Freud, Sigmund (1910-006/1912.en): The Future Chances of Psychoanalytic Therapy

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CHAPTER XII.

THE FUTURE CHANCES OF PSYCHOANALYTIC THERAPY.¹

As the main object of this assemblage is for practical purposes,
I will therefore take as my opening address a practical theme
which will appeal not so much to your scientific as to your medical
interest. I am indeed mindful of your judgment of the success
of our therapy and I also take for granted that most of you have
passed through the two initiative phases, to wit, the enthusiasm
over the unexpected progress of our therapeutic accomplishment,
and the depression over the enormous difficulties which stand
in the way of our efforts. However, it really does not matter in
what stage of this development some of you may be, I shall show
today that we are by no means at the end of our therapeutic
resources for combating the neuroses and that we have a right
to expect a considerable improvement in our therapeutic chances
in the future.

I believe that the reinforcement will come from three sides:

1. Through inner progress.
2. Through a gain in authority.
3. Through the general effect of our work.

By inner progress I understand the progress (a) in our analytic
knowledge, (b) the progress in our technique.
(a) The progress in our knowledge: To be sure, we do not
yet know everything that we need for the understanding of our
patients’ unconsciousness. It is therefore clear that any progress
in our knowledge means additional strength for our therapy. As
long as we did not understand anything we did not accomplish
anything; and the more we shall learn to understand the more we
shall accomplish. In the beginning, the psychoanalytic treatment
was inexorable and inexhaustible. The patient had to tell every-
thing himself, and the activity of the physician consisted in con-
stantly urging him to continue. Today things look brighter. The
treatment consists of two parts, of that which the physician dis-
 

¹Lecture delivered before the second Psychoanalytic Congress at Nürn-
berg in 1910.

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teor

covers himself and tells the patient, and of the elaboration of that
which he heard from the patient. For the mechanism of our
treatment is really very easy to grasp. We give the patient the
conscious expected ideas through the model of which he is enabled
to find in himself the unconscious ones. This is the intellectual
help which facilitates for him the overcoming of the resistance
between the conscious and the unconscious. I also call your atten-
tion that this is not the only mechanism utilized in the analytic
treatment; you are all acquainted with the (more powerful) mechan-
ism lying in the utilization of the “transference.” I shall endeavor
in the future to deal with all these relationships which are im-
portant for the understanding of the treatment in a “General
Method of Psychoanalysis.” Nor is it necessary for me to reject
your objection that in the present practice of our treatment the
proof of the correctness of our assumption becomes obscured.
You will not forget that these proofs are to be found elsewhere,
and that a therapeutic encroachment cannot be conducted like a
theoretical examination.

Allow me now to touch upon some spheres wherein we can learn
something new and where we actually discover something new
every day. The most prominent of these is the symbolism in the
dream and in the unconscious. A theme forcibly contested, as
you know! It is no small merit that our colleague, W. Stekel,
has earned, when he devoted himself to dream symbolism, uncon-
cerned about the protests raised by all the opponents. Here there
is really much to be learned; my “Interpretation of Dreams”
written in 1899 received important supplements from the study
of symbols.

I should like to tell you something about one of these newly
recognized symbols. Sometime ago I learned that a psychologist
who is unfamiliar with our work remarked to one of my friends
that we are surely overestimating the secret sexual significance
of dreams. He stated that his most frequent dream was of climb-
ing a stairway and that there was surely nothing sexual behind
this. Our attention having been called to this objection, we direct-
ed our investigations to the occurrence of stairways, stairs, and
ladders in the dream, and we soon ascertained that stairs (or any-
thing analogous to them) represents a definite symbol of coitus.
The basis for this comparison is not difficult to find. Under

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rhythmic intervals and with increasing difficulty in breathing one
reaches a height, and may come down again in a few rapid jumps.
Thus the rhythm of coitus is recognizable in climbing stairs. Let
us not forget to consider the usage of language. It shows us
that the “climbing” or “mounting” is, without further addition,
used as a substitutive designation of the sexual act. In French
the step of the stair is called “la marche”; “un vieux marcheur”
corresponds exactly to our “an old climber.” Concerning another
interesting symbol, the one of “rescuing” and its changed signifi-
cance you will find a description in our publication.² But I am
forced to stop here else I shall not come to the other points.

Everyone of you will convince himself from his own experience
how different it is to face a new case after you have examined
the structure of some typical case. Now suppose we could put
together under a few formulæ the lawful in the structure of the
neuroses, just as we succeeded in doing with the symptom forma-
tion of hysteria. How secured our prognostic judgment would
thereby become! Indeed just as the obstetrician discovers from
the inspection of the placenta whether it is completely expelled or
whether harmful remnants are still left behind, so, independent of
the result and the occasional state of the patient we could say
whether we definitely succeeded in our work, or whether we must
expect relapses or new symptoms.

(b) I hasten to the innovations in the technical spheres where
the most part is still to be definitely confirmed, and where much
is just now beginning to become clear. The psychoanalytic tech-
nique has now two objects in view, to save the physician effort,
and to open to the patient the broadest avenue to his unconscious.
You know that an important change has taken place in our tech-
nique. When we practised the cathartic treatment our aim was
to explain the symptoms; next, we turned away from the symp-
toms, and aimed at the discovery of the “complexes”—a word
that was made indispensable by Jung—; and now we turn our
work directly to the discovery and the overcoming of the “resist-
ances,” justly trusting that the complexes will readily surrender
with the recognition and the overcoming of the resistances. Some
of you have since then shown a desire to look over and classify
these resistances. I would therefore ask you to examine your

²Jahrbuch f. Psych., Vol. II.

