference than about
the positive. This of course corresponds to the circumstance that
interest in the destructive and aggressive impulses in general is
only a comparatively recent development. Transference was regarded
predominantly as a libidinal phenomenon. It was suggested that in
everyone there existed a certain number of unsatisfied libidinal impulses,
and that whenever some new person came upon the scene these impulses
were ready to attach themselves to him. This was the account of transference
as a universal phenomenon. In neurotics, owing to the abnormally large
quantities of unattached libido present in them, the tendency to transference
would be correspondingly greater; and the peculiar circumstances of
the analytic situation would further increase it. It was evidently
the existence of these feelings of love, thrown by the patient upon
the analyst, that provided the necessary extra force to induce his
ego to give up its resistances, undo the repressions and adopt a fresh
solution of its ancient problems. This instrument, without which no
therapeutic result could be obtained, was at once seen to be no stranger;
it was in fact the familiar power of suggestion, which had ostensibly
been abandoned long before. Now, however, it was being employed in
a very different way, in fact in a contrary direction. In pre-analytic
days it had aimed at bringing about an increase in the degree of repression;
now it was used to overcome the resistance of the ego, that is to
say, to allow the repression to be removed.
But the situation became more and more
complicated as more facts about transference came to light. In the
first place, the feelings transferred turned out to be of various
sorts; besides the loving ones there were the hostile ones, which
were naturally far from assisting the analyst's efforts. But, even
apart from the hostile transference, the libidinal feelings themselves
fell into two groups: friendly and affectionate feelings which were
capable of being conscious, and purely erotic ones which had usually
to remain unconscious. And these latter feelings, when they became
too powerful, stirred up the repressive forces of the ego and thus
increased its resistances instead of diminishing them, and in fact
produced a state of things that was not easily distinguishable from
a negative transference. And beyond all this there arose the whole
question of the lack of permanence of all suggestive treatments. Did
not the existence of the transference threaten to leave the analytic
patient in the same unending dependence upon the analyst?
All of these difficulties were got over
by the discovery that the transference itself could be analysed. Its
analysis, indeed, was soon found to be the most important part of
the whole treatment. It was possible to make conscious its roots in
the repressed unconscious just as it was possible to make conscious
any other repressed material--that is, by inducing the ego to abandon
its resistances--and there was nothing self-contradictory in the fact
that the force used for resolving the transference was the transference
itself. And once it had been made conscious, its unmanageable, infantile,
permanent characteristics disappeared; what was left was like any
other `real' human relationship. But the necessity for constantly
analysing the transference became still more apparent from another
discovery. It was found that as work proceeded the transference tended,
as it were, to eat up the entire analysis. More and more of the patient's
libido became concentrated upon his relation to the analyst, the patient's
original symptoms were drained of their cathexis, and there appeared
instead an artificial neurosis to which Freud gave the name of the
`transference neurosis'. The original conflicts, which had led to
the onset of neurosis, began to be re-enacted in the relation to the
analyst. Now this unexpected event is far from being the misfortune
that at first sight it might seem to be. In fact it gives us our great
opportunity. Instead of having to deal as best we may with conflicts
of the remote past, which are concerned with dead circumstances and
mummified personalities, and whose outcome is already determined,
we find ourselves involved in an actual and immediate situation, in
which we and the patient are the principal characters and the development
of which is to some extent at least under our control. But if we bring
it about that in this revivified transference conflict the patient
chooses a new solution instead of the old one, a solution in which
the primitive and unadaptable method of repression is replaced by
behaviour more in contact with reality, then, even after his detachment
from the analysis, he will never be able to fall back into his former
neurosis. The solution of the transference conflict implies the simultaneous
solution of the infantile conflict of which it is a new edition. `The
change', says Freud in his Introductory Lectures, `is made possible
by alterations in the ego occurring as a consequence of the analyst's
suggestions. At the expense of the unconscious, the ego becomes wider
by the work of interpretation which brings the unconscious material
into consciousness; through education it becomes reconciled to the
libido and is made willing to grant it a certain degree of satisfaction;
and its horror of the claims of its libido is lessened by the new
capacity it acquires to expend a certain amount of the libido in sublimation.
The more nearly the course of the treatment corresponds with this
ideal description the greater will be the success of the psycho-analytic
therapy'. (3)I quote these words of Freud's to make it quite clear
that at the time he wrote them he held that the ultimate factor in
the therapeutic action of psychoanalysis was suggestion on the part
of the analyst acting upon the patient's ego in such a way as to make
it more tolerant of the libidinal trends.
THE SUPER-EGO
In the years that have passed since he wrote this passage Freud has
produced extremely little that bears directly on the subject; and
that little goes to show that he has not altered his views of the
main principles involved. Indeed, in the additional lectures which
were published last year, he explicitly states that he has nothing
to add to the theoretical discussion upon therapy given in the original
lectures fifteen years earlier. (4) At the same time there has in
the interval been a considerable further development of his theoretical
opinions, and especially in the region of ego-psychology. He has,
in particular, formulated the concept of the super-ego. The re-statement
in super-ego terms of the principles of therapeutics which he laid
down in the period of resistance analysis may not involve many changes.
But it is reasonable to expect that information about the super-ego
will be of special interest from our point of view; and in two ways.
In the first place, it would at first sight seem highly probable that
the super-ego should play an important part, direct or indirect, in
the setting-up and maintaining of the repressions and resistances
the demolition of which has been the chief aim of analysis. And this
is confirmed by an examination of the classification of the various
kinds of resistance made by Freud in Hemmung Symptom and Angst (1926).
(5) Of the five sorts of resistance there mentioned it is true that
only one is attributed to the direct intervention of the super-ego,
but two of the ego-resistances--the repressionresistance and the transference-resistance--although
actually originating from the ego, are as a rule set up by it out
of fear of the super-ego. It seems likely enough therefore that when
Freud wrote the words which I have just quoted, to the effect that
the favourable change in the patient 'is made possible by alterations
in the ego' he was thinking, in part at all events, of that portion
of the ego which he subsequently separated off into the super-ego.
Quite apart from this, moreover, in another of Freud's more recent
works, the Group Psychology (1921), there are passages which suggest
a different point--namely, that it may be largely through the patient's
super-ego that the analyst is able to influence him. These passages
occur in the course of his discussion on the nature of hypnosis and
suggestion. (6) He definitely rejects Bernheim's view that all hypnotic
phenomena are traceable to the factor of suggestion, and adopts the
alternative theory that suggestion is a partial manifestation of the
state of hypnosis. The state of hypnosis, again, is found in certain
respects to resemble the state of being in love. There is 'the same
humble subjection, the same compliance, the same absence of criticism
towards the hypnotist as towards the loved object'; in particular,
there can be no doubt that the hypnotist, like the loved object, 'has
stepped into the place of the subject's ego-ideal'. Now since suggestion
is a partial form of hypnosis and since the analyst brings about his
changes in the patient's attitude by means of suggestion, it seems
to follow that the analyst owes his effectiveness, at all events in
some respects, to his having stepped into the place of the patient's
super-ego. Thus there are two convergent lines of argument which point
to the patient's super-ego as occupying a key position in analytic
therapy: it is a part of the patient's mind in which a favourable
alteration would be likely to lead to general improvement, and it
is a part of the patient's mind which is especially subject to the
analyst's influence.
