Papers on Technique, Freud

Recommendations to Physicians Practicing Psychoanalysis (1912)

Listening. Freud writes that the analyst should listen to his patient in a particular way, not focusing on anything specific the patient has said but maintaining the same “evenly-suspended attention” at all times. If the analyst concentrates on something specific, his attention will become fixed on that idea, and he will consequently miss some of the other things the patient says.

This type of listening is the “necessary counterpart” to the fundamental rule: Just as the patient should say everything that comes to his mind without censure — no matter how illogical or unseemly something might seem — so too the analyst must give “equal notice to everything” the patient says says. In so doing, the analyst allows himself to hear the patient’s unconscious material. Put differently, the analyst is turning “his own unconscious like a receptive organ towards the transmitting unconscious of the patient. He must adjust himself to the patient as a telephone receiver is adjusted to the transmitting microphone. Just as the receiver converts back into sound waves the electric oscillations in the telephone line which were set up by sound waves, so the doctor's unconscious is able, from the derivatives of the unconscious which are communicated to him, to reconstruct that unconscious, which has determined the patient's free associations.”

Here’s a paraphrase of how my supervisor described this type of listening: “One way I listen to patients when they have digressions/noise – I try to listen by letting go of logic, letting go of preconceived notions, try to not connect the dots, try to allow myself to be in state of reverie, listen as the material goes by, tune in my unconscious to their unconscious, try to listen for things that capture my attention, even if they’re enigmatic, things that elicit a feeling inside myself.”

In order to listen in this way, the analyst must not allow his own resistances which prevent his conscious mind from understanding what his unconscious mind has perceived. Having this ability isn’t necessarily easy, and for this reason Freud recommends that the analyst should have undergone his own “psychoanalytic purification,” thus ensuring that he himself has “become aware of those complexes of his own which would be apt to interfere with his grasp of what the patient tells him.” In order to become an analyst, Freud believes that one must learn to analyze his own dreams, something which many need outside help to accomplish.

Memory. The analyst should not worry about remembering what the patient is saying but should simply listen. If the analyst does this, he will remember everything he needs to remember. “Those elements of the material which already form a connected context will be at the doctor's conscious disposal; the rest, as yet unconnected and in chaotic disorder, seems at first to be submerged, but rises readily into recollection as soon as the patient brings up something new to which it can be related and by which it can be continued.” The analyst only runs the risk of forgetting what the patient has said when he is “disturbed by some personal consideration,” i.e., when he has “fallen seriously below the standard of an ideal analyst.”

Notes. The analyst shouldn’t take notes during sessions because it will prevent him from listening with this evenly-suspended attention. To be more specific, when the analyst writes, part of his “mental activity” is tied up, mental activity “which would be better employed in interpreting what one has heard.” Freud makes a few exceptions to this rule, saying, for example, that the analyst can write down dates and “the text of dreams.” Although Freud doesn’t even write these things down. Regarding dreams, “I get the patient to repeat them to me after he has related them so that I can fix them in my mind.”

Abstinence. Freud advises analysts to model themselves on “the surgeon, who puts aside all his feelings, even his human sympathy, and concentrates his mental forces on the single aim of performing the operation as skillfully as possible.” If he fails to do this, he will not only get into “a state of mind which is unfavorable for his work” but will also be “helpless against certain resistances of the patient, whose recovery, as we know, primarily depends on the interplay of forces in him.” Freud acknowledges that this stance is one of “emotional coldness” but emphasizes that it “creates the most advantageous conditions for both parties: for the doctor a desirable protection for his own emotional life and for the patient the largest amount of help that we can give him to-day.” In other words, if the analyst does not put his feelings aside, it will be tougher for him to see the patient feel distressed, and he will therefore support the patient’s resistances (defenses) when his job is to help to learn to put away these defenses.

