Glover, Edward (1924). “Active therapy” and psychoanalysis—a critical review. International Journal of Psychoanalysis, 5: 269–311.
In 1919 Freud gave his keynote paper to the Congress in Budapest, where the psychoanalytic world was reunited after the war Freud’s paper concluded with optimism and the sweeping statement that “the large scale application of our therapy will compel us to alloy the pure gold of analysis with the copper of direct suggestion” (Freud, 1919a, p. 168). The time was one of hope and renewal.
In that year, Ferenczi’s views focused initially on a therapeutic problem that arose when affect was very separate from the intellect and its representations. He reported experiments with an active technique. In 1922, at Freud’s instigation, an essay prize was offered, in the journal and the Zeitschrift, on the topic “The relation of psycho-analytic technique to psycho-analytic theory”. In response, Ferenczi produced a book with Otto Rank, The Development of Psychoanalysis (1925) (originally published in German, Entwicklungsziele der Psychoanalyse, in 1923). Ferenczi took this opportunity to elaborate his methods further.
Ferenczi and Rank’s book acknowledged Freud’s distinction between remembering and repeating (Freud, 1914g). Many have critiqued the book which led to Ferenczi becoming somewhat estranged from mainstream psychoanalysis. Freud, who had at first supported Ferenczi’s “active technique”, later caustically commented, “The best way to shorten treatment, is to carry it out correctly” (quoted in Glover, 1928, p. 185). Alexander’s concern about the technique centred around the responsibility for id impulses which the analyst risks taking from the patient in the active technique:
Every time that we resort to commands and prohibitions (including the setting of a term) we are yielding to [the patient’s] unconscious tendencies, even though a skilful application of this method may often advance the analysis for the time being. The main resistance is directed against accepting responsibility for the instinctual life, against independent judgment and the task of dealing with the infantile relations to the parents, which have been revived in analysis.
[Alexander, 1925, p. 494]
Edward Glover’s long paper, republished here, is a meticulously argued appraisal of the place of Ferenczi’s “new’”method in the development of psychoanalytic technique. First of all, the “active therapy” is merely a technique to adopt in certain intractable cases, where the gratification aroused by the analysis itself undermines the motivation to learn from the analysis. As Glover states, the intervention may be to prohibit a masturbatory satisfaction, like crossing the legs on the couch—or it might be to order certain libidinal satisfactions, like the use of obscene words. There is, as Sachs (1925) said, a deliberate attempt to alter the relation between ego and id, rather than to interpret it.
Despite Freud’s vision of a psychoanalysis alloyed with other methods, a constant suspicion has remained that non-interpretive intervention means a pollution of the pure gold, not a useful alloying. At the same time, work with difficult patients has attracted a constant interest in non-interpretive interventions. Ironically, in 1946 Alexander introduced his “corrective emotional experience” (Alexander & French, 1946), which proved just as contentious as the book he had reviewed. In addition, developments in self-psychology (Kohut, 1971) and certain analysts of the
ACTIVE TECHNIQUE 141 object-relations (Rayner, 1992) and inter-subjectivist (Renik, 1995) schools experiment with the analyst’s disclosure of his or her counter-transference. This debate has been influenced and stimulated by the re-reading of Ferenczi in the last ten years (Berman, 1996).
Glover’s paper is valuable as it presents the innovations of active technique against the backdrop of an exposition of psychoanalytic therapy as it was understood then. In the course of his very extensive argument he covered a great deal of the theory of interpretation. Glover developed from this point a general interest in defining and describing analytic technique. He became more authoritative in a number of works he later published (Glover, 1927–1928, 1931). In a book (Glover, 1955), he reported the results of a questionnaire researching other analysts’ methods. The paper here republished sets out the criteria by which we could assess even current arguments for non-interpretive interventions.
Alexander, F. (1925). Review of Developments in Psychoanalysis (Entwicklungsziele der Psychoanalyse) by Sandor Ferenczi and Otto Rank. International Journal of Psychoanalysis, 6: 484–496.
Alexander, F., & French, T. M. (1946). Psychoanalytic Therapy. New York: Ronald Press.
Berman, E. (1996). The Ferenczi renaissance. Psychoanalytic Dialogues, 6: 391–411.
Ferenczi, S. (1919). Technical difficulties in the analysis of a case of hysteria. Zeitschrift für Psychanalyse, 5: 34–40.
Ferenczi, S., & Rank, O. (1925). The Development of Psychoanalysis (Entwicklungsziele der Psychoanalyse). New York: Nervous and Mental Disease Publishing.
Freud, S. (1914). Remembering, repeating and working-through. S.E., 12: 145–156. London: Hogarth Press.
Freud, S. (1919). Lines of advance in psychoanalysis. S.E., 17: 157–168. London: Hogarth Press
Glover E. (1927–1928). Lectures on technique in psycho-analysis. International Journal of Psychoanalysis, 8: 311–338; 486–520; 9: 7–46; 181–218.
Glover, E. (1931). The therapeutic effect of inexact interpretation: a contribution to the theory of suggestion. International Journal of Psychoanalysis, 12: 397–411.
Glover, E. (1955). The Technique of Psychoanalysis. London: Balliere, Tindall and Cox.
Kohut, H. (1971). The Analysis of the Self. New York: International Universities Press.
Rayner, E. (1992). Matching, attunement and the psychoanalytic dialogue. International Journal of Psychoanalysis, 73: 39–54.
Renik, O. (1995). The role of an analyst’s expectations in clinical technique: reflections on the concept of resistance. International Journal of Psychoanalysis, 43: 83–94.
Sachs, H. (1925). Metapsychological points of view in technique and theory. International Journal of Psychoanalysis, 6: 5–12.
Edward Glover
To limit a review of work on active technique to a consideration of the technical suggestions made by Ferenczi would be, as Ferenczi himself suggests, to misunderstand the use of the word “active” and in reality to leave out of account important stages in the history of psycho-analytic therapy.
As he points out, the Breuer–Freud cathartic method was essentially one of great activity. A vigorous attempt was made, under hypnosis if necessary, to awaken memories, i.e. not only was the attitude of the physician an active one, but the patient was called upon to make definite strenuous efforts. Further, the present method is passive only by contrast. It is true that the patient remains passive, but the physician cannot permit the patient’s phantasies to continue indefinitely and, when the material is ready to crystallize, the former must abandon his passivity and interpret in order to make easier the associative paths otherwise barred by resistance. During this “obstetrical thought-assistance”, as Ferenczi calls it, the patient remains, as before, passive.
If one follows the development of technique from the time of the cathartic method onwards, it is clear that, not only in stating the aims of psycho-analysis, but in the working out of the dynamics of transference, resistance, etc., most contributions to psycho-analytic literature (and especially those of Freud himself) are contributions to the problem of activity in technique. One might refer, for instance, to Freud’s working out of the stages in psycho-analytic therapy where he distinguishes a first phase, during which libido is detached from the symptoms and crowded on to the transference, from the second when the battle rages round this new object, libido is freed, and to prevent withdrawal of this libido to the unconscious, the ego is educated by the interpretative suggestions of the analyst to the point of reconciliation of the two.1
In his work on the dynamics of the transference,2 too, Freud lays down conceptions of regression and re-activation with corresponding resistance which are fundamental for the theoretical consideration of active technique and his description of the plasticity of libido and its capacity for collateral circulation is one which Ferenczi uses freely and with effect. Indeed, Freud’s early paper on dream-interpretation in analysis is a contribution to the subject of activity in so far as he deprecates the use of interpretation as an art per se (i.e. what might be called an arbitrary or active use of interpretation), and lays down that it must be subject to the same rules as treatment in general, with the rider that active interpretation can be occasionally followed as a concession to scientific interest.3
More directly concerned with the transference situation are Freud’s remarks on the dangers of “repetition” and the function of “working through”, in which he points out that the aim of the physician must be the remembering and reproduction in the psychic plane. The physician, he says, must enter into a long-drawn-out fight to prevent the patient discharging impulses in action which should be limited to mental expression. Successful prevention of this nature can be regarded as a triumph and the physician should see to it that the patient does not carry significant repetitions into action.4
In 1910 Freud laid down that in anxiety-hysteria the patient cannot produce the necessary material as long as he is protected by the condition of the phobia and that, although it is not possible for him to give up these precautionary measures from the outset, one must assist by translation of the unconscious until such time as he can bring himself (sich entschliessen) to give up the protection of the phobia and lay himself open to a now much reduced anxiety.5
After an interval of eight years, and shortly after the publication of Ferenczi’s paper on active treatment in hysteria, he returns to the same point with a significant change in the verb. “One will hardly ever overcome a phobia”, he says, “by waiting until the patient is induced to give it up as the result of analysis. Treated in this way he will never bring up the material so necessary for a convincing solution of the problem. One must adopt other measures. Take, e.g. the case of agoraphobia of which two types are recognized, one slight, the other more severe. The former suffer from anxiety when they walk in the street unaccompanied but they have not altogether given up going by themselves: the latter protect themselves by giving up the attempt. In these latter cases success can only be attained by inducing the patient under the influence of analysis to behave like cases of the slighter type, i.e. to go about alone and to fight down the resultant anxiety. In this way the phobia is slightly weakened and only then will the patient produce associations which will lead to its solution.”6
In the same paper he says that the principle of activity lies in the carrying out of treatment in a state of abstinence; substitute-satisfactions must be denied, especially the most cherished of satisfactions. Not every one, of course, and not necessarily sexual intercourse. The sufferings of the patient should not come to an end too quickly, and when we have alleviated them by breaking up and reduction of symptoms, we must induce sensitiveness at some other point by means of privation. At the same time we must be on the look-out for substitute-formations. Unhappy marriages and bodily ill-health are the most common forms of relief from neurosis. Abstinence originally led to symptom-formation, and it must be the mainspring of the will to health. Again in reference to the obsessional neurosis, “I have no doubt that in these cases the proper technique lies in waiting until the treatment has itself become a compulsion, and in forcibly restraining the compulsion to disease with this counter-compulsion”. The use of the term “induce” (bewegen) in the case of anxiety-hysteria and of “forcibly restrain” (gewaltsam unterdrücken) in the case of the obsessional neurosis is of significance.
Other writers have worked on the same theme from much the same point of view, as, for example, where Reik7 likens psychoanalysis to the work of a machine for the running of which some degree of friction is indispensable; on the whole, the previous quotations may be taken as representing the general point of view. Now, whilst these observations seem to have been dictated by a combination of clinical expediency and widening of theoretical insight, in Ferenczi’s case there seems in addition to run throughout a consistent train of thought, given increasing consideration in an attempt to make the technique more effective in exceptional cases and generally to shorten, if possible, a lengthy procedure.
