Freud - Complete Works (424 page)

Remembering, Repeating And Working-Through

2504

   Further dangers arise from the
fact that in the course of the treatment new and deeper-lying
instinctual impulses, which have not hitherto made themselves felt,
may come to be ‘repeated’. Finally, it is possible that
the patient’s actions outside the transference may do him
temporary harm in his ordinary life, or even have been so chosen as
permanently to invalidate his prospects of recovery.

   The tactics to be adopted by the
physician in this situation are easily justified. For him,
remembering in the old manner - reproduction in the psychical field
- is the aim to which he adheres, even though he knows that such an
aim cannot be achieved in the new technique. He is prepared for a
perpetual struggle with his patient to keep in the psychical sphere
all the impulses which the patient would like to direct into the
motor sphere; and he celebrates it as a triumph for the treatment
if he can bring it about that something that the patient wishes to
discharge in action is disposed of through the work of remembering.
If the attachment through transference has grown into something at
all serviceable, the treatment is able to prevent the patient from
executing any of the more important repetitive actions and to
utilize his intention to do so
in statu nascendi
as material
for the therapeutic work. One best protects the patient from
injuries brought about through carrying out one of his impulses by
making him promise not to take any important decisions affecting
his life during the time of his treatment - for instance, not to
choose any profession or definitive love-object - but to postpone
all such plans until after his recovery.

   At the same time one willingly
leaves untouched as much of the patient’s personal freedom as
is compatible with these restrictions, nor does one hinder him from
carrying out unimportant intentions, even if they are foolish; one
does not forget that it is in fact only through his own experience
and mishaps that a person learns sense. There are also people whom
one cannot restrain from plunging into some quite undesirable
project during the treatment and who only afterwards become ready
for, and accessible to, analysis. Occasionally, too, it is bound to
happen that the untamed instincts assert themselves before there is
time to put the reins of the transference on them, or that the
bonds which attach the patient to the treatment are broken by him
in a repetitive action. As an extreme example of this, I may cite
the case of an elderly lady who had repeatedly fled from her house
and her husband in a twilight state and gone no one knew where,
without ever having become conscious of her motive for decamping in
this way. She came to treatment with a marked affectionate
transference which grew in intensity with uncanny rapidity in the
first few days; by the end of the week she had decamped from me,
too, before I had had time to say anything to her which might have
prevented this repetition.

Remembering, Repeating And Working-Through

2505

   The main instrument, however, for
curbing the patient’s compulsion to repeat and for turning it
into a motive for remembering lies in the handling of the
transference. We render the compulsion harmless, and indeed useful,
by giving it the right to assert itself in a definite field. We
admit it into the transference as a playground in which it 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. Provided only
that the patient shows compliance enough to respect the necessary
conditions of the analysis, we regularly succeed in giving all the
symptoms of the illness a new transference meaning and in replacing
his ordinary neurosis by a ‘transference-neurosis’ of
which he can be cured by the therapeutic work. The transference
thus creates an intermediate region between illness and real life
through which the transition from the one to the other is made. The
new condition has taken over all the features of the illness; but
it represents an artificial illness which is at every point
accessible to our intervention. It is a piece of real experience,
but one which has been made possible by especially favourable
conditions, and it is of a provisional nature. From the repetitive
reactions which are exhibited in the transference 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.

Remembering, Repeating And Working-Through

2506

   I might break off at this point
but for the title of this paper, which obliges me to discuss a
further point in analytic technique. The first step in overcoming
the resistances is made, as we know, by the analyst’s
uncovering the resistance, which is never recognized by the
patient, and acquainting him with it. Now it seems that beginners
in analytic practice are inclined to look on this introductory step
as constituting the whole of their work. I have often been asked to
advise upon cases in which the doctor complained that he had
pointed out his resistance to the patient and that nevertheless no
change had set in; indeed, the resistance had become all the
stronger, and the whole situation was more obscure than ever. The
treatment seemed to make no headway. This gloomy foreboding always
proved mistaken. The treatment was as a rule progressing most
satisfactorily. The analyst had merely forgotten that giving the
resistance a name could not result in its immediate cessation. One
must allow the patient time to become more conversant with this
resistance with which he has now become acquainted, to
work
through
it, to overcome it, by continuing, in defiance of it,
the analytic work according to the fundamental rule of analysis.
Only where the resistance is at its height can the analyst, working
in common with his patient, discover the repressed instinctual
impulses which are feeding the resistance; and it is this kind of
experience which convinces the patient of the existence and power
of such impulses. The doctor has nothing else to do than to wait
and let things take their course, a course which cannot be avoided
nor always hastened. If he holds fast to this conviction he will
often be spared the illusion of having failed when in fact he is
conducting the treatment on the right lines.

