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Full text of "Are You Considering Psychoanalysis"

CO >- DO 

164723 



CQ CO 



OSMANIA UNIVERSITY LIBRARY 

No. 1 31 34/H81R Accession No. 26264 

^ujior Homey, K'* 
Title A*e you considering psychoanalysis 

This book should be returned on or befotil^hedate'iasl'marked below. 



Are You Considering 
Psychoanalysis ? 



Are You Considering 
Psychoanalysis? 



Edited by KAREN HORNEY, M.D. 




NEW YORK W W NORTON & COMPANY INC. 



Copyright, 1946, 



W. W. NORTON & COMPANY, INC., NEW YORK, N. Y. 



Book Design by John Woodlock 



PRINTED IN THE UNITED STATES OF AMERICA 
FOR THE PUBLISHERS BY THE VAIL-BALLOU PRESS 



Contents 



Foreword 

By THE CONTRIBUTORS 



Introduction 9 

By KAREN HORNEY, M.D. 



Why Psychoanalysis? 15 

By ALEXANDER REID MARTIN, M.D. 



What Schools of Psychoanalysis Are There? 37 

By VALER BARBU, M.D. 



What Is a Neurosis? 61 

By MURIEL IVIMEY, M.D. 



Contents 



What Are Your Doubts About Analysis? 93 

By HAROLD KELMAN, M.D. 



Who Should Your Analyst Be? 135 

By HAROLD KELMAN, M.D. 



What Do You Do in Analysis? 159 

By ELIZABETH KILPATRICK, M.D. 



What Does the Analyst Do? 187 

By KAREN HORNEY, M.D. 



How Does Analysis Help? 211 

By MURIEL IVIMEY, M.D. 



How Do You Progress After Analysis? 235 

By KAREN HORNEY, M.D. 



Index 259 



VI 



Foreword 



VV HEN the Association for the Advancement of Psy- 
choanalysis was founded in May, 1941, it defined com- 
munity education in psychoanalysis as one of its aims. 
With that end in view, a group of interested laymen or- 
ganized the Auxiliary Council for the Association in 
March, 1942. 

Since that date, the Auxiliary Council has been spon- 
soring lectures in psychoanalysis for the laity. These lec- 
tures are conducted under the auspices of the Associa- 
tion and are given by recognized psychoanalysts all of 
whom are affiliated with the Association. The topics are 
chosen for their public interest and in response to a 
public need. One of these lecture series was entitled Are 
You Considering Psychoanalysis? The demand for this 
course, the audience attendance and response, and the 
numerous suggestions received that the lectures be made 
more generally available contributed to the decision to 
publish them in book form. At the suggestion of the 
contributors, it was agreed that royalties from this book 

7 



Foreword 



be utilized for the furtherance of the purpose for which 
the Auxiliary Council was organized. 

The basic premises underlying the thinking of all the 
contributors are essentially the same. This has given the 
book a unity in its fundamental approach. However, it 
is natural that each contributor brings to his interpreta- 
tion of the basic tenets of the psychology here developed 
his own particular individuality. As a result, there is vari- 
ation not only as to details of interpretation but also as 
to points of emphasis and of style. The book thus pos- 
sesses the dual advantages of unity of approach and 
diversity of presentation. 

The first editing was done jointly; after each of us had 
read all the chapters, we all got together to discuss the 
content of each chapter. The prevailing spirit during 
these joint editorial meetings was so co-operative that 
they remain in our memory as an unusually good hu- 
man experience. 

Dr. Horney was willing to assume the responsibility of 
being our chief editor. To this task she brought the wealth 
of her psychoanalytic knowledge, the experience she 
gained from writing four major works on psychoanalysis, 
and the welding influence of her personality. 

Miss Dorothea Oppenheimer was our literary editor. 
We want to take this opportunity to thank her for her 
effective and co-operative efforts. 

The contributors' task was made easier and given zest 
by the interest and suggestions of W. W. Norton. His 
encouragement and backing gave us a most favorable 
and agreeable start. THE CONTRIBUTORS 

8 



Introduction 



JLEOPLE of our time and civilization are increasingly 
in need of psychological help. Also to an increasing 
degree they are aware of their need. They seek thera- 
peutic help from psychiatrists, psychologists, social 
workers, ministers, and from books. Or they turn to 
religious and ethical movements, the leaders of which, 
convinced they have found a way for a more satisfactory 
life, are eager to point it out to others. 

In their search for help, more and more people are 
turning to psychoanalysis. Some, without knowing 
much about it, grasp at the promise analysis holds and 
are ready to plunge into it blindly. As a rule, this is not 
harmful. A conscientious analyst will not attempt 
therapy unless he sees a reasonable chance of helping 
the patient. And while being analyzed, the patient 
gradually learns what analysis means and what it in- 
volves. 

9 



Introduction 



But, while not actually harmful, such lack of prepara- 
tion for analysis is not desirable. The patient should be 
sufficiently informed about the process itself; he should 
know what he may expect from it and what is expected 
of him. Finally, he should have some understanding of 
the deeper meaning and the goals of analysis. The main 
purpose of this book is to prepare the patient for the 
three stages of the therapeutic process before, during, 
and after analysis. 

What do people want to know and what should they 
know before they decide to be analyzed? The authors 
of this book have pooled their findings specific informa- 
tion sought by patients before analysis, questions asked 
after lectures and experience in treatment. 

In the first place the patient wants to know whether 
he can be analyzed with some chances of success. Can 
analysis really do something about his drinking, his de- 
pressions? Or does he really need analysis? He may feel 
that if it were not for his eating spells or his fear of 
heights, he would be quite all right. Is this difficulty 
important enough to warrant a lengthy and incisive 
therapy? Usually he feels still more concerned if he does 
not suffer from any such grossly visible symptoms, but 
has "merely" a pervasive dissatisfaction with life, feels 
tense or diffusely inhibited, has intangible difficulties 
with the other sex or with people in general. And so, on 
the one hand, he worries about whether analysis can 
help him particularly if his disturbances are of long 
standing. On the other hand, he feels he is not really ill 
and hence not justified in asking for help. 
10 



Introduction 



Another patient may be fairly clear about needing 
and wanting an analysis but has fears and doubts about 
the procedure and wishes to discuss them. Will analysis 
make him introspective and selfish? Does it stand for 
moral license? Does it interfere with artistic faculties? 
Will it disturb his marriage or religion? Will it so upset 
him that he cannot carry on with his job? Will it make 
him dependent on the analyst? 

Again others have already decided to be analyzed but 
feel at a loss as to how to go about it. To whom should 
they go? Is it important that the analyst be a man or 
a woman? Is it important that the patient likes him? 
Does it make any practical difference in therapy whether 
the analyst adheres to this or that school of thought? 

Finally, the patient wants to be informed about such 
practical issues as expenses, time, length of analysis. The 
last question usually cannot be answered precisely. But 
the patient should know the criteria upon which the 
length of an analysis depends. 

In many instances, without knowing it, the patient 
needs more than factual information about the issues 
mentioned. His questions, his worries, his concerns may 
be greatly determined by his personal neurotic problem, 
by his specific fears, expectations, demands on himself, 
claims for special prerogatives, by his pessimistic view 
of himself and of life in general. The preliminary inter- 
view, then, may turn into a piece of analysis. And he may 
need this help before getting started. 

In this book we have tried to clarify these issues. We 
have tried to give factual information, and where there 

11 



Introduction 



was no clear-cut answer to a question we have indicated 
criteria which should enable a person to evaluate the 
question on his own. We have also attempted to point out 
those unconscious factors that may render certain ques- 
tions and worries more poignant than they actually are. 

As to the nature of analytical work, we found less 
guidance in the way of questions raised. People are 
apparently curious about it but their notions are perhaps 
too vague for concrete inquiries. However, our experi- 
ence with patients during analysis showed us the factors 
about which they usually lack clarity. By and large we 
had to decide what we believe is relevant to know. First 
of all, most patients are not prepared for having real 
work to do in analysis, because they secretly hope that 
relieving insights will automatically be theirs. Even 
though emotional factors that interfere with the patient's 
work on himself will have to be analyzed as they emerge, 
he should realize clearly from the beginning how much 
the length and outcome of the analysis depend on his 
initiative, productivity, and co-operation. So we describe 
at some length what the patient is expected to do in 
analysis. But he should know, too, what the analyst does 
and what kind of help the analyst can reasonably expect 
from him. 

Last but not least, we have tried to convey an under- 
standing of the meaning and the goals of analysis by 
raising the question: what should be achieved when 
analysis is terminated? This question, to our knowledge, 
has never been satisfactorily answered. Our answer fol- 
lows from our belief that analysis is essentially one of 
12 



Introduction 



the most valuable helps to our growth as human beings. 
This implies that analysis is not and cannot be limited 
to the time during which patient and analyst work to- 
gether. It is a process that in the form of constructive 
scrutiny should go on as long as we live. Analysis does 
not aim at turning out a finished product. Rather, its 
purpose is achieved when the patient can proceed on 
his own. Methods of progress after analysis are indicated. 
This book is mainly directed to those who consider 
analysis for themselves or for their friends or relatives. 
It will also, however, give to those who are seriously 
interested in analysis a clearer picture of its nature and 
its aim. We hope that it will help to dispel mysterious 
notions about analysis by removing unrealistic expecta- 
tions of a magic cure. Many neurotic people may dislike 
having such hopes destroyed, but it is constructive for 
them to approach analysis in the sober spirit of expecting 
results only from actual labor done. 

KAREN HORNEY 



13 



Why Psychoanalysis? 



ALEXANDER REID MARTIN, M.D. 



OF the most significant and far-reaching cultural 
developments of our time has been the rapid growth of 
public interest in psychiatry and its offspring, psycho- 
analysis. Emotional and psychological factors are now 
more and more widely recognized and accepted as 
causes of disease and serious disability. This whole trend 
received its greatest impetus from the experiences of 
World War II. The induction process which screened 
and classified the nation's manhood gave us the first ac- 
curate estimate of the appalling waste of human po- 
tentialities resulting from emotional illness. The evidence 
furnished by the psychiatric services that efficiency, mo- 
rale, and the capacity to wage war successfully depended 
as much upon emotional health as upon physical health 
has helped to integrate more closely psychiatry and psy- 
choanalysis not only with medicine but with the social 
sciences and the humanities. The status of psychoanaly- 

15 



Are You Considering Psychoanalysis? 

sis, in particular, was greatly enhanced by the rapid and 
dramatic success achieved in the treatment of cases of 
so-called combat fatigue. These men were not analyzed 
but the rationale and method of their treatment was 
based almost entirely upon the experience and findings 
of psychoanalysis. 

From the Surgeon General's Office came the stagger- 
ing announcement that out of 4,650,000 men rejected at 
the induction level for all causes, 1,825,000 or 39 per cent 
were rejected because of some type of personality dis- 
order. Despite this screening, 43 per cent of all medical 
discharges from the services were neuropsychiatric cases 
while another 20 per cent of all discharges had personal- 
ity defects. A survey of our entire wartime population, 
conducted by the Surgeon General's Office, revealed that 
about 50 per cent of all people in the United States who 
seek medical help present primarily emotional difficul- 
ties, that is to say, some type of psychoneurotic reaction 
to the problems in their lives. To those who are thus 
manifestly disabled by emotional factors we have to add 
a large group of people whose emotional disability and 
crippling go unrecognized. If we also include those who 
end in mental hospitals or in suicide, we have some idea 
of the immensity of this whole social problem and the 
great need for increased understanding and help. 

To the better understanding and prevention of these 
disorders psychoanalysis has a great contribution to 
make. There is little doubt that many of the disabilities 
can be prevented through the timely use of psychoana- 
lytic insight in parent guidance and education and, fail- 
16 



Why Psychoanalysis? 



ing this, can be greatly helped by psychoanalytic treat- 
ment. The mobilization of the nation's psychiatric and 
psychoanalytic resources and the extensive research ne- 
cessitated by total war provided strong evidence that 
emotional conditions in family life rather than individual 
economic circumstances are responsible for initiating 
most of the personality disorders of our young men and 
women. 

Psychoanalysis concerns itself with the subtle inter- 
play and formative influence in every human relation- 
ship. It has helped to make it clear that each of us is a 
unique and integral part of society and has an indispensa- 
ble contribution to make to the health of the social body. 
Accordingly the factors that produce psychoneurosis and 
personality disorders are part of everyday life for all 
of us and concern conditions for which we are or can be 
responsible. 

Any medical discipline that enlists in the service of 
bettering the emotional conditions of living should be 
widely understood. Psychoanalysis has passed the experi- 
mental stage. It has become an accepted medical disci- 
pline and like all other medical disciplines is continually 
undergoing change and improvement. Gradually it is 
extending its sphere of influence in the medical and social 
sciences and in education and is widening its field of 
effective application. 

Psychoanalysis would be even more widely accepted 
and effective today were it not for the fact that those peo- 
ple who are most in need of treatment are usually quite 
unaware of the real cause of their difficulties. You will 

17 



Are You Considering Psychoanalysis? 

see in the course of this book how deep-seated, uncon- 
scious factors determine the feelings, attitudes, and pat- 
terns of behavior of the neurotic individual to the detri- 
ment of his personality. You will see how unwittingly 
he perpetuates his condition. Without being aware of 
it he practices the most amazing, paradoxical and intri- 
cate self-deceptions, rationalizations, and face-saving 
strategies. These not only obscure the real source and 
nature of his illness and the immense waste involved but 
blind him to his great need for help. Wherever there is 
reluctance to undertake analysis, where many justifica- 
tions are put forward for postponement and delay, and 
where misconceptions persist, such unconscious proc- 
esses can be suspected. This is particularly true of the 
person who remains adamant in his refusal to see 
the need for analysis or who appears to "protest too 
much." 

Because of the unconscious elements in the neurotic 
individual that work against his best interests, it is very 
often some close associate who first recognizes the need 
for help of some kind. The family doctor, close relatives, 
or friends are in a position to enlist analytic help long 
before it would ever be considered by the patient. But 
they are unprepared for this role. 

Hence, the person who does consider psychoanalysis 
for the alleviation of emotional or nervous conditions 
that have no determinable physical cause is often plied 
with suggestions such as these: "Yow don't have to go to 
an analyst that's only for people who can't help them- 
selves. All you need is a little will power. Try and snap 
18 



Why Psychoanalysis? 



out of it." Or "You're in a rut what you need is a change, 
a new outlook on life." Or "Forget yourself; get your mind 
off yourself; take a vacation." Or "If you want to unbur- 
den yourself, go to your family doctor or your minister." 

By reason of such advice which in many instances 
gains the support of the family doctor it too often hap- 
pens that psychoanalysis is considered only after every- 
thing else has failed. Out of this situation comes the 
widely prevailing last-resort attitude toward psycho- 
analysis, one of the obstacles to its wider use. For it dis- 
courages consideration during the early phases of illness 
when analysis in all probability would be better able to 
demonstrate its value. 

The great tragedy is that too many individuals suffer 
for years and pass through the hands of many doctors 
and friends before they finally consider analysis. A sensi- 
tive, psychologically astute associate or physician will 
very often note the indications for psychoanalysis before 
the patient can, or he will recognize an earlier and a dif- 
ferent set of indications than those put forward by the 
patient. 

Certain unconscious processes and conflicts involving 
the whole personality form the hidden central core of 
neurotic difficulties. They invariably cause a disturbance 
in functioning which may or may not reveal itself to any- 
one. It should be clearly understood, however, that the 
outward signs and symptoms of such a disturbance will 
give the individual no real indication of the nature of 
the unconscious determinants. In a great many instances 
neither the patient nor his associates recognize the rela- 

19 



Are You Considering Psychoanalysis? 

tionship of the various signs and symptoms to his deeply 
disordered life. 

This disturbance in functioning will always involve the 
total personality, but it may make itself felt or reveal 
itself only in one particular area of functioning. For 
instance, the difficulties may be evidenced mainly in 
human relationships as in irritability, marked shyness, 
inability to get along with others. They may be ex- 
pressed in circumscribed fears such as fear of dark- 
ness, heights, closed spaces, etc. Or they may manifest 
themselves in excessive emotional responses to the ex- 
ternal situation such as worrying, depressions, temper 
outbursts. Or the disturbance may be seemingly re- 
stricted to physical functions. 

In many instances the disturbances are obvious to no 
one but the individual himself, and he may take great 
pains to conceal his difficulties from others. In this cate- 
gory are strong feelings of inadequacy or immaturity, 
popularly known as the inferiority complex, feelings of 
incapacity for work, difficulties in concentration, or an 
inability to enjoy anything. Often the patient has a sense 
of being cramped and unable to grow despite outward 
appearances of comfort, luxury, and leisure and there is 
a dissatisfaction that cannot be reconciled with the ex- 
ternal picture. Other very common subjective symptoms, 
which the individual may keep to himself for many years, 
are feelings of stagnation, boredom, and a sort of emo- 
tional deadness. All these symptoms of dissatisfied and 
cramped functioning characterize unconscious ways of 
living that lend themselves readily to analysis. But here 
20 



Why Psychoanalysis? 



again the individual does not usually relate his difficul- 
ties to a disorder within himself. He may blame external 
conditions or, if he does blame himself, he does not have 
the true explanation. He is likely to seek extraneous re- 
lief in various forms before he considers analysis. 

Alcohol and drugs are frequently sought by such peo- 
ple as means of blinding themselves to their difficulties 
and of hiding them from others. Such means, though in- 
tended as a relief from disturbance of function, actually 
result in further impairment of functioning and thus 
vicious circles are set in motion. Psychoanalysis is seldom 
sought in early alcoholism because there is very often a 
strong inclination to conceal the fact from others. The 
most difficult person to reach is the one who feels that 
his pferiodic alcoholism is an understandable and justi- 
fiable way of seeking relief from external stress. By this 
rationalization he successfully conceals from himself his 
real unconscious problem. 

Unconscious processes can cause serious disturbance 
of organic and physiological functioning, involving for 
instance sleep, eating, and the sexual life. Some of these 
are obvious only to the individual such as sleeplessness, 
fatigue, drowsiness, loss of appetite, uncontrollable eat- 
ing or drinking, headaches, gastrointestinal disturbances, 
or dizziness. Other physical symptoms are obvious to 
others suclTas profuse sweating, blushing, vomiting, 
stuttering, and twitching. In the absence of any organic 
disease, we must consider such symptoms as expressions 
of deeply hidden conflicts in human relations. Physi- 
cians in the psychosomatic field of psychiatry have 

21 



Are You Considering Psychoanalysis? 

pointed out that unsuspected conflicts and emotional 
difficulties can give rise to disturbances of organic func- 
tions simulating most of the conditions listed in medical 
textbooks. 

Contrary to general belief, hidden conflicts do not 
necessarily or invariably disturb sexual functioning. 
There is no doubt, however, that many of them first ex- 
press themselves in the sexual life for instance in ex- 
cessive masturbation, frigidity, and impotence. Hence, 
all persistent sexual difficulties should be seen as local 
signals of deep-seated, extensive disorders involving the 
whole individual and all his relationships with others. 

Adherence to Freudian psychology still leads a great 
majority of patients to believe that, regardless of the 
symptoms they present, the basic cause is always a sex- 
ual one. And analysis is sought with this in mind. It is 
now becoming increasingly clear that the great impor- 
tance of sexuality in neuroses lies in the fact that the 
basic patterns and conflicts of life are often more clearly 
revealed and find more vivid expression in the sexual 
relationship than in any other; for here the most intense 
feelings and the closest human intimacy and contact are 
involved. However, although the pattern adopted for 
giving and receiving sexual gratification is very often 
the epitome of the whole integrated life pattern, it is 
never its determinant. 

Homosexuality should be seen, like any other per- 
sonality trait, merely as one expression of the individ- 
ual's attempt to deal with hidden conflicts that affect his 
entire life. Here, in his sexual life, the individual presents 
22 



Why Psychoanalysis? 



a local expression of a compromise with his hidden con- 
flicts a compromise that is subjectively valuable and 
satisfactory to him. The compulsive habitual pattern dis- 
closed in sexual or intimate relationships with the same 
sex is, then, a localized manifestation of the individual's 
whole attitude toward life. The homosexual is unaware 
that original potentialities or resources are wasted, mort- 
gaged, or lost in maintaining such a pattern. As long as 
he is perfectly satisfied, he will meet any suggestions 
that he consider analysis with scorn, contempt, and deri- 
sion. When some dissatisfaction develops and he under- 
takes analysis of his homosexuality, success depends 
upon the nature of the whole neurotic structure, of which 
homosexuality is only one manifestation or symptom. 

Finally, in a great number of cases, the individual does 
not suffer from any of the manifest disturbances that 
we have mentioned. Despite underlying neurotic con- 
flicts, to all outward appearances he may function very 
well. Such people may be emulated and adored. They 
have managed to arrange their lives in such a way as to 
counterbalance and satisfy to some extent their conflict- 
ing neurotic needs. There is but one criterion by which 
their underlying disturbances can be detected and this 
applies to all neuroses namely the discrepancy between 
potentialities and actual achievement. In spite of suc- 
cesses in this or that field of endeavor, they are living 
below their original potential. Such people usually scorn 
analysis. The great difficulty lies in bringing them to a 
realization of the waste involved in their particular way 
of life. 

23 



Are You Considering Psychoanalysis? 

Neurotic disturbances are often difficult to detect be- 
cause people tend to deceive themselves by converting 
their compulsive attitudes toward life into virtues. We 
find negativistic defiance and contrariness hailed as 
rugged individualism and originality; reactive compli- 
ance, as loyalty. The inability to say no becomes unself- 
ishness and kindness. The inability to take a stand 
on anything is seen as great tolerance and broad- 
mindedness. The inability to concentrate, persevere, and 
sustain interest in any one thing is glorified as versatility. 
The fear of sexual intimacy is glorified as chastity. The 
whole picture is indicative of a delicate and precarious 
balance of conflicting and compulsive tendencies. The 
slightest departure from the habitual mode of life imme- 
diately arouses intense overreactions, feelings of anx- 
iety, insecurity, and indecision. Often the individual 
does not at first see his extreme overreactions as at all 
disproportionate; he feels that they are completely justi- 
fied. Such overreactions are usually first observed by 
close associates. 

The individual's glorification of his compulsive atti- 
tudes blinds him to the real difficulties, quite obvious to 
others, in his relationships. So he does not see his own 
need for psychoanalysis. 



The reader may ask at this point: granted that these 
personality difficulties exist and that they constitute a 
tremendous social problem, can psychoanalysis really 
do something about them? 
24 



Why Psychoanalysis? 



I would prefer to proceed positively here and say what 
psychoanalysis is rather than what psychoanalysis is not, 
but there are certain popular misconceptions which 
should first be cleared up. 

Many people regard psychoanalysis as a form of dis- 
section of the psyche, a breaking-down process similar 
to chemical analysis. They think of it as a kind of research 
and diagnostic instrument that serves primarily to reveal 
certain unsuspected feelings and attitudes toward them- 
selves and others. They believe that the analyst, having 
demonstrated the presence of such attitudes and feel- 
ings, proceeds to give advice and treatment and, in keep- 
ing with the basic premise, attempts to "synthesize" the 
individual. There are some physicians and psychiatrists 
who do proceed in this manner with the sincere convic- 
tion that they are practicing psychoanalysis. This is es- 
sentially misuse and misapplication of the whole method. 
Psychoanalysis originated as a therapeutic procedure 
and in proper hands it operates continually, from the 
very beginning, as a relieving process. The doctor does 
not "synthesize" the patient. Rather, as the patient comes 
to free himself from his neurotic entanglements, con- 
structive forces within him are simultaneously set in 
motion that enable him to grow as a human being. 

Analysis is not the kind of treatment one ordinarily 
associates with a doctor-patient relationship. A condi- 
tion is treated, it is true, but it is not treated by a prescrip- 
tion, a formula, or a blueprint from the analyst. This 
must be understood very clearly, for many individuals 
expect the analyst to advise them, to tell them how to 

25 



Are You Considering Psychoanalysis? 

lead their lives. The experienced analyst does not set out 
to do this. His intention is to help the patient, through 
increasing self-expression and gradual opening up, to see 
and to feel for himself the kind of life he is really lead- 
ing, and the analyst hopes to develop in him the capacity 
and willingness to change. To the question "What should 
I do?" the analyst would be inclined to say "First let us 
find out all of what you are doing/' 

There is a common belief that psychoanalysis is anal- 
ogous to confession, to the bringing out of certain ex- 
periences and behavior of which the patient is fully 
conscious, but which he has felt to be socially so unac- 
ceptable and blameworthy that he has never been able to 
reveal them to anyone. Many who feel this way will not 
see the need for psychoanalysis and will be inclined to 
say: "Why be psychoanalyzed? Just let go and confide 
in someone. Confession is good for the soul!" 

Analysis, while interested in all the motives for and 
the value of confession, is in no sense a confessional pro- 
cedure. Rather, as you will learn, it uses its various tech- 
niques for the primary purpose of self -revelation: to 
reveal determinants and derivatives of everyday conduct 
and feelings that the patient is unconsciously hiding 
from himself. Many of these hidden tendencies and 
feelings, which began quite consciously in childhood, 
persist as an unconsciously self-perpetuated part of 
everyday living although they are detrimental to growth 
and have only subjective value for the individual. 

Nor is analysis a teaching procedure that strives to 
superimpose facts upon individuals. It tries, rather, to 
26 



Why Psychoanalysis? 



elicit thoughts, feelings, and the inner and outer experi- 
ences of everyday living of which we are unaware. It 
aims to remind rather than to inform; and in contrast to 
the customary advice to the unhappy to "try to forget," 
analysis will say "try to remember." It is primarily a pro- 
cedure of enlightening, revealing, awakening. Psycho- 
analysis in the vanguard of the search for truth about 
human beings is essentially a process of education. But 
here "education" is conceived according to its original 
derivation and meaning, in the sense of educere, to lead 
or draw out. 

Many individuals come to analysis with the impres- 
sion that their getting well depends entirely upon re- 
membering childhood experiences. However, analysis is 
never undertaken merely in order to bring forgotten 
memories into consciousness. The recall of unhappy ex- 
perience upon which Freud placed such great em- 
phasis while of considerable importance and a great 
aid in bringing about awareness of one's whole life is no 
longer the ultimate therapeutic objective. The major em- 
phasis in the analytic method is no longer on the so-called 
genetic causes but rather on the immediate perpetuating 
causes. Therapy aims at bringing about greater and 
greater awareness of what is going on in the immediate 
present. It is the linking of the past with the present, 
the patient's awareness of how and why the past pat- 
terns are operating in the present, that leads to genuine 
insight. 

To the question "Why psychoanalysis?" the analyst 
will say: "Because psychoanalysis is the first organized 

27 



Are You Considering Psychoanalysis? 

medical discipline to blaze a trail into the unknown, un- 
explored dark continent that constitutes all of man's life 
lying below the level of his consciousness. Because it can 
help man get in touch with the darker reaches of his life 
and learn the deeply hidden sources of his strength and 
weakness. Because analysis is the most effective means 
toward revealing and dissipating acquired unconscious 
conflicts and other factors responsible for personality 
difficulties and toward disclosing and releasing the orig- 
inal potentialities for creative and constructive living." 

The question could be answered more simply: "In 
order to know yourself." With the recent development of 
a broader concept of self, the fundamental therapeutic 
dictum "Know thyself has acquired greater significance 
and value. Now that we see self as a unique but integral 
part of the social body, we see that knowing thyself 
means knowing what is going on consciously and un- 
consciously between ourselves and others as well as what 
is going on inside ourselves. 

While psychoanalysis deals with disturbances inside 
the individual, it is unique among medical therapies in 
its equal and constant concern with what goes on be- 
tween individuals. It deals, much more than is generally 
realized, with the everyday problems of living with 
others. 

Psychoanalysis seeks to improve the patient's aware- 
ness of what is going on in his present relationships with 
people and in his relationship with himself; to bring 
about awareness of those ways of living and feeling that 
are so habitual that they have been lost sight of. Con- 
28 



Why Psychoanalysis? 



tinuous use is made of the whole analyst-patient rela- 
tionship to assist the emergence into consciousness of 
habitual characteristics, tendencies, and feelings which, 
in the neurotic, are in serious conflict. 

If we regard acquiring awareness as the main reason 
for analysis your next logical question will be: "But is 
awareness, in itself, sufficient? If I find out what kind of 
person I am, will I change? Will I get over my fears and 
anxieties? Will I become more constructive and crea- 
tive?" To this we can say that it is only through the strug- 
gling emotional process of acquiring awareness, of facing 
emerging conflicts, attitudes and feelings through the 
medium of the patient's personal relationship with the 
analyst that he finds his strength and reaches for the first 
time a true evaluation of his real self, his real feelings, 
and his true potentialities for change and growth. 

