Our Inner Conflicts

Conclusion: Resolution of Neurotic Conflicts

THE MORE we realize what infinite harm neurotic conflicts inflict on the personality, the more stringent appears the need truly to resolve them. But since, as we now understand, this cannot be done by rational decision nor by evasion nor by the exertion of will power, how can it be done? There is only one way: the conflicts can be resolved only by changing those conditions within the personality that brought them into being.

This is a radical way, and a hard one. In view of the difficulties involved in changing anything within ourselves, it is quite understandable that we should scour the ground for short cuts. Perhaps that is why patients— and others as well—so often ask: Is it enough if one sees one’s basic conflict? The answer is clearly, no.

Even when the analyst—discerning quite early in the analysis just how the patient is divided—is able to help him to recognize this split, the insight is of no immediate profit. It may bring a certain relief in that the patient begins to see a tangible reason for his troubles instead of simply being lost in a mysterious haze; but he cannot apply it to his life. A perception of how his divergent parts operate and interfere with one another makes him no less divided. He hears these facts as one hears a strange message; it seems plausible, but he cannot realize its implications for himself. He is bound to invalidate it by manifold unconscious mental reservations. Unconsciously he will insist that the analyst is exaggerating the magnitude of his conflicts; that he would be quite all right if it were not for outside circumstances; that love or success would rid him of his distress; that he can evade his conflicts by keeping away from people; that though it may be true of ordinary folk that they cannot serve two masters, he with his unlimited powers of will and intelligence could manage to do so. Or he may feel—again unconsciously—that the analyst is a charlatan or a well-meaning fool, feigning professional cheerfulness; that he ought to know the patient is ruined beyond repair—which means that the patient responds to the analyst’s suggestions with his own feeling of hopelessness.

Since such mental reservations point to the fact that the patient either clings to his particular attempts at solution—these being much more real to him than the conflicts themselves—or that he fundamentally despairs of recovery, all the attempts and all their consequences must be worked through before the basic conflict can profitably be tackled.

The search for an easier road has given rise to another question, lent weight by Freud’s emphasis on genesis: Is it enough to relate these conflicting drives— once they have been recognized—to their origins and early manifestations in the childhood situation? Again the answer is, no—and again, for the most part, the same reasons apply. Even the most detailed recollection of his early experiences gives the patient little beyond a more lenient, more condoning attitude toward himself. It in no way makes his present conflicts any less disrupting.

A comprehensive knowledge of early environmental influences and the changes they effected in the child’s personality, though it has little direct therapeutic value, does have a bearing on our inquiry into the conditions under which neurotic conflicts develop.1 It was, after all, the changes in his relations with himself and others that originally brought about the conflicts. I have described this development in previous publications² as well as in the earlier chapters of this book. Briefly, a child may find himself in a situation that threatens his inner freedom, his spontaneity, his feeling of security, his self-confidence—in short the very core of his psychic existence. He feels isolated and helpless, and as a result his first attempts to relate himself to others are determined not by his real feelings but by strategic necessities. He cannot simply like or dislike, trust or distrust, express his wishes or protest against those of others, but has automatically to devise ways to cope with people and to manipulate them with minimum damage to himself. The fundamental characteristics that evolve in this way may be summarized as an alienation from the self and others, a feeling of helplessness, a pervasive apprehensiveness, and a hostile tension in his human relations that ranges from general wariness to definite hatred.

As long as these conditions persist, the neurotic cannot possibly dispense with any of his conflicting drives. On the contrary, the inner necessities from which they stem become even more stringent in the course of the neurotic development. The fact that the pseudo solutions increase the disturbance in his relations with others and with himself means that a real solution becomes less and less attainable.

The goal of therapy, therefore, can only be to change the conditions themselves. The neurotic must be helped to retrieve himself, to become aware of his real feelings and wants, to evolve his own set of values, and to relate himself to others on the basis of his feelings and convictions. If we could achieve this by some magic, the conflicts would be dispelled without their having even to be touched upon. As there is no magic, we must know what steps have to be taken to bring about the desired change.