   This working-through of the
resistances may in practice turn out to be an arduous task for the
subject of the analysis and a trial of patience for the analyst.
Nevertheless it is a part of the work which effects the greatest
changes in the patient and which distinguishes analytic treatment
from any kind of treatment by suggestion. From a theoretical point
of view one may correlate it with the ‘abreacting’ of
the quotas of affect strangulated by repression - an abreaction
without which hypnotic treatment remained ineffective.

2507

OBSERVATIONS ON TRANSFERENCE-LOVE

(FURTHER RECOMMENDATIONS ON THE TECHNIQUE
OF PSYCHO-ANALYSIS III)

(1915)

2508

Intentionally left blank

2509

OBSERVATIONS ON TRANSFERENCE-LOVE

(FURTHER RECOMMENDATIONS ON THE TECHNIQUE
OF PSYCHO-ANALYSIS III)

Every beginner in psycho-analysis probably
feels alarmed at first at the difficulties in store for him when he
comes to interpret the patient’s associations and to deal
with the reproduction of the repressed. When the time comes,
however, he soon learns to look upon these difficulties as
insignificant, and instead becomes convinced that the only really
serious difficulties he has to meet lie in the management of the
transference.

   Among the situations which arise
in this connection I shall select one which is very sharply
circumscribed; and I shall select it, partly because it occurs so
often and is so important in its real aspects and partly because of
its theoretical interest. What I have in mind is the case in which
a woman patient shows by unmistakable indications, or openly
declares, that she has fallen in love, as any other mortal woman
might, with the doctor who is analysing her. This situation has its
distressing and comical aspects, as well as its serious ones. It is
also determined by so many and such complicated factors, it is so
unavoidable and so difficult to clear up, that a discussion of it
to meet a vital need of analytic technique has long been overdue.
But since we who laugh at other people’s failings are not
always free from them ourselves, we have not so far been precisely
in a hurry to fulfil this task. We are constantly coming up against
the obligation to professional discretion - a discretion which
cannot be dispensed with in real life, but which is of no service
in our science. In so far as psycho-analytic publications are a
part of real life, too, we have here an insoluble contradiction. I
have recently disregarded this matter of discretion at one
point,¹ and shown how this same transference situation held
back the development of psycho-analytic therapy during its first
decade.

  
¹
In the first section of my contribution to
the history of the psycho-analytic movement
(1914
d
)

Observations On Transference-Love

2510

   To a well-educated layman (for
that is what the ideal civilized person is in regard to
psycho-analysis) things that have to do with love are
incommensurable with everything else; they are, as it were, written
on a special page on which no other writing is tolerated. If a
woman patient has fallen in love with her doctor it seems to such a
layman that only two outcomes are possible. One, which happens
comparatively rarely, is that all the circumstances allow of a
permanent legal union between them; the other, which is more
frequent, is that the doctor and the patient part and give up the
work they have begun which was to have led to her recovery, as
though it had been interrupted by some elemental phenomenon. There
is, to be sure, a third conceivable outcome, which even seems
compatible with a continuation of the treatment. This is that they
should enter into a love-relationship which is illicit and which is
not intended to last for ever. But such a course is made impossible
by conventional morality and professional standards. Nevertheless,
our layman will beg the analyst to reassure him as unambiguously as
possible that this third alternative is excluded.

   It is clear that a psycho-analyst
must look at things from a different point of view.

