Freud - Complete Works (803 page)

   Another advantage of
transference, too, is that in it the patient produces before us
with plastic clarity an important part of his life-story, of which
he would otherwise have probably given us only an insufficient
account. He acts it before us, as it were, instead of reporting it
to us.

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   And now for the other side of the
situation. Since the transference reproduces the patient’s
relation with his parents, it takes over the ambivalence of that
relation as well. It almost inevitably happens that one day his
positive attitude towards the analyst changes over into the
negative, hostile one. This too is as a rule a repetition of the
past. His obedience to his father (if it is his father that is in
question), his courting of his father’s favour, had its roots
in an erotic wish directed towards him. Some time or other that
demand will press its way forward in the transference as well and
insist on being satisfied. In the analytic situation it can only
meet with frustration. Real sexual relations between patients and
analysts are out of the question, and even the subtler methods of
satisfaction, such as the giving of preference, intimacy and so on,
are only sparingly granted by the analyst. A rejection of this kind
is taken as the occasion for the change-over; probably things
happened in the same way in the patient’s childhood.

   The therapeutic successes that
occurred under the sway of the positive transference are open to
the suspicion of being of a
suggestive
nature. If the
negative transference gains the upper hand, they are blown away
like chaff before the wind. We observe with horror that all our
trouble and labour hitherto have been in vain. Indeed, what we
might have regarded as a permanent intellectual gain by the
patient, his understanding of psycho-analysis and his reliance on
its efficacy, suddenly vanish. He behaves like a child who has no
power of judgement of his own but blindly believes anyone whom he
loves and no one who is a stranger to him. The danger of these
states of transference evidently lies in the patient’s
misunderstanding their nature and taking them for fresh real
experiences instead of reflections of the past. If he (or she)
becomes aware of the strong erotic desire that lies concealed
behind the positive transference, he believes that he has fallen
passionately in love; if the transference changes over, then he
feels insulted and neglected, he hates the analyst as his enemy and
is ready to abandon the analysis. In both these extreme cases he
has forgotten the pact that he made at the beginning of the
treatment and has become useless for continuing the common work. It
is the analyst’s task constantly to tear the patient out of
his menacing illusion and to show him again and again that what he
takes to be new real life is a reflection of the past. And lest he
should fall into a state in which he is inaccessible to all
evidence, the analyst takes care that neither the love nor the
hostility reach an extreme height. This is effected by preparing
him in good time for these possibilities and by not overlooking the
first signs of them. Careful handling of the transference on these
lines is as a rule richly rewarded. If we succeed, as we usually
can, in enlightening the patient on the true nature of the
phenomena of transference, we shall have struck a powerful weapon
out of the hand of his resistance and shall have converted dangers
into gains. For a patient never forgets again what he has
experienced in the form of transference; it carries a greater force
of conviction than anything he can acquire in other ways.

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   We think it most undesirable if
the patient
acts
outside the transference instead of
remembering. The ideal conduct for our purposes would be that he
should behave as normally as possible outside the treatment and
express his abnormal reactions only in the transference.