Since every neurosis—no matter how dramatic and seemingly impersonal the symptoms—is a character disorder, the task of therapy is to analyze the entire neurotic character structure. Hence the more clearly we can define this structure and its individual variations, the more precisely can we delineate the work to be done. If we conceive of neurosis as a protective edifice built around the basic conflict, the analytical work can roughly be divided into two parts. One part is to examine in detail all the unconscious attempts at solution that the particular patient has undertaken, together with their effect on his whole personality. This would include studying all the implications of his predominant attitude, his idealized image, his externalization, and so on, without taking into consideration their specific relationship to the underlying conflicts. It would be misleading to assume that one cannot understand and work at these factors before the conflicts have come into focus, for although they have grown out of the need to harmonize the conflicts, they have a life of their own, carrying their own weight and wielding their own power.

The other part covers the work with the conflicts themselves. This would mean not only bringing the patient to an awareness of their general outline but helping him to see how they operate in detail—that is, how his incompatible drives and the attitudes that stem from them interfere with one another in specific instances: how, for example, a need to subordinate himself, reinforced by inverted sadism, hinders him from winning a game or excelling in competitive work, while at the same time his drive to triumph over others makes victory a compelling necessity; or how asceticism, stemming from a variety of sources, interferes with a need for sympathy, affection, and self-indulgence. We would have to show him also how he shuttles between extremes: how, for instance, he alternates between being overstrict with himself and overlenient; or how his externalized demands upon himself, reinforced perhaps by sadistic drives, clash with his need to be omniscient and all-forgiving, and how in consequence he wavers between condemning and condoning everything the other fellow does; or how he veers between arrogating all rights to himself and feeling he has no rights at all.

This part of the analytical work would encompass, furthermore, the interpretation of all the impossible fusions and compromises the patient is trying to make, such as trying to combine egocentricity with generosity, conquest with affection, domination with sacrifice. It would include helping him to understand exactly how his idealized image, his externalization, and so on have served to spirit away his conflicts, to camouflage them and to mitigate their disruptive force. In sum, it entails bringing the patient to a thorough understanding of his conflicts—their general effect on his personality and their specific responsibility for his symptoms.

On the whole, the patient offers a different sort of resistance in each of these sections of analytical work. While his attempts at solution are being analyzed he is bent on defending the subjective values inherent in his attitudes and trends, and so fights any insight into their real nature. During the analysis of his conflicts he is primarily interested in proving that his conflicts are not conflicts at all, and therefore blurs and minimizes the fact that his particular drives are really incompatible.

As to the sequence in which subjects should be tackled, Freud’s advice is and probably always will be of foremost significance. Applying to analysis principles valid in medical therapy, he stressed the importance of two considerations in any approach to the patient’s problems: an interpretation should be profitable, and it should not be harmful. In other words the two questions an analyst must have in mind are: Can the patient stand a particular insight at this time? and, Is an interpretation likely to have meaning for him and to set him thinking in a constructive way? What we still lack are tangible criteria of precisely what a patient can stand and what is conducive to stimulating constructive insight. The structural differences from one patient to another are too great to permit of any dogmatic prescriptions in regard to the timing of interpretations, but we can take as a guide the principle that certain problems cannot be tackled profitably and without undue risk until particular changes have taken place in the patient’s attitudes. On this basis we can point to a few measures that are invariably applicable:

It is useless to confront a patient with any major conflict as long as he is bent on pursuing phantoms that to him mean salvation. He must see first that these pursuits are futile and interfere with his life. In highly condensed terms, the attempts at solution should be analyzed prior to the conflicts. I do not mean that any mention of conflicts should be assiduously avoided. How cautious the approach needs to be depends on the brittleness of the whole neurotic structure. Some patients may be thrown into a panic if their conflicts are pointed out to them prematurely. For others it will have no meaning, will simply slide off without making any impression. But logically one cannot expect the patient to have any vital interest in his conflicts as long as he clings to his particular solutions and unconsciously counts on “getting by” with them.