Anonymity. Young analysts will be tempted to share information in order to be kind to his patient, e.g., to share his own struggles to put the patient on equal footing with himself. However, this is problematic, as such an analyst risks turning the analysis into “treatment by suggestion.” Yes, it might help the patient to share personal information sooner in the treatment that he would have otherwise. But this sharing does not help to make conscious what is unconscious in the patient. Moreover, it makes the resolution of the transference (which is “one of the main tasks” of analysis) more difficult. Freud believes that the analyst “should be opaque to his patients and, like a mirror, should show them nothing but what is shown to him.”

Neutrality. When the patient begins to make progress, it might be tempting for the analyst to encourage the patient to focus his newfound energy on “new aims,” as he might want to “make something specially excellent of a person whom he has been at such pains to free from his neurosis.” However, the analyst must hold back because some patients will be limited in the ability to sublimate. If the analyst pushes the patient “unduly towards sublimation” and cuts him off from “the most accessible and convenient instinctual satisfactions, we shall usually make life even harder for them than they feel it in any case.” The analyst must accept his patient’s weaknesses and “must be content if one has won back some degree of capacity for work and enjoyment for a person even of only moderate worth.”

The Dynamics of Transference (1912)

During analysis, transference “emerges as the most powerful resistance to the treatment.” For instance, when a patient stops free associating, it is usually because his dominant association is connected to the analyst. In order to understand why this is the case — why transference is the most powerful resistance to treatment — Frued first explains the nature of neurosis. When one is neurotic, he writes, one part of his libido is directed toward reality and is capable of becoming conscious while another part of his libido is directed toward his infantile imagos and remains unconscious. This latter part has gone unconscious, he adds, because it was not not satisfied in the external world.

Analysis, of course, begins to make this part of libido conscious — for example, by pushing the patient to realize his feelings for his infantile imagos. In so doing, the analyst aims to liberate this part of the libido, to make it “serviceable for reality.” But when the analysis begins to make the libido conscious, “all the forces” that kept it unconscious in the first place now “rise up as ‘resistances’ against the work of analysis.” It is at this point that the patient’s ego makes use of transference in its efforts to keep his libido unconscious. The ego accomplishes this by moving the patient to transfer his infantile objects onto his therapist. In so doing, the patient’s feelings for his infantile objects remains unconscious, as he instead feels these feelings for his therapist.

As an example (and this is my own example), imagine that I have an unconscious desire for my mother. (This desire need not be sexual.) This desire initially went unconscious because it was not able to be satisfied in reality. Further imagine that I enter analysis and in the course of treatment become increasingly aware of this desire. The awareness is sure to cause pain, the pain occurring because this desire was never satisfied. And so in order to protect myself from this pain, my ego does a bait-and-switch. Instead of becoming aware of my desire for my mother, I began in some important ways to relate to my therapist as though he’s my mother. This is a compromise; my ego cannot squash my infantile desire, so it allows some of this desire to be transferred onto my analyst.

The transference is the patient’s last defense against his unconscious desires becoming conscious, and so he hangs on to it tenaciously. It is for this reason that ultimately “every conflict has to be fought out in the sphere of transference.”

Freud next wants to understand why transference is “so admirably suited to be a means of resistance.” The reason doesn’t seem obvious, as transference often creates relationships characterized by affection and safety, relationships in which it should be easy for the patient to bare his soul to the analyst.

Of course, this is not what happens, and to understand why, Freud says that we must understand that there are different types of transference, positive transference and negative transference. Positive transference contains affectionate feelings which are conscious, and it also contains sexual feelings which are unconscious.[1] Positive transference and negative transference often exist at the same time, a phenomenon Freud refers to as “ambivalence.” It is the existence of ambivalence that explains transference “in the service of resistance.”

Freud acknowledges that he has still not adequately explained why the patient with transference-resistance becomes so, well, irrational — disregarding the fundamental rule of analysis, forgetting the very reason he started treatment, and “how he regards with indifference logical arguments and conclusions which only a short time before had made a great impression on him.” To explain these phenomena, he reminds us that the process of making the libido conscious requires us to “penetrate into the realm of the unconscious.” And the unconscious, as dreams show us, is a crazy, irrational place. Or as Freud puts it: Unconscious impulses present themselves “in accordance with the timelessness of the unconscious and its capacity for hallucination.” 