   Let us take the case of the
second outcome of the situation we are considering. After the
patient has fallen in love with her doctor, they part; the
treatment is given up. But soon the patient’s condition
necessitates her making a second attempt at analysis, with another
doctor. The next thing that happens is that she feels she has
fallen in love with this second doctor too; and if she breaks off
with him and begins yet again, the same thing will happen with the
third doctor, and so on. This phenomenon, which occurs without fail
and which is, as we know, one of the foundations of the
psycho-analytic theory, may be evaluated from two points of view,
that of the doctor who is carrying out the analysis and that of the
patient who is in need of it.

   For the doctor the phenomenon
signifies a valuable piece of enlightenment and a useful warning
against any tendency to a counter-transference which may be present
in his own mind. He must recognize that the patient’s falling
in love is induced by the analytic situation and is not to be
attributed to the charms of his own person; so that he has no
grounds whatever for being proud of such a ‘conquest’,
as it would be called outside analysis. And it is always well to be
reminded of this. For the patient, however, there are two
alternatives: either she must relinquish psycho-analytic treatment
or she must accept falling in love with her doctor as an
inescapable fate.¹

  
¹
We know that the transference can manifest
itself in other, less tender feelings, but I do not propose to go
into that side of the matter here.

Observations On Transference-Love

2511

   I have no doubt that the
patient’s relatives and friends will decide as emphatically
for the first of these two alternatives as the analyst will for the
second. But I think that here is a case in which the decision
cannot be left to the tender - or rather, the egoistic and jealous
- concern of her relatives. The welfare of the patient alone should
be the touchstone; her relatives’ love cannot cure her
neurosis. The analyst need not push himself forward, but he may
insist that he is indispensable for the achievement of certain
ends. Any relative who adopts Tolstoy’s attitude to this
problem can remain in undisturbed possession of his wife or
daughter; but he will have to try to put up with the fact that she,
for her part, retains her neurosis and the interference with her
capacity for love which it involves. The situation, after all, is
similar to that in a gynaecological treatment. Moreover, the
jealous father or husband is greatly mistaken if he thinks that the
patient will escape falling in love with her doctor if he hands her
over to some kind of treatment other than analysis for combating
her neurosis. The difference, on the contrary, will only be that a
love of this kind, which is bound to remain unexpressed and
unanalysed, can never make the contribution to the patient’s
recovery which analysis would have extracted from it.

   It has come to my knowledge that
some doctors who practise analysis frequently prepare their
patients for the emergence of the erotic transference or even urge
them to ‘go ahead and fall in love with the doctor so that
the treatment may make progress’. I can hardly imagine a more
senseless proceeding. In doing so, an analyst robs the phenomenon
of the element of spontaneity which is so convincing and lays up
obstacles for himself in the future which are hard to overcome.

Observations On Transference-Love

2512

   At a first glance it certainly
does not look as if the patient’s falling in love in the
transference could result in any advantage to the treatment. No
matter how amenable she has been up till then, she suddenly loses
all understanding of the treatment and all interest in it, and will
not speak or hear about anything but her love, which she demands to
have returned. She gives up her symptoms or pays no attention to
them; indeed, she declares that she is well. There is a complete
change of scene; it is as though some piece of make-believe had
been stopped by the sudden irruption of reality - as when, for
instance, a cry of fire is raised during a theatrical performance.
No doctor who experiences this for the first time will find it easy
to retain his grasp on the analytic situation and to keep clear of
the illusion that the treatment is really at an end.

   A little reflection enables one
to find one’s bearings. First and foremost, one keeps in mind
the suspicion that anything that interferes with the continuation
of the treatment may be an expression of resistance. There can be
no doubt that the outbreak of a passionate demand for love is
largely the work of resistance. One will have long since noticed in
the patient the signs of an affectionate transference, and one will
have been able to feel certain that her docility, her acceptance of
the analytic explanations, her remarkable comprehension and the
high degree of intelligence she showed were to be attributed to
this attitude towards her doctor. Now all this is swept away. She
has become quite without insight and seems to be swallowed up in
her love. Moreover, this change quite regularly occurs precisely at
a point of time when one is having to try to bring her to admit or
remember some particularly distressing and heavily repressed piece
of her life-history. She has been in love, therefore, for a long
time; but now the resistance is beginning to make use of her love
in order to hinder the continuation of the treatment, to deflect
all her interest from the work and to put the analyst in an awkward
position.