Such plausible notions as these were
followed up almost immediately after the super-ego made its first
debut. (7) They were developed by Ernest Jones, for instance, in his
paper on `The Nature of Auto-Suggestion'. (8) Soon afterwards (9)
Alexander launched his theory that the principal aim of all psycho-analytic
therapy must be the complete demolition of the super-ego and the assumption
of its functions by the ego. According to his account, the treatment
falls into two phases. In the first phase the functions of the patient's
super-ego are handed over to the analyst, and in the second phase
they are passed back again to the patient, but this time to his ego.
The super-ego, according to this view of Alexander's (though he explicitly
limits his use of the word to the unconscious parts of the ego-ideal),
is a portion of the fundamental apparatus which is essentially primitive,
out of date and out of touch with reality, which is incapable of adapting
itself, and which operates automatically, with the monotonous uniformity
of a reflex. Any useful functions that it performs can be carried
out by the ego, and there is therefore nothing to be done with it
but to scrap it. This wholesale attack upon the super-ego seems to
be of questionable validity. [t seems probable that its abolition,
even if that were practical politics, would involve the abolition
of a large number of highly desirable mental activities. But the idea
that the analyst temporarily takes over the functions of the patient's
super-ego during the treatment and by so doing in some way alters
it agrees with the tentative remarks which I have already made.
So, too, do some passages in a paper
by Rado upon `The Economic Principle in Psycho-Analytic Technique'.
(10) The second part of this paper, which was to have dealt with psycho-analysis,
has unfortunately never been published; but the first one, on hypnotism
and catharsis, (11) contains much that is of interest. It includes
a theory that the hypnotic subject introjects the hypnotist in the
form of what Rado calls a `parasitic super-ego', which draws off the
energy and takes over the functions of the subject's original superego.
One feature of the situation brought out by Rado is the unstable and
temporary nature of this whole arrangement. If, for instance, the
hypnotist gives a command which is too much in opposition to the subject's
original super-ego, the parasite is promptly extruded. And, in any
case, when the state of hypnosis comes to an end, the sway of the
parasite super-ego also terminates and the original super-ego resumes
its functions.
However debatable may be the details
of Rado's description, it not only emphasizes once again the notion
of the super-ego as the fulcrum of psychotherapy, but it draws attention
to the important distinction between the effects of hypnosis and analysis
in the matter of permanence. Hypnosis acts essentially in a temporary
way, and Rado's theory of the parasitic super-ego, which does not
really replace the original one but merely throws it out of action,
gives a very good picture of its apparent workings. Analysis, on the
other hand, in so so far as it seeks to affect the patient's super-ego,
aims at something much more far-reaching and permanent--namely, at
an integral change in the nature of the patient's super-ego itself.
(12) Some even more recent developments in psycho-analytic theory
give a hint, so it seems to me, of the kind of lines along which a
clearer understanding of the question may perhaps be reached.
INTROJECTION AND PROJECTION
This latest growth of theory has been very much occupied with the
destructive impulses and has brought them for the first time into
the centre of interest; and attention has at the same time been concentrated
on the correlated problems of guilt and anxiety. What I have in mind
especially are the ideas upon the formation of the super-ego recently
developed by Melanie Klein and the importance which she attributes
to the processes of introjection and projection in the development
of the personality. I will re-state what I believe to be her views
in an exceedingly schematic outline. (13) The individual, she holds,
is perpetually introjecting and projecting the objects of its idimpulses,
and the character of the introjected objects depends on the character
of the id-impulses directed towards the external objects. Thus, for
instance, during the stage of a child's libidinal development in which
it is dominated by feelings of oral aggression, its feelings towards
its external object will be orally aggressive; it will then introject
the object, and the introjected object will now act (in the manner
of a super-ego) in an orally aggressive way towards the child's ego.
The next event will be the projection of this orally aggressive introjected
object back on to the external object, which will now in its turn
appear to be orally aggressive. The fact of the external object being
thus felt as dangerous and destructive once more causes the id-impulses
to adopt an even more aggressive and destructive attitude towards
the object in self-defence. A vicious circle is thus established.
This process seeks to account for the extreme severity of the super-ego
in small children, as well as for their unreasonable fear of outside
objects. In the course of the development of the normal individual,
his libido eventually reaches the genital stage, at which the positive
impulses predominate. His attitude towards his external objects will
thus become more friendly, and accordingly his introjected object
(or super-ego) will become less severe and his ego's contact with
reality will be less distorted. In the case of the neurotic, however,
for various reasons-whether on account of frustration or of an incapacity
of the ego to tolerate id-impulses, or of an inherent excess of the
destructive components-development to the genital stage does not occur,
but the individual remains fixated at a pre-genital level. His ego
is thus left exposed to the pressure of a savage id on the one hand
and a correspondingly savage super-ego on the other, and the vicious
circle I have just described is perpetuated.
THE NEUROTIC VICIOUS CIRCLE
I should like to suggest that the hypothesis which I have stated in
this bald fashion may be useful in helping us to form a picture not
only of the mechanism of a neurosis but also of the mechanism of its
cure. There is. after all, nothing new in regarding a neurosis as
essentially an obstacle or deflecting force in the path of normal
development; nor is there anything new in the belief that psycho-analysis
(owing to the peculiarities of the analytic situation) is able to
remove the obstacle and so allow the normal development to proceed.
I am only trying to make our conceptions a little more precise by
supposing that the pathological obstacle to the neurotic individual's
further growth is in the nature of a vicious circle of the kind I
have described. If a breach could somehow or other be made in the
vicious circle, the processes of development would proceed upon their
normal course. If, for instance, the patient could be made less frightened
of his super-ego or introjected object, he would project less terrifying
imagos on to the outer object and would therefore have less need to
feel hostility towards it; the object which he then introjected would
in turn be less savage in its pressure upon the id-impulses. which
would be able to lose something of their primitive ferocity. In short,
a benign circle would be set up instead of the vicious one, and ultimately
the patient's libidinal development would proceed to the genital level,
when, as in the case of a normal adult, his super-ego will be comparatively
mild and his ego will have a relatively undistorted contact with reality.
(14)
But at what point in the vicious circle
is the breach to be made and how is it actually to be effected`? It
is obvious that to alter the character of a person's super-ego is
easier said than done. Nevertheless, the quotations that I have already
made from earlier discussions of the subject strongly suggest that
the super-ego will be found to play an important part in the solution
of our problem. Before we go further, however, it will be necessary
to consider a little more closely the nature of what is described
as the analytic situation. The relation between the two persons concerned
in it is a highly complex one, and for our present purposes I am going
to isolate two elements in it. In the first place, the patient in
analysis tends to centre the whole of his idimpulses upon the analyst.
I shall not comment further upon this fact or its implications, since
they are so immensely familiar. I will only emphasize their vital
importance to all that follows and proceed at once to the second element
of the analytic situation which I wish to isolate. The patient in
analysis tends to accept the analyst in some way or other as a substitute
for his own super-ego. I propose at this point to imitate with a slight
difference the convenient phrase which was used by Rado in his account
of hypnosis and to say that in analysis the patient tends to make
the analyst into an `auxiliary super-ego'. This phrase and the relation
described by it evidently require some explanation.