With increased awareness he will come to feel that 
many of his attitudes, standards, and feelings toward 
himself and others, which he has clung to as indispensa- 
ble, are mutually incompatible, actually detrimental to 
his well-being and no longer essential. He will realize 
that he is deceiving himself and that his gains are illusory. 
His creative resources are seen to be mortgaged in main- 
taining his way of life and only hollow victories scored. 

Analysis, like other branches of medicine, is mainly 
concerned with causes rather than with symptoms; but 
some important differences enter into this field. We must 
remember that in a great many instances the patient's 
symptoms represent his unconscious attempts at finding 
relief from and compensation for deeply disturbed feel- 

29 



Are You Considering Psychoanalysis? 

ings: they are self-deceptive devices that help him to 
remain unaware of his conflicting tendencies. Therefore, 
though he asks to be rid of his symptoms, there is at the 
same time a real underlying fear that they will be taken 
away from him. Analysis does not try primarily and im- 
mediately to get rid of symptoms. Rather, it has a careful 
regard for them as significant and integral elements of 
the whole personality, a greater understanding of their 
protective purpose or unconscious function in the neu- 
rotic scheme, and a clear realization of what each symp- 
tom is trying to express and what it means and does to 
the patient. 

It must be emphasized that the patient who mani- 
fests definite symptoms is in distress because a delicately 
balanced compromise of compulsive and incompatible 
elements expressed, for instance, in some particular 
fixed pattern of living has been upset or because he is 
unable to achieve such a compromise. When in difficult 
life situations these compromises fail to operate, many 
of the symptoms arise for which psychoanalysis is first 
considered: morbid apprehension, tension, anxiety, 
panic, the feeling that "everything is going to pieces." 
Under these circumstances the neurotic's world is going 
to pieces. He does not realize, however, that it is not 
worth saving. Consequently, most of these people, when 
they seek analysis, unconsciously want to restore the 
old balance and the old defensive patterns. They are 
"helped" by any therapy that advocates a return to nor- 
mal or back to the old self policy. Unfortunately this 
kind of therapy prevails all too widely and is one way in 
30 



Why Psychoanalysis? 



which our culture unconsciously perpetuates neurotic 
patterns. This should be clearly recognized because many 
who seek analysis are unconsciously motivated by an 
impelling need to restore a pattern of living that never 
was helpful in the first place and that will inevitably 
break down again. 

Thus we begin to see that even when psychoanalysis 
is sought there are unconscious tendencies to use the 
experience to serve neurotic needs and to keep deeply 
hidden conflicts from emerging into consciousness. One 
unconscious neurotic motive for being analyzed is a com- 
pulsive need for power. Analysis is then sought to gain 
influence over others, to read minds and foretell the fu- 
ture. The analyst is seen as a man of magic, and there is 
a desire to acquire through him a similar omnipotence. 
Such motives prevail in those people who intellectualize 
every human problem, who are always ready with ex- 
planations and interpretations of symptoms and man- 
nerisms, and are always wishing to guide others. 

Certain people undertake psychoanalysis because of 
an unconscious neurotic need for someone to protect and 
comfort them, upon whom they can become strongly 
dependent. 

Still others who seek analysis have lived lives of habit- 
ual unquestioning obedience, loyalty, and obsequious- 
ness. They do everything that is expected of them but 
give nothing of themselves. Unconsciously they behave 
in this way toward the analyst, and feel justified in ex- 
pecting in return the miracle of cure that is, a reward 
without expending any real active effort in the process. 

31 



Are You Considering Psychoanalysis? 

Many patients enter analysis without any awareness of 
this expectation of miracles. Quite unconsciously a bar- 
gaining relationship with the analyst is set up in which 
the patient is compliant, submissive, docile. He will sac- 
rifice a great deal; he will undergo hardship and depri- 
vation coming, for instance, at 7:30 every morning 
during all of which he is unconsciously building up a 
tremendous claim on the analyst. 

Where there are parents or relatives, a wife or a hus- 
band, advising and paying for the analysis, the patient 
may submit to the experience in a very co-operative man- 
ner and then, unconsciously, use the experience in vari- 
ous ways to humiliate, impoverish, or weaken the family, 
even endeavoring to use the analyst as an ally. 

Many will present themselves for analysis with the 
idea sometimes verbalized and sometimes not of be- 
coming defiantly independent of the family, and they too 
will unconsciously endeavor to use the analyst as an ally 
in the service of this purpose. 

Fundamentally the neurotic does not really deceive 
himself, for he never develops any real sustained feeling 
of security. What disturbs him and what he dislikes in 
himself is his whole neurotic pattern of living, its pre- 
carious balance, its insufficiency, its demands, its hypoc- 
risies and self-deceptions. Unless he becomes more aware 
and faces the unconscious conflicts so well concealed 
within his pattern of living, he remains the unconscious 
perpetuator of that pattern. 

We can see here another way of describing the func- 
tion of analysis that is, to make the individual aware 
32 



Why Psychoanalysis? 



of the philosophy of life he defends so strongly and re- 
gards so highly, aware of the emptiness and the waste 
involved in following and maintaining such a philosophy, 
and aware of the resources that are being so expended. 

We must never lose sight of the fact that, although 
much of the individual's energy is mobilized to maintain 
his particular neurotic approach to life or to re-establish 
it, there is always a positive, active, creative element in 
him that is working toward genuine, healthy growth. In 
other words, the growth principle is constantly operat- 
ing. In earlier life the individual's symptoms and neu- 
rotic pattern of living were actually his first attempts to 
deal with his life problems so that healthy growth and 
self-expression could take place. Instead of aiding his 
constructive drive, a blind and insensitive culture rein- 
forced his neurotic pattern, and ultimately this was self- 
perpetuated. The analyst represents one individual so 
trained that he will not repeat the error of the patient's 
culture and unconsciously complement or supplement 
the patient's neurotic ways. 

The greater the neurosis, the less the manifest picture 
of the individual is like that of the true man. The real 
individual is lost in a web of entanglements and neurotic 
conflicts with all their determinants and derivatives. 
With the analyst, he sets out to find himself. 

It must be emphasized that the goal of analysis is not 
to uncover weaknesses. The process of revelation ulti- 
mately discloses a person's strength. Those elements 
which are thought of or felt as weaknesses are always 
secondary; they are the network, the entanglements, and 

33 



Are You Considering Psychoanalysis? 

the defenses that hide and obscure the original basic 
strength and unique potentialities. Analysis liberates 
energy from its involvement in conflicting and wasteful 
patterns of living. 

It is not sufficient that the patient seek analysis to be- 
come healthy. He must ask: "Healthy for what?" To that 
we might say: "Healthy for closer creative intercourse 
with others." The goal of analysis is to narrow the gulf 
between individuals, to bring about closer creative rela- 
tionships, to bring about greater interdependence of liv- 
ing. And this becomes more and more feasible as the 
individual, through analysis, becomes aware of himself 
as a unique, integral part of the social body. 

The patient's improvement in his relationship with 
others occurs simultaneously with an improvement in 
his relationship with himself. Freud was of the opinion 
that an instinctive and innate hostility prevents man 
from ever getting close to himself and to others. We can- 
not subscribe to this fatalistic theory. Psychoanalysis 
shows that man is prevented from maintaining his essen- 
tial closeness to people and to reality, from becoming 
aware of his interdependence, not by instinctive, innate 
factors but by acquired neurotic elements. The hostility 
that Freud defined as instinctive is actually a defensive, 
reactive hostility. Far from operating in the service of 
.self-preservation, such hostility, aggression, or destruc- 
itiveness only serves to preserve illusions. Analysis seeks 
to reveal those attitudes and feelings and tendencies that 
prevent individuals from growing closer together, from 
recognizing their interdependence. It deals with those 
34 



Why Psychoanalysis? 



neurotic elements that perpetuate detachment and isola- 
tion. 

The old saying "familiarity breeds contempt" echoes 
the Freudian fatalism, but it is true only for those who 
are defensive, grandiose, with no real sense of humility. 
Familiarity certainly does reveal the weaknesses of man, 
but it also reveals his strengths. It reveals ugliness but, 
at the same time, beauty. Those who have the courage 
and the humility to open their eyes and to draw more 
closely to their limitations can at the same time and 
only at the same time see their real strength. Because 
analysis increases awareness, it reveals potentialities and 
genuine feelings and makes possible a true evaluation of 
one's assets and liabilities. "Love thy neighbor as thy- 
self" becomes meaningful and applicable only as you 
come to "love thyself." You must first know yourself and 
accept yourself for what you are. 

Unless you have a genuine warm affection for your- 
self and a self-regard based upon knowing yourself, you 
can have no affectionate regard for others. It is not a mat- 
ter of loving some illusion of yourself. When there can 
be recognition and acceptance of your own frailties and 
limitations, then there can be acceptance of the frailties 
and limitations of others. The important point is that 
only by having the strength and the courage to open our 
eyes to the so-called unacceptable and ugly in ourselves 
and in others can there be any awareness of what is beau- 
tiful and sound. 

These psychoanalytic principles received their strong- 
est and most unquestionable substantiation from men 

35 



Are You Considering Psychoanalysis? 

exposed to the grim realities of war. It was commonly 
recognized among soldiers that the best leaders in com- 
bat, as well as the most reliable ones, were those who 
feared the worst and hoped for the best in other words, 
those who could admit that they were afraid, who had 
the strength to see and feel the worst features of reality 
in themselves and others, because at the same time they 
could also see and feel the best features of reality. 

With a knowledge of one's worth, the sense of inade- 
quacy, of shallowness, of emptiness so characteristic of 
neurosis is dissipated, and the individual feels free to 
give, and to give without expectation of a reward. A per- 
son who is aware of his basic strength needs no appeal to 
him to give. He has a greater capacity to feel whole- 
heartedly, richly and deeply because he feels strong 
enough to prevent his reactions from overwhelming and 
getting the better of him. Only with the courage and the 
strength to feel sadness and pain can there be any ability 
to feel real joy. 



36 



What Schools of Psychoanalysis 
Are There? 

VALER BARBU, M.D. 



IHE WEALTH of the material with which psycho- 
analysis deals has necessitated the constant develop- 
ment of new concepts. The purpose of these concepts 
is to facilitate orientation and to promote focusing on 
specific problems. A review of the more fundamental 
concepts of psychoanalysis would seem desirable. 

If you have already done some reading of psycho- 
analytic literature you will know that psychoanalysis 
was founded by Freud and that in the course of time vari- 
ous other schools of thought have developed. In this 
chapter I shall review briefly the theories of the most 
representative schools of psychoanalysis. 

The fact that several different theories have emerged 
has not been detrimental, on the whole, to the progress of 
psychoanalysis, but has served rather as an incentive 
toward the development of a more comprehensive view- 
point. Furthermore, the differences are not merely of 

37 



Are You Considering Psychoanalysis? 

theoretical interest but are of practical importance also, 
because the therapist's approach is largely determined 
by the particular theory he holds. 

Sigmund Freud, the founder of psychoanalysis, was 
for many years also its chief contributor. The early ana- 
lytic theories were almost entirely his creation. In the 
course of time, several of his most important disciples 
left Freud, because of disagreement on theoretical issues, 
and founded their own schools. The more orthodox 
Freudians completely repudiated the ideas of these se- 
cessionists. In recent years, however, some of the most 
experienced analysts of the old school have also at- 
tempted a rather radical revision of the theoretical field 
of psychoanalysis, in an effort to make it capable of 
further development. The most outstanding of these is 
Karen Homey. 

As a method of therapy, psychoanalysis is based on 
the principle of self-knowledge. It makes a particular 
study of the unconscious motivations and conflicts that 
stand in the way of the individual's fuller development 
as a person. Since these problems are rather universal, 
psychoanalysis offers help not only for the sick, but also 
for the relatively healthy, in the effort to achieve a fuller 
development. 

Since we can devote only one chapter to the subject 
of schools, this presentation must be limited to the essen- 
tial features of each theory. Adler, Rank, and Jung differ 
rather widely from Freud, as well as among themselves. 
Horney's approach, on the other hand, is a more direct 
outgrowth of Freudian psychoanalysis. 
38 



What Schools of Psychoanalysis Are There? 
THE THEORETICAL CONCEPTS OF FREUD 

In the 1880's and 90's, Freud observed patients suffer- 
ing from major symptoms of hysteria and made the dis- 
covery that some of them were relieved of their symp- 
toms if they could be helped to recall painful childhood 
experiences. He was also impressed by the fact that they 
were preoccupied chiefly with thoughts and feelings of 
a sexual nature. He drew the conclusion that the difficul- 
ties were caused by sexual frustration. He subsequently 
developed a theory of sexuality, the libido theory, which 
has remained the backbone of the orthodox Freudian 
approach. 

According to Freud, the most important factor in de- 
termining the growth of the personality is the sexual de- 
velopment. However, in his theory the concept of sex- 
uality has acquired a very broad meaning, so that it has 
become synonymous with love as well as with pleasure- 
seeking of any kind. 

Freud ascribed great importance to the libido, which 
he defined as the energy of the sexual instinct as repre- 
sented in the mind. 

At the most primitive stage of development, the as yet 
undifferentiated libido is thought to be invested in 
one's own body. This is the stage of narcissism in which 
the infant is supposed to be in love, as it were, with him- 
self. Freud assumed that during the first five or six years 
of life the individual has to go through a basic sexual 
development in the course of which the libido undergoes 
some predetermined transformations, characterized by 

39 



Are You Considering Psychoanalysis? 

certain phases. This development is made possible by 
the availability of a certain amount of love and is inter- 
fered with by deprivation of love or by traumatic or up- 
setting experiences which the child cannot handle emo- 
tionally or which have the meaning of deprivation of 
love. 

The foundations of sexuality are laid in early child- 
hood. The earliest expression of sexuality occurs in con- 
nection with certain zones of the body the oral, anal, 
and genital zones respectively. These are invested with 
pleasure and their specific physical functions become 
particularly important to the child at a certain period 
in his development. 

Freud maintained that each zone has a corresponding 
kind of libido, and he therefore called these areas erog- 
enous zones. Accordingly, three main varieties of libido 
are postulated the oral, anal, and genital libido. The 
oral and the anal represent earlier and more primitive 
forms of libido and they later merge into the genital 
libido. 

The function of a particular erogenous zone occupies 
the center of the stage at a given period of early child- 
hood and characterizes that particular phase. Because 
of the biological instinctive nature of the libido, the 
phases are considered inevitable. Freud assumed that 
activities connected with a certain zone satisfy not only 
important bodily needs but specific psychological needs 
as well and that they serve as a basis for the development 
of certain character traits. Rather complex personality 
traits are thus considered to be derivatives of certain 
40 



What Schools of Psychoanalysis Are There? 

forms of libido. Insatiability and the desire to exploit are 
derived from oral libido; orderliness, hoarding, obstinacy, 
sadism are considered anal character traits; capacity to 
love is correlated with the genital stage. These traits are 
considered to be constituents of the oral, anal, or genital 
"character" respectively. 

The genital zone becomes more important as the child 
gets involved in the so-called Oedipus complex. He wants 
sexual union with the parent of the opposite sex and is 
jealous and harbors death wishes toward the parent of 
the same sex. The Oedipus complex is not thought of 
merely as a product of a certain life situation of the child 
but as a biological necessity, a phase to which the human 
being is predestined by nature. The Oedipus complex in 
the boy involves the castration complex, that is, the fear 
of retaliation by punishment on the offending organ and 
the wish to protect oneself by passivity. Freudian analy- 
sis considers the Oedipus complex to be the nucleus of 
every neurosis. The little girl goes through a similar de- 
velopment with the difference that, not having a penis, 
she has to compensate for this defect by phantasying that 
originally she did have one, but that it was cut off as 
punishment for her sexual desires. It was cut off by her 
natural rival, the mother. She harbors an intense con- 
scious or unconscious envy of a penis. Feminine psychol- 
ogy, according to Freud, inevitably bears the mark of 
what he termed "penis envy/' 

In order to get from one phase to another one has to 
graduate, as it were, from the preceding one. Freud con- 
ceived of the libido in strictly quantitative terms, in anal- 

41 



Are You Considering Psychoanalysis? 

ogy with the principles of conservation and transforma- 
tion of energy in physics. Therefore if much libidinal 
energy is tied down by fixation, for instance on the oral 
zone, there is little left for the anal or genital zone and 
for activities considered to be derived from these forms 
of libido. 

If, as a result of traumatic experiences, a considerable 
amount of libido becomes fixated at one or several zones, 
this will interfere with the individual's development and 
will result in neurosis. Symptoms may not break out until 
later in life when, under the influence of emotional strain, 
great quantities of libido are thrown back to the fixation 
points. This process is called regression. Freud attempted 
to explain the differences between the various neuroses 
and psychoses according to the amounts of libido that 
were fixated at the oral, anal, or genital level respectively. 

Freud assumed that the task of therapy is to release the 
dammed-up libido, and thus help the neurotic to avail 
himself of this energy. As a result of therapy, the libido 
is set free to follow its course as prescribed by its instinc- 
tive nature. 

In a later period, Freud came to distinguish two basic 
instincts in man the eros, or life instinct, and the death 
instinct. The life instinct includes all forms of the libido 
and represents the life-promoting tendencies. It is op- 
posed by the death instinct which is destructive and 
represents the wish to return to the inorganic state. 

The theory of the death instinct reveals a rather pes- 
simistic view of human nature, according to which man 
is predestined by his instinctive nature either to hurt 
42 



What Schools of Psychoanalysis Are There? 

himself or to direct this tendency toward others in some 
form of destructiveness, which may take a collective ex- 
pression in such a phenomenon as war. 

As he further developed his theory Freud came to con- 
sider the personality as being constituted by three parts, 
all of them partly or largely unconscious: the id, the ego, 
and the superego. The id is the instinctual libido reser- 
voir. The ego is the part that makes contact with the 
external world. The superego is built on the basis of 
parental prohibitions and represents the internalized 
parental authority, the voice of the parent in oneself. 
The superego is endowed with self-destructive forces 
which Freud also considered to be instinctual in nature 
and derived from the death instinct. 

In the light of the Freudian theory, the ego appears as 
a mere battleground of the other two forces which pull 
the individual in opposite directions. The ego is forced 
to develop various mechanisms with which to protect 
itself from being overrun by the inimical forces of the 
id and the superego. These defense mechanisms are 
aimed at evading the repressed strivings or at denying 
their true nature. Repression is considered the most im- 
portant defense mechanism in neurosis. It is an uncon- 
scious process and is caused by conflict. What Freud 
usually meant by repression was the active keeping out 
of consciousness of the id strivings, the sexual strivings 
that are prohibited by the superego. The ego was later 
thought of as having to make a synthesis between the 
superego and the id. 

An important variety of defense is the reaction f orma- 

43 



Are You Considering Psychoanalysis? 

tion. In defense against his sadism, for instance, a person 
may develop a reaction formation in which opposite 
tendencies are displayed, such as a drive to be exces- 
sively kind. Such defense mechanisms are mere make- 
shifts and the repressed forces continue to operate in 
the unconscious or to manifest themselves in disguised 
ways. The character of the person was then conceived of 
as being constituted chiefly of such reaction formations. 

In order to mobilize the fixated libido, Freud thought 
it most important that in analysis one should strive to 
recover the earliest memories related to infantile sexual 
wishes. He believed that the neurosis is maintained 
mainly by the continuous pressure of these prohibited 
infantile wishes, because of which the neurotic must suf- 
fer from guilt and from symptoms that represent sexual 
gratifications. Accordingly it is necessary that in analysis 
the patient relive the so-called infantile libido situations. 

In analysis the repressed strivings are gradually 
brought to consciousness and since Freud thought of 
them as primarily erotic wishes directed toward the par- 
ents, he saw them as being automatically directed toward 
the person of the analyst. This process Freud called 
transference. The patient places the analyst in the role 
of father or mother. By transference the libido is de- 
tached from the objects to which it was fixated on an 
infantile level and is transferred to the analyst and 
thereby made available for the ego's more mature use. 
Transference love in analysis is supposed to be the force 
through which the patient changes. 

In analysis, according to Freud, the neurotic individ- 
44 



What Schools of Psychoanalysis Are There? 

ual is under constant inner compulsion to repeat the 
vicissitudes of the sexual instinct which demands grati- 
fication. During analysis the oral, anal, and genital phases 
come up and are permitted a freer flow toward the resolu- 
tion of the Oedipus complex. Freudian analysis is focused 
on this process. It is also necessary that the superego be 
reduced in intensity and that the individual relinquish 
enough narcissism to make his libido available for nor- 
mal sexual relations. Through analysis the conflict be- 
tween the id and the superego is diminished and the ego 
is thereby strengthened. 

Freud devised a specific method for obtaining the ma- 
terial for analysis. This is the free association technique 
a most valuable tool. The patient is instructed to say 
everything that comes to his mind, regardless of whether 
it appears important or unimportant, rational or irra- 
tional. Psychoanalysts still adhere to this fundamental 
rule. It leads to the uncovering of most important mate- 
rial, which is then discussed and interpreted. 

Dreams were found by Freud to furnish excellent 
material for free association. He believed that dreams 
represent disguised fulfillments of unacceptable and 
therefore repressed unconscious sexual wishes. Dreams 
reveal the working of the unconscious. Freud worked 
out a method by which to interpret the distortions and 
the symbolic meaning contained in dreams. 

Freud found the following limitations to analysis: the 
instincts may be constitutionally too strong; the individ- 
ual may be too narcistic; a specific limitation in men, 
too strong resistance to the recognition of passive homo- 

45 



Are You Considering Psychoanalysis? 

sexuality and, in women, refusal to give up the penis 
envy, 

Freud's concept of human nature emphasizes what he 
thought of a$' instinctive needs. According to Freud, hu- 
man psychology is governed ultimately by these biologi- 
cal forces. In the old Freudian type of analysis the analyst 
is very passive. The main focus is on the analysis of the 
libido and the rest of the personality is expected to take 
care of itself. 

Many of Freud's observations have a sound basis and 
have been epoch making. Many of his theoretical formu- 
lations, on the other hand, have been misleading and in 
the course of time a radical revision became necessary. 
It is my belief that such revision has been made success- 
fully only by Karen Horney. 

It was Freud who found that neurotic difficulties be- 
gin in childhood. He called our attention to the impor- 
tance of sexuality in human life and was a pioneer in 
fighting the secrecy and hypocrisy with which the sub- 
ject was surrounded at the time of his early work. He dis- 
covered that we are influenced by irrational emotional 
forces to a much larger extent than we like to believe; 
that the neurotic actively resists facing some of the emo- 
tional forces which drive him; that these forces are 
powerful and that as a result of repression they operate 
largely unconsciously; that they appear in many forms; 
that these forms can be recognized by methodical pro- 
cedure; that they are interrelated in terms of content as 
well as in their energetic or dynamic aspect. 

However, he made some unwarranted assumptions. 
46 



What Schools of Psychoanalysis Are There? 

Among them is the supposition that neurotic difficulties 
are basically instinctive and preponderantly sexual in 
nature and that the unconscious emotional forces which 
drive the healthy and the neurotic, the child and the 
adult are mainly certain varieties of the sexual instinct. 
His extension of the concept of sexuality is entirely un- 
warranted and has led to a disastrous confusion of think- 
ing in regard to the fundamentals of human nature and, 
more specifically, to a one-sided emphasis on sexuality 
in the psychology of early childhood. The assumption 
that the basic problems of the adult neurotic revolve 
around unresolved infantile sexuality and that conse- 
quently the analysis of the adult neurotic should deal 
chiefly with the vicissitudes of infantile sexuality is un- 
justifiable. Even though the life of the child is naturally 
merged into sensuality to a much larger extent than the 
life of the adult, the neurotic child's basic problems are 
not exclusively of a sexual nature and therefore even a 
child's analysis should not focus on sexuality to the ex- 
clusion of other aspects of his development. 

Freud's emphasis and extension of sexuality, it must be 
admitted, allowed him to cover a large area of the inner 
life of man and it gave him a tool with which to engage 
the neurotic's interest in himself by tempting him to 
do it in his own neurotic terminology, as it were. Never- 
theless, it also enabled Freud to avoid tackling our ethi- 
cal conflicts. A therapist equipped with such a tool will 
not run the risk of being accused of trying to moralize 
to the patient, but he will also leave some of the patient's 
basic problems untouched. 

47 



Are You Considering Psychoanalysis? 

Finally, Freud's theory that feminine psychology is 
governed by penis envy and his assumption of a basic 
death instinct in man are probably erroneous and bar 
the way to an effective therapy. 



ALFRED ABLER S INDIVIDUAL PSYCHOLOGY 

Adler was a collaborator of Freud who parted from 
him about 1910. At first he conceived of the neurotic in- 
dividual as one who constantly strives for superiority 
in order to compensate for some organic inferiority. 
Later he put less emphasis on organ inferiority and took 
a more thoroughgoing psychological view. 

Owing to unfavorable constitutional and social fac- 
tors, the individual who is headed toward a neurotic 
development is deeply impressed by his weakness and 
helplessness. In order to overcome his feeling of inferior- 
ity and to hide it from himself and others, he develops a 
drive toward superiority. The only healthy solution that 
is possible for him is to develop social feeling. In treat- 
ment, he must be shown that he is following an impos- 
sible goal. He is shown the way toward integration with 
society. 

In evaluating an individual we must find out the rela- 
tive strength of his need to dominate and the strength of 
his social feeling. The greater the latter in proportion to 
the former, the more valuable the personality. 

Two conditions are essential to the healthy mental 
growth of a child: he must have healthy organs and he 
must have an opportunity to develop social feeling. In 
48 



What Schools of Psychoanalysis Are There? 

our society a child with inferior organs is at great dis- 
advantage. He is made to feel inadequate as a person. 
He will easily develop a hostile and domineering atti- 
tude toward his environment. He may show this in an 
aggressive way; he may disguise it by adopting a sub- 
missive attitude. As he grows up, such an individual tends 
to become more or less isolated from society. This faulty 
basic attitude tends to persist through life. 

Every child has feelings of inferiority, but he can 
gradually overcome them through social feeling. The 
essential task of upbringing is to enable him to achieve 
this development. Persistence of a feeling of inferiority 
would prevent such development. Compensatory striv- 
ings for power would similarly lead to a thwarted growth. 
Other people in the child's environment, particularly his 
parents, may help or hinder his growth as a person. They 
may help his development by guiding him toward social 
goals. They may hinder it by stressing the child's inferi- 
ority and by expressing contempt for him, or by incit- 
ing him to excessive ambition at the expense of social 
feeling. 

The unconscious, to Adler, is that which the individ- 
ual does not wish to know about, so as not to have to take 
responsibility for it. The more responsible the individ- 
ual is, the larger his sphere of consciousness and the less 
his need of an unconscious. 

A single psychological phenomenon for instance, an 
attitude or a sample of behavior cannot therefore be 
understood in isolation but only in the broader context 
of the personality. The most important context for Adler 

49 



Are You Considering Psychoanalysis? 

is the unconscious striving for superiority. The key to 
psychopathology is to correlate the particular phenom- 
enon with the secret goal of the individual. Therapy con- 
sists in enabling him to develop the healthy goal of social 
usefulness. 

Adler believed that he could explain all neurotic phe- 
nomena by this single principle of the inferiority com- 
plex. He was the first to depart from the libido theory. 
Unfortunately, he also discarded some of the more valu- 
able parts of the Freudian method. He made little use of 
the free association technique and deprived himself of 
the opportunity of working through his patient's prob- 
lems in detail. Although there is much truth in it, his 
approach seems rather crude and his theory one-sided. 

OTTO RANK'S WILL THERAPY 

Rank's book by this title appeared in an English trans- 
lation in 1936. He objected to Freudian analysis on the 
ground that it aimed toward changing the neurotic per- 
son into an ill-defined, formless, average type. In con- 
trast, Rank believed that the neurotic had more in com- 
mon with the creative. He spoke of both as "the strong 
willed," with the difference that the will of the creative 
is affirmative and that of the neurotic is negative. 