Referring in a reminiscential vein to his pre-analytic days, Ferenczi tells how a peasant suffering from attacks of loss of consciousness came to consult him. While his history was being noted, which elicited a story of conflict with the father, the patient broke off in a faint in the middle of a sentence, namely, “I must work like a scavenger whilst—” At this point Ferenczi seized the patient, shook him vigorously, and shouted to him to complete the sentence, which then ran—”whilst my younger brother stays at the home farm.” The loss of consciousness proved to be a flight from reality, and the patient was amazed to find himself completely and immediately cured.8
Passing over intervening stages, we find Ferenczi, in his paper on transitory symptom-formations (1912), regarding such miniature neuroses as points of attack for dealing with the patient’s strongest resistances.9 Such symptoms being affectively experienced in the patient’s own person lead, after suitable analysis, to that conviction of the correctness of interpretation which cannot be attained by logical insight alone. They are representations of unconscious feeling stirred up by analysis and forced back, which, no longer capable of complete suppression, are converted into somatic symptoms, an explanation the quantitative factor of which has recently been emphasized by Alexander.10
In order not to disturb the case-illustration of Ferenczi’s development in technique, his general paper on technique11 may be considered here, although really it follows that on the analysis of hysteria. It contains many excellent suggestions of a general kind, from which the following, more active, may be selected. The patient can defeat the analyst with the latter’s own weapons. Asked to produce associations without regard to content, the former will produce only nonsensical associations and try to reduce both analysis and analyst to absurdity. This must be stopped by interpretation of the underlying intent, the patient’s triumphant counter, namely, “I’m only doing what you ask”, being met with the explanation that to produce solely nonsensical associations is in itself a form of thought selection. Sudden silence is a transitory symptom which, if persisting after interpretation, must be met with silence. In some cases a patient breaking off with an “à propos” can be asked to finish his sentence, since this involves not connected thinking, but connected saying of what is already thought. Obscene words must be spoken, and the compromise of writing them down should be avoided. Do not be content with generalities: concrete representations rather than philosophical speculations constitute the real association form, an interjected “for example” often getting nearer to the unconscious content. On the question of influencing the patient’s decisions his views may be summed up briefly; first find whether the decision is really urgent or whether it is being thrown at the analyst as a gas-bomb to cause confusion. If real and the patient has any capacity for decision, let him decide; if real but the patient is incapable of decision from reality-testing reasons, he may be helped; if real but the incapacity for decision is of the form of a phobia, make the patient come to some decision.
Although there is nothing new in the way of theoretical consideration in this paper, or in a short note on influencing the patient during treatment which appeared in the previous Zeitschrift, still the general tendency to active interference once ordinary interpretation seems to fail is quite outstanding.
The logical development of these tendencies is to be found in Ferenczi’s method of dealing with the analysis of some cases of hysteria.12 On one occasion, observing that a patient’s analysis approached a condition of stalemate, he prescribed a certain period within which treatment must be finished. The patient, however, hid her resistance behind a positive transference which was characterized by passionate love declarations; treatment was ended at the stated time, leaving the former quite satisfied with the result. Renewed after an exacerbation of symptoms, analysis again brought about improvement, but just up to the previous stage; beyond that the love-defence was again brought into play and again treatment was ended (this time owing to extrinsic causes). A third attempt was made with an identical result, but now Ferenczi observed that in the perpetual love-phantasies connected with the physician the patient remarked on certain genital sensations. In addition she lay always with the legs crossed. This led to a discussion on masturbation, the performance of which she denied. Finally Ferenczi forbade her to cross the legs, explaining that she thus discharged unconscious excitations in a larval form of masturbation, and the result of this prohibition was immediate increase of bodily and mental restlessness, accompanied by phantasies similar to those of delirium. Infantile experiences and circumstances conducing to illness were remembered in fragments. But again the analysis lingered, and the transference-love masked resistance. Then Ferenczi made the discovery that she eroticized her household activities, as in unconsciously working with the legs pressed together. Prohibition of these extra-mural gratifications led merely to a slight improvement, but also to the performance of various plucking movements during the hour. These were carried out on, so to speak, “indifferent” parts of the body, but became masturbation equivalents capable of producing orgasm. They had been carried out in childhood, and now, after due suppression, sexuality found its way back to the genital zone, the immediate result of which was the return of an infantile obsessional neurosis. After solution of the latter, an irritation of the bladder made its appearance, usually at times unsuitable for relief. This relief was in turn forbidden, and the patient finally reported an act of genital masturbation, a regressive stage which did not last long and led gradually to pleasure in normal intercourse.
Ferenczi then formulated his new rule, namely, watchfulness for larval forms of masturbation giving cover to libido and possibly displacing the whole sexual activity, i.e. a short way for the discharge in motility of pathogenic phantasies, a short-circuiting of consciousness. These forms must be forbidden when noticed, and in reply to criticism Ferenczi points out that this is a provisional measure. Sometimes the completed treatment renders this form of gratification superfluous, but not always. Masturbation for the first time in a patient’s life during treatment is a favourable turn in events, but only if manifest masturbation with conscious erotic phantasies. Larval forms must be analysed, but must first be forbidden, to prevent short-circuiting, and only when the patient can endure these conscious phantasies may he be given freedom to masturbate.
Many larval forms are not neurotic, many are neurasthenic, and many are unconsciously gratified throughout life, as in the case of persons who, preoccupied in business or metaphysical speculation, with hands deep in the pockets, touch, press, or rub the penis. Similarly, clonic contraction of calf-muscles, and, in women engaged in housework, pressing together of the limbs. The danger is that lack of orgasm leads to anxiety states or that the small discharges obtained disturb potency in a way not occurring in ordinary conscious masturbation. There may be, too, a transference from symptomatic actions to tics convulsif, many of which are stereotyped masturbation equivalents.
Ferenczi then sets about a detailed consideration of the rationale of active technique which is available in his paper given at the Hague Congress,8 but in the meanwhile he has added to, systematised and differentiated stages in the process.
We have seen that he regards the cathartic method as above all active and the passive technique as containing an active component in the form of interpretation, which is permissible by actual authority of the transference, the patient remaining meanwhile passive. But this activity or passivity is practically limited to mental functions, and apart from the rules about punctual attendance, and the making of decisions without guidance or alternately the shelving of decisions, the actions of the patient are not directly interfered with. The experience with anxiety-hysteria, where phobias are brought into actual play with resultant accessibility of new material, is the one exception which demands a category by itself. Here the active interference is not so much on the part of the physician as on the part of the patient; a task is laid upon him which leads to the doing of unpleasant things.
Fortified by Freud’s declaration of the necessity for carrying out treatment in a state of abstinence, Ferenczi finds occasion for a new variety of task, in cases with masturbatory touching of the genitals, stereotypies, tic-like movements, namely, the giving up of pleasurable activities. Here is his first illustration.
The patient, a musician with phobias and obsessive fears, amongst other inhibitions suffers from stage-fright and attacks of deep blushing. Although able to practise complicated finger exercises when alone, she cannot do so in public, and more, although really gifted, has the obsessive thought that she must blame herself for incapacity. Her breasts are large, and thinking herself to be observed much in the street, she is at a loss to know how to conceal her bust, sometimes crossing her arms to press in the breasts. Yet doubt follows all attempts. She is sometimes shy in manner, sometimes bold, unhappy if not noticed, alarmed if any real attention is paid to her. Her mouth smells, she thinks, yet a visit to the dentist can show no abnormality whatever.
After some analysis with Ferenczi she understands her main constructions, yet her condition does not satisfy him. One day she remembers a vulgar street “catch”, which her elder sister, who, by the way, was rather tyrannical towards her, used to sing. She repeats the double entendre and remains silent, whereupon Ferenczi asks her to sing the air, which after a prolonged delay (two hours in all) she does, hesitatingly at first, but later with a full soprano. The resistance continues, but on hearing that her sister was in the habit of accompanying the song with suggestive gestures, he asks her to reproduce these gestures exactly. Having done so once, she begins to show a taste for repetition, which leads to a countermand. Then for the first time come memories of her brother’s birth, singing and dancing before parents who dote on her. An order to conduct part of a symphony leads to the discovery of penis-envy (the baton) and the compulsory playing of a difficult piano part sheds light on her dread of examinations. Her self-blame is on account of the masturbation represented by the finger exercises. Similarly a request to go to the public swimming-bath uncovers the exhibitionistic motive behind her breast-ceremonial, and the discovery that she was passing flatus during the analytic hour in a kind of play, retaining and letting go, led, on the countermanding of this activity, to the tracing of the anal-erotic motive in the mouth-smelling fancy. Finally, treatment was greatly helped by the interpretation of certain movements and gestures whilst on the piano stool: these were carried out and stopped to order, and an unconscious masturbatory practice was revealed.
The technique applies not only in the activation and control of erotic tendencies, but also in the case of highly subliminated activities. A patient whose interest in versification was only partly gratified in puberty is asked to write poetry and displays distinct poetic gift, behind which is the desire for masculine productivity, clitoris-fixation and anæsthesia. When forbidden the new activity, it transpires that really a misuse of talent is in question, the masculine attitude is secondary, a genital trauma having led to displacement to auto-erotism and homosexuality. She only takes to the pen when she fears non-fulfilment of her female functions. The result is a re-established capacity for normal female activity.
Here we have the two stages—”painful” tasks, then “painful” abstinences, commands and prohibitions. The former render repressed instinct-components into conscious wish-formations and the latter force the awakened excitations back to infantile situations and repetitions. Since these have been subjectively experienced by the patient and objectively observed in flagrante delicto, they cannot be denied. In both stages the mechanism is that of producing a situation of privation.
When of course the patient is already active, masturbates, produces symptomatic acts and transitory neuroses, there is no need for the first stage, forbidding alone is necessary, although sometimes it is advisable to encourage first the full acting out of such situations. Urinary habits, flatus activities, sphincter play in general, various gestures, handling of the face, movements of the legs, shaking of the body, are suitable points d’appui. Even apparent contradictions in theoretical technique are sometimes permissible, as when a patient threatens to cheat in analysis and is encouraged to do so, or when he seems to be associating beside the point and is arbitrarily brought back to connect and complete the broken thread of thought.
Then as to indications: the technique must be used as little as possible, since the passive attitude is best, not only for the patient, but—and this deserves italicizing—also for the physician. It is a therapeutic adjuvant, to be used sparingly like the forceps in midwifery.
It can be used in all forms of neurosis, but it is more often indispensable in obsessions and in anxiety-hysteria; in pure conversion-hysteria it is seldom needed.
In this grouping two dangers are present: a. the cure may be too rapid, as where an inhibited woman suddenly becomes bold, is surrounded by admirers, and breaks off treatment at the end of the first stage; b. the resistances encountered may lead to the premature termination of treatment.
Masturbation has already been considered, but Ferenczi adds to this a note on forbidding unsuccessful attempts at satisfaction on the part of impotent persons, although this, he says, is by no means an axiom.
Ferenczi then asks: Can the attitude of the physician be made use of in a more active sense; can the interpretative suggestion which influences the ego in analysis be carried over in some cases in a kind of pedagogic guidance in which some form of praise or blame can be made use of? Leaving this question unanswered, he makes the suggestion that, as the neurotic has something of the child in him, child methods are to a certain extent applicable, more especially in the maintaining of an optimum temperature in the transference situation by a shade of coolness in the heated stages, and of friendliness in the reserved phases.