THE ANALYST AS `AUXILIARY SUPER-EGO'
When a neurotic patient meets a new object in ordinary life, according
to our underlying hypothesis he will tend to project on to it his
introjected archaic objects and the new object will become to that
extent a phantasy object. It is to be presumed that his introjected
objects are more or less separated out into two groups, which function
as a `good' introjected object (or mild super-ego) and a `bad' introjected
object (or harsh super-ego). According to the degree to which his
ego maintains contacts with reality, the `good' introjected object
will be projected on to benevolent real outside objects and the `bad'
one on to malignant real outside objects. Since, however, he is by
hypothesis neurotic, the `bad' introjected object will predominate,
and will tend to be projected more than the `good' one; and there
will further be a tendency, even where to begin with the `good' object
was projected, for the `bad' one after a time to take its place. Consequently,
it will be true to say that in general the neurotic's phantasy objects
in the outer world will be predominantly dangerous and hostile. Moreover,
since even his `good' introjected objects will be `good' according
to an archaic and infantile standard, and will be to some extent maintained
simply for the purpose of counteracting the `bad' objects, even his
`good' phantasy objects in the outer world will be very much out of
touch with reality. Going back now to the moment when our neurotic
patient meets a new object in real life and supposing (as will be
the more usual case) that he projects his `bad' introjected object
on to it--the phantasy external object will then seem to him to be
dangerous; he will be frightened of it and, to defend himself against
it, will become more angry. Thus when he introjects this new object
in turn, it will merely be adding one more terrifying imago to those
he has already introjected. The new introjected imago will in fact
simply be a duplicate of the original archaic ones, and his super-ego
will remain almost exactly as it was. The same will be also true mutatis
mutandis where he begins by projecting his `good' introjected object
on to the new external object he has met with. No doubt, as a result,
there will be a slight strengthening of his kind super-ego at the
expense of his harsh one, and to that extent his condition will he
improved. But there will be no qualitative change in his super-ego,
for the new `good' object introjected will only be a duplicate of
an archaic original and will only reinforce the archaic `good' super-ego
already present.
The effect when this neurotic patient
comes in contact with a new object in analysis is from the first moment
to create a different situation. His superego is in any case neither
homogeneous nor well-organised; the account we have given of it hitherto
has been over-simplified and schematic. Actually the introjected imagos
which go to make it up are derived from a variety of different stages
of his history and function to some extent independently. Now, owing
to the peculiarities of the analytic circumstances and of the analyst's
behaviour, the introjected imago of the analyst tends in part to be
rather definitely separated off from the rest of the patient's super-ego.
(This, of course, presupposes a certain degree of contact with reality
on his part. Here we have one of the fundamental criteria of accessibility
to analytic treatment; another, which we have already implicitly noticed,
is the patient's ability to attach his id-impulses to the analyst.)
This separation between the imago of the introjected analyst and the
rest of the patient's super-ego becomes evident at quite an early
stage of the treatment; for instance in connection with the fundamental
rule of free association. The new bit of super-ego tells the patient
that he is allowed to say anything that may come into his head. This
works satisfactorily for a little; but soon there comes a conflict
between the new bit and the rest, for the original super-ego says:
`You must not say this, for, if you do, you will be using an obscene
word or betraying so-and-so's confidences'. The separation off of
the new bit--what I have called the `auxiliary' super-ego--tends to
persist for the very reason that it usually operates in a different
direction from the rest of the super-ego. And this is true not only
of the `harsh' super-ego but also of the `mild' one. For, though the
auxiliary super-ego is in fact kindly, it is not kindly in the same
archaic way as the patient's introjected `good' imagos. The most important
characteristic of the auxiliary super-ego is that its advice to the
ego is consistently based upon real and contemporary considerations
and this in itself serves to differentiate it from the greater part
of the original super-ego.
In spite of this, however, the situation
is extremely insecure. There is a constant tendency for the whole
distinction to break down. The patient is liable at any moment to
project his terrifying imago on to the analyst just as though he were
anyone else he might have met in the course of his life. If this happens,
the introjected imago of the analyst will be wholly incorporated into
the rest of the patient's harsh super-ego, and the auxiliary super-ego
will disappear. And even when the content of the auxiliary super-ego's
advice is realised as being different from or contrary to that of
the original super-ego, very often its quality will be felt as being
the same. For instance, the patient may feel that the analyst has
said to him: `If you don't say whatever comes into your head, I shall
give you a good hiding', or, `If you don't become conscious of this
piece of the unconscious I shall turn you out of the room'. Nevertheless,
labile though it is, and limited as is its authority, this peculiar
relation between the analyst and the patient's ego seems to put into
the analyst's grasp his main instrument in assisting the development
of the therapeutic process. What is this main weapon in the analyst's
armoury? Its name springs at once to our lips. The weapon is, of course,
interpretation. And here we reach the core of the problem that I want
to discuss in the present paper.
INTERPRETATION
What, then, is interpretation? and how does it work? Extremely little
seems to be known about it, but this does not prevent an almost universal
belief in its remarkable efficacy as a weapon: interpretation has,
it must be confessed, many of the qualities of a magic weapon. It
is, of course, felt as such by many patients. Some of them spend hours
at a time in providing interpretations of their own--often ingenious,
illuminating, correct. Others, again, derive a direct libidinal gratification
from being given interpretations and may even develop something parallel
to a drug-addiction to them. In nonanalytical circles interpretation
is usually either scoffed at as something ludicrous, or dreaded as
a frightful danger. This last attitude is shared, I think, more than
is often realized, by a certain number of analysts. This was particularly
revealed by the reactions shown in many quarters when the idea of
giving interpretations to small children was first mooted by Melanie
Klein. But I believe it would be true in general to say that analysts
are inclined to feel interpretation as something extremely powerful
whether for good or ill. I am speaking now of our feelings about interpretation
as distinguished from our reasoned beliefs. And there might seem to
be a good many grounds for thinking that our feelings on the subject
tend to distort our beliefs. At all events, many of these beliefs
seem superficially to be contradictory; and the contradictions do
not always spring from different schools of thought, but are apparently
sometimes held simultaneously by one individual. Thus, we are told
that if we interpret too soon or too rashly, we run the risk of losing
a patient: that unless we interpret promptly and deeply we run the
risk of losing a patient; that interpretation may give rise to intolerable
and unmanageable outbreaks of anxiety by `liberating' it: that interpretation
is the only way of enabling a patient to cope with an unmanageable
outbreak of anxiety by 'resolving' it; that interpretations must always
refer to material on the very point of emerging into consciousness:
that the most useful interpretations are really deep ones; `Be cautious
with your interpretations!' says one voice; `When in doubt, interpret!'
says another. Nevertheless, although there is evidently a good deal
of confusion in all of this, I do not think these views are necessarily
incompatible; the various pieces of advice may turn out to refer to
different circumstances and different cases and to imply different
uses of the word `interpretation'.
For the word is evidently used in more
than one sense. It is, after all, perhaps only a synonym for the old
phrase we have already come across--making what is unconscious conscious',
and it shares all of that phrase's ambiguities. For in one sense,
if you give a German-English dictionary to someone who knows no German,
you will be giving him a collection of interpretations, and this,
I think, is the kind of sense in which the nature of interpretation
has been discussed in a recent paper by Bernfeld. (15) Such descriptive
interpretations have evidently no relevance to our present topic,
and I shall proceed without more ado to define as clearly as I can
one particular sort of interpretation, which seems to me to be actually
the ultimate instrument of psycho-analytic therapy and to which for
convenience I shall give the name of `mutative' interpretation.
I shall first of all give a schematized
outline of what I understand by a mutative interpretation, leaving
the details to be filled in afterwards; and, with a view to clarity
of exposition, I shall take as an instance the interpretation of a
hostile impulse. By virtue of his power (his strictly limited power)
as auxiliary super-ego, the analyst gives permission for a certain
small quantity of the patient's id-energy (in our instance, in the
form of an aggressive impulse) to become conscious. (16) Since the
analyst is also, from the nature of things, the object of the patient's
id-impulses, the quantity of these impulses which is now released
into consciousness will become consciously directed towards the analyst.