   The method by which we strengthen
the weakened ego has as a starting-point an extending of its
self-knowledge. That is not, of course, the whole story but it is a
first step. The loss of such knowledge signifies for the ego a
surrender of power and influence; it is the first tangible sign
that it is being hemmed in and hampered by the demands of the id
and the super-ego. Accordingly, the first part of the help we have
to offer is intellectual work on our side and encouragement to the
patient to collaborate in it. This first kind of activity, as we
know, is intended to pave the way to another, more difficult, task.
We shall not lose sight of the dynamic element in this task, even
during its preliminary stage. We gather the material for our work
from a variety of sources - from what is conveyed to us by the
information given us by the patient and by his free associations,
from what he shows us in his transferences, from what we arrive at
by interpreting his dreams and from what he betrays by his slips or
parapraxes
. All this material helps us to make constructions
about what happened to him and has been forgotten as well as about
what is happening in him now without his understanding it. But in
all this we never fail to make a strict distinction between
our
knowledge and
his
knowledge. We avoid telling him
at once things that we have often discovered at an early stage, and
we avoid telling him the whole of what we think we have discovered.
We reflect carefully over when we shall impart the knowledge of one
of our constructions to him and we wait for what seems to us the
suitable moment - which it is not always easy to decide. As a rule
we put off telling him of a construction or explanation till he
himself has so nearly arrived at it that only a single step remains
to be taken, though that step is in fact the decisive synthesis. If
we proceeded in another way and overwhelmed him with our
interpretations before he was prepared for them, our information
would either produce no effect or it would provoke a violent
outbreak of
resistance
which would make the progress of our
work more difficult or might even threaten to stop it altogether.
But if we have prepared everything properly, it often happens that
the patient will at once confirm our construction and himself
recollect the internal or external event which he had forgotten.
The more exactly the construction coincides with the details of
what has been forgotten the easier will it be for him to assent. On
that particular matter
our
knowledge will then have become
his
knowledge as well.

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4988

   With the mention of resistance we
have reached the second and more important part of our task. We
have already learnt that the ego protects itself against the
invasion of undesired elements from the unconscious and repressed
id by means of anticathexes, which must remain intact if it is to
function normally. The more hard-pressed the ego feels, the more
convulsively it clings (as though in a fright) to these
anticathexes, in order to protect what remains of itself from
further irruptions. But this defensive purpose does not by any
means accord with the aims of our treatment. What we desire, on the
contrary, is that the ego, emboldened by the certainty of our help,
shall dare to take the offensive in order to reconquer what has
been lost. And it is here that we become aware of the strength of
these anticathexes in the form of
resistances
to our work.
The ego draws back in alarm from such undertakings, which seem
dangerous and threaten unpleasure; it must be constantly encouraged
and soothed if it is not to fail us. This resistance, which
persists throughout the whole treatment and is renewed at every
fresh piece of work, is known, not quite correctly, as the
resistance due to repression
. We shall find that it is not
the only one that faces us. It is interesting to notice that in
this situation the party-divisions are to some extent reversed: for
the ego struggles against our instigation, while the unconscious,
which is ordinarily our opponent, comes to our help, since it has a
natural ‘upward drive’ and desires nothing better than
to press forward across its settled frontiers into the ego and so
to consciousness. The struggle which develops, if we gain our end
and can induce the ego to overcome its resistances, is carried
through under our direction and with our assistance. Its outcome is
a matter of indifference: whether it results in the ego accepting,
after a fresh examination, an instinctual demand which it has
hitherto rejected, or whether it dismisses it once more, this time
for good and all. In either case a permanent danger has been
disposed of, the compass of the ego has been extended and a
wasteful expenditure of energy has been made unnecessary.

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   The overcoming of resistances is
the part of our work that requires the most time and the greatest
trouble. It is worth while, however, for it brings about an
advantageous alteration of the ego which will be maintained
independently of the outcome of the transference and will hold good
in life. We have also worked simultaneously at getting rid of the
alteration of the ego which had been brought about under the
influence of the unconscious; for whenever we have been able to
detect any of its derivatives in the ego we have pointed out their
illegitimate origin and have instigated the ego to reject them. It
will be remembered that it was one of the necessary preconditions
of our pact of assistance that any such alteration of the ego due
to the intrusion of unconscious elements should not have gone
beyond a certain amount.