A lifelong student of cultural history and of the psy- 
chology of religion and art, Rank considered the crea- 
tive tendency as the essentially human quality. Man's 
creativeness is bound up with his spiritual strivings and 
50 



What Schools of Psychoanalysis Are There? 

found its earliest expression in religion. There his crea- 
tiveness was projected upon supernatural beings. In his 
gods, man could worship his own wish and phantasy of 
greatness. Since this was a projected force and therefore 
beyond his control, he also dreaded it and had to placate 
it continually. Man's belief in immortality, which is ex- 
pressed in religion, is not based merely on the awareness 
or the fear of death but more fundamentally it is an 
expression of his need to grow and to expand as a person. 
Man projected his own ideal self upon the gods and ex- 
pressed his aspirations in art and religion. In the course 
of time he became more conscious of the meaning of his 
illusions, and he is now beginning to realize that his chief 
problem is what he wants to make of himself. 

The neurotic according to Rank is a person who can 
no longer project his needs on God as historical man did. 
At the same time, because of conflict, he is unable to live 
up to his aspirations and will therefore deny them. Be- 
cause of this denial of his will, he suffers from a continu- 
ous feeling of guilt. By will, Rank means the will to be 
oneself and the capacity to use one's irrational forces 
creatively. In therapy the neurotic should learn to recog- 
nize his will and to take responsibility for it. 

The neurotic and the artist are the most individual- 
istic people of our time. The will necessarily means assert- 
ing oneself as an individual and this implies wanting to 
be different. In order to become a distinct entity, one 
must develop the capacity to stand on one's own ground 
and to separate. Denial of this tendency results in the 

51 



Are You Considering Psychoanalysis? 

need to unite, to love. Freud took the neurotic need for 
love at its face value, but to Rank it was reactive and not 
genuine. 

Man needs something to believe in. This is what he 
calls the truth. Rank said that the neurotic knows too 
much truth and that what he needs is illusions. He spoke 
of religion, art, philosophy, and love as "the great spon- 
taneous psychotherapies of man/' the therapeutic value 
of which lies in the fact that through them man can use 
his illusions creatively. 

Rank's critics considered this a cynical standpoint be- 
cause of its suggested implication that mankind must 
live on illusions. But viewed in the perspective of history, 
the beliefs of mankind, which were always supposedly 
based on truth, have continually changed and thus what 
people believe in is evidently not the objective, final 
truth. The truth is something provisional, something to 
be developed. But one has to have faith. Rank empha- 
sized the need for faith in oneself and in one's own truth. 
This includes the need to develop one's own ethical 
standards. However, Rank took for granted the need for 
illusions. 

From Rank's standpoint, Freud's therapy is biological 
because it is centered on instinct; Adler's is social because 
it sets out to align the individual with society. He con- 
sidered his own truly psychological because it is individ- 
ual centered. It emphasizes the will of the individual, 
which is the essence of his psyche. To Rank, the individ- 
ual is his own creator. Therapy is not a matter of biology 
or sociology but of psychology, and it works by provid- 
52 



What Schools of Psychoanalysis Are There? 

ing in the analytical situation a controlled experience 
that may lead to the development of faith in one's in- 
dividuality. 

The weakness of the Rankian method lies in its inade- 
quate character analysis. Rank's therapy, like Adler's, is 
an attempt to solve neurotic difficulties by the applica- 
tion of one principle. 

CARL GUSTAV JUNc's ANALYTICAL PSYCHOLOGY 

The chief cause of neurotic disturbances, according to 
Jung, is the failure to live according to the laws of the 
soul. In his numerous writings Jung has worked out and 
formulated in detail his own system of the structure of 
the psyche. The laws of the psyche are considered given 
by its own nature, and they are conceived as universal 
and eternal. The task of therapy coincides with that of 
wisdom; it is to make it possible to learn to live accord- 
ing to these inner laws. The internal harmony is made 
possible by the balance between the conscious and the 
unconscious. The true way of life is to live according to 
the order that reigns in the unconscious. 

The structure of the psyche consists largely of pairs 
of opposites, such as thinking and feeling, sensation and 
intuition, as four varieties of function, and extraversion 
and introversion as two basic attitudes. Difficulties arise 
when one of these modes is overemphasized to the detri- 
ment of its opposite. Similarly, the conscious and the 
unconscious are thought of as complementary. 

Parts of the personality may be split off and continue 

53 



Are You Considering Psychoanalysis? 

an autonomous existence, of which the individual is not 
aware. These are called complexes. Symptoms, such as 
slips of the tongue, may indicate their existence. Jung 
agrees with Freud that these complexes are often the 
result of traumatic experiences. Years ago, Jung devised 
the association experiment for the detection of com- 
plexes. 

Later, however, Jung derived his understanding of the 
unconscious chiefly from a study of the symbolism con- 
tained in all mythologies and, more particularly, in the 
ancient Eastern religious systems and from similar sym- 
bols he found in dreams. Whereas Freudian dream inter- 
pretation emphasizes the repressed sexual wishes, Jung 
sees dream symbols as the expression of timeless pat- 
terns of the unconscious. The personal unconscious is 
determined by the universal collective unconscious, and 
the patterns of the latter are called the archetypes. Ex- 
amples of archetypal images are the mother, the father, 
the hero, the virgin birth, the rebirth, paradise, the wise 
man, the snake, the fish, the Sphinx, the world tree, etc. 
Their number is limited, and they stand for typical and 
fundamental human experiences. 

The social f agade called the "persona" may take on 
a rigidity that leads to a suppression of the deeper uncon- 
scious. The darker side of our personality the "shadow" 
causes difficulty because of our tendency to disavow it 
and to project it upon others. It is necessary that we allo- 
cate it where it belongs in ourselves. Certain typical 
unconscious content refers to the experiences charac- 
teristic of the opposite sex, and such content is sup- 
54 



What Schools of Psychoanalysis Are There? 

posed to be active in everyone. It is termed anima in men 
and animus in women. In working toward the develop- 
ment of one's real self, the persona, the shadow, the ani- 
mus or anima must be thoroughly understood and their 
content be brought into harmony with the deeper levels 
of the collective unconscious. The same working through 
is necessary with regard to the so-called personal un- 
conscious. 

Suppression and neglect of the unconscious leads to 
the conscious being overflooded by the unconscious in 
a chaotic way. Such a state of regression constitutes, 
however, at the same time, a challenge to bring oneself 
into harmony with the unconscious. This can be facil- 
itated through therapy. Therapy does not create a new 
order; it merely brings about more favorable conditions 
for the predetermined order of the unconscious to estab- 
lish itself. 

Jung strives toward a formal clarity and precision such 
as obtains in theoretical physics. He believes that it is 
particularly the man of Western civilization who needs 
outside help to square himself with the unconscious, be- 
cause he has become estranged from it to an unusual 
degree. 

While all schools agree in regarding the neurotic as a 
person whose inner balance is disturbed, each considers 
him from a different angle, and consequently each offers 
a different remedy. With Freud the emphasis is on the 
difficulties of the sexual development; with Adler it is 
the overcoming of the egocentric inferiority-superiority 
drive by adjustment to society; with Rank it is the estab- 

55 



Are You Considering Psychoanalysis? 

lishment of the uniqueness and independence of the 
individual through creativeness and assertion of his own 
will; for Jung it is a problem of getting oneself in har- 
mony with the inner structure of the soul which is con- 
ceived in terms supposedly valid for all times and places. 
What Jung offers is akin to a religious solution. His 
system may be regarded as an attempt at devising a uni- 
versal scientific religion. It is probable that at the present 
time, at any rate, only a few selected individuals would 
respond to this method. 



New developments in psychoanalysis that took place 
in the 1930's are associated with the names of Harry 
Stack Sullivan, Erich Fromm, and Karen Horney. It is 
characteristic of all three that they abandoned Freud's 
one-sided orientation resulting from his strict adherence 
to the libido theory but that they preserved, on the 
whole, many of his other basic formulations. 

In the course of intensive psychiatric work in mental 
institutions, Sullivan found that the development of the 
individual's insight into his relationship with other peo- 
ple was an essential factor in therapy. In consequence, 
sexuality was seen as only a part of the larger scheme of 
human relationship. Erich Fromm is not a medical man 
but a sociologist and a psychoanalyst, and with this un- 
usual combination of knowledge he saw more clearly 
than most the influence of the social-economic factors on 
character development. His findings indicated that neu- 
56 



What Schools of Psychoanalysis Are There? 

rotic difficulties were not fixed biological developments 
but potentially plastic psychological reactions. 



KAREN HORNEYS THEORY OF PSYCHOANALYSIS 

Karen Homey has been largely responsible for the de- 
velopment in recent years of a more progressive type of 
psychoanalysis. She has presented her views on neurosis 
clearly and consistently in several books. Her theory will 
be taken up in the f ollowing chapter. I shall here attempt 
only to indicate how Horney's approach differs in spirit 
from Freudian analysis. 

We must try to see Freud in the perspective of his time. 
The late nineteenth century was predominantly mate- 
rialistic and cynical in its thinking. This was partly due 
to the astounding advances made in the sciences: the 
progress of physics and chemistry, the discovery of germs 
as causes of diseases, the progress of pathology and, 
finally, Darwin's theory of the evolution of man from 
the animal. The animal nature of man was stressed. 
Something had to be found in his animal nature to ac- 
count for his difficulties as a human being. Parts were 
made to account for the whole. Sexuality appeared to 
Freud as the foundation of personality and character. 
Specialization was glorified; larger horizons were lost 
sight of. Freud's theories fit very well into this so-called 
scientific period. 

Gradually medical men themselves became aware of 
the dangers of specialization and isolation from other 

57 



Are You Considering Psychoanalysis? 

branches of knowledge, especially those of sociology and 
the humanities, and they began to show an interest in a 
broader viewpoint. This was in keeping with progress 
in the field of philosophy, in which a better understand- 
ing of the relationship of parts to the whole was achieved. 
The importance of grasping the meaning of larger struc- 
tures became more and more evident. In the field of 
psychoanalysis this viewpoint led to a re-examination of 
the meaning of sexuality. In the place of the Freudian 
formula, according to which character is determined by 
sexuality, it was found that sexuality was largely deter- 
mined by character. 

Horney's theory is an expression of this development. 
Therapy, according to her, involves the understanding of 
the whole neurotic character structure. The healthy per- 
son has a certain strength, unity, and capacity of self- 
determination. Everyone has the inherent capacity to 
develop into such a person. In the neurotic individual 
this development has been interfered with. The growth 
of a personality is largely determined by the kind of 
relationships developed with other people. Neurotic de- 
velopment is the consequence of disturbed human re- 
lationships, and the neurotic structure perpetuates the 
disturbed relationships with people. 

Analysis as seen by Homey offers a human relation- 
ship that is realistically secure and in which one has an 
opportunity to bring the neurotic devices out into the 
open, to see them as part of oneself, and to take an in- 
terest in modifying them. In place of neurotic solutions 
of problems, one can acquire reasonable ways of dealing 
58 



What Schools of Psychoanalysis Are There? 

with oneself and with others. Through one's own effort 
one finds a way to win back one's birthright, confidence 
in one's own resources, and self-esteem based on belief 
in values one can live up to. 

Although Horney rejects the libido theory, she may 
be considered a follower of Freud. Like Freud, she be- 
lieves that the chief task of psychoanalysis is the study 
of unconscious motivations. In analysis she makes con- 
sistent use of the Freudian technique of free association. 
The important difference is that in place of the analysis 
of the libido she puts analysis of all the unconscious com- 
ponents of the character. There is no minimizing of the 
neurotic difficulties. One has to deal with them in all 
their complexity. The neurotic attitudes are compara- 
ble in their strength, pervasiveness, and consistency to 
philosophies of life. Although largely unconscious, they 
are defended with great energy and tenacity. In conse- 
quence, the individual suffers great emotional loss and 
may entertain feelings of hopelessness. 

Nevertheless, in contrast with Freud, Horney's out- 
look is definitely optimistic. There is no need to assume a 
basic destructiveness in human nature. The fuller under- 
standing of the neurotic structures also opens better 
ways by which the neurotic conflicts can be resolved. 
Therapy should set free the individual's inherent capac- 
ity to grow into a wholesome human being. 



59 



What Is a Neurosis? 



MURIEL IVIMEY, M.D. 



WE HAVE given you a general review of the different 
schools of psychoanalysis, ending with a brief section 
on the theories developed by Karen Horney. In this chap- 
ter I shall discuss her point of view in some further detail. 
I shall deal with what is fundamentally important in 
neurosis in order that you may get a general understand- 
ing of its manifold difficulties, its various manifestations, 
and its innumerable symptoms. My main focus will be 
on the total character of the neurotic personality from 
which these difficulties arise rather than on the mani- 
festations or symptoms themselves. This theory of neu- 
rosis is the basis of discussion in the ensuing chapters. 

Theory is an essential tool in scientific work. It is not 
to be confused with guesswork or speculation or pure 
abstraction. It is a rational and logical attempt to explain 
and correlate as many of the observed phenomena as 
possible at a given period in the development of a sci- 

61 



Are You Considering Psychoanalysis? 

ence. Since no theory is ever perfect, sooner or later 
weaknesses and false concepts come to light. Then scien- 
tists modify and revise their theory. When experience 
reveals evidence that calls for radical changes, an en- 
tirely new approach to scientific problems becomes nec- 
essary. Sometimes people feel uneasy or skeptical about a 
new theory for it means that they must abandon accus- 
tomed ways of thinking. However, many who have had 
their own doubts about the validity of existing concepts 
are willing and eager to learn of progress in theory that 
offers greater benefits to mankind in the practical appli- 
cation of a science. 

Our new theory brings into sharp and unequivocal 
focus the psychic life of man his entity as a person. We 
believe that psychic being or personality has its own 
unique essence and directives, its own forces for survival, 
its own dynamics of development and growth, and its 
own internal and external fulfillment. Its development 
and growth can be interfered with; it can become sick, 
inhibited, and distorted. Neurosis is the expression of 
this kind of development. With this focus a psychology 
emerges clear and distinct, unconfused with issues relat- 
ing to organic instinctual considerations as basic factors 
in attempting to understand man's nature, sick or well. 

This frees us to consider much more comprehensively 
all aspects of human nature hot only those that pertain 
to the sex life, or those that pertain to physical status 
( organ inferiority ) , or those that pertain to the spiritual 
and mystical nature but the whole of man's nature, in- 
cluding these aspects and others. The particular phe- 
62 



What Is a Neurosis? 



nomena that earlier psychoanalytic theories had not 
sufficiently taken into account and explained were those 
relating to the individual's relationships with others and 
his relationship with himself. We focus on the individual 
in his human environment or social setting in its broad 
sense. We are convinced that neurosis originates in and 
remains essentially a disturbance in human relations. 

We conceive of personality as acquiring structure in 
response to environmental conditions. This concept of 
structure is somewhat analogous to the physicist's con- 
cept of atomic structure as consisting of elements and 
forces tending to maintain the structure and to effect 
function in relation to other bodies. Each personality has 
its own unique psychic elements and forces that main- 
tain the integrity of the structure. Each personality func- 
tions in accordance with its individual characteristics in 
relation to other personalities. 

We make another important step in viewing human 
nature. We break with the arbitrary assignment of spe- 
cific innate psychological differences between men and 
women on the basis of sex alone. Anthropological and 
sociological studies have produced convincing evidence 
that what have been taken for fundamental psychosex- 
ual differences are preponderantly the consequence of 
external cultural influences. Our experience in psycho- 
analysis shows us that these differences are not rooted 
in the male and female constitution. 

The crucial period in personality development is early 
childhood; the child is malleable and the human environ- 
ment is the decisive factor in character formation. A 

63 



Are You Considering Psychoanalysis? 

relatively good psychic environment favors develop- 
ment of a strong nucleus of personality which leads to 
expansion and greater fulfillment. In a poor, barren, or 
obstructive psychic environment the inner core of per- 
sonality is unsubstantial and shaky; this leads to the 
development of a neurotic character structure. The in- 
dividual who has had quite a good start may encounter 
overwhelmingly disadvantageous conditions in later 
childhood or adolescence that he may not have sufficient 
strength to cope with, and neurotic tendencies may de- 
velop. On the other hand, a child in whom weaknesses in 
structure have begun to develop may come into a life 
situation so favorable that he is able to develop more 
strongly. As a rule, however, the early outlines in char- 
acter formation in an unfavorable environment tend to 
become set and confirmed. 

In the course of time an enormous and complicated 
elaboration is effected in order to strengthen inner weak- 
ness. This serves in later life situations that actually have 
no relation to the original unfavorable environment. So 
there comes to be a marked discrepancy between an in- 
dividual's concept of his present environment and the 
realities of that environment. Also, in the course of time 
the individual's potential mental and emotional capac- 
ities to deal with life as it really is have increased enor- 
mously. But he feels and behaves and acts according to 
the established patterns of his character structure as it 
developed under the original unfavorable conditions. 
Here is another discrepancy, an internal one, between 
64 



What Is a Neurosis? 



the neurotic personality and the potentially strong and 
healthy personality. 

We keep these discrepancies in view and focus mainly 
on the difficulties that beset him in his inner life and the 
consequent difficulties in his relationships with others, 
rather than on the external environmental situation. For 
whatever his external situation may be, favorable or un- 
favorable, he does not see it realistically nor can he real- 
istically mobilize his best resources to cope with it. So 
while we focus on environmental factors in childhood in 
attempting to understand what is going on in personal- 
ity development in the formative stages, we focus on the 
accomplished fact of the present neurotic structure when 
it is already developed. 

Now let us consider personality development in its 
early phases. In the very young infant evidences of self 
seem to be limited to his reactions to physical well-being 
and physical discomfort. Day by day, week by week, and 
month by month immature reasoning, thinking, plan- 
ning, and discrimination come into play. We say the 
baby is getting to be somebody, a person. He has spon- 
taneous and original impulses that are the expressions of 
a self in the process of developing. He fumbles, experi- 
ments, embarks on various undertakings and adventures, 
tries himself out in this or that situation, devises projects, 
seeking always to extend his experience. The more he 
feels himself to be active and able and effective, the 
more he wants to experience and the stronger is his urge 
to grow in his feeling of himself. 

65 



Are You Considering Psychoanalysis? 

He notices people around him and begins to know 
who they are and what they do for him and to him. Then 
he begins to differentiate between people according to 
their dealings with him and between different attitudes 
of the same person toward him. If their ways are benign 
and understanding and encouraging, he evolves free and 
natural ways of functioning and a sense of well-being and 
sureness and confidence in himself. 

In view of his factual immaturity and relative weak- 
ness, his strongest needs are personal warmth, reliability, 
and regard for his immaturity. As his judgment and rea- 
soning develop he needs understanding, respect, and 
justice. These qualities and capacities in those who take 
care of him mean genuine love for him, which he appre- 
ciates and understands. Such would be the ideal psychic 
environment. However, these perfect conditions rarely 
exist in our society. Although we have learned scientifi- 
cally to control conditions for the best development of 
other living things plants and animals we cannot 
artificially provide perfect conditions for human beings. 
This is the great hazard in human life. 

What are unfavorable psychic conditions in the early 
environment? The closest and most influential relation- 
ship in the child's early life is with his parents or those 
who take the place of parents, such as relatives, nurses, 
guardians, institution authorities, etc. The most potent 
adverse influences are the shortcomings of such persons 
their inexperience and inability to give genuine love to 
the child for himself alone with no ulterior or spurious 
aims; intense "love" and adoration; unreliability and in- 
66 



What Is a Neurosis? 



consistency in regard to understanding, guidance, and 
rational discipline; overindulgence; oversolicitude; fa- 
voritism; capriciousness; unpredictability and injustice 
when the spoiled child runs wild. 

Parents sometimes demand intense love and devotion 
which the child cannot give; he thus fails to live up to 
exorbitant expectations and is rejected and made to 
feel wanting or guilty. He lives in a sort of emotional 
alternating current that goes on and off, in which he 
can only be confused. Active antagonism is obviously 
frightening as are humiliations, ridicule, contempt, inap- 
propriate use of authority, and too rigid or cruel disci- 
pline. Excessive physical punishment is a real hardship 
and does affect personality development. However, psy- 
chological discipline that cramps, frustrates, and crushes 
the child's feeling of his value as a human being is far 
worse. Overemphasis on and excessive expectations in 
conventional social behavior and school performance 
give the child a feeling that he is no good as he is, but is 
worth something only if he comes up to arbitrary stand- 
ards. Inattention, coldness, and remoteness in parents 
are likely to set up a feeling of vagueness and eeriness in 
the child's feeling about himself. He gets no feeling of 
reality about his existence as a person if he does not see 
himself as real and important in the eyes of others. 

In addition to these adverse psychological conditions, 
many parental attitudes bear the imprint of general cul- 
tural prejudices and distortions of human values com- 
mon in the community, state, country, or civilization at 
large. For instance, the following attitudes are frequently 

67 



Are You Considering Psychoanalysis? 

communicated through parents: a preference for boys 
and a prejudice against girls, or vice versa; attaching spe- 
cial values to personal appearance and physical develop- 
ment; intense competitive strivings for popularity, dates, 
high marks at school, educational accomplishment; the 
possession of money, fashionable clothes, material things 
that are the criteria of "belonging"; pernicious political 
ideologies; dishonesty, cynicism, decadence, which may 
taint a whole culture or civilization. 

These attitudes and prejudices are not always medi- 
ated by parents, but may be encountered outside the 
home. They are likely to affect the child's sense of his 
own worth if emotional factors in the home have already 
contributed to an inner sense of precariousness. But if 
relationships in the home have contributed to the de- 
velopment of a strong and secure inner core of person- 
ality, the child may not be much affected by adverse 
conditions from cultural sources outside. Other adverse 
influences of the same nature as those exercised by par- 
ents are projected by siblings, other relatives, and serv- 
ants in close contact with the child. 

Normally, children are aware of being small and less 
capable than those who are older and taller and able to 
accomplish more than children do. Nevertheless, under 
favorable environmental conditions, they have an inner 
sense of personal importance and value. They cope with 
life with originality, freedom, and strong persistence to 
learn and overcome obstacles. If the environment does 
not present positive threats, the child's feeling of disad- 
vantage usually disappears in the course of later develop- 



What Is a Neurosis? 



ment and successful accomplishment as his experience 
broadens in school and social life. 

According to the extent to which the relationships of 
others toward the child fall short of being favorable, feel- 
ings of insecurity arise in him. According to the extent 
to which conditions are positively against the interests 
of the child's development, his inner feeling is one of real 
peril or of fear for his survival as a person. Such feelings 
of insecurity, peril or fear give rise to inferiority feelings. 
This expression is used rather commonly to refer to sim- 
ple feelings of being at a disadvantage or feelings of in- 
adequacy but it has much stronger implications. Inferi- 
ority feelings involve feelings of being of little or no 
worth as a human being, of not having the status that 
others have, of being despised and cast out of a place 
with others. 

Since there is no such thing as perfect understanding 
or pure essence of love for a child, inferiority feelings are 
probably very common in childhood. Those that persist 
have their origin in a sense of real danger to the self. The 
child feels helpless, abandoned, alone, isolated; he feels 
there is no one to go to who can be trusted and the whole 
world is hostile to him. He inevitably develops a sense 
of hostility to the world. The state of feeling helpless, 
isolated, and hostile is called basic anxiety. Basic anxiety 
is the motivating force that starts the neurotic process 
going. In order to allay basic anxiety, the child mobilizes 
his resources and energies, and his attitudes and be- 
havior toward others are modified in the interest of in- 
suring his safety. 

69 



Are You Considering Psychoanalysis? 

There is a deep human need to orient oneself in rela- 
tion to other human beings. We are beginning to discern 
phenomena in human relationships that express this need 
and that are manifested in three kinds of movement in 
relation to others : ( 1 ) tendencies to move toward others 
in affection, trust, and interdependency ; ( 2 ) tendencies 
to move against others in opposition to them and to stand 
up for one's own interests, and defeat others; (3) tend- 
encies to move away from others in order to cultivate 
oneself as a separate entity. These three types of move- 
ment were first identified in exaggerated manifestations 
in disturbed, anxiety-ridden individuals. They appeared 
as compulsive and indiscriminate. If the individual was 
frustrated in expression and satisfaction of them, he felt 
intense discomfort. 

Without the element of exaggeration, the tendency to 
go toward others is expressed in being friendly and con- 
siderate, in being in close, affectionate rapport, in trust- 
ing people, asking for help when it is needed, giving help, 
in yielding to others when it is appropriate. The tendency 
to go against others is expressed in standing up to others, 
insisting on one's own rights, pushing one's own claims, 
competing with others with the aim of excelling, pro- 
testing and fighting if necessary when one is ill-used, be- 
ing alert and on guard against insidious attack. The 
tendency to move away from others is expressed in with- 
drawing and maintaining personal privacy. It satisfies 
natural interests in self-sufficiency and independence, 
natural needs for solitude, respite from the impact of the 
outer world, contemplation necessary for maintaining 
70 



What Is a Neurosis? 



contact with oneself and for developing one's own crea- 
tive capacities. 

A child who has a sense of inner precariousness or 
basic anxiety has to regulate his movements in human 
relationships according to his need for safety, and his 
movements in relationships with others become invested 
with forces and energies necessary to attain it. When he 
moves toward others, he is driven by intense needs for 
affection, needs to find someone to cling to in undue 
dependence, to be excessively compliant, appeasing, 
placating, and conciliatory. When he moves against 
others, he feels he must dominate, override, get the best 
of others, and fight for supremacy. Movement away from 
others is expressed in extreme withdrawal, pulling away, 
covering up, and hiding. These are called neurotic trends. 
They are neurotic because, provoked by an inner state 
of trepidation and alarm, they are imbued with excessive 
tensions and are carried out with an excessive amount of 
energy in striving for the particular goal of each trend, 
which in each case means safety. A literal paraphrase of 
the term neurotic would be "full of nervousness," or 
"full of nervous tension." 

Neurotic trends are characterized by constant and 
intense preoccupation with the goal of the trend and 
with the means to achieve it, and they are pursued with 
relentless tenacity. This is the quality of compulsiveness. 
They also have the quality of indiscriminateness, that is, 
the individual must get everyone to like him, or he must 
be defiant and aggressive on all occasions, or he must 
protect himself by withdrawing as a blanket policy. And 

71 



Are You Considering Psychoanalysis? 

finally, when the individual is frustrated in his neurotic 
aims and activities, he feels unsafe, anxious, or panicky. 
He may not feel anxiety as such but it may be transmuted 
into a depression, or an outburst of rage, or a state of 
paralyzing blankness, or disorders of bodily function. 

Because of basic anxiety all three aspects of movement 
in relation to others become compulsive and indiscrimi- 
nate. In individual children, some one group of trends 
with their special needs and aims is emphasized and 
adopted as a preferred way to cope with the environ- 
ment. Whether constitutional variations in individual 
children play a role in the selection of a particular group 
of trends is not clear at present; this question will have 
to wait upon further research. Whatever may come to 
light, it is fairly certain that the influence of environment 
is the prime factor in necessitating the adoption of some 
means to insure safety. So we see different types of solu- 
tion of the problem of anxiety in childhood in the 
approval-seeking, obedient, submissive child; the rebel- 
lious, defiant child; and the quiet, withdrawn child. Later 
developments show that no matter which general type 
of reaction first emerges, neurotic trends of the other 
two categories have also developed although they may 
not be in evidence. 

There is a great expansion of needs in the course of 
time. All people with whom the neurotic individual 
comes in contact take on the aspect of "prospects" for the 
satisfaction of neurotic needs, and all situations repre- 
sent mainly a potential field in which to operate on these 
terms. If the individual is predominantly approval- 
72 



What Is a Neurosis? 



seeking and compliant, he must get everyone to like him, 
whether or not others have likable and valuable quali- 
ties, whether or not the individual really likes them, and 
whether or not they are of real importance to him. He 
must always be approved of; he must always be indulged 
and protected and privileged. Neurotic aggressiveness 
drives a person to offensive attitudes and behavior 
toward everybody, whether or not they are threatening 
and antagonistic to him, and whether or not there is 
anything necessary and constructive to be gained in 
defeating others. Trends to isolate oneself from others 
dictate extreme independence; even when the individual 
is really in need of human contact, he must guard his 
privacy to the point of foregoing necessary help. The 
same general principle holds true regardless of the rela- 
tive importance of situations. The neurotic person will 
behave in the same compulsive way whether he is mak- 
ing a trivial purchase or pursuing his lifework. 