In the earlier part of his paper Ferenczi differentiated psychoanalytic suggestion from the popular variety, in so far as psychoanalytic suggestion does not say to the patient, “There is nothing the matter with you”, and also in that the psycho-analytic interpretations are based on memories or repetitions, and not explanatory conversion, as by Dubois.
He now anticipates possible retaliatory criticisms from Bjerre, Jung and Adler. But Bjerre neglects pathogenic causes, and contents himself with taking the patient’s mental and ethical guidance in hand. Jung detaches the patient from the past and links his attention to the tasks of life, whilst Adler concerns himself not with the analysis of libido, but with the nervous character.
Ferenczi, on the other hand, deals with individual or isolated activities, and even then not as an a priori moral influence, but merely to counter the pleasure principle, to dam up eroticism (die “Unmoral”), and to remove obstacles to the progress of an analysis of causes. He may, however, in some stages not only tolerate the erotic tendency, but encourage it.
Returning to suggestion, he insists that in active technique certain measures only are presented, apart altogether from the idea of successful outcome, and, indeed, without any certainty of knowing what the outcome will be. No improvement is promised: rather the contrary. The stimulation of a new distribution of psychic energy promises discomfort, and often disturbs the placid torpor of the stagnant analysis.
Catharsis again hoped to awaken memories and thus release affect; active therapy stimulates activities and inhibitions in the hope of attaining secondary unconscious material. Analysis begins where catharsis ends. Catharsis is an aim and end in itself; active therapy is a means to an end. It increases resistances by stimulating the sensitiveness of the ego, and increases the symptoms by increasing conflict; the new condition of tension or increase in tension disturbs hitherto untouched areas. Like the counter-irritant treatment, it not only discovers hidden foci, but increases immunity; the great vessels are tied and circulation flows through the smaller arteries lying deep in the tissues.
In so far as the phrase “active technique” is associated with the name of Ferenczi, it is necessary to be guided strictly by the indications laid down by Ferenczi himself. From these it will be seen that this technique is by no means to be regarded as a therapy in itself, but rather as a special procedure devised to meet a special analytical situation, namely, where the substitute-gratification of libido-impulses forms a barrier to examination of the underlying unconscious formations. This gratification may be present with comparatively little qualification in numerous larval forms of masturbation, or directly in the form of neurotic character-traits; or, again, it may be qualified by the compromise-formation of the symptom. Hence the application of the procedure may be merely occasional during some analyses or much more constant in others, as, for example, some cases of anxiety-hysteria and in obsessional neurosis. In either instance a prerequisite of its application is the establishment of a durable transference situation where the analyst’s active interference is supported by the authority of the imago he represents.
Considering the question merely from this point of view, two criticisms occur, one of general principle, and the other of detail, both of which have been made by Van Ophuijsen.13 First as to the principle. Van Ophuijsen considers that active technique is really an important alteration in so far as the analyst makes use of the transference-situation instead of immediately analysing it. Secondly, that as these resistance states, which necessitate active therapy, may be regarded as “repetition” phenomena, Ferenczi should have limited his rule in the case of larval masturbation by prohibiting this only when it is the source of resistance at the time. In reality, Van Ophuijsen’s criticism of detail involves yet another principle, that of the therapeutic part played by the compulsion to repeat and the working through of traumata in the transference-situation, and on these points I should like to offer the following observations:
Transference.—As far as transference is concerned, the situation might be put as follows: In psycho-analysis a “transference neurosis” gradually replaces the original neurosis, and this former must be dealt with in turn by repeated analytical interpretation of the repetition-compulsion, as manifested in the transference-resistances. One must ask, therefore: Do not active interferences on the part of the analyst disturb the transference picture as a spontaneous repetition, since the recognition by the patient of transference material as such is greatly facilitated by the passive role of the analyst and his impersonality? In other words, when the father-imago is revived by a figure that does not advise, persuade, convert, or command, it is more easily recognized as such than when it is anchored to the present by a real situation in which a physician actually does advise, persuade, convert or command a patient. From this point of view, too, the possibility of blunders present even in an orthodox analysis is heightened by the hazard of piling up even stronger resistances. Again, since the patient is in a “transference” neurosis, i.e. an affective relation to the analyst repeating the infantile fixation, he is “sensitized” to even ordinarily trivial behaviour on the part of the analyst and reacts to it with massive affect, i.e. with a psychical anaphylactic reaction.
In ordinary analysis, however, the recognizable triviality of the occasion conjoined with a prompt analysis of its significance usually prevents a “second fixation” occurring. Now since the final stage of analysis is agreed to be arrived at through the analytic dissolution of the “transference neurosis” anything in the nature of a “second fixation” must surely constitute a difficulty.
The answer of the “activist” to this criticism is in effect that he is throwing a sprat to catch a mackerel, that the most important repetition is wanting, being more or less actively satisfied elsewhere, and in such cases, and in such cases only, the durability of the transference can be put to the hazard. If he fails, and the analysis is broken off, he is in no worse case than the protagonist of passive methods who has merely attained stalemate.
This is still open to the counter that it is unnecessary to make a rule of involving the direct authority of the imago in such situations, and that repeated analysis of the gain through illness, of the gain through larval acts, or of the gain from indulging character-traits, can be made to focus the patient’s attention on the performance or non-performance of such traits or acts. In so far as this focusing is arbitrarily determined it is an active step, but it avoids the necessity of the physician, so to speak, entering the arena clad in the mantle of the imago.
As a matter of fact, although Ferenczi frequently mentions the danger of losing a patient inherent in the application of active technique, at only one point does he mention the opposite risk; speaking of influencing the outside life of patients incapable of coming to a decision, he says: “Here the physician should be aware that he is no longer behaving as a psycho-analyst, that indeed his interference may cause positive difficulty as regards duration of treatment, e.g. an unwished-for strengthening of the transference-relationship.”
Repetition phenomena.— know from Freud that the transference is in itself a repetition phenomenon, and that the greater the resistance the more does repetition replace memory-work. The main fight then is to prevent repetition obtaining motor discharge and to use the transference when serviceable as a playground in which the patient is given almost complete freedom to expand. This leads to the establishment of an artificial illness, the “transference-neurosis”, a provisional state having the characteristic of real experience. But the interpretation of this experience does not immediately overcome resistance; the patient must be allowed time to work through the compulsion. At this stage, says Freud, “the physician can only wait and permit a course which can neither be avoided nor indeed hastened”.14 He summarizes the position later15 by saying that this transference neurosis must be allowed as little repetition as possible, but notes that the relationship between memory and reproduction varies in every case. The patient as a rule cannot be spared this part of the treatment, part of his forgotten existence must be re-experienced. It would seem then that the conditions under which varying degrees of play can be allowed to this repetition-compulsion ought to be accurately studied before any conclusions can be drawn as to the point at which active interference might be permissible.
We are now familiar with the general economic function of the biological repetition-compulsion in binding traumatic stimuli, and so in working through traumata. There is, however, a natural tendency to regard transference phenomena (involving, as they do, relations with an imago) as in themselves the complete representation of this economic function.
The extension of libido to the object by means of primary identification, the ultimate mode of object-choice and the vicissitudes which this choice undergoes provide a series of situations during the repetition of which the analyst plays a repertory part. The role is mainly that of an object, but even where narcissistic choice has prevailed developmentally over the anaclitic type and the analyst is made to play from time to time the part of subject by identification, the situation in both cases represents an extension of libido from ego to object. Since this series of situations has developed gradually from early stages of primary narcissism, it is small wonder that the subject-object polarity should occupy the foreground of the analytic picture, and that the part played by narcissistic libido in repetition should tend to be minimized. Repetition can, however, make use of the analytic technique itself for the working through of auto-erotic vicissitudes, i.e. unconnected with the object, or more correctly, connected with the self as object. This represents the primary narcissistic stage in the modification of instinct before the impulse is turned towards the object.16 Now, although both auto-erotic and subject-object activities might be included under the common heading of ontogenetic vicissitudes, or individual modifications, of the compulsion to repeat, they are clearly distinguishable from each other as regards amenability to transference influence. It is, of course, true that auto-erotic manifestations are capable of influence through the transference in two ways: first, that historically the subject was induced to abandon conscious manifestations either through the direct influence of the object, or by the influence of the object indirectly as introjected ego-ideal; secondly, that where autoerotic manifestations are regressively activated, the regression has taken a path which is still associatively linked to the object. It retraces the steps taken in the first limitation of auto-erotic impulses under object influence, and a situation arises which is somewhat loosely analogous to that of regressive hate which really continues love at the anal level.17
But whilst this degree of modification of auto-erotic impulses through the object exists, we know that many of the component-impulses continue from the primary stage to the point of serving the interests of genital primacy without direct modification;16 indeed, that they continue to serve pleasure interests apart from object-choice and genital primacy, just as narcissism runs a course apart from the contributions made by narcissism to object-choice. In this sense, then, they differ from the sadism and exhibitionism “pairs” by being unmodified, and are autonomic by permission of the pleasure-principle;18 repetitions are therefore found not in the transference situation, but in the patient’s own aberrations in following the analytic rule, his traits and mannerisms, i.e. not in his relations to the analyst, but to the technique of the analysis. Again, however much the ego may be influenced by the object or by the ego-ideal, it is arguable that the abandonment of narcissistic enjoyment may, under certain conditions, such as ego-sensitiveness, or perhaps a time factor, constitute in itself a trauma comparable with and even stronger than the traumata which lead later to the abandonment of the parental Oedipus relation (or which are caused by this abandonment). I am indebted here to a suggestion of Mrs Isaacs in reference to suckling, that there may be an optimum psychic duration of this process, curtailing or lengthening of which may prove a trauma in itself. Here then would be an additional source of “pain”, likely to be worked through by auto-erotic repetition and less amenable to the transference.
Now, although these ontogenetic or individual modifications of the compulsion to repeat comprise the larger part of analytic repetition phenomena, and even so with “subject–object” repetitions forming, as it were, a screen behind which auto-erotic repetitions are more difficult to distinguish, we cannot afford to jettison entirely what might be called the phylogenetic aspects of the compulsion. These will consist mainly of two manifestations: first, the primary economic biological function of any organism to use repetition as a “binding” mechanism;19 and secondly, the repetitions of racial traumata not yet racially worked through. Some hint of the latter is given in the so-called archaic reactions, as in some female types of castration reaction, and in the incompleteness with which in certain archaic types active impulses have undergone passive changes; of course, the idea of psychic phlogeny is in keeping with this assumption.
At this point we reach the delicate question of the hereditary factors operating on ego-development, not only phylogenetically, but individually. In particular one would have to consider whether the history of racial libido-development can work or has wrought any permanent change in ego-structure, and secondly how far, in any individual, permanent ego-injury can be wrought by massive libido disorder.