This is the critical point. If all goes well, the patient's ego will
become aware of the contrast between the aggressive character of his
feelings and the real nature of the analyst, who does not behave like
the patient's `good' or `bad' archaic objects. The patient, that is
to say, will become aware of a distinction between his archaic phantasy
object and the real external object. The interpretation has now become
a mutative one, since it has produced a breach in the neurotic vicious
circle. For the patient, having become aware of the lack of aggressiveness
in the real external object, will be able to diminish his own aggressiveness;
the new object which he introjects will be less aggressive, and consequently
the aggressiveness of his super-ego will also be diminished. As a
further corollary to these events, and simultaneously with them, the
patient will obtain access to the infantile material which is being
re-experienced by him in his relation to the analyst.
Such is the general scheme of the mutative
interpretation. You will notice that in my account the process appears
to fall into two phases. I am anxious not to pre-judge the question
of whether these two phases are in temporal sequence or whether they
may not really be two simultaneous aspects of a single event. But
for descriptive purposes it is easier to deal with them as though
they were successive. First, then, there is the phase in which the
patient becomes conscious of a particular quantity of id-energy as
being directed towards the analyst; and secondly there is the phase
in which the patient becomes aware that this id-energy is directed
towards an archaic phantasy object and not towards a real one.
THE FIRST PHASE OF INTERPRETATION
The first phase of a mutative interpretation--that in which a portion
of the patient's id-relation to the analyst is made conscious in virtue
of the latter's position as auxiliary super-ego--is in itself complex.
In the classical model of an interpretation, the patient will first
be made aware of a state of tension in his ego, will next be made
aware that there is a repressive factor at work (that his super-ego
is threatening him with punishment), and will only then be made aware
of the id-impulse which has stirred up the protests of his super-ego
and so given rise to the anxiety in his ego. This is the classical
scheme. In actual practice, the analyst finds himself working from
all three sides at once, or in irregular succession. At one moment
a small portion of the patient's super-ego may be revealed to him
in all its savagery, at another the shrinking defencelessness of his
ego, at yet another his attention may be directed to the attempts
which he is making at restitution-at compensating for his hostility;
on some occasions a fraction of id-energy may even be directly encouraged
to break its way through the last remains of an already weakened resistance.
There is, however, one characteristic which all of these various operations
have in common; they are essentially upon a small scale. For the mutative
interpretation is inevitably governed by the principle of minimal
doses. It is, I think, a commonly agreed clinical fact that alterations
in a patient under analysis appear almost always to be extremely gradual:
we are inclined to suspect sudden and large changes as an indication
that suggestive rather than psycho-analytic processes are at work.
The gradual nature of the changes brought about in psycho-analysis
will be explained if, as I am suggesting, those changes are the result
of the summation of an immense number of minute steps, each of which
corresponds to a mutative interpretation. And the smallness of each
step is in turn imposed by the very nature of the analytic situation.
For each interpretation involves the release of a certain quantity
of id-energy, and, as we shall see in a moment, if the quantity released
is too large, the highly unstable state of equilibrium which enables
the analyst to function as the patient's auxiliary super-ego is bound
to be upset. The whole analytic situation will thus be imperilled,
since it is only in virtue of the analyst's acting as auxiliary super-ego
that these releases of idenergy can occur at all.
Let us examine in greater detail the
effects which follow from the analyst attempting to bring too great
a quantity of id-energy into the patient's consciousness all at once.
(17) On the one hand, nothing whatever may happen, or on the other
hand there may be an unmanageable result; but in neither event will
a mutative interpretation have been effected. In the former case (in
which there is apparently no effect) the analyst's power as auxiliary
superego will not have boon strong enough for the job ho has sot himself.
But this again may be for two very different reasons. It may be that
the id-impulses ho was trying to bring out were not in fact sufficiently
urgent at the moment: for, after all, the emergence of an id-impulse
depends on two factors-not only on the permission of the super-ego,
but also on the urgency (the degree of cathexis) of the id-impulse
itself. This, then, may be ono cause of an apparently negative response
to an interpretation, and evidently a fairly harmless ono. But the
same apparent result may also be duo to something else; in spite of
the id-impulse being really urgent, the strength of the patient's
own repressive forces (the degree of repression) may have been too
great to allow his ego to listen to the persuasive voice of the auxiliary
superego. Now here we have a situation dynamically identical with
the next ono we have to consider, though economically different. This
next situation is one in which the patient accepts the interpretation,
that is, allows the idimpulse into his consciousness, but is immediately
overwhelmed with anxiety. This may show itself in a number of ways:
for instance, the patient may produce a manifest anxiety-attack, or
he may exhibit signs of `real' anger with the analyst with complete
lack of insight, or he may break off the analysis. In any of these
cases the analytic situation will, for the moment at least, have broken
down. The patient will be behaving just as the hypnotic subject behaves
when, having been ordered by the hypnotist to perform an action too
much at variance with his own conscience, ho breaks off the hypnotic
relation and wakes up from his trance. This state of things, which
is manifest where the patient responds to an interpretation with an
actual outbreak of anxiety or ono of its equivalents, may be latent
where the patient shows no response. And this latter case may be the
more awkward of the two, since it is masked, and it may sometimes,
I think, be the effect of a greater overdose of interpretation than
where manifest anxiety arises (though obviously other factors will
be of determining importance here and in particular the nature of
the patient's neurosis). I have ascribed this threatened collapse
of the analytic situation to an overdose of interpretation: but it
might be more accurate in some ways to ascribe it to an insufficient
dose. For what has happened is that the second phase of the interpretative
process has not occurred: the phase in which the patient becomes aware
that his impulse is directed towards an archaic phantasy object and
not towards a real one.
THE SECOND PHASE OF INTERPRETATION
In the second phase of a complete interpretation, therefore, a crucial
part is played by the patient's sense of reality: for the successful
outcome of that phase depends upon his ability, at the critical moment
of the emergence into consciousness of the released quantity of id-energy,
to distinguish between his phantasy object and the real analyst. The
problem hero is closely related to one that I have already discussed,
namely that of the extreme liability of the analyst's position as
auxiliary super-ego. The analytic situation is all the time threatening
to degenerate into a 'real' situation. But this actually means the
opposite of what it appears to. It moans that the patient is all the
time on the brink of turning the real external object (the analyst)
into the archaic one; that is to say, he is on the brink of projecting
his primitive introjected imagos on to him. In so far as the patient
actually does this, the analyst becomes like anyone else that he meets
in real life--a phantasy object. The analyst then ceases to possess
the peculiar advantages derived from the analytic situation; ho will
be introjected like all other phantasy objects into the patient's
superego, and will no longer be able to function in the peculiar ways
which are essential to the effecting of a mutative interpretation.
In this difficulty the patient's sense of reality is an essential
but a very feeble ally; indeed, an improvement in it is ono of the
things that we hope the analysis will bring about. It is important,
therefore, not to submit it to any unnecessary strain: and that is
the fundamental reason why the analyst must avoid any real behaviour
that is likely to confirm the patient's view of him as a 'bad' or
a good' phantasy object. This is perhaps more obvious as regards the
'bad' object. If, for instance, the analyst wore to show that he was
really shocked or frightened by ono of the patient's id-impulses,
the patient would immediately treat him in that respect as a dangerous
object and introject him into his archaic severe super-ego. Thereafter,
on the one hand, there would be a diminution in the analyst's power
to function as an auxiliary super-ego and to allow the patient's ego
to become conscious of his id-impulses-that is to say, in his power
to bring about the first phase of a mutative interpretation; and,
on the other hand, ho would, as a real object, become sensibly less
distinguishable from the patient's 'bad' phantasy object and to that
extent the carrying through of the second phase of a mutative interpretation
would also be made more difficult. Or again, there is another case.