Observations On Transference-Love

2513

   If one looks into the situation
more closely one recognizes the influence of motives which further
complicate things - of which some are connected with being in love
and others are particular expressions of resistance. Of the first
kind are the patient’s endeavour to assure herself of her
irresistibility, to destroy the doctor’s authority by
bringing him down to the level of a lover and to gain all the other
promised advantages incidental to the satisfaction of love. As
regards the resistance, we may suspect that on occasion it makes
use of a declaration of love on the patient’s part as a means
of putting her analyst’s severity to the test, so that, if he
should show signs of compliance, he may expect to be taken to task
for it. But above all one gets an impression that the resistance is
acting as an
agent provocateur
; it heightens the
patient’s state of being in love and exaggerates her
readiness for sexual surrender in order to justify the workings of
repression all the more emphatically, by pointing to the dangers of
such licentiousness. All these accessory motives, which in simpler
cases may not be present, have, as we know, been regarded by Adler
as the essential part of the whole process.

   But how is the analyst to behave
in order not to come to grief over this situation, supposing he is
convinced that the treatment should be carried on in spite of this
erotic transference and should take it in its stride?

   It would be easy for me to lay
stress on the universally accepted standards of morality and to
insist that the analyst must never under any circumstances accept
or return the tender feelings that are offered him: that, instead,
he must consider that the time has come for him to put before the
woman who is in love with him the demands of social morality and
the necessity for renunciation, and to succeed in making her give
up her desires, and, having surmounted the animal side of herself,
go on with the work of analysis.

   I shall not, however, fulfil
these expectations - neither the first nor the second of them. Not
the first, because I am writing not for patients but for doctors
who have serious difficulties to contend with, and also because in
this instance I am able to trace the moral prescription back to its
source, namely to expediency. I am on this occasion in the happy
position of being able to replace the moral embargo by
considerations of analytic technique, without any alteration in the
outcome.

Observations On Transference-Love

2514

   Even more decidedly, however, do
I decline to fulfil the second of the expectations I have
mentioned. To urge the patient to suppress, renounce or sublimate
her instincts the moment she has admitted her erotic transference
would be, not an analytic way of dealing with them, but a senseless
one. It would be just as though, after summoning up a spirit from
the underworld by cunning spells, one were to send him down again
without having asked him a single question. One would have brought
the repressed into consciousness, only to repress it once more in a
fright. Nor should we deceive ourselves about the success of any
such proceeding. As we know, the passions are little affected by
sublime speeches. The patient will feel only the humiliation, and
she will not fail to take her revenge for it.

   Just as little can I advocate a
middle course, which would recommend itself to some people as being
specially ingenious. This would consist in declaring that one
returns the patient’s fond feelings but at the same time in
avoiding any physical implementation of this fondness until one is
able to guide the relationship into calmer channels and raise it to
a highest level. My objection to this expedient is that
psycho-analytic treatment is founded on truthfulness. In this fact
lies a great part of its educative effect and its ethical value. It
is dangerous to depart from this foundation. Anyone who has become
saturated in the analytic technique will no longer be able to make
use of the lies and pretences which a doctor normally finds
unavoidable; and if, with the best intentions, he does attempt to
do so, he is very likely to betray himself. Since we demand strict
truthfulness from our patients, we jeopardize our whole authority
if we let ourselves be caught out by them in a departure from the
truth. Besides, the experiment of letting oneself go a little way
in tender feelings for the patient is not altogether without
danger. Our control over ourselves is not so complete that we may
not suddenly one day go further than we had intended. In my
opinion, therefore, we ought not to give up the neutrality towards
the patient, which we have acquired through keeping the
counter-transference in check.