Freud - Complete Works (578 page)

Introductory Lectures On Psycho-Analysis

3484

   And indeed, the greater our
experience the less we are able to resist making this correction,
though having to do so puts our scientific pretensions to shame. On
the first few occasions one might perhaps think that the analytic
treatment had come up against a disturbance due to a chance event -
an event, that is, not intended and not provoked by it. But when a
similar affectionate attachment by the patient to the doctor is
repeated regularly in every new case, when it comes to light again
and again, under the most unfavourable conditions and where there
are positively grotesque incongruities, even in elderly women and
in relation to grey-bearded men, even where, in our judgement,
there is nothing of any kind to entice - then we must abandon the
idea of a chance disturbance and recognize that we are dealing with
a phenomenon which is intimately bound up with the nature of the
illness itself.

   This new fact, which we thus
recognize so unwillingly, is known by us as
transference
. We
mean a transference of feelings on to the person of the doctor,
since we do not believe that the situation in the treatment could
justify the development of such feelings. We suspect, on the
contrary, that the whole readiness for these feelings is derived
from elsewhere, that they were already prepared in the patient and,
upon the opportunity offered by the analytic treatment, are
transferred on to the person of the doctor. Transference can appear
as a passionate demand for love or in more moderate forms; in place
of a wish to be loved, a wish can emerge between a girl and an old
man to be received as a favourite daughter; the libidinal desire
can be toned down into a proposal for an inseparable, but ideally
non-sensual, friendship. Some women succeed in sublimating the
transference and in moulding it till it achieves a kind of
viability; others must express it in its crude, original, and for
the most part, impossible form. But at bottom it is always the
same, and never allows its origin from the same source to be
mistaken.

   Before we enquire where we are to
find a place for this new fact, I will complete my description of
it. What happens with male patients? There at least one might hope
to escape the troublesome interference caused by difference of sex
and by sexual attraction. Our answer, however, must be much the
same as in the case of women. There is the same attachment to the
doctor, the same overvaluation of his qualities, the same
absorption in his interests, the same jealousy of everyone close to
him in real life. The sublimated forms of transference are more
frequent between one man and another and straightforward sexual
demands are rarer, in proportion as manifest homosexuality is
unusual as compared with the other ways in which these instinctual
components are employed. With his male patients, again, more often
than with women, the doctor comes across a form of expression of
the transference which seems at first sight to contradict all our
previous descriptions - a hostile or
negative
transference.

Introductory Lectures On Psycho-Analysis

3485

   I must begin by making it clear
that a transference is present in the patient from the beginning of
the treatment and for a while is the most powerful motive in its
advance. We see no trace of it and need not bother about it so long
as it operates in favour of the joint work of analysis. If it then
changes into a resistance, we must turn our attention to it and we
recognize that it alters its relation to the treatment under two
different and contrary conditions: firstly, if as an affectionate
trend it has become so powerful, and betrays signs of its origin in
a sexual need so clearly, that it inevitably provokes an internal
opposition to itself, and, secondly, if it consists of hostile
instead of affectionate impulses. The hostile feelings make their
appearance as a rule later than the affectionate ones and behind
them; their simultaneous presence gives a good picture of the
emotional ambivalence which is dominant in the majority of our
intimate relations with other people. The hostile feelings are as
much an indication of an emotional tie as the affectionate ones, in
the same way as defiance signifies dependence as much as obedience
does, though with a ‘minus’ instead of a
‘plus’ sign before it. We can be in no doubt that the
hostile feelings towards the doctor deserve to be called a
‘transference’, since the situation in the treatment
quite certainly offers no adequate grounds for their origin; this
necessary view of the negative transference assures us, therefore,
that we have not gone wrong in our judgement of the positive or
affectionate one.

   Where the transference arises,
what difficulties it raises for us, how we overcome them and what
advantages we eventually derive from it - these are questions to be
dealt with in a technical guide to analysis, and I shall only touch
on them lightly to-day. It is out of the question for us to yield
to the patient’s demands deriving from the transference; it
would be absurd for us to reject them in an unfriendly, still more
in an indignant, manner. We overcome the transference by pointing
out to the patient that his feelings do not arise from the present
situation and do not apply to the person of the doctor, but that
they are repeating something that happened to him earlier. In this
way we oblige him to transform his repetition into a memory. By
that means the transference, which, whether affectionate or
hostile, seemed in every case to constitute the greatest threat to
the treatment, becomes its best tool, by whose help the most secret
compartments of mental life can be opened.

Introductory Lectures On Psycho-Analysis

3486

   But I should like to say a few
words to you to relieve you of your surprise at the emergence of
this unexpected phenomenon. We must not forget that the
patient’s illness, which we have undertaken to analyse, is
not something which has been rounded off and become rigid but that
it is still growing and developing like a living organism. The
beginning of the treatment does not put an end to this development;
when, however, the treatment has obtained mastery over the patient,
what happens is that the whole of his illness’s new
production is concentrated upon a single point - his relation to
the doctor. Thus the transference may be compared to the cambium
layer in a tree between the wood and the bark, from which the new
formation of tissue and the increase in the girth of the trunk
derive. When the transference has risen to this significance, work
upon the patient’s memories retreats far into the background.
Thereafter it is not incorrect to say that we are no longer
concerned with the patient’s earlier illness but with a newly
created and transformed neurosis which has taken the former’s
place. We have followed this new edition of the old disorder from
its start, we have observed its origin and growth, and we are
especially well able to find our way about in it since, as its
object, we are situated at its very centre. All the patient’s
symptoms have abandoned their original meaning and have take on a
new sense which lies in a relation to the transference; or only
such symptoms have persisted as are capable of undergoing such a
transformation. But the mastering of this new, artificial neurosis
coincides with getting rid of the illness which was originally
brought to the treatment - with the accomplishment of our
therapeutic task. A person who has become normal and free from the
operation of repressed instinctual impulse in his relation to the
doctor will remain so in his own life after the doctor has once
more withdrawn from it.