Supposing the analyst behaves in an opposite way and actively urges
the patient to give free rein to his id-impulses. There is then a
possibility of the patient confusing the analyst with the imago of
a treacherous parent who first encourages him to seek gratification,
and then suddenly turns and punishes him. In such a case, the patient's
ego may look for defence by itself suddenly turning upon the analyst
as though he were his own id, and treating him with all the severity
of which his super-ego is capable. Here again, the analyst is running
a risk of losing his privileged position. But it may be equally unwise
for the analyst to act really in such a way as to encourage the patient
to project his `good' introjected object on to him. For the patient
will then tend to regard him as a good object in an archaic sense
and will incorporate him with his archaic `good' imagos and will use
him as a protection against his `bad' ones. In that way, his infantile
positive impulses as well as his negative ones may escape analysis,
for there may no longer be a possibility for his ego to make a comparison
between the phantasy external object and the real one. It will perhaps
be argued that, with the best will in the world, the analyst, however
careful he may be, will be unable to prevent the patient from projecting
these various imagos on to him. This is of course indisputable, and,
indeed, the whole effectiveness of analysis depends upon its being
so. The lesson of these difficulties is merely to remind us that the
patient's sense of reality has the narrowest limits. It is a paradoxical
fact that the best way of ensuring that his ego shall be able to distinguish
between phantasy and reality is to withhold reality from him as much
as possible. But it is true. His ego is so weak--so much at the mercy
of his id and super-ego-that he can only cope with reality if it is
administered in minimal doses. And these doses are in fact what the
analyst gives him, in the form of interpretations.
INTERPRETATION AND REASSURANCE
It seems to me possible that an approach to the twin practical problems
of interpretation and reassurance may be facilitated by this distinction
between the two phases of interpretation. Both procedures may, it
would appear, be useful or even essential in certain circumstances
and inadvisable or even dangerous in others. In the case of interpretation
(18) the first of our hypothetical phases may be said to `liberate'
anxiety, and the second to `resolve' it. Where a quantity of anxiety
is already present or on the point of breaking out, an interpretation,
owing to the efficacy of its second phase, may enable the patient
to recognize the unreality of his terrifying phantasy object and so
to reduce his own hostility and consequently his anxiety. On the other
hand, to induce the ego to allow a quantity of id-energy into consciousness
is obviously to court an outbreak of anxiety in a personality with
a harsh superego. And this is precisely what the analyst does in the
first phase of an interpretation. As regards `reassurance', I can
only allude briefly here to some of the problems it raises. (19) I
believe, incidentally, that the term needs to be defined almost as
urgently as `interpretation', and that it covers a number of different
mechanisms. But in the present connection reassurance may be regarded
as behaviour on the part of the analyst calculated to make the patient
regard him as a `good' phantasy object rather than as a real one.
I have already given some reasons for doubting the expediency of this,
though it seems to be generally felt that the procedure may sometimes
be of great value, especially in psychotic cases. It might, moreover,
be supposed at first sight that the adoption of such an attitude by
the analyst might actually directly favour the prospect of making
a mutative interpretation. But I believe that it will be seen on reflection
that this is not in fact the case: for precisely in so far as the
patient regards the analyst as his phantasy object, the second phase
of the interpretation does not occur--since it is of the essence of
that phase that in it the patient should make a distinction between
his phantasy object and the real one. It is true that his anxiety
may be reduced; but this result will not have been achieved by a method
that involves a permanent qualitative change in his super-ego. Thus,
whatever tactical importance reassurance may possess, it cannot, I
think, claim to be regarded as an ultimate operative factor in psycho-analytic
therapy.
It must here be noticed that certain
other sorts of behaviour on the part of the analyst may be dynamically
equivalent to the giving of a mutative interpretation, or to one or
other of the two phases of that process. For instance, an `active'
injunction of the kind contemplated by Ferenczi may amount to an example
of the first phase of an interpretation; the analyst is making use
of his peculiar position in order to induce the patient to become
conscious in a particularly vigorous fashion of certain of his id-impulses.
One of the objections to this form of procedure may be expressed by
saying that the analyst has very little control over the dosage of
the id-energy that is thus released, and very little guarantee that
the second phase of the interpretation will follow. He may therefore
be unwittingly precipitating one of those critical situations which
are always liable to arise in the case of an incomplete interpretation.
Incidentally, the same dynamic pattern may arise when the analyst
requires the patient to produce a `forced' phantasy or even (especially
at an early stage in an analysis) when the analyst asks the patient
a question; here again, the analyst is in effect giving a blindfold
interpretation, which it may prove impossible to carry beyond its
first phase. On the other hand, situations are fairly constantly arising
in the course of an analysis in which the patient becomes conscious
of small quantities of id-energy without any direct provocation on
the part of the analyst. An anxiety situation might then develop,
if it were not that the analyst, by his behaviour or, one might say,
absence of behaviour, enables the patient to mobilize his sense of
reality and make the necessary distinction between an archaic object
and a real one. What the analyst is doing here is equivalent to bringing
about the second phase of an interpretation, and the whole episode
may amount to the making of a mutative interpretation. It is difficult
to estimate what proportion of the therapeutic changes which occur
during analysis may not be due to implicit mutative interpretations
of this kind. Incidentally, this type of situation seems sometimes
to be regarded, incorrectly as I think, as an example of reassurance.
`IMMEDIACY' OF MUTATIVE INTERPRETATIONS
But it is now time to turn to two other characteristics which appear
to be essential properties of every mutative interpretation. There
is in the first place one already touched upon in considering the
apparent or real absence of effect which sometimes follows upon the
giving of an interpretation. A mutative interpretation can only be
applied to an id-impulse which is actually in a state of cathexis.
This seems self-evident; for the dynamic changes in the patient's
mind implied by a mutative interpretation can only be brought about
by the operation of a charge of energy originating in the patient
himself: the function of the analyst is merely to ensure that the
energy shall flow along one channel rather than along another. It
follows from this that the purely informative `dictionary' type of
interpretation will be non-mutative, however useful it may be as a
prelude to mutative interpretations. And this leads to a number of
practical inferences. Every mutative interpretation must be emotionally
`immediate'; the patient must experience it as something actual. This
requirment, that the interpretation must be `immediate', may be expressed
in another way by saying that interpretations must always be directed
to the `point of urgency'. At any given moment some particular id-impulse
will be in activity; this is the impulse that is susceptible of mutative
interpretation at that time, and no other one. It is, no doubt, neither
possible nor desirable to be giving mutative interpretations all the
time; but, as Melanie Klein has pointed out, it is a most precious
quality in an analyst to be able at any moment to pick out the point
of urgency. (20)
`DEEP' INTERPRETATION
But the fact that every mutative interpretation must deal with an
`urgent' impulse takes us back one more to the commonly felt fear
of the explosive possibilities of interpretation, and particularly
of what is vaguely referred to as `deep' interpretation. The ambiguity
of the term, however, need not bother us. It describes, no doubt,
the interpretation of material which is either genetically early and
historically distant from the patient's actual experience or which
is under an especially heavy weight of repression--material, in any
case, which is in the normal course of things exceedingly inaccessible
to his ego and remote from it. There seems reason to believe, moreover,
that the anxiety which is liable to be aroused by the approach of
such material to consciousness may be of peculiar severity. (21) The
question whether it is `safe' to interpret such material will, as
usual, mainly depend upon whether the second phase of the interpretation
can be carried through. In the ordinary run of case the material which
is urgent during the earlier stages of the analysis is not deep. We
have to deal at first only with more or less far-going displacements
of the deep impulses, and the deep material itself is only reached
later and by degrees, so that no sudden appearance of unmanageable
quantities of anxiety is to be anticipated. In exceptional cases,
however, owing to some peculiarity in the structure of the neurosis,
deep impulses may be urgent at a very early stage of the analysis.