   The further our work proceeds and
the more deeply our insight penetrates into the mental life of
neurotics, the more clearly two new factors force themselves on our
notice, which demand the closest attention as sources of
resistance. Both of them are completely unknown to the patient,
neither of them could be taken into account when our pact was made;
nor do they arise from the patient’s ego. They may both be
embraced under the single name of ‘need to he ill or to
suffer’, but they have different origins though in other
respects they are of a kindred nature. The first of these two
factors is the sense of guilt or consciousness of guilt, as it is
called, though the patient does not feel it and is not aware of it.
It is evidently the portion of the resistance contributed by a
super-ego that has become particularly severe and cruel. The
patient must not become well but must remain ill, for he deserves
no better. This resistance does not actually interfere with our
intellectual work, but it makes it inoperative; indeed, it often
allows us to remove one form of neurotic suffering, but is ready at
once to replace it by another, or perhaps by some somatic illness.
The sense of guilt also explains the cure or improvement of severe
neuroses which we occasionally observe after real misfortunes: all
that matters is that the patient should be miserable - in what way
is of no consequence. The uncomplaining resignation with which such
people often put up with their hard fate is most remarkable, but
also revealing. In warding off this resistance we are obliged to
restrict ourselves to making it conscious and attempting to bring
about the slow demolition of the hostile super-ego.

   It is less easy to demonstrate
the existence of another resistance, our means of combating which
are specially inadequate. There are some neurotics in whom, to
judge by all their reactions, the instinct of self-preservation has
actually been reversed. They seem to aim at nothing other than
self-injury and self-destruction. It is possible too that the
people who in fact do in the end commit suicide belong to this
group. It is to be assumed that in such people far-reaching
defusions of instinct have taken place, as a result of which there
has been a liberation of excessive quantities of the destructive
instinct directed inwards. Patients of this kind are not able to
tolerate recovery through our treatment and fight against it with
all their strength. But we must confess that this is a case which
we have not yet succeeded in completely explaining.

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   Let us once more glance over the
situation which we have reached in our attempt at bringing help to
the patient’s neurotic ego. That ego is no longer able to
fulfil the task set it by the external world (including human
society). Not all of its experiences are at its disposal, a large
proportion of its store of memories have escaped it. Its activity
is inhibited by strict prohibitions from the super-ego, its energy
is consumed in vain attempts at fending off the demands of the id.
Beyond this, as a result of continuous irruptions by the id, its
organization is impaired, it is no longer capable of any proper
synthesis, it is torn by mutually opposed urges, by unsettled
conflicts and by unsolved doubts. To start with, we get the
patient’s thus weakened ego to take part in the purely
intellectual work of interpretation, which aims at provisionally
filling the gaps in his mental assets, and to transfer to us the
authority of his super-ego; we encourage it to take up the struggle
over each individual demand made by the id and to conquer the
resistances which arise in connection with it. At the same time we
restore order in the ego by detecting the material and urges which
have forced their way in from the unconscious, and expose them to
criticism by tracing them back to their origin. We serve the
patient in various functions, as an authority and a substitute for
his parents, as a teacher and educator; and we have done the best
for him if, as analysts, we raise the mental processes in his ego
to a normal level, transform what has become unconscious and
repressed into preconscious material and thus return it once more
to the possession of his ego. On the patient’s side a few
rational factors work in our favour, such as the need for recovery
which has its motive in his sufferings, and the intellectual
interest that we may awaken in him in the theories and revelations
of psycho-analysis; but of far greater force is the positive
transference with which he meets us. Fighting against us, on the
other hand, are the negative transference, the ego’s
resistance due to repression (that is, its unpleasure at having to
lay itself open to the hard work imposed on it), the sense of guilt
arising from its relation to the super-ego and the need to be ill
due to deep-going changes in the economics of his instincts. The
share taken by the last two factors decides whether the case is to
be regarded as slight or severe. Apart from these, a few other
factors may be discerned as having a favourable or unfavourable
bearing. A certain psychical inertia, a sluggishness of the libido,
which is unwilling to abandon its fixations cannot be welcome to
us; the patient’s capacity for sublimating his instincts
plays a large part and so does his capacity for rising above the
crude life of the instincts; so, too, does the relative power of
his intellectual functions.