Each trend is implemented, in time, with special 
strategies, tactics and maneuvers appropriate to it. 
These are seen more clearly in individuals in whom 
trends of one category predominate, and in whom 
trends of other categories are kept out of sight or re- 
pressed. The predominantly compliant individual de- 
velops, in the course of time and experience, endearing, 
flattering and cajoling methods; he goes to great lengths 
to be submissive, self-effacing, never to put forward any 
claims for himself. The predominantly aggressive indi- 
vidual develops special alertness to the weaknesses, 
flaws, and sensitivities of others in order to increase his 

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Are You Considering Psychoanalysis? 

advantage; he cultivates the arts and skills of the fighter, 
and callously overrides the rights and interests of 
others. Inattention, coldness, great guardedness in re- 
spect to approaches of others, extreme independence 
and self-sufficiency are methods employed by the pre- 
dominantly detached individual to keep a distance 
between himself and others. 

Associated with each neurotic trend are special sen- 
sitivities, fears, and inhibitions. People with strong 
compliancy trends are especially sensitive to displeasure 
or anger in others, are fearful of anything approaching 
an argument or fight, and are unable to be demanding 
or aggressive. Those who are mainly compulsively ag- 
gressive are wary of affectionate, considerate behavior 
and treatment and are generally inhibited in any ex- 
pression of softer feelings. People who are predomi- 
nantly detached are extremely uncomfortable when it 
is necessary to be in close contact with others; they 
dread anything which threatens their independence 
and self-sufficiency, and they are quite strictly limited 
in respect to any kind of real personal intimacy. 

The neurotic individual evolves special falsely ra- 
tionalized values for neurotic trends in order to justify 
them and in order not to see them in their true light. 
For if he did, he would have to realize that they are 
indefensible. He comes to regard them as sensible, 
logical, necessary, unavoidable, attractive, praiseworthy, 
and superior to other ways. And conversely, he regards 
natural healthy ways as inferior, impractical, senseless 
or positively immoral. 
74 



What Is a Neurosis? 



With the development of neurotic trends as safety 
devices, basic anxiety is apt to recede into the back- 
ground of consciousness, although in some individuals 
it is felt as a secret, lurking sense of being a lonely, 
friendless child in a hostile world. In others, it is com- 
pletely lost sight of but persists as a smoldering core in 
the personality. In the course of time it acquires accruals 
of intensity arising from various sources. The very per- 
sistence of the means to insure safety keeps alive and 
enhances the illusion of loneliness and danger and the 
constant practice of neurotic maneuvers reinforces the 
sense of driving necessity to protect oneself. The success 
of the devices comes to have the significance of proof 
of their validity. "It always works, so it must be right." 
Undiscerning and uncritical friends subscribe to the 
compulsive needs of the neurotic individual and unwit- 
tingly support him in his notion of necessity and validity. 

In the pursuance of neurotic aims and the practice of 
neurotic ways, the individual has not developed natural, 
appropriate ways of dealing with life. Hence, when his 
neurotic devices fail him he has nothing else and is really 
helpless. He is then exposed to his worst terror being 
completely at the mercy of the world. Ernie Pyle writes 
of the reaction to the sound of a shell when soldiers are 
under fire: "The sound produces a kind of horror that is 
something more than mere fright. It is a confused form 
of acute desperation." Just as the soldier is helpless in 
this situation, so the neurotic is essentially helpless 
because he actually has no means to fend off the hostility 
of the world. 

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Are You Considering Psychoanalysis? 

The neurotic individual's expectations of danger from 
the outside are enhanced because his impulses are super- 
charged. He would surrender completely and abjectly 
in the interests of dependency; his aggressive drives 
would lead him to antagonize and alienate others; his 
tendencies to isolate himself would set him off fur- 
ther and further in loneliness. So his very safety devices, 
while warding off dangers, constitute at the same time 
a threat to safety. Compliancy trends lead to being 
exploited; aggressiveness stirs up counterattack and 
alienates affectionate people; and detachment tend- 
encies lead to ostracism. But the neurotic individual 
does not realize that what happens to him is to a large 
extent the result of his own behavior and activities; 
nevertheless, he suffers from these consequences. 

In addition, the simultaneous existence in the indi- 
vidual of neurotic trends belonging to these three cate- 
gories leads to the generation of more anxiety from inter- 
nal sources, He has three means of achieving safety all 
of which are at variance with each other. Getting ap- 
proval and establishing clinging, dependent relation- 
ships constitute attempts to achieve safety by means that 
are diametrically opposite to rebellious, offensive, and 
aggressive tactics. And these means which bring him 
into close contact with others, one in excessive friendli- 
ness, the other in enmity, are at variance in turn with his 
compulsive needs to withdraw and isolate himself. Iso- 
lation endangers compliant attitudes as well as aggres- 
sive drives because it interferes with the individual's 
attempts at getting affection and protection on the one 
76 



What Is a Neurosis? 



hand, and prevents him from maintaining his aggressive 
position on the other. 

If impulses from discrepant and incompatible sources 
arise simultaneously, they can create a most serious 
dilemma, the dilemma of conflict. The individual has no 
choice of compulsive means to insure safety since the 
forces involved in all his compulsive ways are equally 
strong. When drives aiming at different goals are felt 
in full force, the individual has the experience of being 
torn apart, of going to pieces. Conflict felt less acutely 
precipitates confusion and anxiety. The individual feels 
threatened with the breakdown of his defense system 
and the penalty for such a breakdown is total vulnera- 
bility in a hostile world. 

The neurotic individual must avoid such a calamity 
at all costs. The rest of this discussion of the neurotic 
character structure deals with the individual's attempts 
to avoid awareness of conflict, of the contradictory quali- 
ties, needs, aims, and values of his incompatible neurotic 
trends. He must create the illusion of integrity, harmony, 
or unity in order to maintain his equilibrium and avoid 
the threat of disintegration. 

We call the means he employs to accomplish this his 
attempts at solution of conflict. When we speak of the 
neurotic solutions of conflict, we mean false or pseudo 
solutions, for there is no real solution of conflict except 
the undoing of the tangled web of irreconcilable neurotic 
trends. We identify four main ways in which the neu- 
rotic individual attempts to solve inner conflict: (1) pre- 
dominance of one set of major neurotic trends; (2) ex- 

77 



Are You Considering Psychoanalysis? 

ternalization of internal problems; (3) construction of 
an idealized image of the self; (4) detachment from 
emotional relationships with others. 

In the first instance, the predominance of one set of 
major neurotic trends, the individual admits neurotic 
trends of one general category into consciousness, though 
without a true appreciation of their significance, and 
represses contradictory trends. He can thus think of 
himself as one kind of person and establish a feeling of 
unity, of not being divided. On the surface such people 
seem to present definite, consistent types of personality 
the affectionate, compliant type, the aggressive type, 
or the detached type. In such "typing" we must remem- 
ber that the obvious traits are only the predominating 
ones, and that incompatible trends exist as tremendously 
potent underground forces which make themselves felt 
in the inner life, though completely unrecognized by 
the individual and vehemently denied as quite alien 
to him. 

Inhibitions are the chief clues to repressed trends. The 
person in whom compliance and dependency predomi- 
nate will be unable to stand up for himself and fight; 
the aggressive type of person is unable to yield and seek 
the good graces of others. Both types are frequently 
unable to contain themselves in solitude. The withdrawn 
type of person is unable to establish intimate personal 
relationships with others either for approval or in aggres- 
sive action. Repressed trends are bound to precipitate 
tensions and to find expression in some form or other. 
Slips of the tongue, inadvertent remarks, forgetting and 
78 



What Is a Neurosis? 



absent-mindedness reveal unknown and unacknowl- 
edged tendencies. Phantasies and dreams contain mate- 
rial that helps us to identify and understand repressed 
neurotic tendencies. The rationalized values for the pre- 
dominating trends are greatly reinforced, and the re- 
pressed trends are devaluated to the point of abhorrence. 

Externalization of inner problems means that the in- 
dividual manages to remain unaware of his neurotic 
trends and conflicts by focusing on other people's diffi- 
culties, their troubles, their weaknesses. He usually feels 
that his environment is in a turmoil, that the world is 
out of joint. He may take a morbid satisfaction in such 
matters. He tends to interfere, criticize, advise, instruct, 
apparently helpfully. But there is always a quality of 
indiscriminateness, indiscretion, and tactlessness that is 
the clue to a driven need to avoid awareness of difficul- 
ties within himself. He tends to put the blame for what- 
ever he suffers in consequence of his own inner conflicts 
upon external conditions, and he may feel helpless and 
swamped by them. He feels he is tired and nervous be- 
cause of his job situation, because of the impossible dis- 
position of his boss, his friend, or his wife. He would say 
that city life is too hectic, that country life is too dull 
He believes he would get on better socially and in his 
work if only he had better clothes or the right connec- 
tions or if only his wife was more helpful. He is con- 
vinced that he flies into an ungovernable temper only 
because someone provoked him, that he married only 
because his wife inveigled him into it. 

He looks to the outside for the solution to his difficul- 

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Are You Considering Psychoanalysis? 

ties a change of location, a different wife, a devoted 
friend who would understand him and he busies him- 
self manipulating and changing the external circum- 
stances of his life. Frequently women believe that having 
a baby would dispel discontent and boredom under the 
impression that, if they had someone to live for, their 
difficulties would disappear. Whatever is really disad- 
vantageous in the external situation is never tackled 
realistically; constructive changes are not undertaken 
and, above all, the individual never looks into himself 
to figure out his responsibility, to discover how he him- 
self could bring about constructive changes. 

The person who attempts to solve conflicts by way of 
creating an idealized image of himself rises above his 
inner difficulties by sustaining himself in phantasies of 
being a superpersonality. He gathers his material for 
this construction of his personality from the falsely ra- 
tionalized values he has created for his neurotic traits. 
The idealized image is a merger of discrepant charac- 
teristics which he does not recognize as discrepant but 
conceives of only as virtues which he arrogates to him- 
self. 

For instance, a woman saw herself as a "benevolent 
business woman with a broad social outlook/' Analysis 
of her personality revealed intense needs for approval 
and compulsive tendencies to comply and submit to 
others. She was overconsiderate and self-sacrificing, ex- 
aggeratedly helpful and overindulgent toward others. 
This was her "benevolence." She also had strong hostile 
80 



What Is a Neurosis? 



aggressive tendencies, expressed mainly in hard-boiled, 
exploitive business practices of which she was quite 
proud, and in subtlely sadistic attitudes and behavior 
in social life and intimate relationships. This was the 
"business woman." She also tended to stand aloof from 
others, to take the position of a bystander and onlooker 
in human affairs, to be unduly independent. These char- 
acteristics were some manifestation of her withdrawal 
tendencies. She had taken traits from each main neurotic 
trend, converted them into virtues in her own estima- 
tion and thus characterized herself to her own satisfac- 
tion in the thumbnail sketch of a "benevolent business 
woman with a broad social outlook." In addition, her at- 
tention was almost exclusively directed to problems out- 
side of herself. Her first statement upon undertaking 
analysis was that she felt she was entirely well adjusted, 
that she had no personal difficulties but would like to see 
if analysis would solve two problems, one in her business 
life and the other connected with her domestic situation. 
The fourth main way in which the neurotic individual 
attempts to eliminate conflict is to avoid all emotional 
involvement with others. This constitutes an attempt to 
ignore or deny contradictory trends by seeing to it that 
no occasion arises in which emotions would come into 
play. It is similar to the basic neurotic trend to with- 
draw from a threatening environment as a safety device 
but is practiced to avoid the danger of becoming aware 
of inner feelings. Avoiding all emotional involvement, 
the individual permits himself only limited dealings with 

81 



Are You Considering Psychoanalysis? 

others through certain limited avenues of approach. 
These are suggested by pressure needs of other drives 
which must also be satisfied. 

For instance, if there are very strong needs for affec- 
tion, the individual may adopt sexuality as the basis of 
relationships with others. In this he maintains emotional 
detachment, satisfies needs for closeness to others, and 
has the illusion that he is participating in a love rela- 
tionship. Or the individual may limit himself to intellec- 
tual interests with others, or business dealings, or other 
practical affairs as common ground and make them the 
whole point of contact. Those who are involved in such 
relationships with him always have the impression that 
they do not really know how he feels about anything 
they do not know him as a whole person. 

The neurotic solution of conflict is a process that takes 
time to evolve. We see individuals who have not yet 
come to a solution, or who show some evidence that 
they are^ beginning to hit upon one, or who flit from 
one solution to another experimentally. All four solutions 
are usually utilized to some extent by the same person, 
sometimes with emphasis on one type of solution. 

Although neurotic solutions of conflict are devised for 
the purpose of holding the personality together and 
maintaining equilibrium, they in their turn constitute 
defenses that must be maintained, else the individual 
feels endangered or upset. A variety of secondary de- 
fenses function as additional insurance against becom- 
ing aware of conflict. These are the cultivation of blind 
spots by which the individual can remain blissfully un- 
82 



What Is a Neurosis? 



aware of contradictions and discrepancies; rationaliza- 
tion, by which he explains away inconsistencies by 
plausible but spurious justifications. 

He also compartmentalizes his thinking, that is, he 
sees no inconsistency in behaving and acting one way 
in private, another way in public; one way toward mem- 
bers of the family, another way toward friends and ac- 
quaintances outside the family; one way toward social 
equals, another way toward those he does not consider 
his social equals, etc. Another common defense is to 
claim arbitrary and unquestioned rightness for every- 
thing he feels and does, including all his flagrant con- 
tradictions and inconsistencies. He may attempt to pro- 
tect himself from awareness of uncontrollable impulses 
by maintaining an iron control over his feelings. 

Still another way of avoiding recognition of contra- 
dictions is to reduce everything to total inconsequential- 
ity by being cynical or flippant. The individual tends to 
take the position that there is no right or wrong, no truth 
or falsehood, that nothing matters enough to constitute 
an issue. Finally he may avoid issues concerning his in- 
ner problems by resorting to extreme elusiveness. Peo- 
ple who exhibit this tendency are slippery, devious, so 
highly circumstantial that their part in events is lost in a 
mass of detail. 

These elaborations in the development of the neu- 
rotic character structure have many consequences 
some of them completely unrecognized by the individ- 
ual himself because he cannot face the issues of cause 
and effect. Some of these consequences are partially 

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Are You Considering Psychoanalysis? 

felt and dimly appreciated as having some connection 
with anxiety. Others are felt acutely and distressingly. 
These last constitute the specific, outspoken complaints 
and symptoms of neurosis. I shall discuss these conse- 
quences all together, and you will see which ones the 
neurotic individual would be blind to, and why, and 
which ones he would complain of. The ones he com- 
plains of are, in effect, the price he pays for the ones he 
needs to retain unrecognized as essential to the integrity 
of the neurotic structure. 

In general, the development and the upkeep of neu- 
rotic patterns consume a prodigious amount of energy 
which could otherwise be used in the development of 
real capacities and gifts, in the cultivation of good hu- 
man relationships, and in the enjoyment of life. This 
wasteful expenditure of energy brings about a sense of 
futility, a feeling that one is not getting enough out of 
life or a vague, sometimes acute discontent. There are 
also likely to be pervasive feelings of strain and fatigue, 
and a need for more rest and more sleep than is required 
by the average healthy person. 

The powerful crosscurrents underlying unresolved 
conflicts result in inertia, ineffectualness, and indeci- 
sion. The individual is unable to settle on a course in life 
and exert his best efforts in some definite, undeviating 
direction. Spontaneous initiative and sustained action 
are extremely difficult. If initiative is not paralyzed, it is 
short-lived and shifting. The individual tends to avoid 
constructive effort. It takes so much out of him since he 
has to reckon with the exhausting intensity with which 
84 



What Is a Neurosis? 



he applies himself and with the counterpull of opposing 
impulses. He is apt to feel jammed, or as if caught in a 
vise. People sometimes complain of a feeling that they 
are stagnating or unable to get on in their work or pro- 
fession. 

Moral values are blunted because the individual be- 
comes habituated to false justifications, rationalizations, 
pretenses, and spurious defenses. Because he manipu- 
lates his values according to the exigencies of neurotic 
needs, he is apt to become cynical and to lose faith or 
belief in everything, including himself. Since he is 
generally motivated by the necessity to avoid anxiety, 
conscious and unconscious exploitation of others is in- 
evitable. Truth and honesty with others and with himself 
go by the board. 

Neurotic persons are necessarily highly egocentric be- 
cause their needs come first. This is so even if needs to 
be self-sacrificing are conspicuous, for the unduly self- 
sacrificing person frustrates others from participating 
on equal terms and inhibits them in developing their 
own resources. This egocentricity is exaggerated to 
enormous arrogance in the process of false solution of 
conflicts. In general, avoidance of awareness of inner 
problems requires explicitly that the individual see noth- 
ing wrong with himself. Each type of solution has its 
particular form of arrogance. Baffling guilt feelings, 
which are quite common, often spring from unconscious 
crookedness, although frequently the reasons for guilt 
feelings are assigned to some circumstance in which 
the individual is factually innocent. 

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Are You Considering Psychoanalysis? 

At the core of every neurotic personality there is more 
or less hopelessness. This stems from being caught in 
conflicts that cannot really be resolved in view of the 
individual's deep feelings of helplessness, isolation, and 
hostility. Besides, his rigid patterns in human relations 
and in whatever he undertakes always bring about the 
same frustration, so he is likely to feel doomed to frustra- 
tion. Neurotic development takes him further and fur- 
ther away from himself, so that he becomes shadowy 
and unreal to himself. He has no real hold on the direc- 
tion of his life and no notion of what he really wants, 
for he is in the grip of forces driving him toward the 
goal of safety only. 

Despair may be so abysmal that he may succumb to 
complete resignation, settle down quietly, and even 
feel somewhat at peace. He "accepts" his fate but for- 
feits the fullness of his real capacities and the real rich- 
ness of his nature. But hopelessness, despair, and resig- 
nation may lead to bitterness and rage against fate, 
which may be focused on those who are participating 
in life and enjoying it. In an attempt to reclaim or sal- 
vage some feeling of self, the individual turns destruc- 
tive and sadistic in revenge. Sadistic tendencies are di- 
rected not only toward others in overt or subtle ways 
but also toward the self. 

As further consequences of unresolved conflicts there 
are many fears, some of them diffuse, some of them spe- 
cific and sharply focused. The individual feels vaguely 
fearful whenever a safety device is threatened, when a 
compromise solution is in danger of failing him, or when 



What Is a Neurosis? 



defenses are jeopardized. He fears the loss of neurotic 
satisfactions, as for instance in any disturbance of his 
idealized image and the gratifications he gets from it in 
his imagination. He fears exposure of his false claims, 
for to him this would mean certain ridicule and humilia- 
tion in the eyes of others and in his own eyes. Since his 
equilibrium is usually shaky and requires constant sup- 
port and stabilization, he is always afraid of being upset. 

Some specific and sharply focused fears connected 
with certain external situations and circumstances arise 
from inner fears which are externalized and symbolized. 
The dread of being in high places and of falling is usu- 
ally connected with fear of loss of equilibrium, of fall- 
ing from the pinnacle of perfection one has arrogated to 
oneself, fear of collapse of one's illusions, of falling into 
the abyss of self -degradation. Fears of being in open 
places may be connected with fears of being alone, being 
separated from others and deserted. Fears of being in 
confined places may be connected with the fears of being 
hemmed in, constricted, being deprived of space which 
are felt by markedly detached people. 

These fears do not usually have one simple direct 
derivation, but may be compounded of fears arising 
from several sources. Fears of germs, infection, or dirt 
in any form are similarly traced to inner sensitivities, 
fears, and inhibitions. Seemingly intractable, external- 
ized fears are likely to have compound derivations in the 
neurotic structure. These fears force the individual to 
extreme precautions which are expressed in avoiding 
contact with certain things, in compulsive hand wash- 

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Are You Considering Psychoanalysis? 

ing or bathing and sometimes quite bizarre means to 
avoid contamination. The thousand-and-one supersti- 
tions concerning good luck or bad luck cause some 
people to adopt peculiar ritualistic mannerisms and be- 
havior. These become conspicuous and sometimes in- 
tolerably burdensome and annoying. 

Generally speaking, the sense of being helplessly 
caught in conflicts and the resultant feeling of impotent 
rage are the components of depressions. Rage may be 
quite deeply repressed; the depression is then diffuse 
and unfocused and the individual is lost in feelings of 
abysmal self-pity. When rage and despair are more con- 
scious and destructive impulses are more openly in play, 
depressions may bring the individual to ruminations on 
suicide or to an actual attempt at self-destruction. 

Other outspoken neurotic manifestations are general 
inhibitions such as inability to think, to concentrate, to 
make decisions, to embark on fresh enterprises, to learn 
something new. Specific inhibitions are related to spe- 
cific fears or phobias, such as inability to go to the upper 
floors of high buildings, to ride on elevators and subway 
trains, to walk in the open street, to be alone. Inability 
to go to sleep has a particular meaning for different peo- 
ple. A common one is the driving necessity to anticipate 
the next day's activities and plan them to the last detail 
so that the individual will be prepared for everything 
with a foolproof schedule. Or, a young man may stay 
awake the whole night through in order to keep an eye 
on the world while others sleep. He drops off to sleep 
when he hears the milkman come up the street, with 
88 



What Is a Neurosis? 



the feeling that the milkman is awake and he, the 
"watchman," can now give over. 

Frequently symptoms are directly connected with re- 
lationships with others, such as inability to get along, 
feeling always an outsider who is excluded by others, 
intense shyness, uncontrollable aggressiveness; terrible, 
frightening impulses to harm others, undue dependence 
on others, inability to love, inability to hate. In this cate- 
gory are specific disturbances in sex life such as frigidity 
and painful intercourse in women, impotence and pre- 
mature ejaculations in men, compulsive sexual promis- 
cuity, aversion to sex relationships with the opposite sex 
and a preference for relationships with persons of one's 
own sex, and undifferentiated sexuality, sometimes 
called bisexuality. 

Many physical manifestations are the expression of 
tensions precipitated by repressed anxiety or rage such 
as flushing or pallor, sweating, palpitation, high blood 
pressure, low blood pressure, muscular tensions of all 
sorts, severe cramping pains, especially around the neck 
and shoulders and lower back, lump in throat, shortness 
of breath, sinking feelings, fainting, sleeping attacks, 
gastrointestinal upsets, constipation, diarrhea, nausea, 
headache, migraine attacks, and some functional dis- 
orders of the reproductive organs. Among the latter are 
painful and irregular menstruation, scanty or suppressed 
menses or profuse and too frequent menses, painful 
erection in men, prostatic turgidity, and some cases of 
prostatitis. 

Some neurotic manifestations represent a subsidiary 

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Are You Considering Psychoanalysis? 

solution the individual has hit upon, some comforting 
and narcotizing agent he has found useful in allaying 
anxiety but which has come to be uncontrollable and 
harmful. In this category alcoholism and drug addic- 
tion are outstanding symptoms. There are also some less 
obvious activities that help one to forget one's worries 
such as engaging hectically and compulsively in social 
activities, hobbies, or work. The clue to the compulsive 
nature of these activities lies in the fact that the individ- 
ual tends to plunge into the activity with exhausting 
"enthusiasm." He does not really enjoy it for what it is 
and thus cannot feel a sense of recreation, and as a result 
the experience leaves him with a feeling of "ashes in the 
mouth." 

You will have noticed that I have used few of the 
familiar diagnostic terms in this chapter such as psy- 
choneurosis, neurasthenia, obsessive-compulsive states, 
claustrophobia, agoraphobia. These terms in themselves 
describe the manifestation in Greek derivatives or other 
language compounds; but thinking in terms of symp- 
toms does not offer any real guide to understanding and 
treatment. Our interest lies in attempting to understand 
the character structure as a whole, its development, and 
the dynamics of the neurotic process in their present 
form and complexity. By this route we get light on the 
meaning of the particular manifestation in the individ- 
ual character structure. 

Finally, there is the neurotic individual who has no 
obvious disturbances of the kind mentioned. You will 
ask, "Is he neurotic?" Yes, he is a "successful" neurotic. 
90 



What Is a Neurosis? 



Such a person shows very obvious contradictions in his 
character and gross deviations in human relationships. 
But he has been successful in blinding himself to them, 
successful in operating with his false solutions of con- 
flict, and successful in making himself practically im- 
mune to disturbance from the outside and from within. 
Many such people live calm lives; they may do valuable 
work, and they do not experience anything out of the 
way in their scheme of life. They would say they haven't 
a nerve in their body. Nevertheless, there is always a 
discrepancy between the life they lead, their actual 
achievements, and the kind of relationships they have 
and the fuller, richer, deeper life possible for them 
by a greater satisfaction in their achievements, and bet- 
ter relationships with others. 

The deficits in character and achievement and rela- 
tionships are the outstanding factors in the "successful" 
neurotic. Basic anxiety exists deeply buried and unex- 
perienced. It could be felt in some crisis or some unfore- 
seen turn of events or even in some trivial contretemps. 
When this happens, it comes as a stunning surprise and 
is quite incomprehensible. 

An example of this is that of a man who came to 
analysis at the behest of a close associate who was 
genuinely appreciative of him and was concerned about 
some of his peculiarities. The patient felt he was com- 
pletely "well adjusted" but he had had one upsetting 
experience, five years previously. He had been lecturing 
to students. A boy in the class asked an irrelevant ques- 
tion. The teacher's mind suddenly went blank, and he 

91 



Are You Considering Psychoanalysis? 

was overwhelmed by total panic. He turned blindly to 
the blackboard and made some illegible scrawls for a 
few moments and then the bell rang for the end of the 
session. After dismissing the class, he went home, and 
was in bed for two weeks with intractable diarrhea. 
He recovered completely from this physical upset and 
returned to work. 

In this chapter I have presented a somewhat detailed 
elaboration of our present theory of neurosis. The main 
outline in neurotic structure and the forces involved 
have been stressed. The discussion suffers somewhat 
from condensation. It may give an impression of sim- 
plicity to some or of great complexity to others. The 
latter comes nearer to the truth. Our experience in at- 
tempting to help the patient to extricate himself from 
his neurosis convinces us that his entanglements are 
tremendously complex. We believe that our formula- 
tions, which are based on dynamic principles originally 
discovered by Freud, include and explain many phe- 
nomena in the neurotic system hitherto ignored or not 
satisfactorily accounted for. While the essentials in our 
formulations can be presented more or less briefly, the 
manifold details of neurotic involvement need much 
further investigation. These are the directions in which 
we continue to work. 



92 



What Are Your Doubts About 
Analysis? 

HAROLD KELMAN, M.D. 



IVlANY people who think of undertaking an analysis 
hesitate because of certain doubts, fears, and misgiv- 
ings. From questions asked after lectures on psycho- 
analysis and by patients in consultations we find that 
the following matters are the most frequent cause of 
concern: the expense in money and time; the effec- 
tiveness of analytic treatment; the harmful effects that 
analysis might produce. In this chapter we shall take 
up these questions in the order of frequency with which 
they usually occur. 

The matter of finances is often the first practical con- 
sideration. You may doubt that you can afford an analy- 
sis. It is true that many people, even with careful budget- 
ing, are still excluded from receiving analytic help for 
financial reasons. There are a number of causes for this 
unfortunate situation, long a matter of serious concern 

93 



Are You Considering Psychoanalysis? 

to analysts. Assuming, however, that you do have the 
means for an analysis but still feel that the fee is too 
much, you might think about it as you do about other 
forms of medical therapy. The total cost of an acute or 
chronic illness may be greater than that of an analysis 
but you do not ask, "Is it necessary?" or "Should I spend 
the money?" Because a physical illness is so real and 
tangible and the discomfort so obvious and acute, it is 
regarded as quite natural to do something about it at 
once. Further, you feel justified in your decision because 
the doctor does something obvious and immediate for 
you. He may give you medicine, put you to bed, or 
operate on you; in any case, you feel that you can legiti- 
mately expect concrete results in a reasonable time. You 
also take as a matter of course the doctor's bills and the 
attendant expenditures for medications, hospitalization, 
and operations. 

With analysis the situation is quite different. You 
may have definite complaints such as a fear of high 
places, attacks of anxiousness, or headaches, but even 
though these symptoms are quite real to you, no one 
else can see them. A checkup with your doctor may 
reveal nothing wrong with you of a physical nature. Be- 
cause you have not been taught to think in terms of 
psychic illness you may conclude that your complaints 
are purely imaginary or, at any rate, not very serious and 
certainly not of the type to warrant the expense or 
possibly the financial sacrifices that analytic therapy 
would entail. You may be confirmed in this attitude by 
your friends and relatives. For all these reasons you 
94 



What Are Your Doubts About Analysis? 

may think of analysis in terms of cost rather than of 
benefits to be derived. 

When you add up the total cost of an analysis, it may 
seem like a very large sum. However, if you will keep 
in mind that you will be paying for it in small sums, 
weekly or monthly, spread out over a period of time, 
the amount will not loom so large. Thinking in these 
terms and with careful budgeting, you may find that 
an analysis is within your means. 