We are then faced by a dilemma. If we give an interpretation of this
deep material, the amount of anxiety produced in the patient may be
so great that his sense of reality may not be sufficient to permit
of the second phase being accomplished, and the whole analysis may
be jeopardised. But it must not be thought that, in such critical
cases as we are now considering, the difficulty can necessarily be
avoided simply by not giving any interpretation or by giving more
superficial interpretations of non-urgent material or by attempting
reassurances. It seems probable, in fact, that these alternative procedures
may do little or nothing to obviate the trouble; on the contrary,
they may even exacerbate the tension created by the urgency of the
deep impulses which are the actual cause of the threatening anxiety.
Thus the anxiety may break out in spite of these palliative efforts
and, if so, it will be doing so under the most unfavourable conditions,
that is to say, outside the mitigating influences afforded by the
mechanism of interpretation. It is possible, therefore, that, of the
two alternative procedures which are open to the analyst faced by
such a difficulty, the interpretation of the urgent id-impulses, deep
though they may be, will actually be the safer.
'SPECIFICITY' OF MUTATIVE INTERPRETATIONS
I shall have occasion to return to this point for a moment later on,
but I must now proceed to the mention of one further quality which
it seems necessary for an interpretation to possess before it can
be mutative, a quality which is perhaps only another aspect of the
one we have been describing. A mutative interpretation must be `specific':
that is to say, detailed and concrete. This is, in practice, a matter
of degree. When the analyst embarks upon a given theme, his interpretations
cannot always avoid being vague and general to begin with; but it
will be necessary eventually to work out and interpret all the details
of the patient's phantasy system. In proportion as this is done the
interpretations will be mutative, and much of the necessity for apparent
repetitions of interpretations already made is really to be explained
by the need for filling in the details. I think it possible that some
of the delays which despairing analysts attribute to the patient's
id-resistance could be traced to this source. It seems as though vagueness
in interpretation gives the defensive forces of the patient's ego
the opportunity, for which they are always on the lookout, of baffling
the analyst's attempt at coaxing an urgent id-impulse into consciousness.
A similarly blunting effect can be produced by certain forms of reassurance,
such as the tacking on to an interpretation of an ethnological parallel
or of a theoretical explanation: a procedure which may at the last
moment turn a mutative interpretation into a non-mutative one. The
apparent effect may be highly gratifying to the analyst; but later
experience may show that nothing of permanent use has been achieved
or even that the patient has been given an opportunity for increasing
the strength of his defences. Here we have evidently reached a topic
discussed not long ago by Edward Glover in one of the very few papers
in the whole literature which seriously attacks the problem of interpretation.
(22) Glover argues that, whereas a blatantly inexact interpretation
is likely to have no effect at all, a slightly inexact one may have
a therapeutic effect of a non-analytic, or rather anti-analytic, kind
by enabling the patient to make a deeper and more efficient repression.
He uses this as a possible explanation of a fact that has always seemed
mysterious, namely, that in the earlier days of analysis, when much
that we now know of the characteristics of the unconscious was still
undiscovered, and when interpretation must therefore often have been
inexact, therapeutic results were nevertheless obtained.
ABREACTION
The possibility which Glover here discusses serves to remind us more
generally of the difficulty of being certain that the effects that
follow any given interpretation are genuinely the effects of interpretation
and not transference phenomena of one kind or another. I have already
remarked that many patients derive direct libidinal gratification
from interpretation as such; and I think that some of the striking
signs of abreaction which occasionally follow an interpretation ought
not necessarily to be accepted by the analyst as evidence of anything
more than that the interpretation has gone home in a libidinal sense.
The whole problem, however, of the relation
of abreaction to psychoanalysis is a disputed one. Its therapeutic
results seem, up to a point, undeniable. It was from them, indeed,
that analysis was born; and even today there are psycho-therapists
who rely on it almost exclusively. During the War [World War 1], in
particular, its effectiveness was widely confirmed in cases of 'shell-shock'.
It has also been argued often enough that it plays a leading part
in bringing about the results of psycho-analysis. Rank and Ferenczi,
for instance, declared that in spite of all advances in our knowledge
abreaction remained the essential agent in analytic therapy. (23)
More recently, Reik has supported a somewhat similar view in maintaining
that `the element of surprise is the most important part of analytic
technique'. (24) A much less extreme attitude is taken by Nunberg
in the chapter upon therapeutics in his text-book of psycho-analysis
. (25) But he, too, regards abreaction as one of the component factors
in analysis, and in two ways. In the first place, he mentions the
improvement brought about by abreaction in the usual sense of the
word, which he plausibly attributes to a relief of endo-psychic tension
due to a discharge of accumulated affect. And in the second place,
he points to a similar relief of tension upon a small scale arising
from the actual process of becoming conscious of something hitherto
unconscious, basing himself upon a statement of Freud's that the act
of becoming conscious involves a discharge of energy. (26) On the
other hand, Rado appears to regard abreaction as opposed in its function
to analysis. He asserts that the therapeutic effect of catharsis is
to be attributed to the fact that (together with other forms of non-analytic
psycho-therapy) it offers the patient an artificial neurosis in exchange
for his original one, and that the phenomena observable when abreaction
occurs are akin to those of an hysterical attack. (27) A consideration
of the views of these various authorities suggests that what we describe
as 'abreaction' may cover two different processes: one a discharge
of affect and the other a libidinal gratification. If so, the first
of these might be regarded (like various other procedures) as an occasional
adjunct to analysis, sometimes, no doubt, a useful one, and possibly
even as an inevitable accompaniment of mutative interpretations; whereas
the second process might be viewed with more suspicion, as an event
likely to impede analysis--especially if its true nature were unrecognised.
But with either form there would seem good reason to believe that
the effects of abreaction are permanent only in cases in which the
predominant aetiological factor is an external event: that is to say,
that it does not in itself bring about any radical qualitative alteration
in the patient's mind. Whatever part it may play in analysis is thus
unlikely to be of anything more than an ancillary nature.
EXTRA-TRANSFERENCE INTERPRETATIONS
If we now turn back and consider for a little the picture I have given
of a mutative interpretation with its various characteristics, we
shall notice that my description appears to exclude every kind of
interpretation except those of a single class-the class, namely, of
transference interpretations. Is it to be understood that no extra-transference
interpretation can set in motion the chain of events which I have
suggested as being the essence of psychoanalytical therapy? That is
indeed my opinion, and it is one of my main objects in writing this
paper to throw into relief-what has, of course, already been observed,
but never, I believe, with enough explicitness-the dynamic distinctions
between transference and extra-transference interpretations. These
distinctions may be grouped under two heads. In the first place, extra-transference
interpretations are far less likely to be given at the point of urgency.