Another subject to be broached gingerly is the idealized image. It would lead us too far afield to discuss here the conditions under which certain aspects of it can be tackled at a fairly early stage. Caution is advisable, however, since the idealized image is often the only part of the patient that is real to him. It may be, what is more, the only element that provides him with a kind of self-esteem and that keeps him from drowning in self-contempt. The patient must have gained a measure of realistic strength before he can tolerate any undermining of his image.

To work at sadistic trends at an early period in the analysis is sure to be unprofitable. The reason lies, in part, in the extreme contrast these trends present to the idealized image. Even at a later period awareness of them often fills the patient with terror and disgust. But there is a more precise reason for postponing this piece of analysis until the patient has become less hopeless and more resourceful: he cannot possibly be interested in overcoming his sadistic trends while he is still unconsciously convinced that vicarious living is the only thing left to him.

The same guide to the timing of interpretations can be employed when its individual application depends upon the particular character structure. For example, with a patient in whom aggressive trends predominate —one who despises feelings as a weakness and acclaims everything that gives the appearance of strength—this attitude with all its implications must be worked through first. It would be a mistake to give precedence to any aspect of his need for human intimacy, no matter how obvious this need was to the analyst. The patient would resent any move of this kind as a threat to his security. He would feel that he must be on his guard against the analyst’s wish to make him a “goody-goody.” Only when he is much stronger will he be able to tolerate his tendencies toward compliance and self-effacement. With this patient one would also have to steer clear for some time of the problem of hopelessness, since he would be likely to resist admitting any such feeling. Hopelessness for him would have the connotation of loathsome self-pity and mean a disgraceful confession of defeat. Conversely, if compliant trends predominate, all the factors involved in “moving toward” people must be thoroughly worked through before any dominating or vindictive tendencies can be tackled. Again, if a patient sees himself as a great genius or a great lover, it would be a complete waste of time to approach his fear of being despised and rejected, and even more futile to tackle his self-contempt.

Sometimes the scope of what can be tackled at the beginning is very limited. This is so in particular when a high degree of externalization is combined with a rigid self-idealization—a position that will countenance no flaws. If certain signs reveal this condition to the analyst, he will save much time by avoiding all interpretations that even remotely imply that the source of the patient’s trouble lies within himself. However, it may be feasible at this period to touch on particular aspects of the idealized image, such as the inordinate demands the patient makes upon himself.

Familiarity with the dynamics of the neurotic character structure also helps the analyst to grasp more quickly and more concisely just what the patient wants to express by his associations and hence what ought to be dealt with at the moment. He will be able to visualize and predict from seemingly insignificant indications one whole aspect of the patient’s personality, and so can direct his attention to the elements to watch for. His position would be like that of the internist who, when he learns that a patient is coughing, perspiring at night, and fatigued in the late afternoon, considers the possibility of pulmonary tuberculosis and is guided accordingly in his examination.

If, for instance, a patient is apologetic in his behavior, is ready to admire the analyst, and reveals self-effacing tendencies in his associations, the analyst will visualize all the factors involved in “moving toward” people. He will examine the possibility of this being the patient’s predominant attitude; and if he finds further evidence he will try to work at this from every possible angle. Similarly, if a patient repeatedly talks of experiences in which he felt humiliated, and indicates that he looks upon the analysis in this light, the analyst will know that he has to tackle the patient’s fear of humiliation. And he will select for interpretation that source of the fear which at the time is most accessible. He may be able, for example, to connect it with the patient’s need for affirmation of his idealized image, provided parts of the image have already come to awareness. Again, if the patient shows inertia in the analytical situation and talks of feeling doomed, the analyst will have to tackle his hopelessness in so far as that is possible at the moment. If this should occur at the very beginning he may be able only to point out its meaning—namely, that the patient has given himself up. He will then try to convey to him that his hopelessness does not spring from a factually hopeless situation but constitutes a problem to be understood and eventually solved. If the hopelessness appears at a later period the analyst may be able to relate it more specifically to his despair of finding a way out of his conflicts or of ever measuring up to his idealized image.