Sometimes when people feel that they cannot afford 
an analysis, closer investigation reveals that their judg- 
ment is dictated by irrational, unconscious fears. Such 
persons may be motivated by an unconscious fear of be- 
coming destitute, which makes them adverse to parting 
with anything. Irrational feelings of incompetence to 
regain what they might spend make it a stringent neces- 
sity to hold on to what they have. Or they may regard 
themselves as so unworthy that they do not feel entitled 
to spend a large amount or even any amount of money 
on themselves. 

In many cases analysis has proved to be a good invest- 
ment and has paid dividends. Not uncommonly there 
is an increase in efficiency and productivity with result- 
ant favorable changes in the patient's job situation. His 
earnings increase and his ability to handle his funds 
improves. Irrational spending or saving stops: he uses 
his money wisely. In cases where money was spent on 
physical illnesses that were an expression of underlying 
emotional problems, or where financial loss was incurred 
through absence from work, these expenses stop. How- 

95 



Are You Considering Psychoanalysis? 

ever, such results, though tangible, should not be con- 
sidered as primary. Increased happiness and lessened 
misery are objectives whose value cannot be calculated 
in figures. 

After you have decided what you can pay, you will 
naturally discuss it with the analyst. In deciding on his 
fee, he will take into consideration whether you have 
correctly evaluated your ability to pay for treatment. If 
he feels that your evaluation is not realistic and that you 
really do not have the means to pay for an analysis or, 
on the other hand, that you can afford a higher fee than 
the one you suggested, he will tell you so. On the basis 
of such a discussion, you will arrive at an agreement as 
to what you both consider a legitimate fee. 

Some people are doubtful about undertaking analysis 
because they feel it takes up too much time. Limitations 
of time may be a real impediment to your being able to 
avail yourself of analytic help. Your working hours may 
be so long that you simply have no spare time. Your 
schedule may make it difficult to find an analyst who is 
free when you are. Analysts are cognizant of this prob- 
lem and try to reserve early morning, lunch, and eve- 
ning hours for persons with tight schedules. They ask 
other patients whose arrangements are more flexible to 
give preference to those who are bound by rigid time 
schedules. 

However, a number of people think they do not have 

enough time for an analysis. Careful examination of your 

schedule may reveal that you have more time than you 

thought or that by budgeting what time you do have 

96 



What Are Your Doubts About Analysis? 

you may be able to carry an analytic program. You may 
discover that you allow time to slip through your fin- 
gers, take much too long to do certain things, or occupy 
yourself with a lot of unnecessary activities. A little self- 
discipline may be all that is necessary to make available 
the time for analytic treatment. Scrutiny of your time 
schedule may lead to the recognition that the way time 
is used, or rather misused, just doesn't make sense. 
Awareness of this fact may lead to a more thorough self- 
examination and the desire for analytic assistance. In 
analysis we frequently see irrational attitudes about 
time. 

You may feel that you are short on time merely at 
present and have the definite intention to start your 
analysis at a later date. You may actually be pressed 
for time, for a longer or shorter period, owing to external 
circumstances such as illness in the family or because 
of a genuine desire to first complete a project or to 
embark on one you already had in mind. But when you 
go from project to project and there always seem to be 
external situations that must be taken care of first, then 
you should try to determine whether your reasons for 
being so constantly occupied, or more probably preoc- 
cupied, are really valid. This is particularly important 
if your schedule is flexible and, to an objective observer, 
you seem to have plenty of time. 

In very few cases has the time factor proved insur- 
mountable. We can cite many instances in which it was 
felt at first that analysis was not possible or was at best 
extremely difficult because of time limitations; yet these 

97 



Are You Considering Psychoanalysis? 

patients managed to work out arrangements and carry 
on their analytic work successfully. Besides, we all know 
that the busiest people always manage to find time for 
activities that they really want to pursue. 

You may ask: "Doesn't an analysis go on and on and 
on?" The length of an individual analysis cannot, as a 
rule, be accurately predicted. It is hard to estimate at 
the outset the three essential factors upon which its 
progress and duration depend: the severity of the neu- 
rosis, the active participation of the patient, and the 
analyst's experience with the particular problems that 
become evident in the course of the analysis. The sever- 
ity of the neurosis is often difficult to estimate because 
appearances are deceptive. Even an experienced analyst 
may err because initially there is much information 
lacking which, were it available, would change his esti- 
mate. An analyst may have a more optimistic outlook 
than is warranted because at the beginning of the work 
his patient is eager and willing both during and between 
analytic sessions. Or the patient may be quick in grasp- 
ing insights and in seeing them for himself. But all of 
this often changes when difficult problems arise; then a 
marked slowing of pace occurs. 

On the whole, the average time for an analysis of a 
severe neurosis is about three years, that is, for the 
thorough working through of the involved character dif- 
ficulties presented. This is reckoned from the time anal- 
ysis is started to its termination. Included in this period 
are interruptions for vacations, illness, or other circum- 
stances. However, the statistical average of three years 
98 



What Are Your Doubts About Analysis? 

may be of limited value to you in gauging the duration 
of your own analysis. Your neurosis may be more severe 
than you believed, or it may be less severe. This also 
holds true for situations where the patient seeks help 
for some particular problem. In some instances the pa- 
tient can be given sufficient help in relatively few inter- 
views to enable him to keep on functioning quite well; 
in others it may be discovered that the problem he 
presents has so many ramifications that only a thorough 
analysis will solve it. Also, he may come with only one 
problem and find after a few interviews that there are 
a number of others he wants to work through. Under 
these circumstances treatment would naturally take 
much longer than was originally estimated. 

If you feel that three years constitute an overwhelm- 
ingly long period, remember that only a small part of 
your day will be devoted to analytic work. For the rest, 
you will be carrying on your usual activities. In time 
you will come to take the daily or tri-weekly hour in 
your stride, as well as the months and the years. The 
more clearly you come to recognize the necessity for 
your analysis, the meaning it gives to your life, and the 
results you obtain from it, the less concerned you will 
be about its duration. Three years does not seem like an 
inordinate period to invest in your future happiness, nor 
a particularly long time for the solution of troubles that 
have been accumulating for thirty or forty years. 

Generally it is easier for people to think of a long- 
term project if it has an educational purpose. It may 
help you to think of your analysis as part of an educa- 

99 



Are You Considering Psychoanalysis? 

tional program with one course. You are the text and 
the source material. The purpose of the project is to 
teach you to see yourself as you are, to remove those 
obstacles in yourself that prevent you from developing 
your best potentialities. 



Distance from centers where analytical help is avail- 
able is another practical consideration that may make 
you doubtful about undertaking analysis. Distance alone 
may not prevent you from receiving some analytic help, 
but when the problem of time or money or both is added, 
even limited analytic help is made almost impossible. 

With enough time and money you may come at in- 
tervals for short periods of concentrated analytic work; 
you may even move to the city where your analyst re- 
sides and remain there until the analysis is terminated. 
Special arrangements may be made for intensive work at 
intervals. When the distance is not too great, a patient 
can be seen for single or double sessions. He can meet 
with his analyst the night of his arrival and again the 
next morning and the evening before his departure. In 
this way he is absent from his job, business, or family 
for only one day. The results of such work have often 
proved satisfactory, even though this procedure may 
have prolonged the duration of the analyses. 

Because of the expense involved, the duration of anal- 
ysis, and the factor of distance, you may be concerned 
about possible interruption of your analytic work by 
reason of external circumstances. For instance, you may 
100 



What Are Your Doubts About Analysis? 

only have enough money to carry you for two weeks or 
two months at a time; it may be impossible for you to 
remain absent from your job or your family any longer 
than that. There may be interruptions owing to acute 
illness or, for reasons of health or business, you may have 
to move too far away to be able to continue work with 
your analyst. Unexpected drains on your funds may 
force you to discontinue your analytic work. A job situa- 
tion or a deadline on a special project might make it im- 
possible for you to devote the necessary time to analysis. 

The effect that an interruption of your analysis will 
have on you depends on a number of factors: the length 
of the interruption, whether or not you had planned for 
it, the progress you have already made in your analytic 
work, and the spirit in which you undertook and con- 
tinued with it. If you knew that you could work for a 
short time only, the interruption would be something 
planned for and expected. You might have preferred to 
continue, but you would not be concerned or upset if 
your over-all plan called for short periods of analysis at 
intervals over a longer period of time. If the spirit in 
which you sought help was one of real determination 
combined with the feeling that no matter how long the 
intervals might be, you would keep returning, you would 
not be irrationally upset. Nor would limited interrup- 
tions, resulting from financial or other external situa- 
tions already expected, cause much hardship. 

If you are well along in your analytic work, an ex- 
pected temporary or even prolonged interruption will 
not be unduly disturbing. Solid work done can be a 

101 



Are You Considering Psychoanalysis? 

source of satisfaction and form a point from which to 
continue on your own. You will have an opportunity to 
get a perspective on yourself, digest what you have 
learned, develop on the basis of this increased self- 
knowledge, and continue working at your problems with 
the analytic equipment you have acquired. This holds 
true for short or longer interruptions at almost any point 
in your analysis. Interruptions, then, can have a bene- 
ficial effect in many instances. Their disadvantage, of 
course, lies in prolongation of the work. 

Even unexpected interruptions may not be too dis- 
turbing if they occur after progress has been made. You 
may feel at loose ends for a time as you would following 
a break in any intimate relationship. You may acutely 
miss the help you have been getting. But in time you 
will find that you can go along on your own much better 
than you ever did before. If unexpected interruptions 
should occur at a period when you are upset by the 
awareness and the working through of major conflicts, 
you may have quite a difficult time of it. However, these 
breaks rarely happen so suddenly that the analyst cannot 
carry out some helpful preparatory work. In the isolated 
instances where this is not possible, a patient may go 
through a period of much suffering before he pulls him- 
self together. However, he can usually reach some kind 
of satisfactory solution. The human organism has a way 
of re-establishing a level of adjustment for a degree of 
successful functioning. 

In addition to unavoidable interruptions, there are 
some that may be avoided. I refer to the situation that 
102 



What Are Your Doubts About Analysis? 

arises when either the patient or the analyst decides to 
discontinue the analysis particularly when the patient 
discovers that he does not really want to be analyzed. In 
order to forestall such interruptions and the concomitant 
feeling of failure on the part of the patient, analysts often 
start work on a trial basis. What is started tentatively 
need not be considered as a commitment. In this way 
both analyst and patient are free to reconsider the mat- 
ter definitely at a later date. If a patient does not con- 
tinue, he need not then have a sense of failure. Nor will 
he regard it as a rejection, should the analyst decide to 
discontinue treatment. Moreover, the analyst will be 
able to determine how serious the patient is about anal- 
ysis and how much incentive for work he has. Such 
trial arrangements also give the analyst an opportunity 
to determine the severity of his patient's neurosis. If he 
finds that a long period of uninterrupted work is neces- 
sary, he may discontinue the treatment should future 
interruptions be likely or certain. Similarly he would 
be averse to working with a patient who could only 
come for short periods at intervals or who lived at some 
distance. The analyst would consider it unwise to upset 
the shaky equilibrium of a patient who might need help 
at any time. It would be better for the patient to con- 
tinue functioning as he does or to wait until he could 
devote the time needed for his analytic work. 

The question of interruptions may raise concern about 
the possibility of having to change your analyst. After a 
break in your work, your analyst might no longer be 
available. If you went to another city, you might be 

103 



Are You Considering Psychoanalysis? 

forced to choose a different analyst. Transfer to another 
analyst can often be advantageous. A second analyst 
brings to the situation a fresh point of view. He may 
see things that his predecessor overlooked. You will 
have had a chance to digest what you have learned 
about yourself and will bring to your second analyst the 
results of that work as well as additional observations 
you yourself have made in the interim. A change of 
analysts, far from being catastrophic or necessitating 
your starting "all over again/' can be beneficial. Nat- 
urally, I am not advocating a change in analysts unless 
it is necessary. 

It is understandable that people want to know if there 
are short cuts in analysis. A number of therapeutic tech- 
niques and procedures are used to shorten analysis. Only 
those frequently used will be mentioned here. There 
are many others that are utilized either alone or in com- 
bination with psychoanalysis. In view of the complexity 
of neurosis, it should be kept clearly in mind that their 
value is limited. Also, the effect of such therapy is fre- 
quently superficial and without lasting benefit. 

Setting an arbitrary termination date often limiting 
treatment to months has been used as a technique for 
shortening analysis. The expectation is that the patient 
will be stimulated to work harder and that it will be 
possible to crowd many more insights into this short pe- 
riod. These insights the patient is to digest at his leisure 
after the analysis. This procedure may in a few cases, 
and under special circumstances, achieve limited suc- 
cess but as a rule it does not attain the purported objec- 
104 



What Are Your Doubts About Analysis? 

tive. The patient does not really receive a short analysis; 
what he does get is a short period of analysis in which 
he receives superficial help with some of his difficulties, 
while most of them are left untouched. One danger of 
this technique is that the patient may be left with the 
notion that he has been completely analyzed. This may 
lead either to confusion, because he cannot understand 
why he is still so disturbed, or to the belief that he is now 
"completely adjusted" and can wear his analysis like a 
badge. 

Hypnoanalysis, a method that combines the use of 
hypnosis and psychoanalysis, is at present receiving 
prominence as a means of shortening analysis. By means 
of this technique the analyst can gain information in 
less time than it would take were he to use free associa- 
tion. It is suggested that resistances can be by-passed 
while the patient is in a trance state. Under hypnosis, 
traumatic events in the patient's life can be recalled and 
re-experienced. The recall and re-experiencing of trau- 
matic events may lead to a diminution in emotional ten- 
sion. It has been claimed that hypnoanalysis hastens the 
therapeutic process because the analyst can use informa- 
tion obtained during hypnosis for interpretation when 
the patient is in his normal state of awareness. Whether 
or not an analysis is really shortened in this way still 
remains to be proved. The question is whether or not 
the information obtained under hypnosis has the same 
meaning as that obtained in a normal state of awareness 
because there is a difference between the analyst's hav- 
ing the information and the patient's realization of its 

105 



Are You Considering Psychoanalysis? 

significance. Rarely have I found difficulty in obtaining 
information. Almost always there seems to be enough 
information forthcoming; the difficulty lies in helping 
the patient to understand it. To me, hypnosis represents 
a distortion of the individual's faculties for participation 
and a distortion of a human relationship. It is my feel- 
ing that therapeutic work can best be carried on in an 
atmosphere that approximates daily living, namely in a 
state of full awareness and with the conscious and will- 
ing participation of both persons concerned. 

Another short-cut procedure now being much dis- 
cussed is narcosynthesis. Under the influence of a drug, 
such as sodium pentothal, the patient re-experiences cer- 
tain life situations. This technique has been much used 
in the armed forces. The objective is to aid the patient 
to relive the painful experience and thus discharge his 
repressed feelings of anxiety and hostility in an atmos- 
phere of security. The therapist then attempts to aid 
the patient to integrate to synthesize the informa- 
tion obtained. Just as in hypnoanalysis, the second phase 
of this procedure requires considerable knowledge and 
skill on the part of the therapist. Narcosynthesis has been 
reported to be of definite, though varied, benefit to 
many. According to my experience, its value is limited. 
The gains appear to come from the psychotherapy given 
and are no greater than the results obtained without 
the use of the drug. The basic validity of this procedure 
might be questioned on the same ground that hypno- 
analysis is questioned. 

Group therapy has also been widely used as a short- 
106 



What Are Your Doubts About Analysis? 

cut method. One of its values lies in bringing many more 
people into contact with psychiatry and psychoanalysis. 
It makes them more aware of their need for help and of 
the possibility of getting such help. Group therapy en- 
ables more people to get some treatment, though it is 
limited and often only superficial. For mild cases it some- 
times appears to be sufficient. It has also been found use- 
ful as a screening procedure. Those patients who do 
not respond are regarded as sicker than the others and 
in need of more intensive individual treatment. The 
rapid rehabilitation of large numbers by one group 
therapist allows the other staff psychiatrists more time 
for the seriously ill patients. Analysts working with 
groups of less than ten and using the concepts of char- 
acter analysis have concluded that clarification is still 
necessary regarding the details of the method and the 
selection of patients. They felt that the results obtained 
were limited. Frequently, however, members of the 
group began individual analyses and this outcome ana- 
lysts regarded as one of the values of group therapy. 



A large number of people are doubtful about the pos- 
sibility of being successfully analyzed. Particularly, they 
question whether fear of crowds, homosexuality, in- 
somnia, or other specific disturbances can be cured. 
Doubts as to the successful treatment of particular dis- 
orders may actually express a doubt about the effective- 
ness of psychoanalysis in general. 

Such doubts often stem from a disbelief in the pos- 

107 



Are You Considering Psychoanalysis? 

sibility of changing human nature. Usually when people 
say, "human nature is that way," they are thinking about 
the unpleasant and destructive things that men do. They 
are not referring to human nature but rather to distorted 
expressions of it. The following statements are repre- 
sentative of such attitudes: "There will always be wars 
as long as there are people"; "all human beings are 
greedy if they weren't, they wouldn't be human"; "man 
is an uncivilized beast, otherwise he wouldn't need so 
many laws to keep him in check." People who talk this 
way are describing the manifestations of neurotic proc- 
esses in emotionally unhealthy human beings. 

What we regard as human nature may best be indi- 
cated by describing what is natural that is, given by 
nature and what is human that is, what differentiates 
man from animals. Human beings, like all others animals, 
have within themselves, as part of their natures, a life 
or growth process. You can call it an urge, impulse, or 
drive. If this process is not impeded, the human being, 
like other animals, grows, expands, develops and relates 
himself to his physical environment so that he can ob- 
tain sustenance and protection, avoid enemies and de- 
fend himself against external factors inimical to that 
growth process. Man, like the animals, is born with cer- 
tain endowments. However, he is helpless for a much 
longer time than animals are and therefore longer de- 
pendent on his environment mainly on his parents. 
This gives him a longer period of time in which to de- 
velop the special resources he possesses his erect walk- 
108 



What Are Your Doubts About Analysis? 

ing position, the specialized use of his hands, his speech, 
and his reason. 

Man because of his long period of helplessness and 
dependency on others in his early years needs, prefers, 
and is able to function best in groups. He can only be- 
come more of an individual as he relates himself better 
to others. Animals take from nature what they find and 
are dependent on its whims; man, on the other hand, can 
co-operate with nature for a more abundant and con- 
tinued return. Man is the only animal that can foresee 
and plan with known ends in view. He has in a measure 
some choice about the future direction of his destiny. 

Man has, from time immemorial, evolved guides for 
conduct expressed in moral codes, philosophies of life, 
religions and forms of government. These same values 
also appear in his ethics, in his art, music, and literature. 
They are expressed in his cultural behavior patterns 
throughout time. Certain social ideals have persistently 
manifested themselves as evidence of man's undying 
hopes and wishes. These may have been differently 
phrased according to the needs of the time or place in 
which they had significance. They have been expressed 
as the belief in the brotherhood of man, in the essential 
unity of all human beings, the importance of good will 
toward oneself and others, the true equality of all people, 
the right to respect one's own dignity and that of others, 
the importance of justice, and finally in the respect for 
man's productiveness whether tilling the soil or follow- 
ing intellectual or artistic pursuits. 

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Are You Considering Psychoanalysis? 

Human nature has not changed since man first began 
living in groups. We cannot and would not want to 
change it. What we want to do is to free each individual 
of the neurotic encumbrances that stand in the way of 
his full development as a unique human being. No two 
people are born with the same vitality, temperament, or 
intelligence. What analysis attempts to do is to free the 
individual so that his innate qualities as a unique person 
and as a human being will not continue to be choked off, 
exploited, or wasted in neurotic distortions but will be 
available for free expression and full enjoyment. 

It is on these positive qualities and constructive striv- 
ings that we count so heavily in analysis. People are not 
born with adverse emotional problems. They become 
destructive of themselves and toward others as a sec- 
ondary consequence of destructive influences around 
them. The analyst's purpose is not to mold people or to 
attempt to impose upon them a pattern of living. His 
job is to help people free themselves of the neurotic ob- 
stacles that stand in the way of their natural growth. To 
attain this objective, he must identify what there is of 
health in the patient and fortify it. 

What, then, is the source of this disbelief in the pos- 
sibility of changing human nature or one's own particu- 
lar nature? It derives from the conception that man can- 
not be an active and effective force in his own life and 
for his own betterment and this viewpoint, in its turn, 
stems from underlying feelings of hopelessness. The in- 
dividual feels caught in the grip of insoluble conflicts. 
Because he is in conflict, his equilibrium is precarious and 
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What Are Your Doubts About Analysis? 

he is in constant fear that it will be shaken. He naturally 
cannot feel secure even in the spurious harmony he pos- 
sesses or feel sufficiently unified for constructive action. 
To such a person, change means a threat to his dubious 
equilibrium and the possibility of being thrown into the 
hopeless chaos of his conflicts. 

Doubts about the possibility of change are sometimes 
expressed in questions such as this one: "Isn't my neu- 
rosis hereditary?" There is no proof that neuroses are 
hereditary. We do know that certain physical qualities 
are inherited from parents. Whether we inherit charac- 
ter traits or behavior patterns is doubtful. A neurosis is 
mainly the outcome of the adverse effects the parents' 
neurotic problems had on the child. The most significant 
evidence against the hereditary nature of neurosis is 
the fact that people with the most diverse heredities 
have been cured of their neuroses even where the family 
tree contained a large percentage of severe mental ill- 
ness. 

"How can I change when I was born that way?" is an- 
other form in which this doubt is sometimes expressed. 
It is true that at birth we all vary in our physical and 
psychological make-up. It is very doubtful, however, 
whether constitutional factors predetermine potential 
neuroses or effect a special variety of neurosis. Many 
physical and psychological qualities that had been con- 
sidered constitutional or hereditary, or both, disappear 
during the course of an analysis. Moreover, people with 
all kinds of neurosis can be treated successfully. 

Disbelief in an ability to change is often formulated in 

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Are You Considering Psychoanalysis? 

a more sophisticated manner, thus: "If you say that my 
neurosis is due to environmental influences, how can 
you expect me to change while I continue to live in the 
very culture that made me that way? Where can I find 
the mythically healthy people you visualize; whom am 
I to emulate? Are you asking me to change the culture I 
live in? What culture can I use as a basis for comparison 
which will also act as a goal toward which I can strive 
and, besides, what can one person alone do against the 
world?" Actually, you do effect changes in your environ- 
ment, just as you are molded by it. This interaction goes 
on constantly; it produces smaller and larger and at 
times even cataclysmic changes in the environment in 
which you live and in yourself. You do not have to initi- 
ate changes; they are inevitable and constant. Your task 
is to identify them and to direct the forces behind them 
into constructive channels. 

True, your environment had its greatest molding effect 
on you when you were most malleable as a child. But 
as an adult you are not dependent on your parents. You 
have developed more resources, greater independence, 
and a capacity for reasoning. With these capacities, you 
can use what is constructive in yourself and in the cul- 
ture in which you live. Our culture, though deficient in 
many ways, is not completely destructive and inimical. 
It does offer a number of opportunities for real satisfac- 
tion and constructive development. 

I am not acquainted with anyone who is completely 
healthy mentally but I do know a number of people 
who approximate that state and many more who are 
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What Are Your Doubts About Analysis? 

moderately healthy. To me it is important to identify 
and co-operate with what is constructive in ourselves 
and in our environment, to work with those growth- 
favoring forces which are all about us. We can use as a 
basis for comparison those around us who are healthier 
than we are and, better still, our own increments of 
development. Satisfaction comes with the progress made 
by the individual's own efforts, from the very process of 
progress itself. The changes he sees in himself will be a 
stimulus to equal, if not exceed, what has been already 
accomplished. 

"Don't you think I'm too old to be analyzed?" is one 
of the commonest expressions of a disbelief in the pos- 
sibility of change. This attitude raises the question "How 
old is old?" A chronological criterion would be of little 
value because some people feel young at fifty and others 
feel old at fifteen. A person is and feels close to his actual 
age to the degree with which he is aware of and enjoys 
his emotional and intellectual maturity derived from 
experience. An exaggerated concern about physical 
health or an overwilling acceptance of emotional rigid- 
ity as a normal expression of aging might cause a per- 
son to forego an analysis because he fears his "blood 
vessels won't stand it." The feeling of being too old for 
analysis may be fortified and justified by the common 
cultural cliche "You can't teach an old dog new tricks." 
The truth is that analysts have worked successfully for 
some time with people not only of forty and fifty but 
also with those sixty and over. Not age, but the severity 
and the duration of the neurosis are the important fac- 

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Are You Considering Psychoanalysis? 

tors to be considered. Naturally an older person has had 
more opportunities to develop a severe neurosis and 
more time in which a neurosis could become ingrained. 
However, one must also keep in mind that a longer life 
gives more opportunities for mitigating and ameliorating 
experiences and that often, with increasing years, comes 
satisfaction from worth-while tasks completed. Free- 
dom may come with a lessening of burdens that fall to 
those who are younger. Age alone, then, should not be 
automatically considered a determining factor against 
analysis. 

Some people are doubtful about the possibility of 
being successfully analyzed because of an underlying 
feeling of worthlessness. They are likely to ask, "Can 
I be analyzed?" or their feeling may be expressed more 
directly in the question, "Am I worth it?" They may 
state flatly, "I am not worth all that trouble/' Such 
people may hold that others could benefit more from an 
analysis or are more entitled to it indicating thereby 
the irrational value their feeling of worthlessness has 
for them. They may take an unconscious pride in their 
martyrdom, self-renunciation, or ability to manipulate 
others into analysis. Their sense of worthlessness may 
also force others to feel sorry for them, to do things for 
them without expectation of return. It may stem from a 
feeling that they have not fulfilled some irrational claims 
they have made on themselves. To the question, "Am I 
worth it?" our answer is "Yes. Every human being has 
worth and should have real significance in his own 
eyes." 

114 



What Are Your Doubts About Analysis? 

The feeling that one is not intelligent enough or suf- 
ficiently well educated to benefit from analysis may be 
another expression of an underlying sense of worthless- 
ness. Some people, simply because of a lack of informa- 
tion regarding analysis, may be under the impression 
that great intelligence and erudition are prerequisites 
to being analyzed. Neither is essential. A person can 
be analyzed even if his formal education has been very 
limited and even if he has a language difficulty. It is pos- 
sible to communicate analytic interpretations to people 
who are illiterate. What is important is their good com- 
mon sense. The feeling of worthlessness expressed in 
the notion that one is not intelligent enough or educated 
enough often springs from unconscious claims for supe- 
riority. People who demand of themselves that they 
should know everything and be brilliant on all occa- 
sions are frequently beset by fears and feelings of being 
stupid. Of course they are not judging themselves on 
the basis of their actual abilities and potentialities but 
rather according to irrational expectations. On the basis 
of such claims everyone would feel stupid. 

An irrational claim for complete self-sufficiency causes 
feelings of worthlessness in some people. They look upon 
the neurotic need to be self-sufficient as a desire to be 
truly independent. They expect of themselves that they 
should function as self-contained units. Deluding them- 
selves into believing that they can function in this way, 
they take irrational pride in what they regard as a virtue. 
They consider it a virtue to be able to do without 
whether it be people, help, pleasure, or comfort. The 

115 



Are You Considering Psychoanalysis? 

capacity to endure the suffering they cause themselves 
they call courage and toughness. Such people feel that 
to consider and, worse still, to accept analytic help would 
make them feel worthless, weak, and self-indulgent. 
They are usually very susceptible to such slogans as: 
"A real man should be able to pull himself up by his own 
bootstraps"; "Control yourself, with enough will power 
you can lick it." Obviously such advice will only make 
the situation worse. The individual who already feels 
worthless because he is failing to attain self-sufficiency 
is told to flagellate himself along the same blind alley. 
Actually better advice would be to seek competent help 
to guide him out of his difficulties. Only by getting rid 
of irrational claims can one experience one's real worth 
and become truly independent. 



