Introduction to Psychoanalysis

Chapter 35 Resistance and Repression (1)
Folks, our need for a better understanding of psychosis will require more material; two of these observations are at our fingertips.They are especially special and surprising at first.We made preparations last year, and it is easier to understand now.

First of all, it is strange and unbelievable that the patient has a strong resistance to us from the beginning to the end when we treat according to the patient's symptoms.However, it is best not to discuss this with the patient's relatives, who always think that we use this to hide the long-term or failure of treatment.Although the patient shows this resistance, he does not admit that he is resisting; if we make him realize the fact of resistance and admit it, it can be called a great progress in treatment.It is conceivable that due to these symptoms, patients and their relatives and friends are troubled, and receiving treatment has made such a huge sacrifice in time, money and spirit, but in the end they refuse all assistance because of the illness.Isn't this too unreasonable?But it is true, and if you attack with inhumanity, we can only answer by citing similar incidents: a person went to the dentist with a toothache, and when the doctor brought pliers to knock out the decayed tooth, he tried to shirk it .

The patient's methods of expressing resistance are numerous and ingenious, and are often difficult to distinguish clearly. The analyst must always be careful.I think you are already familiar with the methods used in psycho-analytic therapy from the analysis of dreams.We will try to put the patient in a calm self-examination situation, without thinking about anything, and then pour out everything that can be felt in the heart, such as feelings, thoughts, and memories, in the order in which they emerge in the mind.We are forewarned against the selection or trade-off of ideas and associations, whether they are too "nasty" or "boring" to utter, or because they are too "unimportant" or "irrelevant" or meaning" is not worth mentioning.We should make him only pay attention to the thoughts that emerge on the surface of his consciousness, throw away all resistance, and then tell him the effectiveness of the treatment, especially the time of treatment will be determined by whether he abides by the basic principles.As far as the method of dream analysis is concerned, we know that associations which are strenuously doubted or denied often contain material for the discovery of the unconscious.

The first thing that happens after the establishment of this maxim is that the patient makes it the first object of resistance.The patient tried every possible method to break free from its shackles.He first said that he had nothing in his heart, but later he had no choice because he thought too much.Next, we are now amazed that he contradicts now this notion and then that; as may be inferred from the pauses in his speech.In the end, he declares that those things which he is ashamed of really should not be said, so this emotion makes him break the covenant.Or he just remembered something and thought it was trivial, or too insignificant, or even so ridiculous that we must not want him to report it.So he procrastinates, now in one way, now in another, he keeps talking about getting it all out, and ends up saying nothing.

No matter what kind of patient we encounter, we always try to hide some part of his mind, so as to defend against the doctor's attack.One patient, usually very intelligent, once kept his most intimate attachments hidden for weeks; when I told him not to violate the principles of psychoanalysis, he pleaded that it was his private business.Psychoanalytic therapy, of course, does not tolerate this right of asylum of the patient. If it were so, it would be as if we were trying to catch criminals while at the same time authorizing special zones in the city of Vienna and prohibiting arrests in markets and squares next to churches.Then of course the criminal will hide in a safe place.Previously, I had granted this extra right to a patient who, because of his ability to return to work, was a government official bound by an oath not to tell anyone about something.He was very satisfied with this result, but I was very dissatisfied. After that, I made up my mind not to let the same situation happen again.

Suspicious and apprehensive, the obsessive-compulsive psychopath easily renders our codes almost useless.Anxiety-hysterics sometimes make these maxims absurd, and they only invoke irrelevant associations that make analysis impossible.However, I don't want to say much about these therapeutic difficulties.You only need to understand that with determination and perseverance we eventually get patients to comply a little bit with the guidelines of therapy, but that their resistance is completely reversed, that is, it takes the form of intellectual criticism, using the tools of logic to explain the accusations of ordinary people against psychoanalytic teachings. For your own use.Therefore, we have to hear from every patient the criticisms and protests that the scientific community has imposed on psychoanalysis.The criticism of us from the outside world is nothing new.Indeed, this is just a storm in a small teacup, and the patient is still persuasive. He prefers me to guide him, refute him, and list some reference books for him to read, so that he can have a deeper understanding; Without involving himself, he became an instant champion of psychoanalysis.In this desire for knowledge, however, we find his resistance; he uses it to escape from the particular work before him, which of course we do not allow.With regard to obsessive-compulsive psychosis, it is not surprising that this resistance also employs a particular strategy.Now that the analyzes were going well, all the problems in the disease gradually became clear, and finally we wondered why the analyzes had no effect on improving the symptoms.It turns out that this obsessive-psychotic resistance, characterized by doubt, succeeds in tying us up.The patient seems to say something like this: "These are very interesting, I am willing to continue to accept the analysis, if it is true, of course it will help me, but I don't believe it at all, if I don't believe it, then my disease will not be affected." Its influence." If things go on like this, in the end all patience wears out, so he expressed firm resistance again.