Nevertheless, because of the infinite individual variations in the structure, the analyst can sometimes proceed only by trial and error. When I speak of error I do not refer to such gross mistakes as imputing motivations that are alien to the patient or a failure to grasp his essential neurotic drives. What I have in mind is the very common error of making interpretations that the patient is not yet ready to assimilate. While gross mistakes are avoidable, the error of making premature interpretations is and always will be unavoidable. We can, however, reach a more speedy recognition of such errors if we are extremely alert to the way in which a patient reacts to an interpretation and are guided accordingly. It seems to me that too much emphasis has been placed on the fact of the patient’s “resistance”— on his acceptance or rejection of an interpretation—and too little on exactly what his reaction signifies. This is unfortunate, because it is the kind of reaction in all its detail that indicates what has to be worked through before the patient will be ready to handle the problem the analyst has pointed out.

The following instance may serve as an illustration. A patient realized that in his personal relationships he showed profound irritation in response to any claim the partner made upon him. Even the most legitimate requests were regarded as coercion and the most merited criticisms as insults. At the same time he felt free to demand exclusive devotion and to express his own criticisms quite frankly. He realized, in other words, that he accorded himself every privilege while denying the partner any. It became clear to him that this attitude was bound to mar, if not destroy, his friendships as well as his marriage. Up to this point he had been very active and productive in his analytical work. But the session after he became aware of the consequences of his attitude was pervaded by silence; the patient was mildly depressed and anxious. The few associations that did appear pointed to a strong tendency to withdraw, which was in decided contrast to his eagerness in previous hours to establish a good relationship with a woman. The impulse to withdraw was an expression of how intolerable the prospect of mutuality was to him: he accepted the idea of equality of rights in theory, but in practice he rejected it. While his depression was a reaction to finding himself in an unsolvable dilemma, the tendency to withdraw meant he was groping for a solution. When he recognized the futility of withdrawing, and saw that there was no way out but to change his attitude, he became interested in the question of why mutuality was so unacceptable to him. The associations that appeared immediately thereafter indicated that emotionally he saw only the alternative of having all rights or no rights whatever. He voiced an apprehension that if he should concede any rights he would never be able to do what he wanted but would invariably have to comply with the wishes of others. This in turn opened up the whole field of his compliant and self-effacing trends which, although they had hitherto been touched upon, had never been seen in their full depth and significance. For a number of reasons his compliance and dependence were so great that he had had to build up the artificial defense of arrogating all rights exclusively to himself. To abandon the defense at a time when his compliance was still a stringent inner necessity would have meant to submerge himself as an individual. Before he could even consider a change in his arbitrary settlement the compliant trends had to be worked through.

It will be clear from everything that has been said throughout this book that one can never exhaust a problem through a single approach; it must be returned to again and again from various angles. This is because any single attitude springs from a variety of sources and assumes new functions in the course of the neurotic development. Thus, for instance, the attitude of placating and “putting up” with too much is originally part and parcel of the neurotic need for affection and must be tackled when that need is being dealt with. Its scrutiny must be resumed when the idealized image is in question. In that light placating will be seen as an expression of the patient’s notion that he is a saint. That it also involves a need to avoid friction will be understood when his detachment is under discussion. Again, the compulsive nature of the attitude will become clearer when the patient’s fear of others and his need to lean over backward from his sadistic impulses come into view. In other instances a patient’s sensitivity to coercion may be seen first as a defensive attitude stemming from his detachment, then as a projection of his own craving for power, and later perhaps as an expression of externalization, inner coercion, or other trends.

Any neurotic attitude or conflict that crystallizes during analysis must be understood in its relation to the personality as a whole. This is what is called working’ through. It involves the following steps: bringing to the patient’s awareness all the overt and hidden manifestations of the particular trend or conflict, helping him to recognize its compulsive nature, and enabling him to attain an appreciation both of its subjective value and its adverse consequences.

