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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

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

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discovers 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 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 mech-
anism lying in the utilization of the “transference.” I shall en-
deavor in the future to deal with all these relationships which are
important 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 di-
rected our investigations to the occurrence of stairways, stairs,
and ladders in the dream, and we soon ascertained that stairs (or
anything 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 an
other interesting symbol, the one of “rescuing” and its changed
significance 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
into the structure of some typical case. Now suppose you could
put together under a few formulæ the lawful in the structure of
the neuroses, just as we succeeded in doing with the symptom
formation 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 resistance. 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 connection: 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
“counter-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-transference in himself. Ever since a large number of
persons practicing psychoanalysis have exchanged ideas concern-
ing their experiences, 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 con-
trol of which leads to the solution of the phobia. Other modifi-
cations 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

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combated impulses of the patient during the treatment, and what
difference it makes whether these impulses are of an active (sa-
distic) 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 expe-
rience 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
without the support of others, or to pronounce an independent
judgment. You cannot form too bad a conception of the mania
for authority and of the inner instability of humanity. The ex-
traordinary 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;
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 accom-
plishment. Our opponents in the Occident wish to allow us an
almost similar disposition of the psyche of our patients. But
since suggestion urged society to send the sick woman to the gyne-
cologist 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 considerably increased our successes, that this would still not
prove the correctness of our assumptions. For suggestion can
manifestly do everything, and our successes would then be consid-
ered 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 psychoanalytic 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
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

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which we psychoanalysts have to tell the world will meet the
same fate, only it will not come so rapidly; we must be able to
wait.

I must finally explain what I mean by the “General Effects”
of our work, and how I came to put hopes upon them. Here
we meet with a very remarkable therapeutic constellation, the like
of which is perhaps not to be found elsewhere. Until you will
recognize in it something long familiar, it will at first appear
strange to you. For you know that the psychoneuroses are
distorted substitutive gratifications of impulses the existence of
which one must deny to himself and to others. Their capacity
to exist rests on this distortion and misjudgment. With the
solution of the riddle they present and with the acceptance of
this solution by the patients these morbid states become incapable
of existence. There is hardly anything like it in medicine; in
fairy tales you hear of evil spirits whose charm is broken as
soon as one can tell them their secretly concealed name.

Now, instead of the individual patient, put all those suffering
from neuroses,—society made up of healthy and abnormal per-
sons—instead of the acceptance of the solution there, put here
the general recognition, and a moment’s reflection will then con-
vince you that the results will not be changed by this substitution.
The success which the therapy can have in the individual must
also appear in the masses. The patients could not make known
their divers neuroses such as their anxious exaggerated love
hatred, their agoraphobia which tells of dis-
appointed ambitions, their compulsive actions which represent
their reproaches for, and safeguards against evil resolutions,—
I say they could not bring them to light if their relatives and
friends from whom they wish to conceal their psychic processes
would know the general meaning of the symptoms. Or if they
knew that whatever they produce in their morbid manifestations
could really be interpreted by others. But the effect will not
confine itself to the concealing of the symptoms,—after all
inaccomplishable—for this forced concealment makes the illness
unavailable. The communication of the secret attacks the most
delicate point of the “etiologic adjustment,” which gives origin
to the neuroses. What is gained by the disease becomes illusory
and hence the only possible result of the changed state of affairs

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brought about by the indiscretion of the physician, is a suspen-
sion of the morbid production.
If this hope seems to you utopic, please remember that the
removal of neurotic symptoms has actually been accomplished in
this manner though only in isolated cases. Just think how fre-
quently the hallucination of the Holy Virgin used to occur in
former times among peasant girls. As long as such a manifesta-
tion drew a large crowd of believers or even resulted in the
erection of a chapel over the holy shrine, the visionary state of
these girls remained inaccessible to suggestion. Today even the
priesthood has changed its attitude towards such manifestations.
They allow the doctor and the policeman to visit the visionary
girl; consequently the holy virgin seldom reveals herself. Or,
allow me to study with you the same process, which I have for-
merly deferred for the future, in an analogous but lower and
more easily observable situation. Let us assume that a circle of
ladies and gentlemen of good breeding have agreed upon making a
day’s excursion to some country place. The ladies have decided
among themselves that if one of them should desire to satisfy a
natural want she was to say aloud that she is going to pick some
flowers. But a mischievous joker discovered this secret and put
on the printed program which was sent to those invited: if the
ladies wish to ease nature they may say that they are going to pick
flowers. Of course, none of the ladies would wish to make use
of this covert allusion then, and this also makes impossible the
use of any other similar formula. What will be the result? The
ladies will admit unabashed their natural wants and the gentle-
men will take no offense at it. Let us now return to our more
serious case. Because the conflicts of life were too difficult for
them so and so many persons have taken refuge in the neuroses
and have thereby attained the unmistakable morbid gain, although
it is a bit too costly for the time. What will those people be
forced to do if the flight into the disease will be closed to them
by the indiscreet explanations of psychoanalysis? They will
have to be honest and acknowledge the impulses which become
active in them, they will have to hold their own in the conflict,
they will fight or give up, and the tolerance of society which will
inevitably be brought about by psychoanalytic explanation will
come to their aid.

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However, let us remember that one must not face the world
as a fanatical hygienist or therapeutist. Let us admit that this
ideal prophylaxis of neurotic diseases will not benefit every indi-
vidual. A great many of those who today are taking refuge in
the disease will not be able to stand the test of the conditions
of the conflict postulated by us, they will soon perish or do some
mischief greater than their own neurotic disease. The neuroses
really have their biological functions. They are protective meas-
ures and are justified socially. Their “morbid gain” is not always
purely subjective. Who among you has not looked behind the
causation of a neurosis and was not forced to admit that the
neurosis was the mildest issue of all the possibilities of the situa-
tion? And should we really sacrifice so much for the eradication
of the neuroses, if the world is filled with other inevitable misery?
Should we therefore give up our efforts to explain the secret
meaning of the neurosis as being in the end dangerous for the
individual and for the workings of society, and should we waive
the right of drawing practical conclusions from a fragment of
scientific knowledge? No. I believe that notwithstanding all,
our duty moves us to another direction. For the morbid gain of
the neurosis is on the whole harmful for the individuals and for
the society. The misfortune that may result in consequence of our
explanation work can surely only strike individuals. The return
to a more truthful and more worthy state of society will not be
too dearly bought at this sacrifice. But above all: all the energies
which are now consumed in the production of neurotic symptoms
in the service of a phantastic world isolated from reality, all
these energies, even if they cannot contribute to the good of the
world will nevertheless help to reënforce the cry for that change
in our civilization in which alone we see salvation for posterity.

I should therefore like to dismiss you with the assurance that
you perform your duty in more than one sense if you treat your
patients by psychoanalysis. You not only work in the service of
science by making use of the only and never returning oppor-
tunity for fathoming the mysteries of neuroses. You not only
give the patient for his suffering the most effective treatment now
at our disposal, but you also contribute your share to that en-
lightenment of the multitude from which we expect, indirectly,
the most thorough prophylaxis against neurotic diseases.