When the patient is under the sway of his unconscious passions, he understandably becomes somewhat oblivious to reality and seeks to act out his unconscious passions. The analyst meanwhile attempts to make sense of these passions, “to submit them to intellectual consideration.” This struggle between patient and analyst, between unconscious and intellect, between understanding and acting out “is played out almost exclusively in the phenomena of transference.” It is in the transference “that the victory must be won— the victory whose expression is the permanent cure of the neurosis.” It is in the transference that the analyst brings to consciousness the patient’s libido. “For when all is said and done,” he concludes, “it is impossible to destroy anyone in absentia or in effigie.”

* * * * *

[1] This latter claim is pretty radical, and he briefly elaborates: “And we are thus led to the discovery that all the emotional relations of sympathy, friendship, trust, and the like, which can be turned to good account in our lives, are genetically linked with sexuality and have developed from purely sexual desires through a softening of their sexual aim, however pure and unsensual they may appear to our conscious self-perception. Originally we knew only sexual objects; and psychoanalysis shows us that people who in our real life are merely admired or respected may still be sexual objects for our unconscious.”

On Beginning of the Treatment (1913)

Freud makes it clear that he is not establishing hardcore rules for analysis but rather recommendations that might not be universally valid. He elaborates: “The extraordinary diversity of the psychical constellations concerned, the plasticity of all mental processes and the wealth of determining factors oppose any mechanization of the technique; and they bring it about that a course of action that is as a rule justified may at times prove ineffective, whilst one that is usually mistaken may once in a while lead to the desired end.”

(1) Selecting patients. Freud first sees patients for 1-2 weeks before deciding whether they will be good candidates for analysis. This “preliminary experiment” allows the analyst to assess whether the patient will be suitable for analysis. During this time, the analyst applies the regular methods of analysis.

Treatment is more difficult if the analyst already knows the patient or if he engages in “lengthy preliminary discussions” before beginning treatment. If either of these conditions exist, the patient will begin treatment already possessing a “transference attitude” which ideally the analyst will be able to “slowly uncover instead of having the opportunity to observe the growth and development of the transference from the outset.”

(2) Analysis is (temporarily) crazy-making. In other words, analysis can make even the most rational person wildly irrational. As Freud puts it, even a neurotic who is capable of performing analysis on others will himself produce “the most intense resistances” as soon as he becomes an analytic patient. “When this happens we are once again reminded of the dimension of depth in the mind, and it does not surprise us to find that the neurosis has its roots in psychical strata to which an intellectual knowledge of analysis has not penetrated.”

(3) Time and money. Freud has a strict policy of leasing each client the same hour of the day. He requires the patient to pay for this hour every day even if he doesn’t show up for a session. Freud believes that if he does not enforce this policy, “the ‘occasional’ non-attendances increase so greatly that the doctor finds his material existence threatened.”

Freud exhorts analysts to talk openly about money. Most “civilized people,” he notes, talk about money they way they talk about sex — “with the same inconsistency, prudishness and hypocrisy.” The analyst, however, must set an example talk about money “with the same matter-of-course frankness to which he wishes to educate [his patients] in things relating to sexual life. He shows them that he himself has cast off false shame on these topics, by voluntarily telling them the price at which he values his time.” And indeed there’s no need for the analyst to feel shame for charging for his services; indeed, the analyst “may put himself in the position of a surgeon, who is frank and expensive because he has at his disposal methods of treatment which can be of use. It seems to me more respectable and ethically less objectionable to acknowledge one's actual claims and needs rather than, as is still the practice among physicians, to act the part of the disinterested philanthropist.”

Similarly, the analyst must not provide his services for free. Doing so would significantly increase the patient’s resistances — “in young women, for instance, the temptation which is inherent in their transference-relation, and in young men, their opposition to an obligation to feel grateful, an opposition which arises from their father-complex and which presents one of the most troublesome hindrances to the acceptance of medical help.” Moreover, offering treatment for free might decrease the patient’s motivation to get better.”