The patient, when he discovers a neurotic peculiarity, tends to avoid examining it by immediately raising the question: “How did it come about?” Whether or not he is aware of doing so, he hopes to solve the particular problem by turning to its historical origin. The analyst must hold him back from this escape into the past and encourage him to examine first what is involved—in other words, to become familiar with the peculiarity itself. He must get to know the specific ways in which it manifests itself, the means he uses to cover it up, and his own attitudes toward it. If, for instance, the patient’s dread of being compliant has become clear, he must see the extent to which he resents, dreads, and despises in himself any form of self-effacement. He must recognize the checks he has unconsciously instituted to the end of eliminating from his life all possibilities of compliance and everything involved in compliant tendencies. He will understand, then, how attitudes apparently divergent all serve this one purpose; how he has numbed his sensitivity to others to the point of being unaware of their feelings, desires, or reactions; how this has made him highly inconsiderate; how he has choked off any feeling of fondness for others as well as any desire to be liked by them; how he disparages tender feelings and goodness in others; how he tends automatically to refuse requests; how in personal relationships he feels entitled to be moody, critical, and demanding but denies the partner any of these prerogatives. Or, if it is the patient’s feeling of omnipotence that has come into focus, it is not enough that he realizes that he has this feeling. He must see how from morning till night he sets impossible tasks for himself; how, for instance, he thinks he should be able to write a brilliant paper on a complex subject at top speed; how he expects himself to be spontaneous and scintillating in spite of his exhaustion; how in analysis he expects to solve a problem the moment he catches a glimpse of it.

Next, the patient must recognize that he is driven to act in accordance with the particular trend, regardless of—and often contrary to—his own desires or best interests. He must realize that the compulsion operates indiscriminately, usually without reference to factual conditions. He must see, for example, that his faultfinding attitude is turned toward friends and enemies alike; that he upbraids the partner no matter how the latter behaves: if the partner is amiable, he suspects him of feeling guilty about something; if he asserts himself, he is domineering; if he gives in, he is a weakling; if he likes to be with him, he is too easily available; if he refuses anything, he is stingy, and so on. Or if the attitude under discussion is the patient’s uncertainty of being wanted or welcome, he must realize that the attitude persists despite all evidence to the contrary. Understanding the compulsive nature of a trend also involves recognizing reactions to its frustration. If, for instance, the trend that has emerged concerns the patient’s need for affection, he would have to see that he feels lost and frightened at any sign of rejection or diminished friendliness, no matter how trivial the sign or how little the other person means to him.

While the first of these steps shows the patient the extent of his particular problem, the second impresses upon his mind the intensity of the forces behind it. Both arouse an interest in further scrutiny.

When it comes to examining the subjective value of a particular trend, the patient himself will often be eager to volunteer information. He may point out that his rebellion and defiance against authority or against anything resembling coercion were necessary and indeed lifesaving, since otherwise he would have been submerged by a dominating parent; that notions of superiority helped or still help to keep him going in the face of his lack of self-respect; that his detachment or his “don’t-care” attitude protects him from being hurt. It is true that associations of this kind come forth in a spirit of defense, but they are also revealing. They tell us something about the reasons why the particular attitude was acquired in the first place, thereby showing us its historical value and giving us a better understanding of the patient’s development. But over and beyond this, they lead the way to an understanding of the present functions of the trend. From the standpoint of therapy these are the functions of prime interest. No neurotic trend or conflict is merely a relic from the past—a habit, as it were, that once established keeps persisting. We can be sure that it is determined by stringent necessities within the existing character structure. The mere knowledge of why a neurotic peculiarity developed originally can only be of secondary value, since what we must change are the forces that operate at present.

For the most part, the subjective value of any neurotic position lies in its counterbalancing some other neurotic tendency. A thorough comprehension of these values, therefore, will provide an indication of how to proceed in any particular instance. If, for example, we are aware that a patient cannot relinquish his feeling of omnipotence because it permits him to mistake his potentialities for realities, his glorious projects for actual accomplishments, we shall know that we must examine the extent to which he lives in imagination. And if he lets us see that he lives this way in order to ensure himself against failure, our attention will be directed toward the factors that lead him not only to anticipate failure but to be in constant dread of it.

