Introduction to Psychoanalysis

Chapter 52 Transfer Effect (2)
If we now devote ourselves to discussing hysteria and obsessive-compulsive psychosis, we immediately encounter a second unexpected fact.After a simple analytical treatment the patient produces a peculiar behavior for us.We believe that considerable attention has been paid to all the forces affecting treatment, and the situation between patient and doctor has been fully considered to arrive at a most reliable plan; however, there seems to be something that we have not considered. Sudden invasion.This new and unexpected phenomenon is itself a complex anomaly; therefore, I will first outline some common and simple cases.

As a patient, he should only care about whether his own psychological conflicts are resolved, but he gradually developed a special interest in doctors.All matters related to the doctor seemed to him to be more important than his own affairs, so he no longer focused on his illness.For a while, he especially obeyed the doctor's arrangement, tried his best to express his gratitude, and his relationship with the doctor became very kind, showing unexpected virtues everywhere.The analyst, therefore, has a good opinion of the patient, and feels very fortunate to be able to treat such a kind patient.The patient is also full of praise for the psychoanalyst, thinking that he is a combination of various virtues. If he has the opportunity to meet the relatives of the patient, he will also hear words of respect and praise for him; I admire and trust him very much; what you say is no different from the law of heaven to him." At this time, perhaps someone with discerning eyes interjects a sentence: "He will not say anything other than you, and he always quotes you It's just disgusting."

Of course, the doctor is very humble at this time, thinking that the patient's respect for him is nothing more than hoping that he can cure his illness, and moreover, the process of treatment has increased the patient's unprecedented knowledge.In this case the analytic treatment has shown a surprising advance. The patient is well aware of the doctor's suggestions and concentrates his attention on the treatment of the symptoms. Therefore, the material required for analysis, namely, his memories and associations, is at his fingertips; The explanations of these new psychological theories are also correct and reliable, so that analysts are also deeply surprised, thinking that the outside world mostly opposes these new psychological theories, but patients are willing to accept them, which is simply exciting.Since the analysis and treatment were so harmonious, the patient's condition gradually improved.

However, this good situation will not last long, and one day will be gloomy.Analytical therapy has thus come to a standstill, and the patient has nothing left to say.We doubtless felt that he had lost interest in this kind of work; sometimes he was deaf when asked to express what was on his mind without having an opinion.At this point, the therapeutic situation no longer influenced his words and deeds; it was as if he had never had a promise or a contract with the doctor to cooperate; on the surface, it was clear that he was distracted by the ulterior motives.It is difficult to continue treatment in this situation because a new resistance has developed.What happened in detail?
If the situation is understandable, the cause of the disturbance is a strong feeling of camaraderie for the doctor himself, which neither the doctor's behavior nor the doctor-patient relationship can reasonably explain.The expression and goal of this emotion should be different according to the situation of the two people.If it is a girl and a young man, it will be considered normal; a girl is often alone with a man, talking about intimate things, and the man is in the position of mentor, so she treats him very well. It is only natural to feel admiration in the heart; however, it is inevitable to have a certain degree of abnormality in the expression of love of a mentally ill woman, these facts are ignored for the time being.The greater the distance between the situation between the two persons and the above hypothetical example, the more inexplicable this admiration becomes.It is also understandable if a young woman is unhappy in her marriage and the doctor is not yet in love, and she has strong feelings for him and is willing to marry him in divorce, or if divorce is impossible and she is secretly in love with him.Such things are common outside of psychoanalysis.But, in such situations, women or women often make such startling confessions, and they also have a special attitude towards the treatment of their illness: they know that there is no other way to cure them but love, and they hoped at first. , from such a relationship, or eventually, can gain comfort that is lacking in real life.With this expectation, they tolerate many troubles of psychoanalysis, and do not hesitate to dissect their own hearts.We could add: "Thus, the unacceptable things come to a better understanding." But these confessions horrify us, and all our considerations come to naught.Have we left out this most important element in the whole problem?
Yet it is true; and the more experienced we are, the less likely it is to deny this new element, which changes the whole problem and shames our scientific calculations.It occurred to us that the first few times we thought it was just an unexpected obstacle to the analytic treatment.However, even in the most irrational or absurd situations, this kind of affection for the doctor does not see the so-called temptation at all, as between an old woman and a gray-haired doctor.In this way, we can no longer regard these events as accidents, but must admit that they are indeed closely related to the nature of the symptoms.