(4) Frequency of analysis. Freud sees his patients 6 days a week. He found that if he sees patients less often, “there is a risk of not being able to keep pace with the patient's real life and of the treatment losing contact with the present and being forced into by-paths.”

(5) Duration of analysis. It’s impossible to know how long an analysis will take. To explain why, he references a vignette from Aesop’s fables in which a wayfarer asks a philosopher how long his journey will be, and the philosopher says that he can’t give an answer without first knowing the length of the wayfarer’s stride. Similarly, knowing how long analysis will take depends on the patient, how quickly he makes progress and whether he at any point slows his rate of progress.

(6) The couch. Freud has his patients lie on a sofa while he sits behind them, out of their sight. He acknowledges that this arrangement is a remnant of the hypnotic method but says it deserves to be retained for a number of reasons, one of them being that while Freud is listening, he too gives himself over to his own unconscious thoughts and doesn’t want the expressions that arise on his face “to give the patient material for interpretations or to influence him in what he tells me.” By doing this, he is less likely to influence the patient’s transference.

(7) Free association. The patient must decide what to talk about in analysis. Freud only provides one instruction, what he refers to as the fundamental rule: 

What you tell me must differ in one respect from an ordinary conversation. Ordinarily you rightly try to keep a connecting thread running through your remarks and you exclude any intrusive ideas that may occur to you and any side-issues, so as not to wander too far from the point. But in this case you must proceed differently. You will notice that as you relate things various thoughts will occur to you which you would like to put aside on the ground of certain criticisms and objections. You will be tempted to say to yourself that this or that is irrelevant here, or is quite unimportant, or nonsensical, so that there is no need to say it. You must never give in to these criticisms, but must say it in spite of them—indeed, you must say it precisely because you feel an aversion to doing so. Later on you will find out and learn to understand the reason for this injunction, which is really the only one you have to follow. So say whatever goes through your mind. Act as though, for instance, you were a traveller sitting next to the window of a railway carriage and describing to someone inside the carriage the changing views which you see outside. Finally, never forget that you have promised to be absolutely honest, and never leave anything out because, for some reason or other, it is unpleasant to tell it.

Freud will tell his patients, “Before I can say anything to you I must know a great deal about you; please tell me what you know about yourself.”

Foreseeing 110 years into the future, he next describes me (yes, me):

There are patients who from the very first hours carefully prepare what they are going to communicate, ostensibly so as to be sure of making better use of the time devoted to the treatment. What is thus disguising itself as eagerness is resistance. Any preparation of this sort should be disrecommended, for it is only employed to guard against unwelcome thoughts cropping up. However genuinely the patient may believe in his excellent intentions, the resistance will play its part in this deliberate method of preparation and will see to it that the most valuable material escapes communication. One will soon find that the patient devises yet other means by which what is required may be withheld from the treatment. He may talk over the treatment every day with some intimate friend, and bring into this discussion all the thoughts which should come forward in the presence of the doctor. The treatment thus has a leak which lets through precisely what is most valuable. When this happens, the patient must, without much delay, be advised to treat his analysis as a matter between himself and his doctor and to exclude everyone else from sharing in the knowledge of it, no matter how close to him they may be, or how inquisitive.

Some patients will come to analysis and say that there’s nothing on their mind, that they don’t have anything to say. This is of course resistance, and the analyst must be pushed to acknowledge “that he has nevertheless overlooked certain thoughts which were occupying his mind. He had thought of the treatment itself, though nothing definite about it, or he had been occupied with the picture of the room in which he was, or he could not help thinking of the objects in the consulting room and of the fact that he was lying here on a sofa—all of which he has replaced by the word ‘nothing.’” Freud adds that every thought the patient has that is “connected with the present situation represents a transference to the [analyst], which proves suitable to serve as a first resistance.” He adds: “We are thus obliged to begin by uncovering this transference; and a path from it will give rapid access to the patient's pathogenic material.”