This must necessarily be so, since in the case of an extra-transference
interpretation the object of the id-impulse which is brought into
consciousness is not the analyst and is not immediately present, whereas,
apart from the earliest stages of an analysis and other exceptional
circumstances, the point of urgency is nearly always to be found in
the transference. It follows that extra-transference interpretations
tend to be concerned with impulses which are distant both in time
and space and are thus likely to be devoid of immediate energy. In
extreme instances, indeed, they may approach very closely to what
I have already described as the handing-over to the patient of a German-English
dictionary. But in the second place, once more owing to the fact that
the object of the id-impulse is not actually present, it is less easy
for the patient, in the case of an extra-transference interpretation,
to become directly aware of the distinction between the real object
and the phantasy object. Thus it would appear that, with extratransference
interpretations, on the one hand what I have described as the first
phase of a mutative interpretation is less likely to occur, and on
the other hand, if the first phase does occur, the second phase is
less likely to follow. In other words, an extra-transference interpretation
is liable to be both less effective and more risky than a transference
one. (28) Each of these points deserves a few words of separate examination.
It is, of course, a matter of common
experience among analysts that it is possible with certain patients
to continue indefinitely giving interpretations without producing
any apparent effect whatever. There is an amusing criticism of this
kind of 'interpretation-fanaticism' in the excellent historical chapter
of Rank and Ferenczi. (29) But it is clear from their words that what
they have in mind are essentially extra-transference interpretations,
for the burden of their criticism is that such a procedure implies
neglect of the analytic situation. This is the simplest case, where
a waste of time and energy is the main result. But there are other
occasions, on which a policy of giving strings of extra-transference
interpretations is apt to lead the analyst into more positive difficulties.
Attention was drawn by Reich (30) a few years ago in the course of
some technical discussions in Vienna to a tendency among inexperienced
analysts to get into trouble by eliciting from the patient great quantities
of material in a disordered and unrelated fashion: this may, he maintained,
be carried to such lengths that the analysis is brought to an irremediable
state of chaos. He pointed out very truly that the material we have
to deal with is stratified and that it is highly important in digging
it out not to interfere more than we can help with the arrangement
of the strata. He had in mind, of course, the analogy of an incompetent
archaeologist, whose clumsiness may obliterate for all time the possibility
of reconstructing the history of an important site. I do not myself
feel so pessimistic about the results in the case of a clumsy analysis,
since there is the essential difference that our material is alive
and will, as it were, re-stratify itself of its own accord if it is
given the opportunity: that is to say, in the analytic situation.
At the same time, I agree as to the presence of the risk, and it seems
to me to be particularly likely to occur where extra-transference
interpretation is excessively or exclusively resorted to. The means
of preventing it, and the remedy if it has occurred, lie in returning
to transference interpretation at the point of urgency. For if we
can discover which of the material is `immediate' in the sense I have
described, the problem of stratification is automatically solved;
and it is a characteristic of most extra-transference material that
it has no immediacy and that consequently its stratification is far
more difficult to decipher. The measures suggested by Reich himself
for preventing the occurrence of this state of chaos are not inconsistent
with mine; for he stresses the importance of interpreting resistances
as opposed to the primary id-impulses themselves--and this, indeed,
was a policy that was laid down at an early stage in the history of
analysis. But it is, of course, one of the characteristics of a resistance
that it arises in relation to the analyst; and thus the interpretation
of a resistance will almost inevitably be a transference interpretation.
But the most serious risks that arise
from the making of extra-transference interpretations are due to the
inherent difficulty in completing their second phase or in knowing
whether their second phase has been completed or not. They are from
their nature unpredictable in their effects. There seems, indeed,
to be a special risk of the patient not carrying through the second
phase of the interpretation but of projecting the id-impulse that
has been made conscious on to the analyst. This risk, no doubt, applies
to some extent also to transference interpretations. But the situation
is less likely to arise when the object of the id-impulse is actually
present and is moreover the same person as the maker of the interpretation.
(31) (We may here once more recall the problem of `deep' interpretation,
and point out that its dangers, even in the most unfavorable circumstances,
seem to be greatly diminished if the interpretation in question is
a transference interpretation.) Moreover, there appears to be more
chance of this whole process occurring silently and so being overlooked
in the case of an extra-transference interpretation, particularly
in the earlier stages of an analysis. For this reason, it would seem
to be important after giving an extra-transference interpretation
to be specially on the qui vive for transference complications. This
last peculiarity of extratransference interpretations is actually
one of their most important from a practical point of view. For on
account of it they can be made to act as `feeders' for the transference
situation, and so to pave the way for mutative interpretations. In
other words, by giving an extra-transference interpretation, the analyst
can often provoke a situation in the transference of which he can
then give a mutative interpretation.
It must not be supposed that because
I am attributing these special qualities to transference interpretations,
I am therefore maintaining that no others should be made. On the contrary,
it is probable that a large majority of our interpretations are outside
the transference--though it should be added that it often happens
that when one is ostensibly giving an extra-transference interpretation
one is implicitly giving a transference one. A cake cannot be made
of nothing but currants; and, though it is true that extra-transference
interpretations are not for the most part mutative, and do not themselves
bring about the crucial results that involve a permanent change in
the patient's mind, they are none the less essential. If I may take
an analogy from trench warfare, the acceptance of a transference interpretation
corresponds to the capture of a key position, while the extra-transference
interpretations correspond to the general advance and to the consolidation
of a fresh line which are made possible by the capture of the key
position. But when this general advance goes beyond a certain point,
there will be another check, and the capture of a further key position
will be necessary before progress can be resumed. An oscillation of
this kind between transference and extratransference interpretations
will represent the normal course of events in an analysis.
MUTATIVE INTERPRETATIONS AND THE ANALYST
Although the giving of mutative interpretations may thus only occupy
a small portion of psycho-analytic treatment, it will, upon my hypothesis,
be the most important part from the point of view of deeply influencing
the patient's mind. It may be of interest to consider in conclusion
how a moment which is of such importance to the patient affects the
analyst himself. Mrs. Klein has suggested to me that there must be
some quite special internal difficulty to be overcome by the analyst
in giving interpretations. And this, I am sure, applies particularly
to the giving of mutative interpretations. This is shown in their
avoidance by psycho-therapists of non-analytic schools; but many psycho-analysts
will be aware of traces of the same tendency in themselves. It may
be rationalized into the difficulty of deciding whether or not the
particular moment has come for making an interpretation. But behind
this there is sometimes a lurking difficulty in the actual giving
of the interpretation, for there seems to be a constant temptation
for the analyst to do something else instead. He may ask questions,
or he may give reassurances or advice or discourses upon theory, or
he may give interpretations--but interpretations that are not mutative,
extra-transference interpretations, interpretations that are non-immediate,
or ambiguous, or inexact--or he may give two or more alternative interpretations
simultaneously, or he may give interpretations and at the same time
show his own scepticism about them. All of this strongly suggests
that the giving of a mutative interpretation is a crucial act for
the analyst as well as for the patient, and that he is exposing himself
to some great danger in doing so. And this in turn will become intelligible
when we reflect that at the moment of interpretation the analyst is
in fact deliberately evoking a quantity of the patient's id-energy
while it is alive and actual and unambiguous and aimed directly at
himself. Such a moment must above all others put to the test his relations
with his own unconscious impulses.
SUMMARY
I will end by summarizing the four main points of the hypothesis I
have put forward:
(1) The final result of psycho-analytic therapy is to enable the neurotic
patient's whole mental organization, which is held in check at an
infantile stage of development, to continue its progress towards a
normal adult state.
(2) The principle effective alteration consists in a profound qualitative
modification of the patient's super-ego, from which the other alterations
follow in the main automatically.