This new fact, which we must admit, may be called "transferring," the transfer of emotion from the patient to the doctor, whose origin cannot be explained by the circumstances of the treatment.What we suspect more is that this emotion has its origin elsewhere, that it has previously been formed in the patient and then took the opportunity to transfer it to the doctor.This expression of emotional transfer can be a passionate courtship or a more tender one.Like a young woman and an old man, although she does not want to be his wife or lover, she most likely wants to be his daughter. A slight change in the libidinal desire can become a Platonic expectation of an ideal friendship.Some women know how to sublimate their emotional transference and take it for granted; others express it only in cruder, primitive, and almost impossible forms.However, their essence is basically the same, and they have a common origin, which is obvious to all.

If we want to limit the scope of this new fact, we must make some additional explanations.What about male patients, for example?Here, we hope at least there is no trouble with gender or sexual attraction.However, their situation is basically the same as that of women; they also feel admiration for the doctor, praise his qualities, submit to all his arrangements, and are jealous of all those connected with him.The sublimation of emotional transfer mostly occurs between men of the same sex, and there is very little direct sexual love, just as the tendency of homosexual love shown by patients can be expressed in other ways.There is a peculiar mode of expression in male patients, which is common to analysts; which at first glance seems to be contrary to what has been said above, and that is a passive or rebellious transference of affect.

The transfer effect is easy to generate in the patient's heart at the beginning of treatment, and becomes the most powerful driving force.If its result is to prompt patients to actively cooperate, it will be beneficial to the progress of treatment, and naturally it will not be easy to attract attention or be discovered; on the contrary, if it becomes a resistance force, it will have to attract attention; at this time, there are two kinds The completely opposite psychological activities make the patient change his attitude towards treatment: first, the power of love is too strong, and the power of carnal desire emerges, thus causing inner resistance against self; second, the emotion of friendship suddenly turns into hostility.On the whole, hostility tends to develop later than friendship, and is hidden behind it; if the two passions occur at the same time, it is a good example of the conflict of emotions which dominates all the most important emotions in people. close relationship.Thus, hostile or friendly emotions are expressions of attachment emotions, just as resistance and obedience, although opposite, are both dependent on others for their existence.Of course, the patient's hostility towards the analyst is also a kind of emotional transfer. Since the treatment situation is not the cause of this emotion, it is consistent with the positive emotional transfer mentioned above to view negative emotional transfer.

Where is the origin of this transference?What difficulties will it bring to our psychoanalysis?How will we overcome these difficulties?What kind of convenience will be obtained by this?Regarding these issues, we will discuss them one by one when we discuss psychoanalytic therapy specifically.The patient demands something of us from the influence of the metastases, and of course we must obey; otherwise it would be foolish to reprimand.If you want to make him overcome the diversion, you might as well tell him the facts directly, explaining to him that his admiration did not arise in the current situation, and naturally it has nothing to do with the doctor, but just a reappearance of his past.So, we ask him to put this reappearance back into memory.At this time, the diversion, which seems to be the greatest obstacle to treatment, whether it is friendly or hostile, can be transformed into the most convenient tool in the treatment's favor, to expose the innermost things of the heart.However, this unexpected phenomenon can not help but surprise you, so I will say a few words about the unpleasant phenomenon caused by it.You must remember that the condition of the patient we are analyzing cannot be said to be over, it is constantly developing like a living organism.The initial treatment is not enough to stop this development, so once the patient is treated, they focus all their attention in one direction.Therefore, the metastases are like a new layer between the cortex and wood layer of a tree, which has new tissues formed to gradually expand the radius of the tree.If the transference of emotion develops in this way, the patient's memories and associations take a backseat.At this time, we should put aside the old symptoms and turn to the treatment of new symptoms.With regard to the new version of these old diseases, the analyst can trace its origin, development and change, and since he himself was the central object of this matter, he is very familiar with this process.All the symptoms of the patient lose their original meaning and take their place in a new meaning; this new meaning is contained in the symptom's effect on transference; otherwise, only those symptoms which could serve as such adaptations are not eliminated.If we can hope to cure this new type of psychosis, we have cured the old symptoms as well, that is to say, we have done all the work of the cure.If the relationship between patient and doctor can be restored to normal and free from the influence of repressed instinctive tendencies, long-term health can also be obtained after leaving the doctor.

