The Collected Works of Sigmund Freud. Sigmund Freud

Чтение книги онлайн.

СКАЧАТЬ the physician, with the aid of suggestion, makes it possible for him to do so. The suggestion works in the nature of an education. We are therefore justified in saying that analytic treatment is a sort of after-education.

      I hope I have made it clear to you wherein our technique of using suggestion differs therapeutically from the only use possible in hypnotic therapy. With your knowledge of the relation between suggestion and transference you will readily understand the capriciousness of hypnotic therapy which attracted our attention, and you will see why, on the other hand, analytic suggestion can be relied upon to its limits. In hypnosis we depend on the condition of the patient’s capacity for transference, yet we are unable to exert any influence on this capacity. The transference of the subject may be negative, or, as is most frequent, ambivalent; the patient may have protected himself against suggestion by very special adjustments, yet we are unable to learn anything concerning them. In psychoanalysis we work with the transference itself, we do away with the forces opposing it, prepare the instrument with which we are to work. So it becomes possible to derive entirely new uses from the power of suggestion; we are able to control it, the patient does not work himself into any state of mind he pleases, but in so far as we are able to influence him at all, we can guide the suggestion.

      Now you will say, regardless of whether we call the driving force of our analysis transference or suggestion, there is still the danger that through our influence on the patient the objective certainty of our discoveries becomes doubtful. That which becomes a benefit to therapy works harm to the investigation. This objection is most often raised against psychoanalysis, and it must be admitted that even if it does not hit the mark, it cannot be waved aside as stupid. But if it were justified, psychoanalysis would be nothing more than an extraordinarily well disguised and especially workable kind of treatment by suggestion, and we may lay little weight upon all its assertions concerning the influences of life, psychic dynamics, and the unconscious. This is in fact the opinion held by our opponents; we are supposed especially to have “balked into” the patients everything that supports the importance of sexual experiences, and often the experiences themselves, after the combinations themselves have grown up in our degenerate imaginations. We can refute these attacks most easily by calling on the evidence of experience rather than by resorting to theory. Anyone who has himself performed a psychoanalysis has been able to convince himself innumerable times that it is impossible thus to suggest anything to the patient. There is no difficulty, of course, in making the patient a disciple of any one theory, and thus causing him to share the possible error of the physician. With respect to this he behaves just like any other person, like a student, but he has influenced only his intelligence, not his disease. The solving of his conflicts and the overcoming of his resistances succeeds only if we have aroused in him representations of such expectations as can agree with reality. What was inapplicable in the assumptions of the physician falls away during the course of the analysis; it must be withdrawn and replaced by something more nearly correct. By employing a careful technique we seek to prevent the occurrence of temporary results arising out of suggestion, yet there is no harm if such temporary results occur, for we are never satisfied with early successes. We do not consider the analysis finished until all the obscurities of the case are cleared up, all amnestic gaps filled out and the occasions which originally called out the suppressions discovered. We see in results that are achieved too quickly a hindrance rather than a furtherance of analytic work and repeatedly we undo these results again by purposely breaking up the transference upon which they rest. Fundamentally it is this feature which distinguishes analytical treatment from the purely suggestive technique and frees analytic results from the suspicion of having been suggested. Under every other suggestive treatment the transference itself is most carefully upheld and the influence left unquestioned; in analytic treatment, however, the transference becomes the subject of treatment and is subject to criticism in whatever form it may appear. At the end of an analytic cure the transference itself must be abolished; therefore the effect of the treatment, whether positive or negative, must be founded not upon suggestion but upon the overcoming of inner resistances, upon the inner change achieved in the patient, which the aid of suggestion has made possible.

      Presumably the creation of the separate suggestions is counteracted, in the course of the cure, by our being continually forced to attack resistances which have the ability to change themselves into negative (hostile) transferences. Furthermore, let me call your attention to the fact that a large number of results of analysis, otherwise perhaps subject to the suspicion that they are products of suggestion, can be confirmed from other unquestionable sources. As authoritative witnesses in this case we refer to the testimony of dements and paranoiacs, who are, naturally far removed from any suspicion of suggestive influence. Whatever these patients can tell us about symbolic translations and phantasies which have forced their way into their consciousness agrees faithfully with the results of our investigations upon the unconscious of transference-neurotics, and this gives added weight to the objective correctness of our interpretations which are so often doubted. I believe you will not go wrong if you give your confidence to analysis with reference to these factors.

      We now want to complete our statement concerning the mechanism of healing, by including it within the formulae of the libido theory. The neurotic is incapable both of enjoyment and work; first, because his libido is not directed toward any real object, and second because he must use up a great deal of his former energy to keep his libido suppressed and to arm himself against its attacks. He would become well if there could be an end to the conflict between his ego and his libido, and if his ego could again have the libido at its disposal. The task of therapy, therefore, consists of freeing the libido from its present bonds, which have estranged it from the ego, and furthermore to bring it once more into the service of the ego. Where is the libido of the neurotics? It is easy to find; it is bound to the symptoms which at that time furnish it with the only available substitute satisfaction. We have to become master of the symptoms, and abolish them, which is of course exactly what the patient asks us to do. To abolish the symptoms it becomes necessary to go back to their origin, to renew the conflict out of which they emerged, but this time with the help of motive forces that were originally not available, to guide it toward a new solution. This revision of the process of suppression can be accomplished only in part by following the traces in memory of the occurrences which led to the suppression. The decisive part of the cure is accomplished by means of the relationship to the physician, the transference, by means of which new editions of the old conflict are created. Under this situation the patient would like to behave as he had behaved originally, but by summoning all his available psychic power we compel him to reach a different decision. Transference, then, becomes the battlefield on which all the contending forces are to meet.

      The full strength of the libido, as well as the entire resistance against it, is concentrated in this relationship to the physician; so it is inevitable that the symptoms of the libido should be laid bare. In place of his original disturbance the patient manifests the artificially constructed disturbance of transference; in place of heterogeneous unreal objects for the libido you now have only the person of the physician, a single object, which, however, is also fantastic. The new struggle over this object is, however, raised to the highest psychic level with the aid of the physician’s suggestions, and proceeds as a normal psychic conflict. By avoiding a new suppression the estrangement between the ego and the libido comes to an end, the psychic unity of the personality is restored. When the libido again becomes detached from the temporary object of the physician it cannot return to its former objects, but is now at the disposal of the ego. The forces we have overcome in the task of therapy are on the one hand the aversion of the ego for certain directions of the libido, which had expressed itself as a tendency to suppression, and on the other hand the tenacity of the libido, which is loathe to leave an object which it has once occupied.

      Accordingly the work of therapy falls into two phases: first, all the libido is forced from the symptoms into the transference, and concentrated there; secondly, the struggle over this new object is carried on and the libido set free. The decisive change for the better in this renewed conflict is the throwing out of the suppression, so that the libido cannot this time again escape the ego by fleeing into the unconscious. This is accomplished by the change in the ego under the influence of the physician’s suggestion. In the course of the work of interpretation, СКАЧАТЬ