Advice for Analysts

 Since every individual is a new and unique combination of psychic elements, the investigation of truth must begin afresh with each case, for each “case” is individual and not derivable from any preconceived formula.  Each individual is a new experiment of life in her ever-changing moods, and an attempt at a new solution or new adaptation.  We miss the meaning of the individual psyche if we interpret it on the basis of any fixed theory, however fond of it we may be.  TDoP 93

For the doctor this means the individual study of every case; for the teacher, the individual study of every pupil.  I do not mean that you should begin each investigation from the very bottom.  What you already understand needs no investigating.  I speak of “understanding” only when the patient or pupil can agree with the interpretations offered; understanding that goes over your patient’s head is an unsafe business for both.  It might be successful with a child, but certainly not with an adult of any mental maturity.  In any case of disagreement the doctor must be ready to drop all his arguments for the sole purpose of finding the truth.   TDoP 93

There are naturally cases where the doctor sees something which is undoubtedly there, but which the patient will not or cannot admit.  As the truth is often hidden as much from the doctor as from the patient, various methods have been evolved for gaining access to the unknown contents.  I purposely say “unknown” and not “repressed” because I think it altogether wrong to assume that whenever a content is unknown it is necessarily repressed.  The doctor who really thinks that way gives the appearance of knowing everything beforehand.  Such a pretence stymies the patient and will most likely make it impossible for him to confess the truth.  At all events the know-all attitude takes the wind out of his sails, though this is sometimes not altogether unwelcome to him, as he can then guard his secret the more easily, and it is so much more convenient to have his truth handed to him by the analyst than be forced to realize and confess it himself.  In this way nobody is the gainer.  Moreover, this superior knowing in advance undermines the patient’s independence of mind, a most precious quality that should on no account be injured.  One really cannot be careful enough, as people are incredibly eager to be rid of themselves, running after strange gods whenever occasion offers.  TDoP 94

  Naiveté is out of place in psychotherapy.  The doctor, like the educator, must always keep his eyes open to the possibility of being consciously or unconsciously deceived, not merely by his patient, but above all himself.  The tendency to live in illusion and to believe in a fiction of oneself – in the good sense or in the bad – is almost insuperably great.  The neurotic is one who falls victim to his own illusions.  But anyone who is deceived, himself deceives.  Everything can then serve the purposes of concealment and subterfuge.  The psychotherapist should realize that so long as he believes in a theory and in a definite method he is likely to be fooled by certain cases, namely by those clever enough to select a safe hiding-place for themselves behind the trappings of the theory, and then to use the method so skillfully as to make the hiding-place undiscoverable.   TDoP 112 

Since there is no nag that cannot be ridden to death, all theories of neurosis and methods of treatment are a dubious affair.  So I always find it cheering when businesslike physicians and fashionable consultants aver that they treat patients along the lines of “Adler,” or of “Kunkel,” or of “Freud,” or even of “Jung.”  There simply is not and cannot be any such treatment, and even if there could be, one would be on the surest road to failure.  TDoP 113

In dealing with psychological developments, the doctor should, as a matter of principle, let nature rule and himself do his utmost to avoid influencing the patient in the direction of his own philosophical, social, and political bent.  Even if all citizens are equal before the law, they are very unequal as individuals, and therefore each can find happiness only in his own way.  This is not to preach “individualism,” but only he necessary pre-condition for responsible action: namely that a man should know himself and his own peculiarities and have the courage to stand by them.  Only when a man lives in his own way is he responsible and capable of action – otherwise he is just a hanger-on or follower-on with no proper personality.  TPoP 26

Freud emphasizes the aetiology of the case, and assumes that once the causes are brought into consciousness the neurosis will be cured.  But mere consciousness of the causes does not help any more than detailed knowledge of the causes of war helps to raise the value of the French franc.  The task of psychotherapy is to correct the conscious attitude and not to go chasing after infantile memories. 

   Naturally you cannot do the one without paying attention to the other, but the main emphasis should be upon the attitude of the patient.  There are extremely practical reasons for this, because there is scarcely a neurotic who does not love to dwell upon the evils of the past and to wallow in self-commiserating memories.  Very often his neurosis consists precisely in his hanging back and constantly excusing himself on account of the past.   TPoP 32

   The human psyche is a thing of enormous ambiguity.  In every single case we have to ask ourselves whether an attitude or a so-called habitus is authentic, or whether it may not be just a compensation for its opposite.  I must confess that I have so often been deceived in this matter that in any concrete case I am at pains to avoid all theoretical presuppositions about the structure of the neurosis and about what the patient can and ought to do.  As far as possible I let pure experience decide the therapeutic aims.  This may perhaps seem strange, because it is commonly supposed that the therapist has an aim.  But in psychotherapy it seems to me positively advisable for the doctor not to have too fixed of an aim.  He can hardly know better than the nature and will to live of the patient.  The great decisions in human life usually have far more to do with the instincts and other mysterious unconscious factors than with the conscious will and well-meaning reasonableness.  The shoe that fits one person pinches another; there is no universal recipe for living.  Each of us carries his own life-form within him – an irrational form which no other can outbid.   TPoP 41

For I do not know what to say to the patient when he asks me, “What do you advise? What shall I do?”   I don’t know either.  I only know one thing: when my conscious mind no longer sees any possible road ahead and consequently gets stuck, my unconscious psyche will react to the unbearable standstill.  TPoP 42

The Transference

  Strictly speaking, transference is the projection of unconscious contents upon the person analyzing the unconscious.  The term “transference,” however, is used in a much wider sense and embraces all the exceedingly complex processes which bind the patient to the analyst.  This bond can turn into an extremely unpleasant obstacle if inexpertly handled.  There are cases where it has even led to suicide.  One of the main reasons for this is the coming to consciousness of certain unconscious contents which throw a new and disturbing light on the family situation.  Things may come up that transform the patient’s love and trust in his parents into resistance and hatred.  He then finds himself in an intolerable state of isolation, and will cling desperately to the analyst as his last remaining link with the world.  If at this critical juncture the analyst, through some technical blunder, snaps even this link, it can lead straight to suicide.  TDoP 154

Advice for analysts – Case # (TDoP 132)

I remember being consulted about a badly behaved little boy.  From the parents’ account I learnt that, at the age of seven, he could neither read nor write, that he would not learn any of his lessons properly, resisting, with unreasoning defiance, every attempt to educate him, and that for two years he had been developing rages in which he smashed everything within reach.  He was intelligent enough, so the parents thought, but totally lacking in goodwill.  Instead of working he lazed about or played with his decrepit old Teddy bear, which for years had been his only toy.  He had been given plenty of other toys, but he viciously destroyed them.  They had even engaged a good governess for him, but she could do nothing with him either.  He was, after a couple of girls, the first and only son, on whom, so it seemed to me, the mother doted especially.  As soon as I saw the child the riddle was solved; the boy was pretty much of an imbecile already, and the mother, who could not endure having a backward son, had so egged on and tormented this essentially harmless and good-natured zany with her ambitions that he went completely berserk out of sheer desperation.  When I spoke to the mother after the examination she was outraged by my diagnosis and insisted that I must have made a mistake. 

There are four methods of investigating the unknown in a patient. 

1.      The Association Method

2.      Symptom Analysis

3.      Anamnestic Analysis

4.      Analysis of the Unconscious