For hysteria, anxiety psychosis and obsessive-compulsive psychosis, the transfer effect is absolutely important for their treatment, so these diseases all belong to "transferred psychosis".Whoever can obtain from psychoanalytic experience an accurate impression of the fact of the transference of emotions will no longer be aware of the nature of those repressed impulses which seek their outlet through symptoms; There is no stronger evidence for libido.We say, therefore, that after studying the phenomenon of emotional transference, we are more convinced that the meaning of the symptom is indeed the vicarious gratification of the libido.

However, we believe that the previous concept of therapeutic effect should now be corrected to be consistent with this new finding.When we apply psychoanalysis to resolve normal conflicts by resistance, he longs for a powerful force that will help him to do what we want of him and restore him to health.Otherwise, he will inevitably repeat the same mistakes, causing the ideas that have entered consciousness to be controlled by repression again.The outcome of the struggle did not depend on his understanding, which was not strong enough or free enough for such an achievement; it depended on his relationship with the doctor.If the affective transference is positive, he will see the doctor as a representative of authority and will be convinced of his views.If no transference is induced or the transference is negative, it will be difficult for the analyst and his observations to attract the patient's attention.The source of trust is love, and no reason is needed.If it is not proposed by a loved one, it will not be considered as an important event.Without love as his support, he cannot influence most people.Intellectually, therefore, a man is influenced by others only in so far as the libido acts on an object; and we think that the best psychoanalysis is of no use to narcissistic people.Such a view is quite reasonable.

Of course, every normal person has a capacity to act on his libido on others; this tendency of the psychotic to transfer emotion is only the more prominent phenomenon of this commonality.Is it not surprising that such important universal commonalities go unnoticed or exploited?In fact, it has already been noticed and exploited.The "hypnosis theory" theoretical system established by Bernheim with his keen thinking is based on the possibility that human beings are more or less likely to be suggested or have "acceptable suggestions".What he called "acceptable suggestibility" is also a tendency to transfer emotions, but he greatly narrowed the scope of this tendency, so that this negative transfer effect was excluded.However, Bernheim never said what suggestion is and how it originated; he thinks this is an indisputable fact.Nor does he understand that "acceptable suggestibility" depends on sexual or libidinal activity.We are therefore compelled to admit that in order to discover the suggestive nature in transference we must give up the treatment in a hypnotic state.

Now, I'm going to stop for a moment and let you reflect on what we've discussed and get your input.I believe that there will be a strong protest in your mind at this time. If you are not given the opportunity to speak, I am afraid that everyone will not listen to the lecture.You must be tempted to say: "So you admit that you have resorted to suggestion like hypnotists do. We have always thought so. But why do you go so tortuously to seek past experience, create subconscious material, analyze So much time, energy, and money have been wasted by all kinds of camouflage, isn't suggestion an effective help in the end? Why do you use suggestion to treat psychotic symptoms? Moreover, if you still use such devious The method of treatment can reveal many important psychological phenomena hidden behind direct suggestion, so who will verify the credibility of these facts? They are also the product of suggestion or accidental suggestion, aren't they? Can't you Is that the way to get patients to accept everything you think is right?"

Your objections are intriguing, and of course I must answer them.But it’s not working today, it’s too late, and I’ll elaborate on it next time.You have to believe that I am bound to answer.Now, then, I must conclude what I have said today.I promised you to use the role of affective transfer to analyze why our treatment is not effective for narcissistic psychosis.

It will suffice for me to explain this phenomenon in a few words, and you will understand how easily the riddle can be solved, and how perfectly and skillfully each fact fits together.Experience has shown that narcissistic psychopaths have no capacity for emotional transference, and if they do, it is very specific and minimal.The reason why they leave the doctor is not hostility but indifference.Therefore, they are not easily influenced by doctors; they are only indifferent to what doctors say, and have no impression, so the methods that are curative for other diseases have no effect on them.They always remain the same, and their repeated attempts to restore health by their own efforts lead to morbid results, which we can do nothing to help.

According to our clinical observations on such patients, they must have given up the betting of libido on the object, and transformed the libido of the object into the libido of the ego.We have also said this.This psychosis is therefore distinct from hysteria, anxiety psychosis, and obsessive-compulsive psychosis.This inference can also be confirmed by their behavior when receiving treatment.Because of their lack of emotional transference, we cannot treat them.

(End of this chapter)