Rational resistance is certainly not the worst kind, and we often overcome it.But the patient always knows how to exhibit resistance within the sphere of the analysis itself, and overcoming these resistances is therefore the most difficult task of psychoanalytic treatment.The patient does not recall an emotion or state of mind in the past life, but directly reproduces it, revives it, and uses the so-called "empathy" to resist the doctor and treatment measures.If the patient is a man, he makes use of the father-son relationship to make the doctor act on his father's behalf, and fights for personal independence and freedom of thought to express his resistance, or because of ambition, the original purpose of ambition is to strive for equality or victory with his father. To father, or put aside the responsibility of repaying gratitude again to rebel.I sometimes think that the patient is trying to find the analyst's fault, trying to defeat him by making him feel inferior, and completely destroying his desire to be cured.Female patients are more accustomed to showing "love" transference to the analyst to achieve the purpose of resisting treatment; and when this love rises to a certain intensity, they turn a blind eye to the interest in actual treatment and the constraints of receiving treatment.Then, the ensuing jealousy and resentment after rejection, no matter how politely, undermined the personal relationship with the doctor.Psychoanalysis thus loses one of its most powerful motivating forces.

We should do more than condemn this resistance.In fact, it already includes a lot of important information in the patient's life. Now that this information has been revealed, the analyst, if his technique is very sophisticated, can directly transform these resistances into great help to himself.It should be noted that such informational material often acts above all as a resistance, a disguised obstacle to treatment.We also learned that the patient resisted with his ego character and personal attitude.These traits of character, thus presented with the symptoms and demands of psychosis, allow us to see material that is not usually readily apparent.You need not feel that we regard the emergence of these resistances as a threatening accident or danger to the analytic treatment.In fact, we already know that these resistances must arise; we are dissatisfied only when they are not properly aroused so that the patient understands that they are resistances.We understand, therefore, that the overcoming of these resistances is the essential work of psychoanalysis and evidence of the modest success of the treatment.

In addition, you must still note that the patient often uses all the incidents of the analysis, such as distracting incidents, or accusations against psychoanalysis by people he admires among friends, or organic dysfunction sufficient to aggravate the psychosis. It hinders psychoanalysis; even every improvement in symptoms can be an incentive to resist treatment.You can thus understand, in general, the force and form of the resistance encountered in the analysis.The reason we go to such lengths at this point is that I want to tell you that our conception of the dynamics of psychosis is based on the experience of all patients who resist treatment of their symptoms.Breuer and I originally used hypnosis as an instrument of psychotherapy.Breuer's first patient was treated entirely in the state of hypnotic suggestion; I also used this method at first.I admit that my work was relatively smooth at that time, and the time was relatively economical; however, the effect of the treatment was repeated and could not last; so I finally gave up hypnotism.I understand that as long as hypnotic treatment is applied, it is no longer possible to understand the dynamics of this disorder.Because during hypnosis, the patient's resistance cannot be observed by the doctor.Hypnosis eliminates the power of resistance. It is true that it can develop part of the phenomenon as a study of psychoanalysis. However, the resistance is also gathered at the dividing line here, and there is no day to break through; so it is related to obsessive-compulsive psychosis. same suspicion.Therefore, I think that after the abandonment of hypnotism, psychoanalysis can be regarded as the real beginning.

If it is so important to study the matter of resistance, it is wiser to do it seriously than to assume its existence very hastily.It may be that some psychoses do for some other reason cause associations to stagnate, and perhaps there is something worthy of our attention concerning the refutations we have often said, and perhaps we should not be free to dismiss the protests of the patient's reason as resistance.What I will tell you, however, is that we do not proceed lightly in this matter; we have the opportunity to observe the condition of the patient before resistance arises and after resistance wears off.While receiving treatment, the degree of resistance is constantly changing. Whenever a new problem looms, the patient's resistance often increases. , the resistance intensity is the lowest.If there are no mistakes in our treatment methods, it will certainly not immediately cause the patient's possible sufficient resistance.Therefore, during analysis, we can easily see that during the process of analysis, the same person sometimes refutes criticisms repeatedly during the process of analysis, and sometimes remains silent.If we make some subconscious information that the patient feels particularly painful invade into his consciousness, he will express extreme resistance; even if he has understood and accepted a lot before, it is inevitable that all previous efforts will be wasted at this moment; when he tries to resist, his behavior is similar to mental retardation or "emotionally blunted" persons.If with our help he overcomes the new resistance, he regains his comprehension.His critical power cannot be exercised alone, so we need not take it seriously; it is only the slave of emotions dominated by resistance.He refuted cleverly what he did not like, but immediately believed what was in his temper.Perhaps we are all the same, and a man under analysis whose intellect is clearly dominated by his emotional life is due to the fact that he is subjected to a powerful oppression during the analysis.

How can we explain the patient's reluctance to have his symptoms disappear and his psychic processes return to normal?We may say that what is at hand here is a powerful force against the progress of the treatment; and it must be the same force that causes the disease at the time.There must also be a psychic process in the first formation of the symptom, the nature of which is to be deduced from our therapeutic experience.From Breuer's observations, we know that the existence of these symptoms is first of all a certain psychic process that cannot be fully carried out under normal conditions, so that consciousness cannot be aroused; the symptom is then a substitute for this unfinished psychic process.Now we know exactly where the forces we suspect are at work.The patient must have tried to prevent the psychic process concerned from intruding into the conscious, and the result became unconscious, and the unconscious acquired the power to form the symptom.During analytic therapy, this powerful force is activated again and prevents attempts to make the subconscious conscious.This is what we know as resistance.The morbid process that is presented due to resistance is called "repression".

(End of this chapter)