(8) Interpretations. Freud says that the analyst should not begin making interpretations until a positive transference has been established, one in which the patient begins to connect the analyst to “one of the imagos of the people by whom he was accustomed to be treated with affection.” In order to establish this positive transference, the analyst should demonstrate a “serious interest” in the patient, “carefully clear away the resistances that crop up at the beginning,” and avoid “making certain mistakes.”

In the early days of analysis, Freud focused on the intellect and helping his patients remember past trauma. He was disappointed to find that even if he could help patients to remember this trauma, their neurosis did not go away. He recalls a time he continued to remind a girl of a traumatic event told to him by the girl’s mother; when Freud reminded her of the event, she would get hysterical and then later forget the event all over again. Such occurrences were one factor that helped Freud to understand that patients have different internal forces at work.

The patient has one force that wishes to be cured from his illness, but he has another force which derives some benefit from the illness. The first force alone is not able to overcome the illness because (1) this force does not know what paths to follow to reach this end and (2) this force does possess the needed energy to oppose the resistances. Analysis works to make both of these things possible. It supplies the needed energy “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.” Freud emphasizes the importance of transference being utilized to overcome the resistances. Moreover, the patient will only make use of insight “in so far as he is induced to do so by the transference.” This is why the therapist must wait until a transference has been established before making an interpretation.

Remembering, Repeating, and Working-Through (1914)

Analysis has changed over the years. Initially, the goal of analysis was to help the patient remember the moment at which his symptoms first appeared. It was believed that if the patient could fully remember this moment and his accompanying mental processes, then he could achieve catharsis or abreaction. The goal of analysis is no longer to focus on identifying the moment the patient’s symptoms originated. Rather, the goal is to study the patient’s free associations and to use interpretations to make conscious the resistances which inhibit his free associations. Once the patient has worked through his resistances, he will then uncover forgotten memories.

When psychoanalysts talk about a person “forgetting” something, they don’t generally mean that that person has amnesia. Rather, they mean that that person has repressed something — an event, a thought, a feeling. Interestingly, although we might have difficulty recalling certain memories, we often act out or repeat these “forgotten” memories. Freud elaborates:

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.

To help the patient to uncover these memories, it helps if early in the analysis, he develops a positive transference. If the transference becomes hostile or “unduly intense,” the patient will again find himself repressing these memories, and “remembering at once gives way to acting out.”

When the patient begins analysis, his attitude toward his illness might change. He now begins to direct his attention toward his illness and resolve to fight it. As treatment continues and he begins to uncover repressed material, some symptoms will intensify. The patient might conclude that he should stop treatment; it’s as though his resistance says, “See what happens if I really give way to things. Was I not right to consign them to repression?” The analyst can counter “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.”

As the analysis continues, “new and deeper-lying instinctual impulses, which had not hitherto made themselves felt, may come to be ‘repeated.’” The analyst’s job throughout is to encourage the patient not to act out his repetitions in real life but to rather talk about them. The patient is allowed to act out his repetitions in the transference, the transference serving as “a playground in which [a repetition] is allowed to expand in almost complete freedom and in which it is expected to display to us everything in the way of pathogenic instincts that is hidden in the patient's mind.”

If all goes well, the patient’s regular neurosis will be replaced by a transference-neurosis. The transference-neurosis displays all the characteristics of the patient’s actual neurosis, but “it represents an artificial illness” which can be treated within the analysis. Through the repetitive actions that occur in the analysis, “we are led along the familiar paths to the awakening of the memories, which appear without difficulty, as it were, after the resistance has been overcome.” (I think he’s using the term “resistance” in a very specific way, to mean resistance to free associating.)

Freud ends his paper by summarizing the work of analysis. The patient’s job is to free associate. The analyst’s job is to make the patient’s resistances conscious to him. Once the resistances begin to be made conscious, the patient’s resistances will likely grow stronger. Although newer analyst’s might despair when this happens, Freud emphasizes that this is the way it has to be. The analyst must simply be patient and allow time for the patient to become more familiar with his resistance and to continue doing the work of analysis; it is through this act of defiance against the resistance that the patient will eventually work through it. Once the patient works through the resistance, he will experience a kind of abreaction of “the quotas of affect strangulated by repression.”