Some people are doubtful about undertaking analysis 
because they are afraid it will harm them in one way or 
another. For instance, you may be concerned about 
what other people will think of you if you are analyzed. 
Adverse judgment about people who are being analyzed 
and about analysis in general is often expressed with 
apparent good intent; at other times baser motives may 
enter in. Since so many people still think that anyone 
who is mentally ill that is, has emotional difficulties 
is crazy, you may be considered insane for needing 
analysis or thinking you need it. Or your decision may 
be regarded as a stupid one: "It's a silly notion you have 
116 



What Are Your Doubts About Analysis? 

and you'll get over it," or "If you want to throw your 
money away, that's your affair." Some may express con- 
tempt and disdain: "You are weak willed"; "You take 
yourself too seriously"; "You're a sucker." Others may not 
stop at making derogatory comments but will do every- 
thing they can to dissuade you from going into analysis. 
Some will attempt to force you into stopping analysis if 
you have started and get you to try some of their pet 
cures. Quite a few people feel competent to advise others 
regarding physical ailments, but there are many more 
who think of themselves as expert in handling the emo- 
tional problems and the most involved psychological 
difficulties of their fellow men. 

You may be legitimately concerned about other peo- 
ple's opinions but if you put off being analyzed because 
you are afraid of what other people might think, this 
may be an expression of your neurosis. Such a fear might 
indicate an indiscriminate need for approval or a fear 
of disapproval. Your associates may be implicitly or ex- 
plicitly opposed to analysis; you may be afraid of their 
criticism. A neurotic need to conform may prevent you 
from rebelling. You may fear that the admission of your 
need for analysis will puncture your reputation as a 
well-balanced person in your own eyes as well as in 
theirs and will be followed by ostracism. The fear of 
being unable to have convictions and stand on your own 
feet, which you may experience as a fear of loneliness 
or isolation, may make leaning on others and clinging 
to them a stringent necessity. You would naturally wish 

117 



Are You Considering Psychoanalysis? 

to choke off any thought or action of your own that might 
incur the displeasure of others without whom you feel 
you cannot exist. 

Actually it is not the person who admits to having 
emotional problems but rather the one who does not 
who is in the indefensible position. Everyone in our 
society is more or less neurotic. The decision to be ana- 
lyzed may be an expression of good sense, courage, and 
sanity rather than an evidence of fundamental weak- 
ness. It is debatable whether the persons who have "ad- 
justed" to the demands of our sick society are not the 
sicker and the weaker for it. By adjust, I mean conform to 
standards and values which are definitely unhealthy at 
the expense of true growth. So many "perfectly ad- 
justed" people are not free, spontaneous, and creative. 
They are caricatures of what a truly alive person should 
be. They function like automatons who live by control- 
ling themselves through will power and intellect, while 
squelching their real feelings. Neurosis may be an expres- 
sion of the refusal to accept as desirable and laudable 
the ruthless individualism and competitiveness of our 
society. It would be my feeling that such a person should 
be respected for his tenacity in refusing to conform. 
He should be admired for his desire to seek help so that 
he may become a truly integrated person capable of 
co-operating with what is constructive in his environ- 
ment and of working against what is destructive. 

Your greatest security against adverse opinions about 
your analytic treatment will come from your own con- 
victions about what you are doing. There may be times 
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What Are Your Doubts About Analysis? 

when comments from others will prove annoying; some 
intrusions will be particularly unpleasant and difficult to 
handle. However, your irrational fears of others' opin- 
ions will be analyzed and you will find that what other 
people think can actually do you no harm. You can avoid 
much of this unpleasantness by regarding analysis as 
your own affair. If patients ask me or if the opportunity 
arises, I tell them to adopt this attitude. Such advice is 
often sufficient reassurance. Nor does it mean that you 
are encouraged to be secretive or surreptitious about 
analysis. You will have all you can do to handle your 
own emotional problems in connection with analysis. 
Discussing your analysis with others may only confuse 
and disturb you. Later on, when you are more certain of 
yourself, you will be able to answer the questions of 
those who are seeking legitimate information for them- 
selves and you will not be upset by those people who, 
overtly or covertly, are bent on upsetting you. 

You may be concerned lest analysis will upset your liv- 
ing arrangements, lest it will interfere with your friend- 
ships, disturb your professional life, or disrupt your 
marriage. What if, as a result of analysis, you do drop 
some of your friends? You may do this because in the 
course of the analysis you will find out that you really 
do not like them, that you have much less in common 
with them than you had thought, and that there are 
other people with whom you would prefer to associate. 
You may find out that they are not real friends but are 
continuing a relationship with you because you are use- 
ful to them or because either you or they have not had 

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Are You Considering Psychoanalysis? 

the courage to break off the "friendship/' If you drop 
them they may feel hurt at first but they may also be 
glad that you have taken the initiative in ending a rela- 
tionship that was continued on false premises or through 
the sheer inertia of both parties. 

You may fear that upsets which occur during analysis 
may disturb your working ability or even make it im- 
possible for you to work at all. It is true that for shorter 
or longer periods you may not be able to work as well 
as you usually do, but this is not an unusual experience 
for any of us. As your analysis progresses and your gen- 
eral efficiency increases, you will be able to carry on 
with your work quite well and at a higher level than at 
your previous best, even though you may be quite dis- 
turbed at times. Where a patient finds it impossible to 
work at some point in his analysis, we often find that 
such an episode has occurred before. He may even have 
sought analysis because of that particular problem. Or 
his efficiency in his work may have been neurotically 
determined and kept up at the expense of other func- 
tions. When such patients lose the neurotic motivations 
for functioning like well-oiled machines, their drive to 
work naturally slackens at times and, as an overreaction, 
may even reach the zero point. When they resume work 
the basis is entirely different and their energies are di- 
rected toward obtaining satisfaction and pleasure in 
many other spheres besides their work. Such people, if 
they do not come to analysis, may break down suddenly 
and completely and under the worst possible circum- 
stances. The reason why they crack up this way is be- 
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What Are Your Doubts About Analysis? 

cause they drive themselves until there is no reserve 
left. 

What about your fears that analysis may upset your 
marriage? Breaking any long and intimate relationship 
with a member of the opposite sex or for that matter 
of the same sex may cause serious repercussions. The 
breakup of a marriage, particularly if there are children, 
may be something almost too frightening to contem- 
plate. Your fears lest your marriage fall apart may be 
quite legitimate; there may be a cooling in the relation- 
ship, obvious indifference, or hostility. Your fears might 
also be an expression of your long repressed doubts 
about the validity of the whole relationship. At times a 
strained situation can be. relieved by giving a patient 
partial insight into a special problem or by making one 
or both partners see clearly what they are doing to dis- 
turb the relationship or what they are failing to do. If a 
marriage, which was well on the way to a breakup and 
possibly should not have occurred in the first place, ter- 
minates after a period of analytic work, the analysis can- 
not be considered the cause. All that can be said is that 
it may have hastened or postponed that separation for 
a longer or shorter period of time. 

Occasionally a patient expresses fears regarding the 
possibility of a breakup of his marriage that turn out to 
be quite unfounded. In such cases, we find that fears re- 
lating to quite different problems were focused on the 
marriage relationship. The reason for this situation and 
the nature of the real fears must be worked through in 
each case. 

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Are You Considering Psychoanalysis? 

My analytic experience with disturbed marital rela- 
tionships has been rather unusual, as I have had the oc- 
casion to analyze husband and wife simultaneously in 
nine instances. I have also worked with just one partner 
of a number of unhappy marriages. This knowledge was 
amplified by discussions of the problem with other ana- 
lysts. On the basis of my findings I can state that separa- 
tions and divorces do take place in the course of and 
after an analysis. But so do engagements and marriages. 
We must ask: "Should a marriage be continued that 
ought not to have happened in the first place or that has 
become so disturbed that one or both persons are misera- 
ble?" It is my feeling that it should not if, in spite of the 
best efforts of both concerned as well as of friends and 
in spite of auspicious external circumstances, a happy 
solution could not be effected. If, in addition, one or 
both partners have grown during a period of analysis 
and become clearer as to what they want out of life and 
still persist in the desire for a separation, I feel that 
divorce would be the wisest decision. 

Can a marriage be salvaged by analysis? Yes it can 
and, more often than not, it becomes a better one, par- 
ticularly if it had been a pretty good marriage before. 
Analysis can make a good marriage better because it 
helps to eradicate frictions that come up so easily where 
people live intimately, as they do in marriage. 

It is generally held that one analyst should not analyze 

husband and wife simultaneously but, as I have already 

mentioned, I have done so in nine instances. In each 

case both partners had severe neuroses. Their main 

122 



What Are Your Doubts About Analysis? 

motivations for entering marriage were the unconscious 
expectations that certain of their neurotic needs would 
be fulfilled by the partner. It was only later in the mar- 
riage not until they were analyzed that this became 
obvious to them. They even found that they had glorified 
some of these needs and some of the partner's neurotic 
drives as virtues. They had not found the hoped-for solu- 
tions to their problems in marriage that is, by living 
with or through another person. Tensions mounted, fric- 
tions increased, and an inordinate strain was thus put on 
a relationship that had already been entered into on so 
many false premises. Because of the mounting difficul- 
ties, whatever the partners really had in common did not 
have a chance to take root and develop. In all instances 
a break had been feared or contemplated on various 
occasions. It is quite possible that without analytic help 
most of these marriages would have ended in separa- 
tion or divorce or would have continued unsatisfactorily. 
As it is all of them have remained intact and on a better 
basis than ever before with the definite possibility of 
steady improvement. How were these results effected? 
At no time was saving the marriage my prime objective; 
rather, it was to make clear to each of the partners what 
factors within themselves were disturbing the relation- 
ship. With such self-understanding and freedom they 
could avail themselves of their own resources and thus 
strengthen themselves as individuals as well as the mar- 
riage relationship which in each case was what they 
wanted. 

Some people fear that analysis will upset their re- 

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Are You Considering Psychoanalysis? 

ligious faith or take it from them altogether. Similar 
fears are expressed concerning faith in a political creed, 
in a particular way of life, in a person in short, in any 
kind of faith adhered to with religious fervor. The per- 
son who fears that he will lose his religious or other 
faith or that he will be proselytized in the course of his 
analysis may be fundamentally uncertain about what 
he regards as his convictions. In an earlier chapter, it 
was pointed out how doubts about oneself and about 
one's beliefs are the result of inner conflicts. The in- 
dividual is divided, torn between the irrational pride 
he has in his neurotic drives and the real values he puts 
on what is genuine in himself. He attempts to achieve a 
feeling of harmony by making some sort of compromise. 
The inevitable result is that he cannot be wholehearted 
in his beliefs. Since he is not aware that the problem 
is in himself, his doubts about himself are expressed as 
fears of being influenced by others, and specifically of 
losing his beliefs and convictions. 

Such inner self-doubt often causes people to cling to 
something external to themselves, for instance a church 
organization, a political party, an abstract dogma or 
creed originated by others and adhered to by a number 
of people, or to some one person. 

People may have a certain faith to begin with because 
they were born of parents with similar leanings. They 
may have kept on believing because it gave them real 
satisfaction and filled a genuine need. But they may 
have continued in their faiths without genuine convic- 
124 



What Are Your Doubts About Analysis? 

tion from sheer inertia or because external circum- 
stances or persons had not caused them to take stock, 
examine, and question. And finally, they may have 
selected a particular faith in exchange for another or for 
a number of others in succession, or as a haven of refuge. 
With this neurotic self-doubting are often associated 
feelings of helplessness and isolation that make leaning 
on a group, a person or an idea a stringent necessity. Be- 
cause such people's need to believe and to belong is so 
necessary, their faith must be blind in order to allay 
their doubts. They use this blind faith to give themselves 
a spurious feeling of conviction which is turned into a 
source of irrational pride. The blind faith is then re- 
garded as a virtue. 

These people fear that what is neurotically motivated 
in their faith will be exposed. Such exposure will make it 
necessary for them to give up leaning on and clinging to 
others, to stand on their own two feet and to live by their 
own efforts. In short they will have to set out to find and 
develop a rational faith in themselves. 

Nothing can make up for your genuine belief in your- : 
self. You have the right to a genuine belief in yourself, 
just as you have the right to respect yourself and to be- 
lieve in your own dignity as an individual. But you can- 
not have this attitude toward yourself unless you feel 
you have worked for it. It is interesting to note that cer- 
tain oriental religions regard as the greatest sin, the sin 
of disbelief in oneself. Without a genuine belief in your- 
self you cannot have faith in anyone or in anything. Anal- 

125 



Are You Considering Psychoanalysis? 

ysis can help you to revive and to regain your faith in 
yourself, strengthening what is genuine in your belief by 
dissipating what is neurotic. 

You may fear that analysis will effect so fundamental 
a change in you that you will lose what you regard as 
your individuality. Analysts cannot and do not want to 
change your fundamental nature as an individual or as 
a human being. On the contrary, by aiding you in free- 
ing yourself of neurotic difficulties, analysis helps you 
to realize your individuality and to develop your unique 
potentialities. It helps you to identify and develop what 
is positive and constructive in yourself. 

Your fear that analysis will cause you to lose your in- 
dividuality may have various unconscious, irrational 
causes. What you think of as your individuality may be 
your neurotic need to feel unique and superior. You 
may fear that analysis will rob you of such neurotic feel- 
ings which constitute your spurious individuality and 
will turn you into a mediocrity, that is, make you like 
everyone else. Being only human holds no fascination 
for a person who has unconscious illusions of grandeur 
about himself. 

A special variation of this fear is the notion that anal- 
ysis might deprive you of your artistic temperament and 
your artistic faculties. Analysis will not diminish or de- 
stroy either. If you have artistic abilities it will make it 
possible for you to develop them. If it turns out in the 
course of your treatment that you had illusions about 
such abilities, you and the world will be happier with- 
out them. Analysis of painters, designers, architects, and 
126 



What Are Your Doubts About Analysis? 

writers has shown that when their conflicts were re- 
solved more of their energies became available for crea- 
tive work. 

You may fear that analysis will change you for the 
worse, that it will make you act in ways quite alien to 
yourself. More specifically, you may fear that it will 
make you selfish, egocentric, unfeeling, aggressive, hos- 
tile, or licentious. On the contrary, analysis will not 
make you that way, but if you do have such trends, 
analysis will bring them clearly to your awareness and 
help you to understand their meaning in order to do 
away with them. 

There is, however, one concern that represents a more 
realistic evaluation of the analytic situation. You may be 
legitimately concerned about the emotional turmoil and 
pain that is a concomitant of the analytic process. There 
are ups and downs in every analysis; there are periods 
of discomfort and periods of relief. There will be times 
when you will be irritable, agitated or depressed. There 
will be other times when you will feel better, more effec- 
tive, and more alive. If you are already quite disturbed 
emotionally, you may wonder whether you could stand 
becoming yet more upset in analysis. 

There are a number of reasons for your becoming up- 
set in the course of your analytic treatment. You may be 
quite disturbed emotionally at the outset and talk about 
it as though you realized it. However, full realization 
comes only later and, with it, the impact of how dis- 
turbed you really were initially. You may be upset by the 
interpretations you receive and the insights you get. 

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Are You Considering Psychoanalysis? 

Awareness of the magnitude of the efforts necessary to 
extricate yourself not only from your present difficulties 
but also from those that have been accumulating before 
and since you came into analysis may also prove disturb- 
ing. And finally, you may be upset because of the deci- 
sions you will have to make and the radical changes you 
will have to effect once you have become aware that pre- 
vious ways of Living are no longer tenable or healthy. 

As you get stronger, your tolerance of the painful 
periods will increase. Having experienced relief, and 
more relief as you get stronger, you will mind the pain- 
ful periods less and less. Also, as your analysis progresses 
the pain will become less intense and the periods of tur- 
moil shorter. Because you feel that you are getting some- 
where with yourself and because you are seeing results, 
your attitude will become more optimistic. Your focus 
and interest will change. Instead of thinking stagnantly 
and maybe stubbornly, "Oh, how painful this is!" you 
will think "I don't like this discomfort. I'm going to find 
the causes for it and get rid of it." Naturally the analyst 
makes every effort to conduct the analysis with the maxi- 
mum of efficiency and the minimum of pain, but a cer- 
tain amount of discomfort is unavoidable. That is what 
you should expect and when you have lived through it, 
you will be the stronger for it. 

You may fear that analysis will make you too intro- 
spective and ruminative. Such a fear may be due to a 
lack of clarity regarding the difference between con- 
structive self-examination with the help of an experi- 
enced person, and destructive morbid introspection and 
128 



What Are Your Doubts About Analysis? 

self -preoccupation. It is far better to examine doubts and 
fears about yourself in the light of genuine understand- 
ing than to live in a state of vague misapprehension and 
to attempt to bury or to deny such fears by a technique 
of flight or narcosis. An aversion to self-examination in 
the presence of another person may be due to a fear of 
exposure or humiliation, an exaggerated need for se- 
crecy and privacy, an irrational suspiciousness. It may 
also spring from an underlying fear that people will 
think you weak for admitting that you cannot solve all 
your problems by exerting your will power, by disciplin- 
ing your feelings through a mental effort. The purpose 
of analysis is to free you of those fears and to help you 
to develop a capacity for self-examination with the help 
of another person who is more experienced in this diffi- 
cult task. 

Some people have a fear of going insane in the course 
of analysis or because of it. They are usually people 
whose neurotic structure is so rickety and brittle that 
their equilibrium is upset by the slightest difficulty. 
They express their fear of loss of equilibrium, of things 
getting out of control, and of falling to pieces as a fear 
of going insane. This fear is a symptom of neurosis and 
disappears like any other symptom when the irrational 
factors that are responsible for its existence are exposed 
and dissipated. 

However, in some cases the fear of going insane may 
be considered quite valid by the analyst. There may be 
a history of one or more psychotic episodes, or even if 
there has not been a previous breakdown, the patient 

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Are You Considering Psychoanalysis? 

may have been on the borderline of a psychosis on many 
occasions. By psychosis we mean that mental state in 
which an individual has lost contact with reality so that 
he no longer perceives himself or his environment as it 
truly is. His depressions or elations are out of keeping 
with the factual situation. Qualitatively and quantita- 
tively a psychosis represents an advanced expression of 
what we see in a neurosis. A psychotic may regard his 
body or his person or others in ways quite alien to their 
reality. He may feel that he has no insides, that he is a 
superbeing and that everyone is a secret special enemy. 
He is judged legally insane if he cannot care for himself, 
if he may do harm to himself or others, if he does not 
know right from wrong, or if he cannot be considered re- 
sponsible for his acts. 

People who have had previous psychotic episodes or 
who have frequently been on the borderline of a psy- 
chosis may have a psychotic episode during the course 
of an analysis. The decision to analyze such patients, the 
manner in which it is to be done, and the circumstances 
all require the most careful and expert analytic judg- 
ment. Both the patient and those close to him must 
be acquainted with the risks involved. However, one 
should not overemphasize the immediate risks and over- 
look the possible long-range gains. The real question is 
whether the patient will become healthier over a long 
period of time even though his progress in analysis 
might be punctuated by psychotic episodes. Or in other 
words whether or not, in the end, the gains will be 
greater than the losses. The decision not to analyze such 
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What Are Your Doubts About Analysis? 

a person also carries responsibilities. The patient may 
continue to have psychotic episodes without having had 
the benefit of analysis; worse still, his episodes might be- 
come more frequent and of longer duration. 

In my opinion, the gains are greater than the losses in 
many such cases. Analysis may stave off further psy- 
chotic episodes. If analytic work is begun where a psy- 
chotic episode appears to be imminent or in an initial 
stage, that episode may be avoided or held off for some 
time. In the meantime much solid work can be done so 
that when the episode does occur it will be of shorter 
duration. Not only may analytic work shorten the psy- 
chotic episodes and lengthen the periods between them, 
but it may also make those intervals more worth while. 
Previous analytic work may also be of help to the thera- 
pist who treats the patient should he be hospitalized, 
for then the patient is already acquainted with the ana- 
lytic procedure. The ultimate aim in the analytic treat- 
ment of such patients is to eradicate mental illness to 
the extent that psychotic episodes no longer occur, to 
enable the patient to grow and develop into a well- 
integrated person who can function on his own. This 
purpose has been achieved in a number of instances. 

A number of people fear that analysis will make them 
too interested in sex, promiscuous, or immoral. Such 
fears may have been stimulated by the overemphasis on 
sexuality in Freud's writings; they may express the indi- 
vidual's unconscious fear of finding out that he has such 
drives or perhaps that he is indulging in sexual activities 
which he does not want interfered with. Such fears may 

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Are You Considering Psychoanalysis? 

also stem from an unconscious prudery that may be ob- 
vious to everyone but the individual himself. His real 
fear may be not of becoming overinterested in sex but 
rather of becoming interested in sex at all. Such a de- 
velopment would interfere with his pride in his ivory 
tower existence. 

Another concern, with the same Freudian back- 
ground, is that the patient will or must "fall in love" 
with his analyst. This fear is caused by a misconception 
regarding the phenomenon technically referred to as 
the patient's transference reaction to his analyst. A pa- 
tient can also "fall in love" as part of his transference in 
the same irrational way he has been "falling in love" be- 
fore he came to analysis. You should have some liking 
for your analyst before you start working with him. If 
you come to like him more as the work proceeds that 
would seem to be natural and desirable and hardly a 
cause for concern unless you had an irrational fear of 
coming to like anyone. 

More often the fear of "falling in love" with one's ana- 
lyst covers up a wish. The individual in that case is really 
more afraid that his love will be rejected than of falling 
in love. Such people would tend to fall in love with the 
analyst as they would with anyone else. For them being 
in love is a life condition. To them love should be able 
to solve all problems. However, to them loving means 
being neurotically dependent on the other person and 
demanding in return for this love that the burden of Me 
be taken over. Such people will make the same demands 
on the analyst. With them, analysis can become quite 
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What Are Your Doubts About Analysis? 

stormy when they realize that the analyst expects them 
to assume the function of living for themselves and that 
they must work for it. 

Others fear that they will become dependent on the 
analyst, that they will feel incapable of making a deci- 
sion without him or will become putty in his hands. They 
worry lest this dependence will cause them to prolong 
the analysis or that, having once terminated it, they will 
tend to keep returning for advice and guidance. If a pa- 
tient has neurotic dependency needs, these needs will 
manifest themselves toward the analyst and will be ana- 
lyzed. The fear of becoming dependent on the analyst 
may come from a lack of comprehension of the nature 
and purpose of the analytic process and a misconception 
of what true independence is. Being truly independent 
does not mean absolute neurotic self-sufficiency. It in- 
cludes the ability and willingness to give and to receive 
help. Hence, returning for an occasional interview with 
your analyst might be an expression of true independ- 
ence, common sense, and good faith. What would be 
more natural and rational than to ask for help from one 
who knows your problems, who has helped you free 
yourself of many of your difficulties, and who is skilled 
in giving just the kind of help you need? He would aid 
you in identifying and clarifying what is disturbing you 
at the time, indicate to you what progress you have made 
on your own, and point out the directions in which fur- 
ther work remained to be done. 



133 



Who Should Your Analyst Be? 



HAROLD KELMAN, M.D. 



WHY IS the choice of an analyst so important? Be- 
cause so much depends on your relationship with him. 
This relationship will be an extended one in the course 
of which you will discuss with great frankness every 
aspect of your life, past as well as present, and will re- 
veal facts about yourself of an intimate and often painful 
nature. It is of paramount importance, therefore, not 
only that you be in essential agreement with the basic 
tenets he follows in therapy and that you have confi- 
dence in him as a capable therapist, but that you have 
the utmost trust in him as an understanding person. 
Your belief in your analyst's integrity must go pretty 
deep to carry you through the trying periods of your 
work when you come to grips with qualities in yourself, 
of which you had not been aware and which you may 
find quite unpleasant to admit. You will share with your 
analyst a difficult task involving radical changes in your- 

135 



Are You Considering Psychoanalysis? 

self and you will often ask for and receive help from him. 

Hence, choosing an analyst is a far more important 
step to take than selecting a physician. When you de- 
cide on a physician for the treatment of a physical ail- 
ment, his competence is your main criterion. His per- 
sonality may play a limited role. But the success of an 
operation, for instance, is not much affected by the cir- 
cumscribed personal contact between patient and sur- 
geon. Once you have selected a physician, you put 
yourself completely in his hands. You ask for his help 
regarding certain specific complaints usually of a 
physical nature. You answer all his questions, most of 
which concern your physical life history. If his examina- 
tion reveals a physical disorder, he prescribes something 
concrete such as medicine. Your attitude is one of sub- 
mission to a person in authority whose suggestions you 
may accept or reject. If you submit, the physician is re- 
sponsible for the results; if you reject his suggestions or 
do not follow them correctly, the responsibility is yours. 

The purpose and extent of a doctor-patient rela- 
tionship are usually circumscribed, and its duration is 
usually short. Should it extend over a longer period of 
time, personal elements may enter into it to a larger 
degree. At no time, however, is the personality of the 
doctor explicitly regarded as a significant factor in the 
therapy. 

From your analyst you expect help with your emo- 
tional difficulties. His questions relate not only to your 
physical history but to your life history as a human 
being. His prescription calls for mutual effort and re- 
138 



Who Should Your Analyst Be? 



sponsibility leading toward a total understanding of the 
patient. The treatment is not only curative but preven- 
tive. It is growth-stimulating, too, and will help you 
improve your human relationships. To reach these objec- 
tives a relationship of an extended nature is necessary. 

Since the choice of an analyst is so important and 
since neurotics are more or less indecisive, they often 
have difficulty in taking this final step even after they 
have already decided to be analyzed. In some, this inde- 
cisiveness may be quite marked and impede or prevent 
a final decision. Such people usually show the same in- 
decisiveness in their work, in their social and personal 
relationships, and in their sex life. They are equally un- 
decided about the selection of a mate, the purchase of 
a dress, or whether to have coffee with the main dish or 
with the dessert. At times this underlying agitation and 
uncertainty may be quite obvious; again it may be cov- 
ered up by various rationalizations. 

The main reason why such a person cannot decide is 
because he is compulsively driven by contradictory and 
irreconcilable trends. He is pulled in opposite directions; 
hence he cannot feel sufficiently unified in his aims to 
act decisively. A person who is thus driven exhausts him- 
self. He may shuttle from one set of neurotic drives to 
the other or he may eventually succeed in giving his 
conflicting trends a spurious veneer of unity. 

As a consequence of his indecisiveness, he may go 
from one analyst to another, yet never arrive at a final 
choice. Frequently he does a good deal of thinking and 
talking about this or that analyst without actually going 

137 



Are You Considering Psychoanalysis? 

to see one. Very often the momentary decision to see an 
analyst leads to a phone call for an appointment that is 
not kept. This practice may go on for years. All analysts 
have had the experience of being called by a prospective 
patient who urgently asks for an immediate appoint- 
ment and during the consultation informs the analyst 
that he has been "thinking about" analysis for a number 
of years. What he refers to as thinking is actually agi- 
tated or rationalized indecisiveness. Unable to decide 
on the right analyst, he may finally solve his dilemma by 
choosing a friend's analyst not necessarily on the basis 
of that analyst's merits or on the evidence of real prog- 
ress in his friend's analysis. To be "absolutely certain" 
he may wait until a number of his friends have success- 
ful analyses. Or he may think he wants to work with a 
particular analyst into whose office he then maneuvers 
a number of his acquaintances. Their satisfactory prog- 
ress is to be the verification of his choice. Often much of 
this indecisiveness about choosing an analyst is really 
based on doubts about analysis per se. 

Do such people ever get to the point of being ana- 
lyzed? Yes, some do. They finally choose an analyst be- 
cause their indecisiveness becomes so intolerable that 
they are forced to act. In this way, at least, they will give 
the impression of being decisive. They may rationalize 
such an action as a well-thought-out decision, and in so 
doing may succeed in convincing themselves and others 
that they are, in fact, really decisive. Obviously this is 
not a genuine decision but at least it gets them into 
analysis. They usually take the last analyst they saw, or 
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Who Should Your Analyst Be? 



the first one they can think of, or one that happened to 
be mentioned recently. External pressure in the nature 
of a life situation, or a friend's urging, may push them 
over the hurdle and literally land them in an analyst's 
office. 

However some people never do reach an analyst's 
office, either because of indecisiveness or because of a 
state of chronic depression or elation or because of 
apathy or inertia. A person who oscillates between de- 
pression and elation may impulsively catapult himself 
into an analysis during his period of elation, knowing 
that he would not be able to do this once the depression 
sets in. In this way he hopes to ward off further periods 
of depression. A patient who chooses an analyst under 
these circumstances may be overoptimistic about his 
analytic prospects and will be disappointed later when 
progress is not as rapid as he thought it would be, but 
at least he does decide on an analyst who will give him 
the help he needs. 