The most important therapeutic step is to bring the patient to see the reverse side of the medal: the incapacitating effects of his neurotic drives and conflicts. Some of this work will have been covered during the preceding steps; but it is essential that the picture be complete in all its detail. Only then will the patient actually feel the need of changing. In view of the fact that every neurotic is driven to maintain the status quo, an incentive powerful enough to outweigh the retarding forces is required. Such an incentive, however, can come only from his desire for inner freedom, happiness, and growth, and from the realization that every neurotic difficulty stands in the way of its fulfillment. Thus if he tends toward derogatory self-criticism he must see how this dissipates his self-respect and leaves him without hope; how it makes him feel unwanted, compelling him to suffer abuse, which in turn causes him to be vindictive; how it paralyzes his incentive and ability to work; how, in order to keep from falling into the abyss of self-contempt, he is forced into defensive attitudes like self-aggrandizement, remoteness from himself, and feelings of unreality about himself, so perpetuating his neurosis.

Similarly, when a particular conflict has become visible during the analytical process, the patient must be made aware of its influence upon his life. In the case of a conflict between self-effacing tendencies and a need for triumph, all the cramping inhibitions inherent in inverted sadism must be understood. The patient must see how he responds to every self-effacing move with self-contempt, and with rage at the person before whom he cringes; and how, on the other hand, he responds to every attempt to triumph over someone with horror of himself and a fear of retaliation.

It sometimes happens that a patient, even when he becomes aware of the whole range of adverse consequences, shows no interest in overcoming the particular neurotic attitude. Instead, the problem seems to fade out of the picture. Almost imperceptibly he shoves it aside and nothing is gained. In view of the fact that he has seen all the harm he inflicts upon himself, his lack of response is remarkable. Nevertheless, unless the analyst is very astute in recognizing this kind of reaction, the patient’s lack of interest may pass unnoticed. The patient takes up another subject, the analyst follows him, until they arrive again at a similar impasse. Only much later will the analyst become aware of the fact that the changes that have taken place in the patient are not commensurate with the amount of work done.

If the analyst knows that a reaction of this kind can occasionally be expected, he will ask himself what factors at work within the patient prevent him from accepting the fact that the particular attitude with its train of harmful consequences must be changed. There are usually a number of such factors, and they can only be tackled bit by bit. The patient may still be too paralyzed by hopelessness to consider the possibility of change. His drive to triumph over the analyst, to frustrate him, to let him make a fool of himself, may be stronger than his self-interest. His tendency to externalize may still be so great that in spite of his recognition of the consequences he cannot apply the insight to himself. His need to feel omnipotent may still be so strong that even though he sees the consequences as inevitable he makes a mental reservation that he will be able to get around them. His idealized image may still be so rigid that he cannot accept himself with any neurotic attitudes or conflicts. He will then merely rage against himself and feel that he ought to be able to master the particular difficulty simply because he is cognizant of it. It is important to be aware of these possibilities, because if the factors that choke the patient’s incentive to change are overlooked, the analysis can easily degenerate into what Houston Peterson calls a “mania psychological”, a psychology for psychology’s sake. Bringing the patient to accept himself under these circumstances constitutes a distinct gain. Even though nothing in the conflict itself has undergone change, he will have a profound sense of relief and will begin to show signs of wanting to disentangle the web in which he is caught. Once this favorable condition for work has been established, changes will soon begin to occur.

Needless to say, the above presentation is not meant to be a treatise on analytical technique. I have attempted to cover neither all the aggravating factors that operate during the process nor all the curative ones. I have not discussed, for instance, any of the difficulties or benefits that arise in connection with the patient’s bringing all his defensive and offensive peculiarities into the relationship with the analyst—though this is an element of great significance. The steps I have described constitute merely the essential processes that must be gone through each time a new trend or conflict becomes visible. It is often impossible to proceed in the order named, since a problem may be inaccessible to the patient even when it has come into sharp focus. As we saw in the example concerning the arrogation of rights, one problem may merely disclose another which must be analyzed first. As long as every step is eventually covered, the order is of secondary importance.