However this may be, a point arises in the consideration of active technique calling for careful decision; how far, that is, repetitions should be merely interpreted, or, assuming that they may be actively interfered with, what interval should be allowed for working through? This problem, interestingly enough, is not necessarily solved even when acting is converted into memory work, since the function of repetition may still be operative auto-erotically when ontogenetic libido-fixation has been loosened, and is probably in any case a permanent factor in the sense of biological function. Not only so; the conversion of acting into memory-work may reach a stage in working back at which early experiences, e.g. primal scenes, etc., cease to be capable of direct reproduction in adult recollection, and may quite conceivably be only capable of reproduction as repetitions. Perhaps the best example of this class of experience would be the cumulative engrams connected with the gratification of the oral libido.
The question of determining the optimum amount of repetition in analysis is obviously one requiring the nicest judgment; a rather outstanding example of the difficulty exists in cases such as20 one treated consecutively by two analysts for over two years, in which daily one-half of the time was spent in the working through of rage affect. Of an opposite type are cases of extreme transference passion where insight is obscured by greater or lesser degrees of projection; here some limitation of analytical repetition is called for it the ultimate success of the analysis is not to be jeopardized. Again, where the technique is adapted by the patient to satisfy mainly urethral, anal and onanistic impulses, the procedure must vary greatly; some hint as to the proper procedure might probably be gained by estimating the amount of modification such impulses seem to have undergone in the history of the individual. Where the larval formations are in the nature of regressions, or where they are adapted to the expression of guilt consciousness or object-defiance, it is probable that active prohibition can be employed effectively. Again, where the larval expression in “association” form of anal or urethral activities plays into the hands of the latent exhibitionist, active interference will probably have fruitful result. On the other hand, one might go so far as to say that, where narcissistic fixation is strong or where the links originally binding the ego to the object have been weakly forged, active technique is bound to fail in that the transference does not hold the key to the situation. It is possible that in the cases described by Ferenczi regression or guilt factors largely determined the persistence of larval traits, but it is clear from a consideration of the second stage of his active technique (when, after interpretation, the newly encouraged or demanded activity is prohibited) that there is a danger of allowing too short a repetition interval to elapse.
Aetiological Factors.—Here, again, a decision would depend on numerous factors, of which the condition of falling ill would seem to be the most important. We know from Freud21 that, apart from that evolution of illness represented in the series privation, introversion and phantasy investment, regression, conflict and compromise-formation in the symptom, a second type exists which falls ill in an attempt to fulfil the demands of reality, i.e. not because of a privation imposed by the outer world, but because, in an attempt to exchange from an older gratification to a later sanctioned gratification, the patient wrecks himself against inner difficulties. An exaggeration of this latter type is seen in the third type, where, owing to developmental inhibitions, the patient turns ill as soon as he passes childhood and has, outside childhood, never reached a normal phase of health. The fourth type exists where, at certain ages and for certain biological reasons, the libido is suddenly increased, and consequently a relative privation occurs. Of course, none of these types are pure, but it would seem that only in the first and last (where absolute or relative libido frustration occurs) is the application of active technique at all promising, and that in the second and third types (where ego-development is faulty) active interference, if any, should be more of the pedagogic type. The criterion is in the last event the condition of the ego. A similar condition is seen in the analysis of young people and of those of rather advanced years. Hug-Hellmuth22 shows how in the adolescent the technique is altered in an active direction, but more as a strengthening under educational guidance. As regards Ferenczi’s type of activity, she thinks that the setting of tasks to children, especially those with inferiority-feeling, is certainly indicated in the later stages, but she is none too enthusiastic, and says later, “A careful avoidance of direct prohibition is more important, and taking counsel with the child is better than both”.
Again, Abraham23 has shown us that in advanced years cases are not necessarily refractory to psycho-analysis, that the age of the neurosis is of more importance than the age of the patient. He definitely alters his technique, however, by treating such cases more like children, encouraging more and explaining more, and often providing stimuli by spontaneous reference to previous work.
Alterations in the usual passive technique such as those of Hug-Hellmuth and Abraham, based as they were on mature consideration of empirical data, go far to confirm the suggestion that no active step should be taken in the usual analysis until something definite is known of the patient’s ego-structure. To say this is, in one sense, merely to repeat one of Ferenczi’s pre-requisites, viz. a serviceable transference; but, on the other hand, it is important to distinguish the disorders of the whole ego induced by libido disturbance from more serious permanent impairments of ego-function. Finally, the possibility that a neurosis may itself be a kind of defensive screen protecting underlying ego-disorder adds a degree of urgency to the suggestion.
A Special Difficulty.—During the theoretical consideration of the transference situation it was suggested that one of the dangers of applying active technique was the production of a “second fixation”, in that the analyst’s injunctions would lend colour in reality to the unconscious identifications of the patient. A practical instance of this, by no means uncommon in routine analysis, may give rise to especial difficulty, and justifies being singled out for emphasis. It is found in those persons who see in the analytical situation a substitute for coitus, where the bearing of the analyst is summed up by the patient in terms of sexual aggression and is interpreted in accordance with heterosexual or homosexual identifications.
The converse situation, in which the physician himself regards the analytic situation in terms of aggression, finds an interesting and, from the point of view of active therapy, a telling illustration in a paper delivered at the Berlin Congress (1922), where von Hattingberg24 considered the significance of the analytical situation itself, paying meticulous attention to the relation of physician and patient, and the state of aggression represented by the supine position of the latter relative to the analyst. It might be argued, of course, that the deeper one carries the analysis either preliminary to or as the result of active technique, the less likelihood there is of such confusion. This, however, would scarcely apply in the case of masochistic impulses which are so deeply rooted. The use of orders and prohibitions with their avowed intention of causing “pain” is surely calculated to play into the hands of the masochist and possibly strengthen the guilt feeling, which, as Freud has pointed out, is responsible for so many of the cases which remain refractory after a long and seemingly complete analysis.25 In such cases active therapy would defeat its own ends by providing another displacement in place of the one attacked.
It might be added here that, although Ferenczi has wisely emphasized the inherent dangers of the method, and the risks of failure, he has not yet published a detailed account of the mechanisms leading to failure; this would have been a valuable supplement to a most valuable contribution.
Summary.—The application of active technique tends to increase the difficulties of transference solution by inducing a “second fixation”, especially where the patient exhibits strong masochistic trends. It affects transference repetitions (involving object-choice), and these have to be distinguished from auto-erotic vicissitudes of the repetition-function. The latter, especially those adapted to unmodified narcissistic gratification, are less accessible to transference influence. Further, there are various phylogenetic manifestations of the compulsion to repeat which operate functionally or in response to ego-defect. Hence the determining of an optimum period for “working through” must vary widely. The valuation of developmental or secondary injuries (of whatever source) to ego-structure is an essential preliminary to the tentative application of active technique.
It remains to consider what methods of approach other than those described by Ferenczi might be included under the more general term of active forms of therapy, and to inquire on what theoretical grounds they are based. In one instance a question of expediency determined the use of a hybrid active technique, where Simmel26 employed a kind of modified catharsis in the treatment of war-neurosis. He laid great stress on abreaction during hypnosis, but found dream-interpretation of invaluable assistance, and made use of hypnosis to make the patient dream in his presence. Special difficulties and the limitations under which this work was carried out rendered full analysis impossible, and in any case no new point in theory is concerned. It is perhaps interesting to remember in this connection that Freud6 in one paper anticipated a state of affairs where, in response to growing demand, a modification of psychoanalytic technique involving suggestion and hypnosis methods might be inevitable.
Work by Nunberg, Hollos, Ferenczi and others on active measures in the treatment of psychotic conditions cannot be conveniently dealt with here. Although exceedingly important, forming in fact the last of four possible main divisions of technique, viz. the technique in childhood, in the neuroses, in old age, and in the psychoses, and although a necessary complement to the full understanding of the technique in the transference-neuroses, it can be excluded from discussion mainly on the grounds that the use of active technique in the sense of the papers already abstracted has, with the possible exception of the neurotic character-trait, centred round libido analysis and presumed a large degree of ego-integrity.
In the same way special technique in childhood is also excluded, since the methods of Hug-Hellmuth are not devised for specially resistant cases, but empirically to meet a special pedagogic-analytical situation, though even here the paper of Sokolnicka27 suggests that with children also the question of active pedagogic interference guided by analytical judgement is not quite settled as against the claims of methodic analysis.
Passing these over, we find that, in general, work on this subject is connected intimately with a study of resistance manifestations.
Resistance.—An early paper by Reik7 considers the factors here as three-fold. The main component is narcissism. The physician becomes identified with the conscience (the ego-ideal being built up from primary narcissism) and therefore bears the full brunt of resistance. The second component is the hostile feeling once attached to the father, later developing as a reaction to the endopsychic perception of the patient’s own homosexual tendencies towards the father. A third is the anal-erotic component. Reik also emphasizes the role of the physician as castrator and the part played by exhibitionism. He then describes many of the more common manifestations of resistance-compromise occurring outside as well as during analysis, recommending careful analysis of, amongst other forms, dumbness (a combination of shame and hostility together with punishment for the hostility: dumb = dead), loquacity, and premature unsuccessful attempts at intercourse on the part of impotent persons. Abraham’s paper28 is confined to the study of a special group of neurotics who produce more or less permanent resistance. The most important characteristic is narcissism and an attitude of stubbornness against the father. The transference is poor, and the patients grudge the analyst his father-role; they wish to do things themselves, and alone, and an identification with the physician takes place, like a child playing the father and wishing to do it better. Auto-analysis is a narcissistic self-enjoyment in defiance of the father, and is really an onanistic equivalent. The patients were chiefly obsessional neurotics.
Abraham calls attention to the connection between “association” and defæcation and between “association” and flatus, the patient’s problem being “if, when and how much”. In such anal cases the cost of treatment even prolonged makes no appeal, since these patients are more parsimonious with unconscious material than with money; nothing is too dear for them to preserve their narcissism. Abraham suggests an alteration in the usual technique in these cases, having discovered that a surprising amount of material may be obtained if the patient is instructed in the narcissistic and hostile nature of his resistance right at the beginning of the analysis. This however, is as far as he goes in suggesting active interference. At this point the interesting paper by Reich29 is relevant in so far as he deals with the analysis of two special narcissistic types and suggests some alterations in technique.
In considering factors conducing to the neurotic character-trait, Reich differs from Alexander, who was inclined to regard such traits as the result either of libido-pressure not in itself strong enough to force its way to symptom-formation or of repression too weak to prevent some degree of gratification in reality. Reich thinks the “trait” is an expression of damaged integrity of the whole or part personality. Behind the castration feeling common to all cases exists a strong narcissistic constellation, itself the result of overstress of erogenicity in oral, anal and urethral zones. This increases ego-libido, and sets up irritability of the whole personality. The more ego-libido is disturbed, the more diffuse the symptom. That hysterical symptoms can be circumscribed is due to their concern with object-libido. The neurotic character-trait is therefore due to a predominance of disturbance in ego-libido; it does not lie between health and neurosis, but is more serious than neurosis. Reich then describes two narcissistic types, one with manifest inferiority-feeling but strong latent narcissism, the other with latent inferiority and manifest compensating narcissism; both are of anal-urethral disposition, both present great difficulty in treatment and in both cases Reich has adopted at certain stages of the treatment an “active” modification of technique. Briefly, there comes a point in analysis of types with manifest inferiority-feeling, when the analyst does not attempt to reassure the patient during his self-depreciation; on the contrary, he agrees with the patient’s self-criticism, pointing out, however, the latent basis of superiority. In the opposite type, with latent castration-inferiority, Reich found that in the midst of self-laudation, it often advanced the analysis to get the patient to rise from the couch and sit opposite.