However, with those people who feel inert and apa- 
thetic, the chances of reaching the point of choosing an 
analyst are far fewer. They speak of themselves as lazy 
or as having limited vitality. They suffer from feelings of 
boredom, hopelessness, despair, and resignation. Such 
people do not feel themselves as effective forces in their 
own lives; they feel, rather, like helpless bystanders. It 
is difficult for them to initiate any action in their own 
behalf. The promptings of others may provide sufficient 
stimulus to carry them into analysis, but when the stim- 
ulus ceases they subside once more into a state of list- 

139 



Are You Considering Psychoanalysis? 

lessness or apathy. They may then drop out of an analy- 
sis or continue with it through sheer inertia. Analysis in 
such cases must move very slowly because for a long 
period almost the entire burden must be carried by the 
analyst. 



The choice of an analyst may be made unnecessarily 
difficult by questions which are culturally or neurot- 
ically determined and should be considered irrelevant 
in most cases. 

Questions concerning the sex of the analyst are raised 
more frequently than any others. In the long run the 
sex of your analyst makes little difference as far as the 
successful conduct of your analysis is concerned. 
Whether the analyst is a man or a woman may be a per- 
tinent consideration should you feel that analysis with 
one of the opposite sex would be inordinately painful 
or difficult. However, such considerations have only rel- 
ative validity and should not deter you from making a 
choice where an analyst of the preferred sex is not avail- 
able. In that case, analysis may be difficult for you for a 
time but whatever underlying disturbances are ex- 
pressed in your attitude toward a particular sex will be 
worked through. You may find that your antipathy was 
exaggerated when you see how rapidly it abates. In fact, 
the reassurance that the analyst gives you on this score 
may be sufficient to make it possible for you to work to- 
gether even though you have a strong dislike for the 
sex of your analyst. 
140 



Who Should Your Analyst Be? 



You may prefer an analyst of one or the other sex 
because you have better and closer relations with per- 
sons of that sex. Because you feel comfortable in their 
presence and familiar with their ways, you may think 
that you will feel the same way about an analyst be- 
longing to the preferred sex. And you fear that working 
with a person of the opposite sex will be just that much 
more difficult, especially if you have a strong antipathy 
toward members of that sex. Your attitudes toward 
either sex may have been significantly determined by 
your feelings toward your father and mother, or toward 
some other important masculine or feminine figure in 
your Me. You may have felt loved or hated by either 
or both of your parents. Without being aware of it, you 
may have extended such attitudes to all men or women. 
Indiscriminate likes or dislikes of this nature are irra- 
tional and, if allowed to carry too much weight, may 
unduly influence you in your choice of an analyst. 

Certain cultural attitudes toward men and women 
cause you to overemphasize the importance of your ana- 
lyst's sex. You may consider so-called masculine and 
feminine attributes constitutionally determined or you 
may be quite conscious that they are culturally derived. 
Considering the multiformity of so-called masculine or 
feminine traits, one can easily make a case either for or 
against an analyst of either sex on this basis. 

Some men prefer a woman analyst because they feel 
that women are more sympathetic and understanding 
than men; that women have motherly instincts; that 
they are kind, warmhearted, patient, affectionate, more 

141 



Are You Considering Psychoanalysis? 

tolerant of human failings, and have a better under- 
standing of suffering. They may fortify their preference 
for a woman analyst by declaring that men are firm, 
hard, and demanding; that they are impatient and in- 
sist on results without complaint even if there is con- 
comitant pain and suffering; that they sometimes tend 
to be brutal and cruel; that they measure other men by 
their own concepts of pride, ambition, and success; that 
their expectations of men are too high. 

Some men, on the other hand, feel that they can work 
only with men analysts. After all, this is a man's world, 
they say, and only a man can appreciate masculine clar- 
ity, directness, and logic. And besides, they may add, 
one can become a real man only by cutting away from 
women's apron strings. Of women they say that they are 
unrealistic and impractical; that they are too romantic 
and sentimental; that they are not emotionally stable; 
that they do not have as high a code of ideals as men 
do; that they feel inferior to men, and therefore resort 
to indirectness and deceit; that they are less competent 
or intelligent than men are. Furthermore, they say, the 
reason women seek careers is that they are frustrated 
in love and a man would not want a frustrated woman 
as an analyst. 

Women may use similar arguments for or against an 
analyst of either sex, but they do so from what is re- 
ferred to as the woman's angle. Because most women 
feel that their position is an inferior one or because they 
feel that a woman's main role in life is marriage, they 
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Who Should Your Analyst Be? 



frequently prefer a man analyst. What may be uncon- 
sciously operative is a contempt for women and an ado- 
ration and overvaluation of men and their position in 
society. There may be a neurotic need for a man's ap- 
proval or a need to own and possess him. Consciously 
such an attitude is expressed by the cultural cliche that 
no woman is complete without her mate. Unconsciously 
there may be the feeling that life is only possible with 
a partner. 

Analytic literature that you have read, or the type of 
analysis with which you have been acquainted, may 
cause you to attach undue importance to the sex of your 
analyst. Since sexuality is of major significance in 
Freudian analysis, the sex of your analyst would under- 
standably seem of great significance to you. Moreover, 
since according to Freud, the outcome of analytic ther- 
apy is largely determined by the recovery of childhood 
memories, you may feel it desirable to have an analyst 
of the same sex as the parent with whom you were in 
greatest conflict or in greatest sympathy. 

At times the presenting complaint itself may cause 
some patients to choose an analyst on the basis of sex. 
This is particularly true with men who are sexually im- 
potent or ejaculate prematurely. Often they are adverse 
to going to a woman analyst. They have marked feelings 
of shame and humiliation. From a rational and cultural 
viewpoint this appears to be reasonable, for they cannot 
stand exposing to a woman their failure to live up to 
their notion of what a man should be. In analysis we 

143 



Are You Considering Psychoanalysis? 

often find this fear to be symptomatic of many othei 
fears as well as a cloak for a general fear of exposure 
and for pervasive fears of being humiliated. 

Neurotic motivations reinforced by prevalent preju- 
dices often distort a patient's perspective in choosing an 
analyst. These motivations may relate to the analyst's 
nationality, his religion or his political belief; the focus 
may be on his native tongue, the shape of his nose or his 
party affiliations. Such prejudices always indicate and 
stem from disturbances in the patient's human rela- 
tionships. 

A difference in language background may sometimes 
be a relevant factor in the choice of an analyst. If a 
patient cannot speak English, it is understandable that 
he seek someone who is fluent in his native tongue be- 
cause so much in analysis depends on verbal com- 
munication. All that is gained from the play on words, 
colloquialisms and tonal inflections would be lost, and 
consequently there might be misconstructions and misap- 
prehensions on the part of both patient and analyst. 
However, the rejection of an analyst because English is 
not his native tongue rarely has a valid foundation. A 
foreign analyst would not attempt to practice in this 
country unless he was fairly conversant in the English 
language. The fact is that many foreign analysts have 
had a good education in English. 

Nor is there any validity in the argument that differ- 
ences in national origins between analyst and patient 
would make analysis impossible or at best very difficult 
It is true that diverse cultures have varying effects on 
144 



Who Should Your Analyst Be? 



the persons who grow up in them to wit, the local and 
regional peculiarities evident in various parts of our 
own United States. But such divergencies constitute 
much less of a problem than a language block, and can 
be handled. Where there is a choice, an American or 
foreigner might do well to select an analyst of his own 
nationality and thus make it easier to accept analysis. 
But actually it will make little difference in the outcome 
of his analysis. 

A patient who insists that his analyst speak his lan- 
guage or come from his cultural background would be 
doing so for neurotic reasons if the patient speaks Eng- 
lish well and has adjusted himself to our ways of living. 
Similar irrational drives would be operative in an Ameri- 
can who will have only an American analyst and who 
argues that his choice is made on the basis of patriotic 
considerations, contradicting thereby the true spirit of 
democracy which he believes he espouses. 

Because of irrational fears of being identified with a 
minority group, a foreigner might select an American 
analyst to get a spurious feeling of belonging to a ma- 
jority. An American might insist on a compatriot be- 
cause he despises minorities, or he might lean over 
backwards to avoid facing his arrogance and contempt 
for people who are in a minority position, and select an 
analyst from that group. 

All of these biased considerations in the choice of an 
analyst may be unconsciously motivated by general mis- 
trust and suspicion, stubbornness, defiance, and arro- 
gance. Or by an unwillingness to learn or change with a 

145 



Are You Considering Psychoanalysis? 

consequent limitation and rigidity of viewpoint. They 
may also be due to a neurotic need to have everything 
one's own way or to bend others to one's will. 

Both Jews and gentiles may prefer a Jewish analyst 
because they believe Jews can understand human suf- 
fering better, having suffered so much themselves. Actu- 
ally, persons of all denominations have had their share of 
suffering and an analyst should be able to understand 
and be helpful to all patients regardless of their back- 
ground or of his own. The assumption made by some 
Jews as well as gentiles that, because Freud was a Jew, 
Jews make better analysts is similarly unwarranted. 

A Jewish patient may prefer having a Jewish analyst. 
Such a preference might be understandable if his Jew- 
ish origin has been a very important factor in the de- 
velopment of his neurosis. A Jewish analyst would be 
close to the patient's problem, and no time would have 
to be lost in explaining the patient's particular difficulty. 
An ingrained fear that every non-Jew is anti-Semitic 
may cause a patient to insist on a Jewish analyst. These 
should not be considered valid reasons for a Jewish pa- 
tient to forego an analysis if a Jewish analyst is not 
available. In the analysis of such patients, it is frequently 
discovered that they place an exaggerated emphasis on 
the fact that they are Jews to explain many other emo- 
tional difficulties unrelated to that particular problem. 
The attitude may be an unconscious attempt to ascribe 
all of their disturbances to an external situation. 

Political and religious prejudices frequently play a 
role in the choice of an analyst. When people display 
146 



Who Should Your Analyst Be? 



such prejudices they are actually expressing the fear 
that their political bent will be considered a neurotic 
manifestation and that they will be proselytized. Though 
an analyst may be in sympathy with a patient's religious 
or political views, the patient cannot validly expect that 
he should be. Some persons go to the length of demand- 
ing that the analyst be an active adherent of the partic- 
ular faith they profess. Such persons have become neu- 
rotically overfocused on one aspect of life and do not 
realize that the analyst is interested in them simply as 
human beings who are suffering. There have been in- 
stances where analysts have helped confirmed fascists, 
whose ideology they viewed with avowed antipathy, 
and so informed their patients at the outset. An analyst 
may tell you of his political affiliation and religious be- 
lief if it is a matter of great importance to you. But what 
should be of crucial interest to you is whether you 
believe he can help you with your emotional difficulties 
regardless of such beliefs. It is well to remember that if 
differences exist they are rarely absolute; nor do they 
exclude agreement on many other aspects of living. What 
is really important for you to know is that whatever con- 
viction or belief of yours is solidly grounded will become 
strengthened in analysis and that only those of your 
leanings will be undermined that are based on neurotic 
premises. This should be the outcome regardless of the 
political or religious views of patient or analyst. 

Concern about the analyst's political bent is frequent 
among communists. One of their arguments is that it 
would be disloyal to divulge party secrets to a person 

147 



Are You Considering Psychoanalysis? 

not belonging to the party or in sympathy with its activi- 
ties. They must depend for their security on the uni- 
versal and ancient oath that every physician takes not 
to divulge confidences made by his patient, nor to use 
such knowledge against him. Except for fascists, no 
person or group has ever challenged a doctor's duty 
never to repeat such information. If analytic scrutiny 
should reveal that what the patient held to be his firm 
belief in the communist cause is actually a spurious at- 
tempt to solve his inner difficulties and if as a result of 
this discovery he drops out of the movement, this can 
only be to his advantage as well as to the advantage of 
the party. This, of course, holds true of any political 
or religious cause. 

Catholics frequently express concern regarding the 
analyst's religion. They fear that their belief will be 
undermined. What was said previously regarding irra- 
tional fears of losing one's belief is also applicable to this 
case. However, legitimate concerns in this regard might 
best be answered by a positive statement of what ana- 
lysts of our school of thought believe. It might be called a 
psychoanalytic credo or philosophy of life. The follow- 
ing are some of its tenets; others are stated or implied 
throughout this book. 

We believe that man is constructive by nature and be- 
comes destructive only when his genuine urge to grow 
and develop has been frustrated. Naturally this is a rel- 
ative matter. No person is completely constructive and 
rarely does anyone become totally destructive, abso- 
lutely inhuman. It is upon these latent constructive 
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Who Should Your Analyst Be? 



forces in the patient and in his environment that we 
count so heavily to help him out of his difficulties. We 
believe, then, that man by his own efforts can free him- 
self of the consequences of those inimical forces which 
made him destructive. 

We believe that man has the capacity to seek and to 
find ways of availing himself of what is innate and orig- 
inal in himself and of enjoying its spontaneous expres- 
sion. We believe that within the limitations of his natural 
endowment and those imposed and created by his par- 
ents, his culture, and his physical environment man can 
exercise a choice regarding the ways and directions of 
his self -betterment. We believe that man has the capac- 
ity to live according to the moral values of decency and 
respect for himself and toward others. We believe that 
man can have a rational faith in himself and that he 
can find solutions to his problems by means of co-opera- 
tion with others. In short, we believe that people can live 
together in a truly democratic society and in a spirit of 
mutuality even though for the present, and for some 
time to come, the strongest stimuli moving them toward 
that goal may be a survival need and a fear of the conse- 
quences of the monstrous destructiveness created and 
unloosed. 

Such a credo, though succinctly stated, has far-reach- 
ing implications. That this state of mutuality does not 
yet exist in the world need not cause us to despair. From 
time to time it has existed to some extent among groups 
and between individuals. It is a goal toward which we 
can aspire. When we are clear about our goal and have a 

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Are You Considering Psychoanalysis? 

true humility about it, we will not have the fantastic ex- 
pectation of seeing it reached in our lifetime. We will be 
able to obtain satisfaction from small successes and from 
some actual progress in moving toward it. With such a 
viewpoint we will be able to be more tolerant of other 
people's ways of reaching that goal since the ultimate 
objective is the same. 



Having discussed a number of irrational and irrele- 
vant factors that should not influence you in your choice 
of an analyst, I shall now suggest some criteria which 
may prove helpful. 

You will want to know whether the analyst is a quali- 
fied practitioner. You can verify his official qualifications 
by consulting medical directories or by inquiring at the 
psychoanalytic institute with which he is affiliated. He 
should be a licensed physician who has served a medical 
internship of at least one year in a mental institution 
accredited for teaching. By the time he completes ana- 
lytic training, he should have been satisfactorily ana- 
lyzed by one senior analyst and have satisfactorily 
treated several patients, under the supervision of two 
other senior analysts. Usually, after a period of one to 
two years of personal analysis, an analyst in training is 
considered qualified to treat patients under the supervi- 
sion of another senior analyst, and independently after 
he has been certified. He must have taken as part of his 
training a series of courses which as a rule extend over a 
period of three years or more. Actually, most analysts 
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Who Should Your Analyst Be? 



have far more than the matriculation qualifications and 
take much more work than is stipulated for certification 
by an accredited psychoanalytic institute. 

It is important for you to know in what school of 
therapy the analyst has been trained. The psychoana- 
lytic institute where he has trained and the psychoana- 
lytic association of which he is a member, or medical 
directories will identify him with a particular school of 
analysis. You can obtain still further information by hear- 
ing him lecture, by reading the papers or books he may 
have written, and finally you might ask him what ana- 
lytic theory he uses when you consult with him. 

Some people hold that theoretical differences in psy- 
choanalytic theory are ultimately of little import, but 
actually they are of very great import. The theory ac- 
cording to which the analyst practices is an expression of 
his philosophy of life. Your analyst's philosophy of life 
is important because it will influence you in the course 
of your analysis. It is inevitable that this should happen 
because you will be exposed to his way of thinking for 
an extended period. You will be influenced in your anal- 
ysis, as you would in any intimate relationship of long 
duration. This does not mean that you will turn out to 
be a rubber stamp of your analyst's thinking. It is not 
important that you agree in details but you should be in 
agreement with the essentials of his view of life. It is 
inevitable that questions about human values come up 
quite frequently in the course of the analysis. The dis- 
cussion of such questions makes great demands on any 
relationship. As it is, the load that the relationship must 

151 



Are You Considering Psychoanalysis? 

carry to fulfill its other tasks is already heavy. If agree- 
ment on essentials is lacking, the strain may be too great 
for the successful conduct of such a venture. 

The particular theory the analyst holds is not only 
expressed in his attitude toward people but determines 
the nature of his therapy what he will tackle in the 
analysis and what his objectives will be. A Freudian 
analyst for instance would be primarily interested in 
the patient's childhood and would spend much time in 
tracking down early life experiences. Our own main 
interest is in the actual character structure as it functions 
in the present. A Freudian analyst would explain many 
personality difficulties from the viewpoint of sexuality, 
while we would relate them to a person's disturbed hu- 
man relationships. According to Freudian concepts, the 
desire to grow is narcistic an evidence of something 
sick. We would regard such a desire as something con- 
structive and healthy. These differences are indicative 
of the importance the analyst's theory has in therapy. 

Whether the analyst is competent will be another vital 
consideration in your choice. You can judge this to some 
degree by hearing him lecture and by discussing his 
ability with those who know him or with people whom 
he has analyzed. He may be recommended by someone 
whose opinion you value. And finally, you may get some 
idea of his ability in an initial consultation with him. 

You may want to know, in this connection, whether 
an analyst must be experienced in order to be compe- 
tent. Experience in analysis is valuable as it is in any 
other endeavor or profession. It sharpens the analyst's 
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Who Should Your Analyst Be? 



perceptions and enables him to grasp problems more 
quickly, even though indications of their presence be 
slight. Experience makes him more deft in giving the 
necessary help for the solution of such problems. If, in 
addition to having learned from his practical work with 
patients, he has kept abreast of recent developments in 
psychoanalysis or even has made original contributions, 
you could not ask for more. However, the value of expe- 
rience should not be overestimated. Analysts who have 
been recently trained and who are therefore less expe- 
rienced have obtained the benefit of all that is available 
in psychoanalytic thinking to date. Then, too, native 
ability or gifts may make up in some measure for a lack 
of experience. 

Age and experience are frequently thought of as going 
hand-in-hand, but this is not always true, either in re- 
gard to life experiences or in regard to experience in 
analysis. Since many physicians decide to become psy- 
choanalysts only after having practiced in some other 
field for a number of years, it may often happen that a 
young analyst has more experience in analysis than an 
older one. 

Cultural cliches can be selected to make a case for or 
against a younger or older analyst. Youth is filled with 
vitality, hope and optimism. Youth is in favor of change 
and of trying out new ideas. Youth has the originality 
and energy to handle difficult tasks for example, analy- 
sis. But young people are immature, undependable and 
lacking in wisdom. And older people have the wisdom 
that comes from the experience of living. Older people 

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Are You Considering Psychoanalysis? 

have greater humility, are more tolerant, and have greater 
sympathetic understanding for human frailties and 
foibles. But they are rigid, fixed in their ideas, narrow 
in their interests and always looking backward rather 
than to the present and the future. Such argumentation 
is not only futile but also dangerous. 

Actually, the age of your analyst is not of crucial im- 
portance. Both younger and older analysts may have 
vitality, curiosity, maturity, and wisdom. Undue em- 
phasis on age is to your disadvantage, as is any one- 
sided and distorted weighing of the facts in attempting 
to arrive at a decision. 

An analyst's reputation may help you in arriving at a 
judgment with regard to his competence. His reputation 
may be based on the books he has written, the lectures 
he has given, or his status in the organizations with 
which he is affiliated. You may want to select an analyst 
on the basis of his fame because you know so little about 
analysis and analysts, and hope that by selecting a fa- 
mous analyst you will be getting one of real ability. Usu- 
ally you will be right. However, you may do as well 
with an analyst of lesser reputation. 

Reputation and large fees are often thought of to- 
gether. A person may want to pay a large fee or the 
highest fee not only because he can afford it but be- 
cause he hopes in this way to assure himself of getting 
a good analyst, possibly the best. In the field of analysis 
as in any other profession, it is to be expected that a 
person with great experience and a high reputation 
would command large fees. However, a person with less 
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Who Should Your Analyst Be? 



experience and one whose fees are not so high may be 
equally competent. 

There are certain cultural attitudes that favor an em- 
phasis on reputation. The fallacious notion is fostered 
that fame and success must necessarily coexist with 
competence. The belief is encouraged that what is most 
expensive is best and that money can buy the best of 
everything, which is, of course, a fallacy. 

An emphasis on reputation may be due to an irrational 
need to live by reflected glory. Hence a famous analyst 
may be sought out of a desire for prestige, a desire to be 
envied by others, and an expectation that the associa- 
tion with such an important person will bring with it 
special privileges. The person who feels he must have an 
analyst of superior reputation may really be seeking one 
with magical ability. He may feel that his difficulties are 
so great that only a superperson can help him; that only 
a superperson can give him the courage and faith to 
break away from whatever upsets him. He may expect 
from this magician a quick, painless cure that requires 
no effort on his part, no real attempt at change. Or he 
may feel that by reason of his own unique qualities 
he deserves such an analyst who will then endow him 
with superabilities. 

Often what people are seeking is not a competent 
analyst but the perfect analyst to whom they feel en- 
titled because of their own perfection. He is to help 
them realize this illusory quality. But the perfect analyst 
does not exist any more than the perfect patient. 

The final criterion for your selection of an analyst will 

155 



Are You Considering Psychoanalysis? 

be your feeling about him as a person. You should feel 
that you can trust him, that he has integrity, that he is 
an understanding human being who is interested in you 
and your problem in short, that he is the kind of per- 
son you would like to work with. The way he thinks, the 
manner in which he goes about his work, and the nature 
of his relationship to his patients should appeal to you. 
Here again you can get some initial impression from 
hearing him at lectures, reading some of his writings, 
talking to his patients or other people who know him 
but, best of all, by talking to him in one or several con- 
sultations. 

The reader may ask, "How can a neurotic person form 
an adequate and valid judgment of another person?" Is 
he capable, for instance, of realistically evaluating the 
analyst's competence? A neurotic is not a completely 
confused person. He is only confused in some ways. In 
fact, in certain spheres his observations and deductions 
may be quite astute. It is well for a person who is neu- 
rotic to know this. The knowledge will prevent him from 
immediately discarding all his judgments and will pro- 
tect him from being deceived by his own confused re- 
actions. It will help him to maintain a certain skepti- 
cism about his feelings and will give him an opportunity 
to examine them more carefully. In this way he will not 
be impressed too readily by the intuitive feeling he has 
about an analyst, nor will he too rashly discard his own 
intuition. 

Furthermore, a person who is neurotic should not be 
too disturbed because he does not have a feeling of deep 
156 



Who Should Your Analyst Be? 



conviction about his reactions or decisions. Although 
an attempt has been made in this chapter to define the 
criteria for selecting an analyst as clearly as possible, 
none are absolute. All are subject to error in the evalua- 
tion and in the weight they should carry. You cannot 
be absolutely certain that you are making the correct 
choice. No one can foresee or take into account all 
possibilities and eventualities. Such an expectation 
would be irrational. Certain risks must be taken. They 
are present in any decision or relationship. After having 
made an evaluation of your needs and goals and the 
evidence at hand, you must take a chance. 



157 



What Do You Do in Analysis? 



ELIZABETH KILPATRICK, M.D. 



JLJURING the evolution of psychoanalytic thinking the 
concept of the patient's role in analysis has been con- 
stantly changing. The greatest change that has taken 
place in conjunction with new theories has been an in- 
crease in the patient's share in the therapeutic process. 
When Freud and Breuer first began their explorations in 
mental catharsis the patient had to make no conscious 
effort whatever. On the contrary, he was reduced to pas- 
sivity by being placed under hypnosis. It was not until 
a later stage, after Freud had discovered ^the value of 
free association, that mental activity on the part of the 
patient began to be encouraged. Thereafter, Freud and 
his followers urged their patients to mention all their 
thoughts, feelings, and impulses during the analytic ses- 
sion. This often necessitated deliberate effort on the 
part of the patient for it meant that he must work against 
the pressure of his own resistance. 

159 



Are You Considering Psychoanalysis? 

Ferenczi carried this technique a step further: he 
required the patient not only to mention everything that 
came to his mind but also to act out his feelings and im- 
pulses. Both Freud and Ferenczi encouraged their pa- 
tients to relive past experiences during the analytic 
hour but Ferenczi introduced a new element: he insisted 
that the patient deal with the analyst not only as some- 
one who represented a figure in his past but at the same 
time as a person in his own right. This development 
opened the way to a more natural, matter-of-fact re- 
lationship between patient and analyst and placed the 
patient in a position to take responsibility for his own 
attitudes and behavior. Present-day analysts continue 
to encourage the patient's mental activity in analysis; 
and therapy as it has now developed demands alert, 
intensive work on the part of the patient as well as the 
analyst. 

This emphasis on shared responsibility constitutes 
without doubt the most significant of the changes in the 
patient's role in analysis. It recognizes the patient's abil- 
ity to exert himself in his own behalf and, even more 
important, it recognizes the existence of an incentive 
toward development and growth. Our concept of neu- 
rosis takes full cognizance of the extent to which neurotic 
trends hamper the patient in his striving toward inner 
freedom, and we see the task confronting analyst and 
patient as an analysis of the entire character structure. 
During the analytic process we see the patient becom- 
ing capable of directing his energies more and more 
surely toward the active solution of his problems and 
160 



What Do You Do in Analysis? 



moving toward the realization of the potentialities which 
he actually has. This form of therapy assumes the right 
of every human being to choose his way of life. It also 
assumes a capacity for internal change and an ability 
to discard even the most cherished habits of thought 
and feelings in the interest of larger growth. 

Under these conditions, as you begin analysis you 
may well anticipate important modifications in your 
view of life and people and in your basic personality. 
You should know that not only your behavior will be 
different but that your feelings will be different as well. 

This does not mean that you will be forced to accept 
anything you do not believe about yourself or to become 
anything against your will. It means rather that you 
will be helped to see the functioning and the conse- 
quences of unconscious neurotic forces around which 
your life has taken shape, and that you will come to ap- 
preciate how hopelessly they defeat the possibility of a 
satisfactory life. Your objective, then, will be to work 
spontaneously toward elimination of these forces in 
order to have more energy available for purposes con- 
structive to your development. 

After you have selected your analyst and before you 
actually begin analysis, there will be practical details to 
settle; these involve mutual agreement and lay the fou**- 
dation for your partnership. Your fee is one of these, fo* 
it should be realistically determined with full fairness 
both to the analyst and to yourself. In response to sub- 
jective needs you may attempt fee plans that are un- 
workable or unjust For example, a patient may be under 

161 



Are You Considering Psychoanalysis? 

the impression that if he makes a financial sacrifice he 
will progress more favorably. Or, on the other hand, he 
may have a sense of demonstrating strength if he ar- 
ranges to pay less than circumstances warrant and so 
seemingly get the best of the analyst. Neither approach 
is sound. Both would be indicative of neurotic needs and 
as such would be, necessarily, material for analysis in 
time. Consequently the one essential is that all possible 
mutual clarity be brought to bear and that the first dis- 
cussion of the fee will be approached with all the hon- 
esty and sincerity you can command. Your analyst 
knows, of course, that some of the factors that deter- 
mine your decision lie beyond your awareness at that 
time. He certainly will not hold you to any rigid stand- 
ard. He may even suggest some reconsideration of the 
initial agreement at a later point. 

The same principle applies to any advance agreement 
with regard to broken appointments. You will be asked 
to assume a measure of responsibility in this area, too, 
even though it is fully understood beforehand that your 
emotional needs may cause you to disregard some of 
your planned visits with the analyst. 

You will want to bear in mind as you start out that, 
generally speaking, your analysis is a private affair be- 
tween your analyst and yourself. You may, however, 
find yourself experiencing a compulsive need to talk 
about it excessively or, on the other hand, to keep it 
unduly secret. Do not worry if you do. No great harm 
will follow either course and, as you would expect, both 
attitudes will come in for examination at the proper 
162 



What Do You Do in Analysis? 



time. The same is true of your desire to read intensively 
in psychoanalytic literature. Do not take this too seri- 
ously. At times you will find that your reading clarifies 
some phase of your analysis; and there may be other 
times when it interferes. A good rule to follow is that 
you should try to understand what you really want to 
get from reading. Is it a clearer insight into your own 
perplexing problems or are you trying to fortify yourself 
against making a realistic approach to these problems 
by making them seem theoretical? 