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material in order to find out whether you can confirm the follow-
ing conection: The most important resistances to the treatment
in male patients seem to emanate from the father complex, and
are explained by the fear for the father, spite against, and dis-
belief in the father.

Other new discoveries in the technique concern the person of
the physician himself. Our attention has been called to the “count-
er-transference” which ensues in the unconscious feelings of the
physician through the influence of the patient, and we advise that
the physician should recognize and overcome this counter-trans-
ference in himself. Ever since a large number of persons practic-
ing psychoanalysis have exchanged ideas concerning their experi-
ences, we have noticed that every psychoanalyst can only go so
far with his patients as his own complexes and inner resistances
allow. We therefore demand that he should begin his activity
with a self-analysis which he should steadily deepen as he gains
experience from his patients. He who does not achieve such self-
analysis should without further ado give up the idea that he has
the ability to treat patients analytically.

We are also beginning to realize that the analytic technique
has to be subjected to certain modifications which depend upon
the form of the disease and upon the predominant impulse of the
patient. We have started with the therapy of conversion-hysteria;
but we must slightly modify our procedure in anxiety-hysteria
(phobias). For these patients cannot produce the final material
for the solution of the phobia as long as they feel themselves pro-
tected by keeping the phobic determination. Of course nothing is
attained from the fact that from the beginning of the treatment
they waive the protective measures and labor under the deter-
mination of the anxiety. One must therefore continue to bring
them help by translating for them their unconscious until they can
make up their minds to waive the protection of the phobia and
expose themselves to a very moderate fear. Only after this has
been accomplished does the material become accessible, the control
of which leads to the solution of the phobia. Other modifications
of the technique which are not yet ripe for judgment are required
in the treatment of the compulsion neuroses. Many important as-
yet unexplained questions arise in this connection; namely, to
what extent may some gratification be allowed the combated

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impulses of the patient during the treatment, and what difference
it makes whether these impulses are of an active (sadistic) or
passive (masochistic) nature.
I hope that you gained the impression that if we knew all which
we are now only surmising, and if we will have brought about
all the improvements in the technique to which the deeper experi-
ence of our patients must lead us, that our medical activity will
then attain a precision and successful confidence not to be found
in all special branches of medicine.
I said that we had much to expect from the gain in authority
that must fall to our share in the course of time. There is no
need for telling you much about the meaning of the authority.
Only the smallest number of civilized people are able to exist with-
out the support of others, or to pronounce an independent judg-
ment. You cannot form too bad a conception of the mania for
authority and of the inner instability of humanity. The extraor-
dinary increase in the neuroses since the depotentialization of
religion may furnish you with a standard for the same. The
impoverishment of the ego through the great expenditure of
repression which civilization demands of every individual may be
one of the chief causes of this condition.
This authority and the enormous suggestion emanating from
it was hitherto against us. All our therapeutic successes were
aimed at this suggestion. It is really surprising that under such
circumstances there were any successes at all. I will allow myself
to go so far as to depict to you the delights of those times when
I was the sole representative of psychoanalysis. I recall the
patients who when assured that I could bring them lasting relief
looked around my unpretentious surroundings and thought of my
little reputation and title and then looked upon me as a pos-
sessor of a sure system of breaking a bank. They argued with
themselves that if this man could do all he pretends he would
look different. It was really not pleasant to perform a psychic
operation while the colleague whose duty it should have been
to assist took special pleasure in spitting into the field of operation,
and while the relatives threatened the operator as soon as they
noticed blood or the restless movements of the patient. Yet an
operation should produce manifestations of reactions; in surgery
we are long accustomed to it. They simply did not believe me,

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just as today they still believe us very little; under such circum
stances there had to be some failures. To form an estimate of
the increase in our therapeutic chances if we gained general con
fidence, think of the position of the gynecologist in the Orient
and in the Occident. All that the gynecologist is allowed to do in
the Orient is done on the arm which is extended to him through
a hole in the wall; he can only feel the pulse. But such an inac
cessibility of the object is proportionate to the medical accomplish
ment. Our opponents in the Occident wish to allow us an almost
similar disposition of the psyche of our patients. But since sug
gestion urged society to send the sick woman to the gynecologist
the latter became the helper and saviour of the woman. Now do
not say that if the authority of society came to our aid and con
siderably increased our successes, that this would still not prove
the correctness of our assumptions. For suggestion can mani
festly do everything, and our successes would then be considered
successes of suggestion and not of psychoanalysis. Against this
I can say that suggestion of society now favors hydro-, dietetic,
and electro-therapy, and still these measures have not succeeded
in combating the neuroses. It remains to be seen whether psy
choanalytic treatment will be able to achieve more.
However, I must put a damper on your expectations. Society
will not hasten to furnish us authority. Society must remain in a
state of resistance towards us because we assume a critical atti
tude towards her. We inform her that she herself plays a great
part in the causation of the neuroses. Just as we make an enemy
of the individual by uncovering his repressions, so society cannot
meet us with a sympathetic reply when we regardlessly lay bare
her infirmities and inadequacies. Because we destroy illusions
we are reproached for endangering ideals. It therefore seems
that the condition through which I expect such great advance in
our therapeutic chances will never come about. And still the
situation is not as despairing as one would now think. As forcible
as the interests and effects of humanity may be, there is still
another force–the intellect. It does not gain authority in the
beginning but is the more sure of it in the end. In the end the
most cutting truths are heard and recognized especially after
the injured interests and affects aroused by them have exhausted
themselves. It was always so until now and the undesired truths