Introduction to Psychoanalysis

Chapter 53 Psychoanalytic Therapy (1)
Everyone, the topic we are going to discuss today must be known to you.In my last lecture, when I admitted that the effects of psychoanalytic therapy depended on transference or suggestion, you objected why direct suggestion was not used, which leads to the following question: that we admit that suggestion has With such an important position, can we still guarantee the objectivity of the findings of psychology?I also promise you a full answer to this question.

Direct suggestion refers to the suggestion of direct resistance according to the symptom, which is a challenge between your authority and the motivation of the disease.In this challenge, you don't have to ask about these motives, as long as the patient doesn't show any symptoms.In other words, it makes no difference whether you hypnotize the patient or not.Bernheim has a unique insight, and has pointed out many times that suggestion has a hypnotic quality in essence. Hypnosis itself is the result of suggestion, a state of being suggested; The result is exactly the same as the suggestion under hypnosis.

Now, shall I first state the results of my experience, or shall I begin with a theoretical discussion?
So, let's start with experience. In 1889 I went to Nancy to visit Mr. Bernheim, became his pupil, and translated into German his work on suggestion.For many years, I have been using suggestion therapy. At the beginning, I used "prohibited suggestion", and later, I combined Breuer's inquiry method of inquiring patients' psychology. Therefore, I have sufficient experience to infer suggestion or The conclusion of hypnotherapy.

According to the ancients' views on medicine, the most ideal treatment method must be rapid and effective, the results can be trusted, and the patients are not disgusted.Bernheim's method of suggestion fully meets two of these requirements.This method is quicker than the analytical method, and does not cause unpleasant emotions to the patient.From the physician's point of view, however, it's much more monotonous; it uses the same approach regardless of the patient, just prevents the occurrence of various symptoms, without understanding the significance or importance of each symptom.Such treatment is mechanical rather than scientific, tinged with charlatanism, but for the sake of the patient's health, we need not worry too much.From the third condition of this ideal therapy, however, hypnotism is an absolute failure, and its results are unreliable.Some conditions respond to this treatment, others do not; for some conditions it responds significantly, for others it does not, and the reasons for this are unknown.However, the most regrettable thing is that the results of the treatment are not long-lasting. After a period of time, if you talk to the patient again, there will always be a relapse or conversion to other symptoms, and then you need to hypnotize again.However, experienced people will warn the patient and discourage him from losing his independence and becoming addicted to it as if he was taking anesthetics due to multiple sleeps.On the other hand, after hypnotherapy, a complete cure has sometimes been achieved with a minimum of effort; but the conditions for this success are difficult to understand.Once, I had a short period of hypnotherapy and healed a patient. It was a woman. Suddenly she became hostile to me for no reason, and the disease relapsed; A settlement was reached and her illness cured, however, she suddenly hated me again.Another time, I treated a patient, also a woman, who was very persistent. I had relieved her psychotic symptoms many times, but when I was making a diagnosis, she suddenly opened her arms around my neck.Like it or not, now that this is the case, we are compelled to investigate the origin and nature of suggestive authority.

This concludes the discussion of experience.To sum up, we can see that aside from the direct suggestion method, it may not be impossible to replace it with other methods.Now, let me explain these facts in relation to each other.Suggestion therapy requires a little more from the physician and less from the patient.This approach is accepted by most doctors.The doctor once said to neurotic patients: "You are just a little nervous, there is nothing wrong with it, and I can say a few words in 5 minutes, and your symptoms will disappear completely." However, there is a minimum here. It is somewhat contrary to the common belief that it is within our power to cure a serious disease completely without the application of any remedies by the limited efforts of the degree.If the symptoms of various illnesses can be compared, experience shows that direct suggestion does not cure mental illness.However, I also understand that this argument is not perfect and unassailable, and there are always exceptions.

According to the experience of psychoanalysis, the suggestion of hypnosis and the suggestion of psychoanalysis have the following differences: First, the treatment of hypnosis technique must whitewash the hidden events in the patient's heart; while psychoanalysis exposes the hidden things and then eliminates them.The former is a disguise, while the latter is an operation.The former does not directly suggest symptoms, but instead increases the force of repression, and cannot alter the entire course of symptom formation.The latter seeks the cause of the disease by analyzing the conflicts that cause the symptoms; using hints to change the final outcome of these conflicts.Hypnotherapy does not allow the patient to do any activities, and of course does not make any changes, so once a new incentive appears, it is even more irresistible.Psychoanalysis requires the patient to work hard like a doctor so that the inner repression can disappear. If this repression can be overcome, the patient's psychological life will have a lasting change and a higher level of development. the power to resist.The main achievement of psychoanalytic therapy is to make the resistance of repression disappear; it is necessary for the patient to be able to do so before the doctor can use "educative" suggestions to help the patient.We therefore say that psychoanalytic therapy may be called "re-educational" therapy.

Now, I hope you realize that there is a difference between the suggestion employed in psychoanalysis and the suggestion employed in hypnotherapy;Now that we have traced the influence of suggestion back to the effect of affective transference, it will become clearer to you how unreliable the results of hypnotherapy, and of course psychoanalysis, are.The success of hypnotherapy depends entirely on the conditions of the patient's affective transference, which are not under our influence; the affective transference of a hypnotized patient is often negative, at best bipolar or in a special way. We are not sure about resisting the transfer of emotion with an attitude.Psychoanalysis, on the other hand, works directly on the transfer of emotion, allowing it to develop freely and thus assisting in therapy.Therefore, we use suggestion as much as possible to control; the patient can no longer freely control his suggestion receptivity as he wants, and if he has the possibility of accepting suggestion, we guide this suggestion receptivity.