The specific symptomatic changes that result from analytical work naturally vary with the subject tackled. A state of panic may subside when the patient recognizes his unconscious impotent rage and its background. A depression may lift when he sees the dilemma in which he was caught. But each piece of analysis well done also brings about certain general changes in the patient’s attitude toward others and toward himself, changes that occur regardless of the particular problem that has been worked through. If we were to take such dissimilar problems as an overemphasis on sex, a belief that reality will accord with one’s wishful thinking, and a hypersensitivity to coercion, we would find that their analysis affects the personality in much the same way. No matter which of these difficulties is analyzed, hostility, helplessness, fear, and alienation from the self and others will be diminished. Let us consider, for example, how alienation from the self is lessened in each of these instances. A person who overemphasizes sex feels alive only in sexual experiences and fantasies; his triumphs and defeats are confined within the sexual sphere; the only asset he values in himself is his sexual attractiveness. It is only when he understands this condition that he can start to become interested in other aspects of living, and so retrieve himself. A person for whom reality is bounded by the projects and plans of his imagination has lost sight of himself as a functioning human being. He sees neither his limitations nor his actual assets. Through analytical work he ceases to mistake his potentialities for accomplishments; he is able not only to face but to feel himself as he really is. The person who is hypersensitive to coercion has become oblivious to his own desires and beliefs, and feels that it is others who dominate and impose upon him. When this condition is analyzed, he begins to know what he really wants, and hence is able to strive toward his own goals.

In every analysis repressed hostility, regardless of its kind and source, will come to the fore and make the patient temporarily more irritable. But each time a neurotic attitude is abandoned, irrational hostility will be diminished. The patient will be less hostile when he sees his own share in the difficulty instead of externalizing, and when he becomes less vulnerable, less fearful, less dependent, less demanding, and so on.

Hostility is primarily allayed by a decrease in helplessness. The stronger a person becomes, the less he feels threatened by others. The accrual of strength stems from various sources. His center of gravity, which had been shifted to others, comes to rest within himself; he feels more active and starts to establish his own set of values. He will gradually have more energy available: the energy that had gone into repressing part of himself is released; he becomes less inhibited, less paralyzed by fears, self-contempt, and hopelessness. Instead of either blindly complying or fighting or venting sadistic impulses, he can give in on a rational basis and so becomes firmer.

Finally, although anxiety is temporarily stirred up by the undermining of established defenses, each step that is profitably taken is bound to diminish it, because the patient becomes less afraid of others and of himself.

The general result of these changes is an improvement in the patient’s relations with others and with himself. He becomes less isolated; to the extent that he becomes stronger and less hostile, others gradually cease to be a menace to be fought, manipulated, or avoided. He can afford to have friendly feelings for them. His relations with himself improve as externalization is relinquished and self-contempt disappears.

If we examine the changes that take place during analysis we see that they apply to the very conditions that brought about the original conflicts. While in the course of a neurotic development all the stresses become more acute, therapy takes the opposite road. The attitudes that arose from the necessity of coping with the world in the face of helplessness, fear, hostility, and isolation become more and more meaningless and hence can be gradually dispensed with. Why, indeed, should anyone want to efface or sacrifice himself for persons he hates and who step on him if he has the capacity to meet others on an equal footing? Why should anyone have an insatiable desire for power and recognition if he feels secure within himself and can live and strive with others without the constant fear of being submerged? Why should anyone anxiously avoid involvement with others if he is able to love and is not afraid to fight?

To do this work takes time; the more entangled and the more barricaded a person is, the more time is required. That there should be a desire for brief analytical therapy is quite understandable. We should like to see more persons benefit from all that analysis has to offer, and we realize that some help is better than no help at all. Neuroses, it is true, vary greatly in severity, and mild neuroses can be helped in a comparatively short period. While some of the experiments in brief psychotherapy are promising, many, unfortunately, are based upon wishful thinking and are carried on with an ignorance of the powerful forces that operate in neurosis. In the case of severe neuroses I believe that the analytical procedure can be shortened only by so bettering our understanding of the neurotic character structure that less time will be wasted in groping for interpretations.

Fortunately analysis is not the only way to resolve inner conflicts. Life itself still remains a very effective therapist. Experience of any one of a number of kinds may be sufficiently telling to bring about personality changes. It may be the inspiring example of a truly great person; it may be a common tragedy which by bringing the neurotic in close touch with others takes him out of his egocentric isolation; it may be association with persons so congenial that manipulating or avoiding them appears less necessary. In other instances the consequences of neurotic behavior may be so drastic or of such frequent occurrence that they impress themselves on the neurotic’s mind and make him less fearful and less rigid.