(3) This modification of the patient's super-ego is brought about
in a series of innumerable small steps by the agency of mutative interpretations,
which are effected by the analyst in virtue of his position as object
of the patient's id-impulses and as auxiliary super-ego.
(4) The fact that the mutative interpretation is the ultimate operative
factor in the therapeutic action of psycho-analysis does not imply
the exclusion of many other procedures (such as suggestion, reassurance,
abreaction, etc.) as elements in the treatment of any particular patient.
NOTES
1. I have not attempted to compile a full bibliography of the subject,
though a number of the more important contributions to it are referred
to in the following pages.
2. Collected Papers, Vol. II.
3. P. 381.
4. New Introductory Lectures (1933). p. 194.
5. Pp. 117-118.
6. P. 77.
7. In Freud's paper at the Berlin Congress in 1922, subsequently expanded
into The Ego and the Id (1923).
8. Int. J. Psycho-Anal., Vol. IV, 1923.
9. At the Salzburg Congress in 1924: 'A Metapsychological Description
of the Process of Cure'. Int. J. Psycho-Anal., Vol. V1, 1925.
10. Also first read at Salzburg in 1924.
11. Int. J. Psycho-Anal., Vol. VI, 1925: in a revised form in German,
Zeitschrift, Bd. XII, 1926.
12. This hypothesis seems to imply a contradiction of some authoritative
pronouncements, according to which the structure of the super-ego
is finally laid down and fixed at a very early age. Thus Freud appears
in several passages to hold that the super-ego (or at all events its
central core) is formed once and for all at the period at which the
child emerges from its Oedipus complex. (See, for instance, The Ego
and the Id, pp. 68-69.) So, too, Melanie Klein speaks of the development
of the super-ego 'ceasing' and of its formation 'having reached completion'
at the onset of the latency period (The Psycho-Analysis of Children,
pp. 250 and 252), though in many other passages (e.g., p. 369) she
implies that the superego can be altered at a later age under analysis.
I do not know how far the contradiction is a real one. My theory does
not in the least dispute the fact that in the normal course of events
the super-ego becomes fixed at an early age and subsequently remains
essentially unaltered. Indeed, it is a part of my view that in practice
nothing except the process of psycho-analysis can alter it. It is
of course a familiar fact that in many respects the analytic situation
reconstitutes an infantile condition in the patient, so that the fact
of being analysed may, as it were, throw the patient's super-ego once
more into the melting pot. Or, again, perhaps it is another mark of
the non-adult nature of the neurotic that his super-ego remains in
a malleable state.
13. See The Psycho-Analysis of Children (1932), passim, especially
Chapters VIII and IX.
14. A similar view has often been suggested by Melanie Klein. See,
for instance, The PsychoAnalysis of Children, p. 369. It has been
developed more explicitly and at greater length by Melitta Schmideberg:
'Zur Psychoanalyse asozialer Kinder and Jugendlicher' (Zeitschrift,
Bd. XVIII, 1932).
15. 'Der Begriff der Deutung in der Psychoanalyse', Zeitschrift fur
angewandte Psvchologie, Bd. 42, 1932. A critical summary of this by
Gero will be found in Imago, Bd. XIX, 1933.
16. I am making no attempt at describing the process in correct meta-psychological
terms. For instance, in Freud's view, the antithesis between conscious
and unconscious is not, strictly speaking, applicable to instinctual
impulses themselves, but only to the ideas which represent them in
the mind. ('The Unconscious', Collected Papers, Vol. IV, p. 109.)
Nevertheless, for the sake of simplicity, I speak throughout this
paper of 'making id-impulses conscious'.
17. Incidentally, it seems as though a qualitative factor may be concerned
as well: that is, some kinds of id-impulses may be more repugnant
to the ego than others.
18. For the necessity for 'continuous and deep-going interpretations'
in order to diminish or prevent anxiety-attacks, see Melanie Klein's
Psycho-Analysis of Children, pp. 58-59. On the other hand: `The anxiety
belonging to the deep levels is far greater, both in amount and intensity,
and it is therefore imperative that its liberation should be duly
regulated'. (Ibid., p. 139.)
19. Its uses were discussed by Melitta Schmideberg in a paper read
to the British Psycho-Analytical Society on February 7, 1934.
20. The Psycho-Analysis of Children, pp. 58-59.
21. Ibid.. p. 139.
22. 'The Therapeutic Effect of Inexact Interpretation', J. In. Psycho-Anal.,
Vol. XII, 1931.
23. Entwicklungsziele tier Psychoanalyse (1924), p. 27.
24. 'New Ways in Psycho-Analytic Technique', In. J. Psycho-Anal..
Vol. XIV, 1933.
25. Allgemeine Neurosenlehre auf psychoanalytischer Grundlage (1932),
pp. 303-304. This chapter appears in English in an abbreviated version
as a contribution to Lorand's Psycho-Analysis Today (1933). There
is very little, I think, in Nunberg's comprehensive catalogue of the
factors at work in analytic therapy that conflicts with the views
expressed in the present paper, though I have given a different account
of the inter-relation between those factors.
26. Beyond the Pleasure Principle, p. 28.
27. 'The Economic Principle in Psycho-Analytic Technique', Int. J.
Psycho-Anal., Vol. VI. 1925.
28. This corresponds to the fact that the pseudo-analysts and 'wild'
analysts limit themselves as a rule to extra-transference interpretations.
It will he remembered that this was true of Freud's original 'wild'
analyst ('Observations on "Wild" Psycho-Analysis' (1910).
Collected Papers, Vol. 11).
29. Entsricklungsziele tier Psychoanalyse, p. 31 .
30. 'Bericht fiber das "Seminar fur psychoanalytische Therapie"
in Wien', Zeitschrift, Bd. XIII. 1927. This has recently been re-published
as a chapter in Reich's volume upon Charakteranalyse (1933), which
contains a quantity of other material with an interesting hearing
on the subject of the present paper.
31. It even seems likely that the whole possibility of effecting mutative
interpretations may depend upon this fact that in the analytic situation
the giver of the interpretation and the object of the id-impulse interpreted
are one and the same person. I am not thinking here of the argument
mentioned above--that it is easier under that condition for the patient
to distinguish between his phantasy object and the real object--but
of a deeper consideration. The patient's original super-ego is, as
I have argued, a product of the introjection of his archaic objects
distorted by the projection of his infantile id-impulses. I have also
suggested that our only means of altering the character of this harsh
original super-ego is through the mediation of an auxiliary super-ego
which is the product of the patient's introjection of the analyst
as an object. The process of analysis may from this point of view
be regarded as an infiltration of the rigid and unadaptable original
super-ego by the auxiliary super-ego with its greater contact with
the ego and with reality. This infiltration is the work of the mutative
interpretations: and it consists in a repeated process of introjection
of imagos of the analyst--imagos, that is to say, of a real figure
and not of an archaic and distorted projection--so that the quality
of the original super-ego becomes gradually changed. And since the
aim of the mutative interpretations is thus to cause the introjection
of the analyst, it follows that the id-impulses which they interpret
must have the analyst as their object. If this is so, the views expressed
in the present paper will require some emendation. For in that case,
the first criterion of a mutative interpretation would be that it
must be a transference interpretation. Nevertheless, the quality of
urgency would still remain important; for, of all the possible transference
interpretations which could be made at any particular moment, only
the one which dealt with an urgent id-impulse would he mutative. On
the other hand, an extra-transference interpretation even of an extremely
urgent id-impulse could never be mutative-though it might, of course,
produce temporary relief along the lines of abreaction or reassurance.
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