Introductory Lectures On Psycho-Analysis

3487

   The transference possesses this
extraordinary, and for the treatment, positively central,
importance in hysteria, anxiety hysteria and obsessional neurosis,
which are for that reason rightly classed together as
‘transference neuroses’. No one who has taken in a full
impression of the fact of transference from his analytic work will
any longer doubt the nature of the suppressed impulses that obtain
expression in the symptoms of these neuroses, and will call for no
more powerful evidence of their libidinal character. It may be said
that our conviction of the significance of symptoms as substitutive
satisfactions of the libido only received its final confirmation
after the enlistment of the transference.

   There is every reason now for us
to improve our earlier dynamic account of the therapeutic process
and to bring it into harmony with our new realization. If the
patient is to fight his way through the normal conflict with the
resistances which we have uncovered for him in the analysis, he is
in need of a powerful stimulus which will influence the decision in
the sense which we desire, leading to recovery. Otherwise it might
happen that he would choose in favour of repeating the earlier
outcome and would allow what had been brought up into consciousness
to slip back again into repression. At this point what turns the
scale in his struggle is not his intellectual insight which is
neither strong enough nor free enough for such an achievement - but
simply and solely his relation to the doctor. In so far as his
transference bears a ‘plus’ sign, it clothes the doctor
with authority and is transformed into belief in his communications
and explanations. In the absence of such a transference, or if it
is a negative one, the patient would never even give a hearing to
the doctor and his arguments. In this his belief is repeating the
story of its own development; it is a derivative of love and, to
start with, needed no arguments. Only later did he allow them
enough room to submit them to examination, provided they were
brought forward by someone he loved. Without such supports
arguments carried no weight, and in most people’s lives they
never do. Thus in general a man is only accessible from the
intellectual side too, in so far as he is capable of a libidinal
cathexis of objects; and we have good reason to recognize and to
dread in the amount of his narcissism a barrier against the
possibility of being influenced by even the best analytic
technique.

Introductory Lectures On Psycho-Analysis

3488

   A capacity for directing
libidinal object-cathexes on to people must of course be attributed
to every normal person. The tendency to transference of the
neurotics I have spoken of is only an extraordinary increase of
this universal characteristic. It would indeed be very strange if a
human trait so widespread and so important had never been noticed
or appreciated. And in fact it
has
been. Bernheim, with an
unerring eye based his theory of hypnotic phenomena on the thesis
that everyone is in some way ‘suggestible’. His
suggestibility was nothing other than the tendency to transference,
somewhat too narrowly conceived, so that it did not include
negative transference. But Bernheim was never able to say what
suggestion actually was and how it came about. For him it was a
fundamental fact on whose origin he could throw no light. He did
not know that his ‘
suggestibilité
' depended
on sexuality, on the activity of the libido. And it must dawn on us
that in our technique we have abandoned hypnosis only to rediscover
suggestion in the shape of transference.

   But here I will pause, and let
you have a word; for I see an objection boiling up in you so
fiercely that it would make you incapable of listening if it were
not put into words: ‘Ah! so you’ve admitted it at last!
You work with the help of suggestion, just like the hypnotists!
That is what we’ve thought for a long time. But, if so, why
the roundabout road by way of memories of the past, discovering the
unconscious, interpreting and translating back distortions - this
immense expenditure of labour, time and money - when the one
effective thing is after all only suggestion? Why do you not make
direct suggestion against the symptoms, as the others do - the
honest hypnotists? Moreover, if you try to excuse yourself for your
long detour on the ground that you have made a number of important
psychological discoveries which are hidden by direct suggestion -
what about the certainty of these discoveries now? Are not they a
result of suggestion too, of unintentional suggestion? Is it not
possible that you are forcing on the patient what you want and what
seems to you correct, in this field as well?’

Introductory Lectures On Psycho-Analysis

3489

   What you are throwing up at me in
this is uncommonly interesting and must be answered. But I cannot
do so to-day: we have not the time. Till our next meeting, then. I
will answer you, you will see. But to-day I must finish what I have
begun. I promised to make you understand by the help of the fact of
transference why our therapeutic efforts have no success with the
narcissistic neuroses.

   I can do so in a few words, and
you will see how simply the riddle can be solved and how well
everything fits together. Observation shows that sufferers from
narcissistic neuroses have no capacity for transference or only
insufficient residues of it. They reject the doctor, not with
hostility but with indifference. For that reason they cannot be
influenced by him either; what he says leaves them cold, makes no
impression on them; consequently the mechanism of cure which we
carry through with other people - the revival of the pathogenic
conflict and the overcoming of the resistance due to repression -
cannot be operated with them. They remain as they are. Often they
have already undertaken attempts at recovery on their own account
which have led to pathological results. We cannot alter this in any
way.