Two facts emerge from consideration of the literature on resistance. It would seem that apart from the active technique practised by Ferenczi there is no organised method of active interference, and that if there is to be any substitute for active invocation of the imago’s authority it can only be effected by a more thorough application of a rigorous deterministic attitude during analysis of such cases, to be continually brought into play during periods of resistance, whether of positive, negative or narcissistic origin. On the other hand, it is to be noted that in examining the causes of resistance to treatment all three writers have paid considerable attention to phenomena which have been described earlier in this paper as narcissistic or auto-erotic modifications of the repetition-compulsion.
To discuss therefore at what stages the application of stricter analytic determinism is indicated, it is necessary to familarise oneself with the various forms of narcissistic “analytical” gratification, and especially with the numerous character-traits and their classification.
Analytical Auto-Erotism.—The outstanding features of the history of transference-dynamics are the division of transference into positive and negative, the operation of ambivalence, the fact that positive as well as negative can cloak a vigorous resistance, and that working through infantile experience can cover equally intense resistance. That the analysis itself can be made use of to exploit auto-erotic stages and characteristics, i.e. repetitions in which the necessity for imago-co-operation is only secondary, has not received the same systematic study. Not only then can coitus and pregnancy situations be gratified in movement and spoken word during the analysis, but, as Ferenczi, Reik and Abraham show, associations can be exploited in the interests of anal-erotic activities (flatus and defæcation), whilst onanistic satisfaction can be displaced not only to association, but to innumerable symptomatic acts and mannerisms. The intense satisfaction of urethral erotism in association, e.g. the continuous or interrupted flow (as where one of my patients identified his free associations and urination in the common phrase, “a flow of golden sovereigns”) is probably not sufficiently recognized. Further, although exhibitionistic and scoptophilic impulses and their reaction-formations are easily recognized and interpreted as such, the persistence of this trait as a possible libido leakage in an “association” form requires constant handling. Ferenczi has recognized this in insisting on the use of obscene words without euphemistic alteration and in the exact detailing of all phantasies. In the writer’s opinion the same applies to the defensive use of adult obscenity to cover infantile experience. Just as inhibition in the use of obscene words current in adult life is a measure of the repression of direct exhibitionistic or viewing activities, so a glib use of the same words may be a measure of the strength of reaction-formations, i.e. obscenity may be employed as a defence against obscenity. Moreover, sadistic and masochistic impulses in addition to more obvious forms of gratification can obtain satisfaction in choice of word and speech forms during analysis, as for example where another of my patients played frequently with clang-associations based on the “hard C” or “K”; this was found to gratify oral, anal and urethral impulses and to provide onanistic satisfaction, the effort necessary to sound “K” being at once defæcation and orgasm. Castration was also represented and the series “coruscating”, “kak”, “cock”, “cunt”, “catsmeat” and “cough” was a tabloid version of the patient’s complex activities. Urethral erotics on the other hand usually dwell on the sibilants.
We are again indebted to Ferenczi30 for suggestions on this very point. In an early paper he calls attention to the use of simile in analysis and regards the interpretation of such as a not unimportant part of technique. The concentration on seeking the comparison leads to a lessening of censorship, so that we get in the simile memory-traces from the life-history of the individual. One patient, for example, likens psycho-analysis to a cure for tapeworms, which continues unsuccessful so long as the head remains in, and subsequent analysis of the simile sheds valuable light on his identifications.
Important as are these auto-erotic gratifications in words, phrases and modes of speech, it would be a mistake to neglect the object-relationship which can be represented in individual words and phrases. We have here an interesting contrast to transference-repetitions, which, as we have seen, tend to obscure auto-erotic repetitions. Further, the manipulation is in both instances peculiarly calculated to foster analytic resistance. We know from Freud31 that the first real investment of objects is a “thing”-investment which is contained in the unconscious, and that the possibility of any object-presentation becoming conscious depends upon a union of the “thing”-presentation with the corresponding “word”-presentation which over-invests the former. He explains how in the transference-neurosis repression of presentations consists in denying to this “thing”-investment translation in words directly connected with the object. Hence the schizophrenic having withdrawn instinctual investment from object-presentations attempts to regain the object by hypercathexis of the word presentation. Now whilst these word-manipulations in the schizophrenic are subject to the “primary process” in a very marked degree, and the neologisms are seemingly quite without meaning, we have reason to assume from the mistakes, neologisms and word-plays so frequently met with in everyday analysis that a similar process is at work with perhaps a different aim. The schizophrenic attempts to heal himself, the neurotic in all probability to retain gratification of unconscious wishes by displacement of investment from thing to word-presentations. However that may be, the necessity of distinguishing auto-erotic from object word-play remains.
The Character-Trait.—In the use of words, either during analysis or in everyday life, we have something which is exceedingly characteristic of the individual, and the question arises whether the general term “neurotic character-trait” is not capable of subdivision. The character-trait is considered by Alexander10 as standing midway between neurosis and health, by Reich as being ultra-neurotic, by Ferenczi as a private psychosis. Its characteristic is that the patient gets more real satisfaction for libido-formations and, in so far as its repetition leads to injury of his own interests, substitutes a real punishment for a symbolic punishment. The patient adopts a stereotyped relationship to life, and makes this a medium of expression. Alexander has suggested that either a relative damming up of libido or inefficient repression is the main factor in its production; Reich, as we have seen, attributes the trait to a narcissistic regression which is necessary for toleration of it. Alexander’s suggestions can both be reduced to a quantitative factor, and in this connection Freud’s32 recent pronouncement is of importance, viz. that neurotic formations are not in themselves so important as the amount of attention (i.e. libido-cathexis) they receive. This would suggest that Reich’s regression factor is only important in so far as it determines the amount of ego and object libido respectively contributed to the character “formation”.
Adopting the term “neurotic” trait without prejudice, it would seem possible to separate traits in which the “word”-presentation is mainly affected from traits where relationship of the self to actual objects (including the self) is concerned. In both groups, too, a main subdivision is possible, viz. traits concerning the subject and traits concerning the object. This subdivision is, perhaps, more difficult in the case of “word”-traits, but in the other instance a line can be drawn more easily between object character-traits and auto-erotic character-traits. The former are then neuroses of action with play and gratification in the real outer world, the latter are neuroses of action with play and gratification on the real self. Gratification of oral libido again provides numerous examples of the auto-erotic trait (sucking and chewing pencils, chewing pieces of paper, smoking, etc.), whilst nose-picking, ear-boring, kneading bread, etc., exemplify anal traits. It is true that in these activities a regressional object-relationship is also found, and without question a “mixed” (over-determined) trait is the rule. Just how mixed it is can be gathered from the parallel instance of onanism (not in itself a trait); here one can trace in operation at the same time direct organ pleasure, narcissistic phantasy-formations and object phantasy-formations. This is probably true of the “smoking” trait. Now it is generally agreed that in the neurotic character-trait we find one of the most potent factors in continued resistance. Further, it is likely that such traits as gratify unmodified narcissistic libido are much less calculated to give rise to unconscious guilt feeling (apart, of course, from racial manifestations of this), can operate independently of the transference situation, and in so far as they are bound up with imago-representations are less amenable to influence and more adapted to the defiance aspect of the negative transference. In short, there is every reason to believe that in the patient’s own use of analytical material and situations there is wide scope for substitute-gratification; possibly here takes place that leakage of libido which, if unobserved, might lead ultimately to the necessity for positive imago-interference.
Analytical Applications.—It has been suggested that the only substitute for “active” technique would be a deliberate focusing of attention to manifestations of resistance, but it does not follow that it is either practicable or politic to examine all such manifestations arbitrarily. Indeed, if we classify the unconscious manifestations of the analytical hour in a somewhat rough way, it will be seen that each of these requires different handling. It is agreed, for example, that direct attack on symptom-formations is inadvisable for the excellent reason that it is hoped to recreate them in a fresh neurosis within the transference. The transitory symptoms, however, are more amenable to direct attack, and it is generally agreed that the symptomatic act, verbal slips, etc., make excellent material for immediate analysis, often uncovering intense resistances.
Practice in the handling of dream-material seems to vary considerably, but whilst on the whole it is to be regarded more as a “theme”, it is still available on special occasions for deliberate analysis, as distinguished from running elucidation in the course of free association. Finally, as we have seen, the character-trait covers numerous manifestations not only in everyday speech and conduct, but in analytical speech and conduct; these provide ample cover for the strongest resistance, and would require not only continuous analysis, but at times of crisis deliberate survey and analytical scrutiny.
It is at any rate a legitimate suggestion that before applying the direct active technique of Ferenczi, a persistent analysis should be made, in order of accessibility, of the symptomatic act, the transitory symptom, repetitive transference-phenomena, auto-erotic repetitions, and finally the neurotic trait.
On a properly constructed couch, every alteration from the supine attitude no matter how slight, every sound, no matter how inarticulate, has to be regarded as strictly determined and during resistance periods as material for unwearied analysis. Failing any advance by this method, the next justifiable step would be the deliberate focusing of analytical attention, whenever possible, on the performance or non-performance of certain substitute-formations, together with a rather arbitrary consideration of narcissistic factors in resistance after the manner of Abraham. If this again failed, the analyst would then take into account the type of falling ill, the quantitative investment of symptoms and—a factor which Jones33 emphasizes on resistance—the existence of gravely defective harmony in the environment, before proceeding to exploit his imago authority by the issue of prohibitions.
Terminology.—It is probable that the use of the term “active” is responsible for some of the difficulties in considering “active technique”, and the word is certainly calculated to give rise to confusion of thought in the minds of enthusiastic psychotherapists. On the other hand, Ferenczi has rightly queried the accuracy of the term “passive” as a description of current therapy. It would, perhaps, be advisable to adopt some terminology which would give a hint as to the psychological mechanisms implied. From this point of view, the “active technique” of Ferenczi is essentially “object” therapy, inasmuch as it depends for its success on the links formed at the earliest stages between the ego and the object.
Regarded from the point of view of libido-investment, it is “quantitative”, a therapy alternately of “expansion” and “deprivation”, of “flooding” and “damming up”. It implies a temporary “displacement” along “regressional” paths; it is not so much “active” as “reactivating”.
“Passive” therapy, on the other hand, whilst in the main an “object” therapy, probably owes some of its success to the play given by the technique to auto-erotic impulses, not only in the production of associations, but, as often occurs, by spontaneous attempts at interpretation.