Now, you might think that, whether the motive force behind psychoanalysis be transference or suggestion, its effect on the patient casts doubt on the objectivity and accuracy of our findings. "Treatment is good and research is bad" is a common saying of opponents of psychoanalysis; although these words are irrational, we should not ignore them.If it has any truth, psychoanalysis becomes the most specific variant of the technique of suggestion therapy, and therefore the most fruitful; ideas about the patient's past experiences, psychic motives, and the unconscious need not be dismissed. Take it seriously.Indeed, the opponents think so; they think that the so-called sexual experiences are conceived in advance by us, and then the meaning of these experiences or themselves are "injected into the patient's mind."To refute these accusations, empirical evidence is more satisfactory than theoretical force.Anyone who has practiced psychoanalysis knows very well that this method cannot give the patient any hints.Of course, it is not difficult to make patients believe in a certain theory and mistakenly believe in doctors, as if they are disciples of doctors.But, in this case, our approach affects only his intellect, not his condition.However, when we ask him to describe what he is looking for in himself, comparable to what actually exists in his own mind, he can resolve the conflict and thus overcome the resistance.When psychoanalysis is in progress, the doctor's wrong assumptions will be gradually eliminated and replaced by correct opinions.Our aim is to apply a very deliberate technique of analysis to prevent the temporary success of suggestion, but even if it is successful, we do not regard the initial curative effect as satisfaction.We believe that the work of psychoanalysis is incomplete if the problematic symptoms are not solved here and there, if the missing memories cannot be replenished, if the cause of the repression has not been found; Seeing these as obstacles to the work of psychoanalysis, rather than as its driving force, we must therefore be constantly disenfranchised from the affective transference which formed them, and to deny the therapeutic effect already achieved.In short, the characteristics of psychoanalysis are enough to distinguish analytic therapy from pure suggestion, and the effect of analytic therapy is also different from that of suggestion.In other suggestive therapies, the effect of emotional transfer is well preserved, but only in psychoanalytic therapy is the emotional transfer itself the object of treatment, and its various forms are constantly dissected and studied.At the end of the analytic treatment, the effect of emotional transfer itself will thus be eliminated. Therefore, the effect after the end of the treatment is a lasting success, but this success must not be based on suggestion, but because of the transformation that has taken place in the patient's heart. , whose inner resistance has been overcome with the aid of suggestion.

In analytic therapy, the prevention of the one-sided influence of suggestion entails a constant battle with resistances which are more apt to disguise themselves as passive hostile feelings.We must also pay attention to the argument that analytic therapy can have numerous results, or be caused by doubts and suggestions, when in fact other materials can be used to prove otherwise.For example, patients with dementia and delusional disorder are not likely to be affected by suggestions.However, the phantasy and symbolic transformations, etc., reported by such patients in the intrusive consciousness are consistent with our results in the unconscious of patients with transference psychosis, so that our analysis, although often questioned, cannot be ignored. Indeed, it is confirmed by objective evidence.I think that if you rely on the analysis in these respects, you cannot go too far wrong.

We shall now complete our account of the therapeutic role of psychoanalysis in terms of libido theory.The psychotic has neither the capacity for pleasure nor the capacity for action; for what his libido clings to is not a real thing, and in the end, by protecting it under repression, so much capacity is consumed that little is left of it. Ability is not enough to express oneself.If his libido is no longer in conflict with the ego, and the ego can dominate the libido, he will no longer be sick.Our therapeutic work, then, consists in freeing him from his former obsessions (of which we have no access, of course) and thus re-serving himself.Where, then, is the libido of the psychopath?It is easy to find, it clings to the patient's symptoms, and the symptoms give it vicarious satisfaction, fulfilling all the demands of the moment.Therefore, we must control the patient's symptoms and eliminate them, and these are precisely the tasks that the patient asks of us.However, if you want to eliminate the symptoms, you must first trace back to the origin of the symptoms, diagnose the contradictions and conflicts before them, and then guide these conflicts and contradictions to another way out with the help of the driving force.If we are to examine repression, we need to use the memory cues which caused the repression to have some effect.It is especially important to pay attention to the relationship between the patient and the doctor and the role of emotional transfer, so that those early impulses will be repeated again, and the patient will try to imitate the previous behavior as much as possible. Therefore, we guide him to stimulate all available forces in his heart and seek Got another way out.In this way, emotional transfer functions like a dueling field in which various forces contend for battle.

All libido and all resistance of libido are concentrated in the relationship between doctor and patient; libido must therefore be detached from the symptom, and the patient seems to have made this artificially acquired affective transference or transference disorder Instead of the original disease, the so-called doctor's "fantasy object" appears, replacing all kinds of unrealistic objects of libido.Thus, with the help of the analyst's suggestion, he wages a new struggle for this object and rises to the highest level of the psychic realm, the result of which is transformed into a normal psychic conflict.Therefore, at this time, the new repressive effect is avoided, the resistance of the ego and the libido is also ended, and the patient's inner consistency is naturally restored.Since the libido has got rid of the temporary object, the analyst, it cannot return to the previous object, but returns to self-service.In the analysis and treatment, the power we overcome should be, on the one hand, the ego's aversion to the libidinal tendency, which is expressed in the tendency of repression;

(End of this chapter)