The therapy effected by life itself is not, however, within one’s control. Neither hardships nor friendships nor religious experience can be arranged to meet the needs of the particular individual. Life as a therapist is ruthless; circumstances that are helpful to one neurotic may entirely crush another. And, as we have seen, the capacity of the neurotic to recognize the consequences of his neurotic behavior and to learn from them is highly limited. We could rather say that an analysis can be safely terminated if the patient has acquired this very capacity to learn from his experiences—that is, if he can examine his share in the difficulties that arise, understand it, and apply the insight to his life.

Knowledge of the role that conflicts play in neurosis and the realization that they can be resolved make it necessary to redefine the goals of analytical therapy. Although many neurotic disturbances belong in the medical sphere, it is not feasible to define the goals in medical terms. Since even psychosomatic illnesses are essentially an ultimate expression of conflicts within the personality, the goals of therapy must be defined in terms of personality.

Thus seen they encompass a number of aims. The patient must acquire the capacity to assume responsibility for himself, in the sense of feeling himself the active, responsible force in his life, capable of making decisions and of taking the consequences. With this goes an acceptance of responsibility toward others, a readiness to recognize obligations in whose value he believes, whether they relate to his children, parents, friends, employees, colleagues, community, or country.

Closely allied is the aim of achieving an inner independence—one as far removed from a mere defiance of the opinions and beliefs of others as from a mere adoption of them. This would mean primarily enabling the patient to establish his own hierarchy of values and to apply it to his actual living. In reference to others it would entail respect for their individuality and their rights, and would thus be the basis for a real mutuality. It would coincide with truly democratic ideals.

We could define the goals in terms of spontaneity of feeling, an awareness and aliveness of feeling, whether in respect to love or hate, happiness or sadness, fear or desire. This would include a capacity for expression as well as for voluntary control. Because it is so vital, the capacity for love and friendship should be especially mentioned in this context; love that is neither parasitic dependence nor sadistic domination but, to quote Mac-murray,3 “a relationship . . . which has no purpose beyond itself; in which we associate because it is natural for human beings to share their experience; to understand one another, to find joy and satisfaction in living together; in expressing and revealing themselves to one another.”

The most comprehensive formulation of therapeutic goals is the striving for wholeheartedness: to be without pretense, to be emotionally sincere, to be able to put the whole of oneself into one’s feelings, one’s work, one’s beliefs. It can be approximated only to the extent that conflicts are resolved.

These goals are not arbitrary, nor are they valid goals of therapy simply because they coincide with the ideals that wise persons of all times have followed. But the coincidence is not accidental, for these are the elements upon which psychic health rests. We are justified in postulating these goals because they follow logically from a knowledge of the pathogenic factors in neurosis.

Our daring to name such high goals rests upon the belief that the human personality can change. It is not only the young child who is pliable. All of us retain the capacity to change, even to change in fundamental ways, as long as we live. This belief is supported by experience. Analysis is one of the most potent means of bringing about radical changes, and the better we understand the forces operating in neurosis the greater our chance of effecting desired change.

Neither the analyst nor the patient is likely wholly to attain these goals. They are ideals to strive for; their practical value lies in their giving us direction in our therapy and in our lives. If we are not clear about the meaning of ideals, we run the danger of replacing an old idealized image with a new one. We must be aware, too, that it does not lie within the power of the analyst to turn the patient into a flawless human being. He can only help him to become free to strive toward an approximation of these ideals. And this means giving him as well an opportunity to mature and develop.

1 As is generally recognized, this knowledge is also of great prophylactic value. If we know what environmental factors are helpful to a child’s development and what factors retard it, a way is opened to the prevention of the rank growth of neuroses in future generations.

² Cf. Karen Horney, New Ways in Psychoanalysis, op. cit., Chapter 8, and Self-Analysis, op. cit., Chapter 2.

³ John Macmurray, op. cit.