In the latter instance this “auto-analysis” is frequently a cover for strong resistance, although, like other resistance-repetitions, a certain amount of play must be given it. The pride in producing associations is in a somewhat different case, and might be regarded in one sense as a kind of temporary sanctioned sublimation of autoerotic impulses, albeit one which lends itself in a unique way to repetition interests. In a sense, too, it could be said that “passive” therapy is of the most advanced type possible, in that it implies an artificial stabilizing of the authority of the ego-ideal, and “active” therapy would seem to be an intermediate stage between passive therapy and analytical suggestion. The deliberate focusing of attention on performance or non-performance of substitutive acts or speech is less a reinforcing of the ego-ideal than the providing of a stimulus-situation with which the ideal must deal. The series would then run: passive interpretative technique, active interpretative technique, and, lastly, the Ferenczi technique based on transference authority, for which some such term as “reactivation (or congestive) technique” would seem more applicable than the one at present used.
Assuming that direct imago-interference is justifiable, there are certain implications consideration of which cannot be avoided. First, what are the logical or expedient limits to laying injunctions on the patient? If, for example, a patient practises larval forms of narcissistic gratification or exhibits auto-erotic traits which, if carried out in their original direct form, would give rise to conscious inhibitions, there does not seem to be any reason, from the purely theoretical point of view, why he should not be asked to reproduce on the couch any one or all of these direct forms.
Ferenczi, it will be remembered, was not content with a performance of his injunctions during non-analytic periods, but insisted on the inhibited act being performed in his presence. And if there are no theoretical limitations to the scope of active technique, at least the empirically expedient limitations should be understood thoroughly.
Then as to the bearing of the analyst. If the latter may stimulate analysis by means of injunctions and prohibitions, should be not be permitted in the last resort to make use of a kind of imago pantomime by actually imitating before the patient what he considers to be a significant imago-detail? The case reported by Groddeck,34 where he stimulates his patient by getting up and imitating before her a certain limping gait, suggests numerous possibilities, which become even more relevant when we consider the training of analysts themselves. It is perhaps a moot point whether all persons being analysed for training would present resistances necessitating the application to themselves of active technique, although, regarding this matter from the point of view of quantitative libido-investment, it is theoretically presumable that they do. In any event, it would seem a prerequisite for the application of active methods that the analyst should have experienced the tension produced by imago-interference—in short, that active therapy should begin at home. It has, of course, been frequently argued that self-analysis is doomed to superficiality, and theoretically it can be understood that the transference-repetition of infantile situations, except in the purely primary narcissistic stages, cannot be attained in the absence of an imago (as Freud puts it, “In the long run, no one can be slain in absentia or in effigie”). Clearly Freud’s definition of resistance as anything that interferes with the course of analysis applies excellently to counter-resistance. Now, since counter-resistance, like resistance, has a sadistic component, the situation of causing “tension-pain” in the patients is obviously calculated to play into the hands of this component.
Studying works on technique with the aid of Ferenczi’s simile-analysis, we find much food for reflection. From a recent book on technique can be taken the following phrases, e.g. “penetrating”, “cause no pain”, “touch lightly with your probe”, “use of force”, “with a steel fist”, “violence, short and sharp”.
It was probably his own reaction against a similar situation, together with an increased sensitiveness to it, which led v. Hattingberg to criticize the analytical supine position as affording, both in actual arrangement and in interpretative technique, opportunity for satisfaction of the analyst’s unconscious aggression. His criticism missed the mark because he read his own conflicts into a theoretical consideration of technique, but it is an excellent example of that same sensitiveness which has already been advanced as one of the reaction difficulties of applying active technique to the patient; indeed, the criticism would be actually justified if an analyst were unaware of an unconscious temptation to indulge aggressive components. It must be granted, of course, that, cœteris paribus, the opposite risk exists in passive technique, namely, where the analyst, by masochistic identification, refrains from exploiting fully the possibilities of passive technique, but this again is a criticism of the analyst’s training, and not of analytic method.
Since the foregoing paper was written there has appeared, as one of a new series of psycho-analytical publications, an essay on the “Developmental aims of psycho-analysis”, by Ferenczi and Rank.36 In a footnote to the introduction the authors state that previous work by one of them on “active” methods has been either ignored or misunderstood by the majority of analysts. That the work has been ignored in periodical literature may perhaps be due to increasing pressure of contributions on other important matters; in this sense the criticism is perhaps justified, but in this sense only. Indeed, one might go so far as to say that the interest aroused by Ferenczi’s work has been reflected not only in animated discussions among groups, but in a constant and increasing stream of private discussion and debate. That it has been misunderstood is a possibility not to be excluded; indeed, the footnote goes on to suggest that misunderstanding may be due to the fact that the papers in question did not deal sufficiently with the orientation of the method in respect to other technical procedure. We must remember, however, that many other generalizations about technique (transference, resistance, repetition, etc.) have been put before, and have been accepted by, the same psycho-analytical audience which is now credited with misunderstanding this latest expedient. This is a psychological phenomenon which can scarcely be explained away on the score of lack of proper orientation. Quite apart from motivations of unconscious resistance, there are two equally feasible explanations: either that satisfactory empirical data were not yet available, or that there existed some general recognition of a change in the dynamic point of view involved.
However that may be, the authors have at any rate compensated for any “lethargic” reaction on the part of their readers by official canonization of “active” methods in a definitely, though perhaps too briefly formulated, scheme of therapeutic procedure. Now it must be noted that in the same periodical literature during the same time no supplementary clinical evidence on “active” methods has been adduced. On the other hand, one of the authors has published a paper37 on libido-processes in treatment and later a more ambitious treatise38 in which all life-processes, including psychological healing-processes, have been regarded from one refracting angle. Hence it is, perhaps, not unfair to suggest that this recent authorization of “active” methods is to some extent at least the result of a happy conjunction of forces, whereby a tendency to give fixed form to treatment at the same time countenances and supports a previously isolated series of important observations. This collaboration adds greatly to the authority of the writers’ pronouncements, an authority to which their previous distinguished contributions would in any case render them entitled, but it has nevertheless some of the disadvantages of composite presentation.
Very briefly then, since one assumes that the essay itself will be carefully studied, the position is as follows:
Freud put the main accent on “remembering” during analysis and regarded the substitution of remembering by a tendency to “re-experience” as a resistance. Ferenczi and Rank regard repetition not only as unavoidable, but in certain instances as the only way of reproducing the actual unconscious. Reproduction therefore is not to be limited, but provided one knows how to control the phenomena, to be insisted upon. When, on account of anxiety and guilt-feeling, repetition is hindered by resistance, this in some instances can only be overcome by active interference, by insisting on repetition. Repetition is therefore the main agent in technique.
For the analyst, psycho-analysis of the patient represents a process within the libido-development of the latter having individual form and definite duration. This process takes an automatic course and the physician’s duty is merely to interfere when resistance disturbances require correction. Analysis permits libido expansion which is often inhibited in real life; it must at certain points insist on this expansion. In general the analyst behaves rather passively towards repetition, as an object or rather phantom object; where correction is necessary he behaves “actively”.
In analysis we have to deal with phases of resistance and of transference, the overcoming of which goes on during the main analytical work, which one might describe as a treatment by libido-withdrawal (a “lowering” cure). In the resistances of the ego we meet with mainly preconscious memory-material or manifest character-peculiarities and ideal-formations. These are overcome gradually. The narcissistic resistances are met with early and often give rise to the greatest difficulty, sometimes necessitating narcissistic injury or temporary suspension of the old ego-ideal.
From the transference there can be reproduced portions of disturbed infantile development; this takes place by translation of unconscious manifestations into the language of consciousness, also by the tendency to repeat old libido-situations. In contradistinction to the manifestations of the resistance-phase, we find here a reproduction of situations which for the most part have never been conscious. These are intensively experienced for the first time through analysis of the transference. The main resistance here is infantile anxiety (guilt-feeling in relation to the parents), which arises from the conflict of ego (ideal) with libidinal tendencies. The neurotic has an excess of guilt-feeling, the reduction of which by partial analytic resolution and abreaction enables libido-tendencies to appear in the form of transference, to be made conscious and to be worked out (verarbeiten).
If infantile libido has thus been freed from repression, if the patient has with the “active” assistance of the analysis found courage to recognize his libidinal tendencies, we have then to separate from the analytic situation the infantile libido reproduced in the transference. This is a special phase of libido “weaning” or, in analytic terminology, it constitutes the correct analysis of the transference. The artificial transference-situation with its now actual tendencies towards fixation must, after suitable working-through, be resolved by demolition of the transference. This must take place gradually as did the automatic libido-development of the first phase under ego-inhibitions. At the point when libido-development is completely unravelled and transfered to analytic fixation, interference on the part of the analyst is directed towards the duration in that “he sets an appointed time by which the unwinding of threads from the analytic reel to the spool of reality must be complete”. This must be adhered to apart from any seeming “progress” made by the patient in the meantime. New ego-resistances appear; the patient wants real libido-gratification in analysis. This must be renounced and the results of analysis accepted.
In the first phase of analysis the patient calls in investments from the advanced ego-positions (personality, neurosis) and guides them back to the Oedipus situation and its fore-stages. The real resistances that are aroused here do not disturb analytic work; they act like a watch-spring in regulating and dosing libido-processes. But they are also more than functional; they reproduce in themselves, hence their analysis is of the utmost importance. If this is successful, the transference in the full unconscious sense is now established. The nature of transference and of resistances show in each case what has happened to the Oedipus libido. In this sense the castration complex represents in analysis the negative Oedipus complex; it is a neurotic means of defence making use of normal infantile bisexuality. With this investigation the disease is now rendered superfluous. Activation and resolution of the primary neurosis in analysis correspond to the chronological sequence in disease; infantile neurosis, clinical neurosis. The first phase represents ego-education in so far as the ego is taught to tolerate ideas running counter to its requirements. In a later phase, after transference is developed, infantile libido-development is completely expanded. The stage of libido-weaning is carried on by ego-energies from the new ideal, plus a component of natural egoism. These ego-energies are, of course, like the capacity for transference, present in all cases which are not insane. On them depends the healing process, i.e. a further transference from analyst to reality. The patient turns to what life offers; sublimation is compressed into a short space.
The creation of the analytic situation reproduces the infantile trauma. The patient shows that it is the ideal parent-imago he wants. We cannot give this in the form he wishes, and even if we did, “as is often the case”,39 we should only apparently “cure” him by making him happy in love. We must bring him up to a painful experience, i.e. the conflict between libido-tendencies and the ego-ideal. Transference establishes a provisory ideal against which the old ideal defends by resistances. These frequently take the form of father-identification with exhibition of obstinacy. Even in this first phase of analysis active interference is required which “need not go beyond that degree of parental authority existing in the transference”. When these ego-resistances are overcome and the transference is widely established, reproduction continues until libido-resistances arise; these fight against recognizing that libido wishes are unattainable in analysis. At this point the nature of the transference is first explained. All explanations and translations are here merely a first resource. In general, the analyst only ceases to be passive when resistances demand some regulation of libido-processes, and here mere translation is less important than understanding the tendency of associations. Every expression of the patient must be understood and interpreted as first and foremost a reaction to the present analytic situation.
Abreaction of affect is still the important therapeutic agent, but with this difference, that in the original catharsis affect was connected with the original experiences, whereas in analysis affect is discharged through and by means of the analyst and analysis. It is the difference between seeking memories to reach affect, and provoking affect to uncover the unconscious. This creates, so to speak, “new actual memories”. The state of privation represented by analysis constitutes a trauma-repetition which is essential to bring about therapeutic conviction.
Later, in a historical review of technique in which certain previous tendencies are criticized, the authors warn against adopting “wild activity” as a substitute for overcoming technical difficulties. They state specifically: “The moderate but, if need be, energetic activity required in analysis is as follows: the physician to a certain extent actually fills the role thrust upon him by the unconscious of the patient and his flight tendencies.” This encourages inhibited repetition-tendencies. “Where the repetition comes about spontaneously, provocation is unnecessary.” In describing the relations of theory to practice, the authors recall how wider application of the new “activity” followed from experiences in dealing with anxiety-hysteria when the patient was made to face certain painful situations.
One of the chief results of the scientific insight attained by analytic observation was the discovery that the Oedipus complex was the root complex and the significance of its repetition in the analytic situation. Nevertheless the most important part of real analytic interference consists neither in the demonstration of an “Oedipus complex” nor simply in its repetition in analysis, but in the loosening or separation of infantile libido from its fixation on the first object. This implies a complete living through in the relation of patient to physician and the latter must occasionally take suitable measures (activity) to uncover traces. The knowledge by means of which we are in a position to interfere at the correct moment and with appropriate dosing, consists in a conviction of the universal significance of certain fundamental early experiences (“as for example the Oedipus conflict”).
It is one of the drawbacks of a short theoretical essay such as that of Rank and Ferenczi that the meaning of certain passages tends to be rather obscure. This difficulty is not in any way lessened in the present instance by almost total absence of clinical illustrative material whereby the exact implications of terminology might be controlled. We know, for example, from Ferenczi’s earlier work that the customary interpretative interference is, in his view, active; moreover, it may be said that his special “activity” as then described has not been in any way modified. Nevertheless, in describing active interference “which need not go beyond that degree of parental authority existing in the transference,” it is clear that the licence permitted must, in the absence of exact definition, vary in accordance with the analyst’s predilections. This is the more important in that the statement in question applies to interference in the first stage of analysis, i.e. before the transference situation has been unfolded.
Another drawback has been appreciated by the authors themselves when they suggest that the idea of hard and fast stages should not be taken too literally. This is a welcome reassurance, not merely for the reason advanced that these stages are not found so schematically in practice, but because a fixed demarcation of stages implies a much more complete knowledge of ego-processes than we are at present entitled to claim. But, although the authors are ready to make allowance for the merging of one phase into the other, no such allowance is hinted at in the application of active steps in technique. Whatever doubt there may be as to the nature of interference in the first stage, there is none as to the use of activity in the unfolding of transference-situations, nor, again, when the time is ripe to commence the last phase of libido-weaning. Whilst this latter seems to cover the process usually known as analysing and dissolving the transference, an additional active step is taken, viz. setting a term to the analysis itself. On theoretical grounds it is difficult to say whether this is merely the climax to a series of deprivation situations or whether it is not merely a completion in the last phase of what is supposed by the authors to have been already completed, viz. the activation and re-experience of infantile libido-situations in the transference. It might be said that, if the transference had been effectively uncovered, this would include complete emotional investigation of the most important privation occurring at the Oedipus stage; in that case the necessity for this final jog during dissolution of the transference would not be too apparent. But perhaps the difficulty is an artificial one, due to thinking too rigidly in stages; in this sense the current elastic handling of cases, whilst seemingly an indication of ineffectively applied knowledge, may prove to be more in keeping with the actual dynamics of the situation. At any rate, it will be interesting to compare in future the results of this manoeuvre as applied by active therapists in all cases with the results occasionally noted by “passive” analysts when, for some reason or other, the stage of transference-dissolution has been of fixed duration. Theoretically, of course, all such comparisons will be beside the point, but as empirical data they will meet on common ground.
In the meanwhile three questions arise: 1. How far has the case for universal application of “active” methods been satisfactorily established? 2. How far does the division into stages together with the process of libido-weaning meet with the exigencies of analytic practice? 3. And how far does our present knowledge of ego-psychology permit us to adopt an attitude of finality on therapeutic procedure?
In the first place, since no additional clinical evidence has been adduced, we are entitled to say that the question is still open to investigation and discussion. A fresh pronouncement of some importance has, however, to be chronicled: the active therapist definitely shoulders the responsibility of actually playing to some extent the imago-role thrust upon him by the patient. There is no need to recapitulate here the considerations already brought forward in the foregoing paper on this point, but, since ego-mechanisms have recently been more widely discussed, it may well be to single out two special aspects of the question. The “active” therapist would discount the dangers of a second fixation on the grounds not only that he really wishes to bring about a second fixation, but that, provided he knows how to dissolve it later, there is no danger. His point seems to be that without this imago-play it may be impossible to secure that toleration of infantile ego-counter impulses which is admittedly the preliminary to analytic success. The natural question arises: Does he, after playing this part, really succeed in dissolving the second fixation, or has he, like the hypnotiseur, gained immediate progress at an ultimate sacrifice? The answer would seem to lie in the part played by the ego-ideal in analysis and, going further back, in the degree to which “Es”-excitations have really been subordinated to control during ideal-formation.
Freud40 has shown that the climax in the series of object-formations (partial to complete), subject-object identifications, and choice of complete love-object, is reached in overcoming the complete Oedipus relation, and that a process of identification on the oral pattern takes place whereby a special stamp is left on the ego. The main point about this early ideal-formation is that, by introjecting the parent, the child has ipso facto built up in himself an active repressing force; obstacles to sexual gratification existing outside the ego are now erected within the ego, and exercise a repressing function, the energy for which is supplied from narcissism via the aim-inhibited impulses and the narcissistic ideal-ego. At the same time there exist in a state of repression allo-erotic relations with parental images, which vary in accordance with identification and the form of the Oedipus complex. Now the parental introjected ego-ideal brings about a denial not only of sexual impulses towards the parents, but, in addition, of erotic phantasy and auto-erotic activities of a direct nature. There is here a striking difference from the new introjection taking place during analysis. To appreciate this we have only to compare the parental attitude with the attitude of “passive” analysts. Whilst the latter clearly indicate the unattainability of direct erotic strivings towards the new object, they entirely suspend “criticism” or “judgment” of the wish-formations and phantasy-activities, or, again, of actual activities outside analysis of a direct auto-erotic or object type. They may interpret, explain or, in the event of libido-leakage, continue to emphasize the nature of these resistance-defences, but they avoid playing the parental role as far as that is possible. This is an extraordinary difference, and to it as well as to the uncovering of anxiety-formations is due the fact that the patient is able to tolerate (hence to uncover) in consciousness the phantasy products of infantile sexuality.
The usual passive therapy thus slowly modifies the old ego-ideal, and even when interpretation pursues a more arbitrary course, as in calling attention repeatedly to the existence of libido-leakages, a stimulus-situation is provided for an increasingly stable system (i.e. adapted to reality). In Ferenczi’s congestive therapy, whilst the authority present in the ideal is invoked, the libidinal imagines are also activated. To these latter situations the patient is already sensitized. “Do this”, “Don’t do that” (Gebot und Verbot) are, after all, the battle-cries of the nursery, and, however laudable their intent, are calculated to reactivate, this time in reality, the associated ideas of parental tyranny and judgment. The analyst who uses them has, moreover, legitimately aroused old phantasy hopes and anticipations. Whoever says “Don’t” may also smack. It is easy to imagine that where the patient has a tendency to self-punishment, especially in the inverted Oedipus situation, the issue of a prohibition provides a real gratification of castration-phantasies, ultimately a symbolic gratification of “passive” technique that entire suspension of criticism, either actual or implied (as in prohibition), permits and assists the gradual introjection of the new ideal without activating in reality a direct infantile libidinal relation to the analyst, that the toleration of ego-counter achieved. It might be argued, indeed, that the prerequisite for any justifiable application of congestive methods is not so much the usual “durable transference”, but what one might call a serviceable alteration of the ego-ideal. It should be noted in passing that, whilst the authors do not see any risk in a second fixation if properly handled, they do call attention (p. 23) to the frequency with which “cure” is effected by allowing the patient some success in his analytical love.
The second point has already been elaborated in the foregoing paper; it concerns the degree to which auto-erotic activities have in the first instance been rendered amenable to object influence. This is again a matter of the stability and over- or under-strictness of the ego-ideal. Where original “Es”-excitations have not been deeply affected by object influence or where component-impulses have only been slightly modified, it would seem that “activity” must defeat its own ends, that we must be even more passive, give more scope to repetition, i.e. to working through, rather than merely to re-experience. It is on some such score that doubts as to the wisdom of a standardised technique become most insistent; one misses in particular any reference to the varying conditions of ego-development or capacity for reality-testing such as are constantly present in analytic practice.
This brings us to consider the advisability of giving a fixed form to the process of analysis. The preliminary criticism might be advanced that in giving this form, and especially in defining the duration of the so-called weaning stage, we run the risk of using methods of treatment which presume a fuller knowledge of ego and libido processes than we at present possess. It is true that the authors appeal against a too rigid demarcation of stages; we must note, however, that the demarcation is effected mainly on a libidinal basis. Perhaps some of the more obvious overlapping of their stages in practice is due to the fact that analysis is regarded mainly as an automatic libido-process within the individual’s history having individual form and duration. The phrase “individual form” is surely another way of saying that ego dispositions and development vary in each case. Indeed it is conceivable that analysis might be divided into phases from the point of view solely of ego-development (e.g. introjection and projection phases, subject-object relations, ideal-formation, etc.); but this would be merely an exercise in ingenuity. The authors certainly attempt to correlate ego and libido processes, but it is perhaps not unfair to say that they seem to take up an attitude of slight impatience with the ego, e.g. in the last phase of analysis we find them still making coercive gestures. It must be added that in putting the accent entirely on a successful “weaning”, a tendency is established which would make analysis less an elastic and adaptable therapeutic process than a rigid discipline based on one general formula. We are bound to recall the point of view of one of the authors in another book, Das Trauma der Geburt, where the application of a formula to instinctual activities and mechanisms is very rigorously carried out. There is, indeed, some indication of this attitude in the significant parenthesis concerning the universality of certain early experiences—”for example, the Oedipus conflict.”41
It is, perhaps, unfair to press comparisons too closely, but the authors on more than one occasion appeal to the practice of general medicine in support of their thesis. It is always a good disciplinary exercise for analysts to study the therapeutic canons of general medicine. But at the same time we must not forget the reluctance of scientifically-minded clinicians to standardize phenomena either in diagnosis or treatment. Standardization in general medicine is usually a preliminary to making new standards to cover exceptions to the previous rule. As for limiting the duration of a phase of treatment, this it is true is sometimes illustrated by the use of transference authority at the bedside, but a rigid application of the parallel would confront us with many perplexing situations, e.g. the limitation of treatment during convalescent or resolution stages of organic disease.
It cannot be too frequently emphasized that the importance of a book of this kind lies mainly in its fundamental tendencies. The problem of “active” therapy still remains a problem to be solved in due course as the result of additional experience and insight. The comments made here are not intended to imply that active steps are empirically unsound. It may well be that in certain cases at certain times the empirical advantages may outweigh any drawbacks inherent in the application of active technique. On the other hand, we are entitled to enter a plea for more prolonged consideration of phenomena and against too rapid a crystallization of set principles. The founder of psycho-analysis has set us an example of patient and penetrating research which cannot be bettered. Doubtless we shall in the future be indebted to the creator of “active” methods for further illuminating observations on the subject; the present essay indeed is full of very cogent criticisms such as we are accustomed to expect from his pen. And here the matter might well rest, were it not that the last chapter of the essay contains speculations of great importance from the point of view of “tendency”. The gist of these speculations is as follows:
The authors suggest that displacement of accent in treatment to “knowing” and “managing” (handeln) will lead in course of time to increasing resemblance between analytical methods and those of general medicine; with this exception, that the timing and “dosage” of interference will be more accurate in the former instance. Hypnosis was not radical because its use concealed psychic motivations; nevertheless it owed its undeniable results to the elimination of intellectual resistances. “It would be an enormous advance in therapeutic efficiency if we could, for example, combine this invaluable advantage of the hypnotic technique with the advantage of possible analytical solution of the hypnotic affect-situation.” So far, psycho-analysis has shown us that the crux of the hypnotic affective relationship is the Oedipus complex, but we do not yet understand the specific conditions of the hypnotic state. If we did, the analyst might again include hypnosis in his technique without fear of producing permanent fixation. Exclusion of intellectual resistances is more necessary since we now penetrate more deeply into the layers of consciousness, thereby making this knowledge itself a means of resistance. The immediate tendency is towards simplification of analytical technique which may possibly bring about a semblance of monotony and formality in analytic methods.
It is clear from this that the authors have taken the wise precaution of hedging round these speculations with conditional clauses; hence the matter cannot be regarded from the point of view of immediate policy requiring immediate consideration. Nevertheless the tendency is noteworthy, and is frankly characterized as such in the last chapter. Reference to the foregoing review (see p. 297) will perhaps indicate that this ultimate tendency had then been in part anticipated. It was originally the present writer’s intention to add to his classification of therapeutic procedure by including a group of “activation methods reinforced by hypnotic technique”, and it may be permissible now to amplify the statement that current “passive” methods are theoretically the most “advanced” methods possible. Then it was suggested that the distinction between methods lay in the physician’s attitude to the patient’s ego-ideal. In the meantime Jones has published a contribution to the nature of auto-suggestion in which is set out with the utmost clearness the essential difference between analytic processes and suggestion or hypnotic processes.42 This paper deserves the closest study, and we can only refer here to his view that the suspension of ego-ideal criticism involved in the latter is effected at the price of repression of allo-erotic impulses, which regress towards auto-erotism. This regression-process runs counter to the raising of assimilative capacity on the part of the ego-ideal. Our attention is thus drawn to an incompatibility in principle, and if analysis is to be combined with suggestion and hypnotic methods, we must be alive to the possibility that the analytic process is much less likely to be completed. It would be an interesting subject for discussion whether in the active (Ferenczi) position we have not already reached a theoretical “debateable land”, in so far as a general passive attitude leading to increased assimilative capacity on the part of the ego-ideal is combined with an active attitude which, whilst intended to increase still further this assimilative capacity, permits regressive identifications by making use of infantile libidinal technique (Gebot, Verbot). Certainly, as Jones remarks,42 one of the strongest resistances exists when the patient projects on to the analyst his own repressed mental processes, identifying him with his own real ego; and we must consider how far actually playing the part ascribed by the patient’s unconscious tends to reinforce this resistance projection.
Returning to the question of hypnotism, we have to note that the advantage anticipated by the writers is that of eliminating intellectual resistances, which, they hold, is the more called for since analysis now penetrates more deeply or widely into conscious layers. This argument is at any rate not quite one-sided. Quite apart from the fact that earlier in the essay the authors associate their more active expedients with libido-resistances, we must ask whether it is not precisely by deeper investigations of action-mechanisms that we may provide that damming-up of the libido, the escape of which in their view necessitated activation methods.43
1. Vorlesungen zur Einführung in die Psychoanalyse, Leipzig, 1917. English translation: Introductory Lectures on Psychoanalysis, International Psycho-Analytical Press, 1922. Lecture XXVIII.
2. “Zur Dynamik der Übertragung”, Zentralblatt für Psychoanalyse, Bd. II, 1912. Republished in Sammlung kleiner Schriften, Vierte Folge.
3. “Die Handhabung der Traumdeutung in der Psychoanalyse”, Zentralblatt für Psychoanalyse, Bd. II, 1912. Republished in Sammlung kleiner Schriften, Vierte Folge.
4. “Weitere Ratschläge zur Technik der Psychoanalyse”, Zeitschrift für Psychoanalyse, Bd. II, 1914. Republished in Sammlung kleiner Schriften, Vierte Folge.
5. “Die Zukünftigen Chancen der psychoanalytischen Therapie”, Zentralblatt für Psychoanalyse, Bd. I, 1910. Republished in Sammlung kleiner Schriften, Vierte Folge.
6. “Wege der psychoanalytischen Therapie”, Zeitschrift für Psychoanalyse, Bd. V, 1919.
7. “Einige Bemerkungen zur Lehre vom Widerstande”, Zeitschrift für Psychoanalyse, Bd. III, 1915. Translated in International Journal of Psychoanalysis, Vol. V, 1924, p. 141.
8. “Weiterer Ausbau der ‘aktiven Technik’”, Zeitschrift für Psychoanalyse, Bd. VII, 1921.
9. Translated in S. Ferenczi, Contributions to Psychoanalysis, Boston, 1916.
10. “The castration complex in the formation of character”, International Journal of Psychoanalysis, Vol. IV, 1923.
11. “Zur psychoanalytischen Technik”, Zeitschrift für Psychoanalyse, Bd. V, 1919.
12. “Technische Schwierigkeiten einer Hysterieanalyse”, Zeitschrift für Psychoanalyse, Bd. V, 1919.
13. Bericht über die Fortschritte der Psychoanalyse 1914–19, p. 131, 1921.
14. “Weitere Ratschläge zur Technik der Psychoanalyse”, Sammlung kleiner Schriften, Vierte Folge, p. 452.
15. Jenseits des Lustprinzips, Wien, 1920. English translation: Beyond the Pleasure Principle, 1922.
16. Cf. Freud, “Triebe und Triebschicksale”, Sammlung kleiner Schriften, Vierte Folge.
17. The various tissue changes induced under hypnosis might be brought forward in support of the complete accessibility of narcissistic libido to object influence. Without going deeply into theoretical consideration of this point (on which much light is shed by Ferenczi in his paper on hysterical materialisation-phenomena), it may be said that such alterations presuppose not only a strong transference capacity (and therefore strong object-modification of subject-impulses), but, as Ferenczi suggests, an advanced state of modification in which the body is “genitalized”. The induction of such changes, themselves in the nature of a transference “conversion”, does not preclude the co-existence of a stream of auto-erotic activity more or less inaccessible to transference influence.
18. It seems probable that even in the case of modified “component” pairs, especially the exhibitionism-scoptophilia pair, the primary narcissistic stage has still continuous gratification throughout life. This is less capable of direct proof owing to the fact that in the second stage of modification, namely, the turning of the impulse from the object against the self, a pseudo-narcissistic phase is attained. In the case of the erotogenic zones the continuance of primary organ-pleasure apart from any modification is more easily demonstrable.
19. Cf. Jenseits des Lustprinzips.
20. Personally communicated by Abraham.
21. “Über neurotische Erkrankungstypen”, Sammlung kleiner Schriften, Dritte Folge, 1921, p. 306.
22. “Zur Technik der Kinderanalyse”, Zeitschrift für Psychoanalyse, Bd. VII, 1921.
23. “Zur Prognose psychoanalytischer Behandlungen in vorgeschrittenem Lebensalter”, Zeitschrift für Psychoanalyse, Bd. VI, 1920.
24. “Zur Analyse der analytischen Situation”, Zeitschrift für Psychoanalyse, Bd. X, 1924.
25. Das Ich und das Es, 1923.
26. Kriegsneurosen und psychisches Trauma, Leipzig, 1918.
27. “Analysis of an obsessional neurosis in a child”, International Journal of Psychoanalysis, Vol. III, 1922.
28. “Über eine besondere Form des neurotischen Widerstandes”, Zeitschrift für Psychoanalyse, Bd. V, 1919.
29. “Zwei narzisstische Typen”, Zeitschrift für Psychoanalyse, Bd. VIII, 1922.
30. “Die Analyse von Gleichnissen”, Zeitschrift für Psychoanalyse, Bd. III, 1915.
31. “Das Unbewusste”, Sammlung kleiner Schriften, Vierte Folge, p. 329 ff.
32. “Certain neurotic mechanisms in jealousy, paranoia and homosexuality”, International Journal of Psychoanalysis, Vol. IV, 1923.
33. Papers on Psycho-Analysis, p. 376, London, 1923.
34. “Eine Symptomanalyse”, Zeitschrift für Psychoanalyse, Bd. VI, 1920.
35. Added in April, 1924.
36. Entwicklungsziele der Psychoanalyse, Internationaler Psychoanaly-tischer Verlag, 1924.
37. Rank: “Zum Verständnis der Libidoentwicklung im Heilungsvorgang”, Internationale Zeitschrift für Psychoanalyse, 1923.
38. Das Trauma der Geburt, Internationaler Psychoanalytischer Verlag, 1924.
39. Reviewer’s italics.
40. Das Ich und das Es, Internationaler Psychoanalytischer Verlag, 1923.
41. Reviewer’s italics.
42. “The nature of auto-suggestion”, International Journal of Psychoanalysis, Vol. IV, 1923.
43. In the literature of active therapy, reference is frequently made to the remarks of Freud in his “Wege der psychoanalytischen Therapie” (1919), concerning simplification of technique. It may be well to consider the context of these remarks. Freud first refers to the possibility of meeting a demand for wider application of the benefits of psycho-analysis especially among the people. He thinks it possible that poor people will be less ready to abandon their neuroses, since their conditions of life are not so attractive and to be ill is to have some claim on social support. He then goes on: “In all probability the application of our therapy to numbers will compel us to alloy the pure gold of analysis with a plentiful admixture of the copper of direct suggestion: indeed, just as in the treatment of war-neuroses, hypnotic influence might be included. But, however this psychotherapy for the people (fürs Volk) may take shape, out of whichever elements it is constituted, the most effective and most important part thereof will assuredly remain that which is borrowed from strict, non-tendencious psycho-analysis.”
* Read before the British Psycho-Analytical Society, Feb. 21, 1923.
† Article citation: Glover, E. (1924). “Active therapy” and psycho-analysis—a critical review. International Journal of Psychoanalysis, 5: 269–311.