The frequency of your analytic sessions may vary, but 
will be agreed upon tentatively at the outset. The num- 
ber of weekly sessions will depend on what the analyst 
considers to be your individual need. If you come with 
an acute problem, the analyst will prefer to see you 
daily in the beginning. And later, although he may see 
you less frequently, you will find him ready to tem- 
porarily increase the number of your visits if you need it 
and if he can make the time available. Other considera- 
tions enter in. Patients differ in the rate at which they 
can work and digest help; some do better with longer 
intervals between appointments. Although it is true, as 
mentioned elsewhere, that it is generally advantageous 
to have four or five analytic sessions a week, patients 
who come less frequently or have treatment intermit- 
tently have been successfully analyzed. This is a point 
to bear in mind in the event of obstacles presented either 
by distance from the analyst, finances, or limitations in 
the amount of time that you and the analyst have avail- 
able. 

163 



Are You Considering Psychoanalysis? 

The usual procedure during the analytic session is 
that you lie on a couch, while the analyst sits in a chair 
behind you. This arrangement generally affords the pa- 
tient maximum opportunity to relax and concentrate on 
himself; he is less influenced by the analyst's presence 
than he would be otherwise. Your analyst will not as- 
sume any inflexible rules regarding the use of the couch, 
however, and may find it advisable to make modifica- 
tions to suit your individual need. Some patients, at the 
beginning of analysis, feel apprehensive about what 
may happen to them and are tense and uncomfortable 
unless they can watch the analyst. Others are so de- 
tached that the unusual position heightens their sense 
of unreality to the extent that they do not feel part of 
the experience they are going through. If for these or 
other reasons the arrangement is disagreeable to you, 
you should feel free to move about or sit in a chair. The 
most important consideration, however, is that you men- 
tion your reactions to the situation at once; for in this 
way you make your individual attitudes available for 
analysis. If you are to derive benefit from your analysis, 
you will hold steadfastly to a determination to be 
frank, honest, and sincere with yourself and the analyst 
throughout. 

Analysis is a growing experience for a patient. Dur- 
ing your analytic sessions you will visualize goals and 
work toward their attainment. Briefly these goals are: 
becoming acquainted with yourself as you are (not as 
you think you are); understanding your particular con- 
164 



What Do You Do in Analysis? 



scious and unconscious attempts at solutions of problems 
which confront you; evaluating these solutions and their 
effects on your life; changing conditions in your per- 
sonality by resolving neurotic conflicts; and, when your 
real self has become free, mobilizing your resources in 
directions of your own choosing. You will work toward 
these goals more or less simultaneously; while becom- 
ing familiar with one part of your personality, you will 
be engaged in evaluating another and changing yet an- 
other. For purposes of clarity I shall describe these proc- 
esses as though they were dealt with one after the other. 

Your first objective will be to know yourself. You 
will say: "But I do! I know a great deal about myself ." 
This is true but the knowing of yourself through anal- 
ysis will be quite different. It will mean a more thorough 
knowing, and a knowing about your motivations. It will 
mean becoming acquainted with and experiencing as 
part of yourself all your conscious and unconscious atti- 
tudes toward life; what you think about yourself and 
about other people; your feelings about your back- 
ground, your past experiences, and what you are doing 
now; what your fears, your hopes, and ambitions are; 
how you think, how you come to decisions, and what 
you do about them; your dreams and your phantasies > 
the things which make you happy, irritable or sad. You 
will learn of the factors which determine your mode of 
life, and the way you meet difficult situations. At first 
you will come to know the things you are aware of to 
some extent already, then those you have vaguely sus- 

165 



Are You Considering Psychoanalysis? 

pected, and from time to time you will learn about ele- 
ments in yourself that are quite new and foreign and 
that you may have difficulty in accepting. 

The process by which this comes about is free asso- 
ciation. It consists in relaxing, and letting your thoughts 
speak for themselves as they arise. This is not quite as 
easy as it sounds. You will have difficulty in always be- 
ing frank, especially at the beginning when you have 
not yet become familiar with your analyst. You may 
have doubts and may question the importance of men- 
tioning everything you think. Your thoughts may seem 
irrelevant and disconnected. Such doubts and hesita- 
tions should all be brought into the open as part of the 
associations. They tell you about yourself. As you asso- 
ciate, you will notice changes in your mood, and at 
times will be anxious or irritable. It is important to talk 
about these reactions too. They give a clue as to which 
of the associations are more significant, and thus open 
the way to discovery of your values and standards of 
life. You may begin a session by talking about your past 
or present life, or by commenting on your thoughts at 
the moment. You may give, like an onlooker, an account 
of everything that has happened to you since the last 
session, or you may go on with a more or less continuous 
story, session after session. 

What you discuss and the particular way you go about 
discussing it will be different from the way in which any 
other human being would proceed. The important issue 
is not what you talk about but what information you 
gain about yourself in doing so. Some of the first advan- 
166 



What Do You Do in Analysis? 



tages of your analysis will be that you are free to say 
anything that comes into your mind, to ask the analyst's 
assistance, and to let him know your reactions to the 
way he goes about helping you. Quite early you will be- 
gin to notice and to comment on what you are doing 
and saying. You may find that you cannot talk as freely 
in analysis as you do elsewhere and that you have dif- 
ficulty bringing up certain topics. This may be due to 
the presence of the analyst or to the nature of what you 
intended to say. In either case you should subject your 
hesitation to further scrutiny. Unless you go into the 
cause of these little hesitations each time they occur, 
they may extend to silences of several minutes, or to a 
whole session or even the greater part of several sessions. 
Struggle against going where your associations lead 
may be indicated by abruptly changing the subject, 
jumping from one thing to another, or not listening to 
what you are saying. When you let the analyst know 
what is going on he will help you to uncover the resist- 
ance and to deal with it. You may come to the session in 
a cheerful mood, and find yourself becoming tense, 
anxious, or irritable. Again, you may feel a burden lift- 
ing as you talk. You may relate these changes to some- 
thing that happened before you came, to something 
the analyst has said or done, or to something you have 
said about yourself. By attempting to understand all 
these occurrences, you begin to take responsibility for 
your share in the analysis. By relating the variations in 
productivity, the mood changes, and the content of the 
associations, you will realize what is of importance to 

167 



Are You Considering Psychoanalysis? 

you and what makes for happiness, fear, or dissatisfac- 
tion in your life. 

As you talk about your associates you will indirectly 
disclose the manner in which you meet life situations 
as well as the values you place on certain human quali- 
ties. At first you will find yourself attempting only to 
analyze the motives and attitudes of others, convinced 
that yours are the natural reactions to what is happen- 
ing around you. In time you will begin to see yourself 
emerging as a definite personality motivated by individ- 
ual wishes and desires, responding to other people and 
dealing with situations in ways peculiar to you. You will 
rightly suspect that you take a definite part in determin- 
ing what happens to you and will begin to ask such ques- 
tions as, "What did I do that permitted me to be taken 
advantage of?" "I want this woman to love me; what am 
I giving in return? What am I willing to give?" In short 
you begin to look inward for reasons for your behavior 
as well as outside yourself. 

A patient said recently: "It is no use dealing with 
labels. I don't know what kind of a person I am and I 
must let myself tell me." As you assume this responsi- 
bility you begin to discover that you are engaged in ful- 
filling many special needs that you were unaware of. 
You find that you have many rigid attitudes. You may 
find that you are in a chronic state of indecision. As you 
hesitate, someone takes what you realize later you 
wanted, and in consequence you feel irritated and re- 
sentful. You may wish to have friends but find you are 
unwilling to share your feelings or your efforts. You may 
168 



What Do You Do in Analysis? 



hold yourself responsible for every misfortune or place 
all the blame on the other person. You may be attempt- 
ing to gain your purpose through passivity and avoiding 
all responsibility. 

A patient may come to analysis with the idea that cer- 
tain characteristics are interfering with his life and find 
through associations that others, previously hidden, are 
more detrimental. For example, a patient complained 
that he was so compliant that everyone took advantage 
of him. In this state of feeling abused he spent several 
sessions talking about other people's shortcomings, em- 
phasizing how various situations should have been han- 
dled, and criticizing others who had opinions which 
differed from his. Meanwhile he pushed aside all the 
analyst's suggestions to listen to what he was telling 
about himself in his associations. Soon he began to re- 
gard the analysis as another of those situations where 
he was being taken advantage of as he felt he was get- 
ting nothing from it. When he was able to deal with his 
expectations here, he began to realize why he felt life to 
be so threatening. He saw himself as a person with 
grandiose notions about his ability who felt it was the 
analyst's function to show him how to make others recog- 
nize him as superior to them. In the light of this insight 
his feeling of compliance and being taken advantage of 
took on a different significance. 

Such disclosures may cause you some discomfort. 
Some of the things you liked about yourself are not 
standing up well under scrutiny. It is disturbing to real- 
ize that you have characteristics you did not know about 



Are You Considering Psychoanalysis? 

and the thought that still others may come out is alarm- 
ing. You may begin to feel sick, humiliated, angry, or 
frightened. You may feel unreal and not understand 
what is being said. These are evidences of anxiety which 
invariably occur during analysis when a patient comes 
upon unacceptable truths about himself, and later when 
he is faced with the necessity of doing something about 
them. You may be able to disregard the discomfort and 
push through to greater clarification, and the anxiety 
will then diminish. 

Or you may unconsciously attempt to relieve the anx- 
iety by doing things that are unrelated to your current 
problem in analysis. This is called resistance. It becomes 
apparent in many ways. You may deny what you dis- 
covered about yourself. You may try to neutralize it by 
talking about other characteristics. For example you 
may have come upon evidences of cruelty in yourself 
and begin to talk of your helpfulness to others. You may 
discover that you have a headache or begin to worry 
about an old physical ailment. You may remember some- 
thing unrelated but urgent that you must talk about. 
You may become absorbed in thinking of others less 
well adjusted than yourself. You may even become dis- 
satisfied with the analyst and the whole analytic process 
and wish to discontinue. If you are to make progress, it 
is your task to be on the alert for these attempts at escape 
and to enlist the analyst's help in your struggle to over- 
come them. 

In describing everyday activities your selection of the 
things you discuss in detail or omit will be significant. 
170 



What Do You Do in Analysis? 



For example you may concentrate on your work because 
you are successful there and wish to emphasize only 
your successes. Or you may feel apart from people and 
try to find in your work the satisfaction you cannot get 
elsewhere; or you may be using it as a way to get closer 
to people. Again you may be looking for reassurance or 
help from the analyst. You may bring up only situations 
in which you have failed, have been unfair, or have hurt 
someone. Whatever you talk about will be used as a 
medium through which you gain access to your con- 
scious and unconscious motivations and, as these are 
elaborated upon, you come to understand their real 
value to you. 

You may be wondering at this point, "But how do I 
get at my unconscious?" There is no wall or chasm be- 
tween the conscious and the unconscious, and as you 
successfully master the art of free association by over- 
coming resistances, your unconscious will be readily 
accessible. Sometimes unconscious material comes to 
the surface through associations with dreams, with a 
snatch of song, sentence, picture, phantasy or old mem- 
ory which recurs quite unheralded. 

As you talk of the people whom you like, dislike, ad- 
mire, emulate, or quarrel with, you will gain insight into 
human values and standards. You may admire a person 
because he has characteristics you admire in yourself. 
You may be blind to or intolerant of undesirable quali- 
ties in others which you have but do not recognize. You 
may sympathize with and expect less from an associate 
because he has characteristics you recognize in yourself, 

171 



Are You Considering Psychoanalysis? 

and are unable to change. You may resent someone who 
has succeeded where you have failed, and be unaware 
of your reason for disliking him. In short, many of your 
feelings and attitudes toward your associates are subjec- 
tively determined. 

Although your relations with friends give you an op- 
portunity for disclosing and evaluating attitudes which 
disturb interpersonal relationships, your relations with 
the analyst will serve this purpose even better. In spite 
of your conscious realistic appreciation of the analyst as 
a physician, and your determination to stick to your pur- 
pose of dealing with your problems during analysis, you 
will become involved emotionally with him. As in all 
human relationships your unconscious needs will affect 
what happens between you. The patient-analyst rela- 
tionship is intense: first, by reason of the especially inti- 
mate nature of the work and, second, because there is 
actually so much more at stake than in other relation- 
ships. You are sharing with the analyst responsibility 
for something that involves your whole future life and 
happiness. You will share in this partnership in a way 
that is representative of your life as a whole. 

Since the analyst is much less involved emotionally 
than your family and friends, you will be able to see 
your attitudes, desires, motivations, and sensitivities in 
a more neutral setting. For example, you may have com- 
pulsive needs for affection and approval which will be 
shown in seeking the good opinion of the analyst, in 
wanting to be his best patient, in wanting to be singled 
out for special favors and protection. You may want to 
172 



What Do You Do in Analysis? 



draw the analyst into social activities and may feel re- 
buffed when he does not accept your invitations. Some 
patients have phantasies of a love relationship or even 
marriage with the analyst. Hostile, aggressive drives are 
shown in wanting to argue and fight with the analyst, 
in suspicions of antagonistic attitudes in the analyst, 
in disparaging and belittling him, in challenging and 
forcing tactics, in refusing help, in overlooking his con- 
siderateness. Tendencies to withdraw emotionally are 
shown in cold, aloof attitudes toward the analyst, in 
wanting to keep everything on a cold, practical basis, 
in attempting to exclude any mutual exchange of feel- 
ing. You may choose a passive role and expect the analyst 
to assume all the responsibility to tell you what is 
wrong with you and what to do about it. You may even 
ask him to tell you what to talk about. 

These are some of the manifestations of neurotic be- 
havior in your relations with the analyst which will 
gradually become apparent to you. You will attempt to 
deal with him in a certain way at one session and quite 
differently at the next one, all in accordance with how 
you feel or what you think he is doing to you or think- 
ing of you. One of your important tasks in analysis is to 
keep aware of such fluctuations in your attitude toward 
the analyst and to work toward reducing the intensity 
of subjective reactions that interfere with co-operative 
effort. 

Many of your associations will concern events from 
the past. From these you will discover that certain atti- 
tudes have existed for a long time. You may have 

173 



Are You Considering Psychoanalysis? 

avoided emotional involvements for years; you may have 
consistently shunned responsibility, or you may not have 
been able to get along with others unless they did ex- 
actly as you wished. With your present knowledge you 
will understand why you have always experienced dif- 
ficulties in certain situations, how you have alienated 
others or been unfair to yourself. Awareness of the part 
you have played in your life and of the length of time 
you have been moving in wrong directions will give you 
a feeling of optimism about the effect of working in an- 
other direction, as well as more patience with the long, 
involved process of analysis. 

As you review your childhood at long range, and with 
an awareness of your own strivings, you will get an ob- 
jective viewpoint for the first time of the adults in your 
early life. You will see them pushed by their own hidden 
striving and in consequence neglectful of the rights of 
you the small child. You will come to understand the 
stresses you were subjected to, and to realize how you 
were driven into adopting devious ways of getting along. 
As you continue to follow yourself through life, you will 
see how devious ways led to more complications until 
you were deeply involved. This will help you to assume 
responsibility for your share in what you have become. 

Dreams are frequently recalled during an analytic ses- 
sion; they are a valuable aid to the patient in gaining 
an insight into his unconscious fears, hopes, and the solu- 
tions he is attempting to reach in his everyday problems. 
They are of particular value to a patient who finds it 
difficult to talk about himself. The way you deal with 
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What Do You Do in Analysis? 



your dreams in analysis will be characteristic of the way 
you undertake any project. You may forget them. You 
may have such long dreams that the following analytic 
session is occupied with recalling them. You may take 
full responsibility for interpreting a dream or you may 
leave it entirely to the analyst. An investigation of these 
attitudes will increase your self-knowledge. 

To benefit from dream analysis you should know that 
your dream is peculiar to you, and that the content is 
correctly understood only when interpreted through 
your associations. Ideas and feelings are frequently dis- 
guised in dreams by symbols, and these too become 
meaningful only through the dreamer's associations. A 
dog, for example, may be a symbol of a friend to one 
dreamer and an enemy to another. Your characteristics 
may be symbolized in various ways frequently by other 
persons, animals, trees, boats, or houses. One patient 
had several anxiety dreams in which she was trying to 
build an enclosure to house many wild and domestic 
animals. The central figure in your dream will be your- 
self in some form, or some person or object representing 
a characteristic in yourself which you are ready to talk 
about. 

Your dream associations may lead in different direc- 
tions. As with all other associations, the path to follow is 
that which leads to a better understanding of yourself. 
They frequently reveal the discrepancy between your 
conscious behavior and unconscious wishes. A young 
woman, who was consciously eager to gain an under- 
standing of herself and to take whatever help the analyst 

175 



Are You Considering Psychoanalysis? 

could give her, began a long stormy analysis by relating 
the following dream: "Two women were fighting for 
the royal blue robe." Her associations were scattered 
and she was obviously uncomfortable. Some time later 
she disclosed her apprehensions about analysis and her 
fear that the analyst would rob her of unusual qualities 
she believed she possessed. 

Dream associations may throw light on how a patient 
is unconsciously dealing with a problem in analysis. The 
following example illustrates how an outwardly com- 
pliant, pleasant patient discovered some of her real moti- 
vations. She dreamed that a salesman was fitting her 
with shoes which were as broad as they were long. While 
she kept encouraging him to show her more shoes she 
was saying to herself, "I won't wear any of them." Her 
associations led to hidden feelings about herself and 
indicated that she believed she had most unusual quali- 
ties. She discovered that she actually did not wish to 
have anything to do with anyone unless she could dic- 
tate the terms. She also discovered her need for approval 
She would have liked to frustrate others' attempts to 
secure anything, but was afraid to do anything overt 
because she was afraid to have anyone dislike her. Her 
solution was to appear compliant but to detach herself 
and remain unconvinced. By this maneuver she was 
able to repress hostility which was aroused when she did 
not have her way, to maintain her unrealistic belief in 
herself, feel loved, and secretly enjoy the satisfaction 
of seeming to have defeated the other. It was most help- 
176 



What Do You Do in Analysis? 



ful for her progress in analysis to realize that she was 
contemplating these tactics toward the analyst. 

As analysis proceeds the patient is rewarded for his 
sincere searching and frankness by a clear revelation of 
himself. He will discover many qualities he likes and 
will wish to cultivate. He will become aware of more 
and more attitudes that are making life intolerable. He 
sees himself ineffectual in work because his attention 
is divided. He finds himself striving to attain certain 
goals only to be dissatisfied when he reaches them. He 
finds he is irritated because he does so much for others 
and when he does something for himself he becomes 
panicky. He recognizes his contempt for himself and his 
hostility toward his fellow men. He attempts to change 
but soon finds himself back in the old pattern. There is 
no real progress until he makes the significant discovery 
that many of his attitudes exist for the purpose of com- 
plying to neurotic trends. Because of this he is unable to 
change them through will power. His whole pattern of 
living is beyond his control. He finds he is continuously 
compelled to follow the dictates of inner drives that are 
often at variance with his best interests. He is in conflict 
between what he wishes to do and what he feels he is 
driven to do. He is indecisive or leaves the decision to 
someone else. As a result of either solution he is anxious, 
depressed, or tired much of his life. 

During analysis he will discover that many attitudes 
have developed in the service of one neurotic trend. He 
may find, for example, that in order to serve a compulsive 

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Are You Considering Psychoanalysis? 

need to be always superior he cannot take an inferior 
role. He cannot learn, but must phantasy that he is better 
informed than others. He must avoid all criticism. He 
must always feel in control. He pushes or wheedles others 
into agreement with him. Accomplishment of these 
purposes brings relief. But the very nature of the neu- 
rotic structure makes the relief temporary, and he is 
driven to greater and greater lengths to get similar satis- 
faction. 

Another group of attitudes serves a different neurotic 
trend operating simultaneously with the first, and the 
patient sees himself frantically attempting to serve two 
masters, making compromises that involve him more 
deeply. He becomes hopelessly lost in confusion and 
anxiety. By analyzing his behavior not only in his 
everyday activities but in the analytic situation itself 
he comes to see the devastating effect of his compulsive, 
conflicting attitudes. They exhaust him, divert his ener- 
gies, and make him ineffectual. 

Eventually the patient comes to realize that the goal 
of his analysis must be the elimination of the neurotic 
trends which motivate his attitudes. Without this there 
can be no relief from the neurotic pattern of living. 

The first part of this task is identification of trends. 
This is accomplished by constantly evaluating attitudes 
and determining the unrealistic neurotic purposes they 
serve. It will be found that there are many groups of con- 
flicting attitudes, and that each group serves a particular 
neurotic trend. 

Another important step is coming to recognize a trend 
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What Do You Do in Analysis? 



as an integral part of your personality for which you are 
responsible, to evaluate it, and to experience it func- 
tioning in relation to other trends. A good illustration of 
this is that of a patient who recognized his dependency 
but took responsibility for it only as he saw it resulting 
in unsatisfactory relationships with other people. He 
made many attempts to get rid of one person after an- 
other on whom he was dependent. But each time he 
disposed of one host he would adopt another. He made 
no progress until he recognized that he was compul- 
sively driven to pass the responsibility for his life over 
to someone else, and in return to serve that person. No 
relationship could be satisfactory on such a basis. He 
made further progress when he evaluated an equally 
strong need, operating simultaneously, to regard himself 
as set apart and possessing most unusual qualities. 

A further step is the important one of becoming con- 
scious of and evaluating the trends with the ultimate ob- 
jective of disposing of them. This will be accomplished 
by analyzing their functions and consequences every- 
where they are found operating. 

Your relation with the analyst, which you found so 
helpful earlier in isolating your attitudes, will be even 
more helpful now in resolving neurotic conflicts. Evi- 
dences of conflicting trends are continually becoming 
apparent in this relationship. For example, you may be 
evaluating your need for power and the analyst can 
point to specific times when this need has made you dis- 
respectful toward him. During one session several trends 
may be seen in operation. You may attempt to please 

179 



Are You Considering Psychoanalysis? 

him and thus win his approval. You may demonstrate 
your need for control by having anxiety when he points 
out something you failed to recognize. You may feel tem- 
porarily successful by misleading him and thus exploit- 
ing him. You may strive to demonstrate independence 
by rejecting all his suggestions. The laboratorylike at- 
mosphere of the analytic situation is ideal for arriving 
at an awareness of what you are doing, of then under- 
standing how unrealistically you are forced to behave 
and how impossible it is for you to achieve any measure 
of success or satisfaction while following these trends. 
Such insights furnish an incentive to give them up. 

Your dream associations will again be helpful here. 
Although you are sincerely making a conscious effort you 
frequently find yourself blocked by an unconscious strug- 
gle against exposure. You become anxious. At this point 
you may have a dream that will provide a clue. Your 
associations will expose new material relative to trends 
or evidences of hidden resistances against insights you 
seem to have accepted. In this way extra tools become 
available for your work of resolving conflicts. A patient, 
who was very intolerant of any shortcomings in himself, 
felt he was able to give up his grandiose notions of him- 
self after a brief evaluation of their effects. After this 
decision he dreamed: "I was sliding down a ramp and got 
stuck. Someone came to help me and I found I was not 
stuck at all just holding on." His associations revealed 
his fear of giving up his high opinion of himself lest he 
would slip to the bottom and others would injure him. 
He was badly off because he was only pretending to be 
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What Do You Do in Analysis? 



high and was in constant fear of being found out and 
punished. From this he went on to talk of the deceptions 
he used in order to feel that he was fulfilling his need to 
be superior, and how he hated people for forcing him 
into these deceptions. He felt they should simply accept 
him as superior without question. 

The subjective value of these trends will be so great 
that every insight into their nature is followed by anx- 
iety; and premature attempts to disregard their dictates 
are often followed by real panic. The patient is quite 
positive in his belief that he cannot exist if he fails to 
meet the demands imposed by them. He has depended 
on them so long he feels he will go to pieces without 
them. The struggle to free himself often produces mental 
states of hopelessness, depression, irritability, detach- 
ment, or inertia. He may become antagonistic toward 
the analyst for exposing a condition which he feels can- 
not be remedied. He may develop psychosomatic symp- 
toms sometimes becoming quite ill physically and feel- 
ing sure the whole trouble is organic. But when the 
anxiety abates he recovers physically. With each new 
insight the hold of the neurotic trend is loosened. Each 
advance is preceded by anxiety, then struggle. As more 
and more freedom is attained, incentive increases, 
more anxiety can be tolerated, and the work goes more 
quickly. 

The intricacies of the neurotic structure are such that 
the patient cannot deal with a specific trend simply by 
isolating it, evaluating its importance to him and its con- 
sequences, and then discarding it. For in the process he 

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Are You Considering Psychoanalysis? 

invariably finds another trend that must be clarified 
before he can proceed. A small area isolated from an 
analysis may clarify some points regarding the patient's 
feelings and how he goes about extricating himself from 
conflicting trends. 

A woman patient reported: "A woman in my club, 
whom I do not like, asked me to make an effort to remove 
the president of the club whom I do like, but who is not 
the best president in the world. I gave many good rea- 
sons why I did not wish to, but finally said, It is against 
what I believe but I'll do it/ I just couldn't help it. Later, 
when I talked with two other members, they said they 
would have nothing to do with it. Gradually it dawned 
on me that I was doing something no one else would do, 
for someone I did not like, against someone I did like. I 
consciously did not wish to do it and had the queerest 
feeling as though I were being pushed. I realized I had 
done similar things before. Only this time I knew I 
wasn't being pushed by anyone." Analysis of the situa- 
tion disclosed that the patient was being forced to work 
toward several conflicting goals at the same time. She 
had been aware of something similar before but this 
time she felt it as an emotional experience. She felt 
actually pulled in different directions. 

Further analysis showed up old insights in a different 
way as well as some new ones. Once again she saw how 
she was always doing whatever anyone asked her with- 
out considering the consequences even though she had 
repeatedly found how it irritated her and interfered 
with other things she wished to do. Each time she was 
182 



What Do You Do in Analysis? 



driven to comply by a feeling that in this way she would 
be approved of and make friends. This instance aroused 
anxiety in her by the recognition of how all her friend- 
ships were endangered, and how other entanglements 
occurred because of this tendency to comply. 

She became aware of her inability to resist appeal to 
her superior judgment. In this particular instance the 
president had some flaws and she felt she should not 
associate with an inferior person. This reinforced the 
compulsion to comply. She felt she must be superior for 
in this way also she would be approved of and make 
friends. She recognized a feeling of satisfaction at being 
able to think about and discuss the president's inferi- 
ority. This helped her to feel superior but, more impor- 
tant, she felt a thrill at being mean to someone. 

This latter realization was most significant to her. She 
had formerly believed herself to have been most kind 
and helpful, even though she felt she had been badly 
treated as a child. She had gradually come to suspect 
she was not as kind as she previously believed, but now 
she discovered that was quite the opposite. She said 
she was really a cruel person and felt relieved after the 
admission. She rushed in and uncovered evidences of 
mean hostile acts, and her pleasure at others' discom- 
forts and failures. She re-evaluated the resentments she 
had harbored against her parents. These insights were 
followed by a short, anxious, unproductive period. She 
then tackled her attitudes toward her work and real- 
ized that what lay at the root of her dissatisfaction was 
Jhat she did things only to prove she could do them 

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Are You Considering Psychoanalysis? 

well, and one way to prove this was to cause another 
person's envy. After this she was able to appreciate the 
part she played in what she thought of as her husband's 
unreasonable attitude toward her. 

Progress will manifest itself in various ways. As the 
subjective value of a trend is reduced, its fulfillment is 
no longer important. When some trends cease to operate, 
others become unnecessary. As you get rid of compul- 
sions, you begin to have more freedom for yourself, more 
interest in improving your life and consequently you 
bring more constructive effort into the analysis. You will 
feel a new quality in your relationship with the analyst. 
You will regard him less as a menace when you are not 
forced to deceive him or to use him to satisfy neurotic 
needs. In everyday life you will find yourself meeting 
old situations in new ways and being surprised that you 
had ever associated fear with them. You will have an 
awareness of being a part of the world about you. As 
you gradually resolve neurotic conflicts you will gain in- 
ner freedom and increasing incentive toward develop- 
ment. Then you will of your own accord test out a variety 
of values which you have not tried before. Gradually you 
will voluntarily discard old patterns that have hampered 
you, decide on new and more substantial goals, and reach 
convictions that will determine your eventual philoso- 
phy of life. 

This brief survey of the patient's role in analysis indi- 
cates what the patient must accomplish if he is to gain 
the insight essential to effecting a constructive change 
in his character structure. In addition we have consid- 
184 



What Do You Do in Analysis? 



ered what his feelings will be as he tackles his problems. 
We have pointed out what his returns are for an honest, 
sincere effort in his own behalf. It is a particular satisfac- 
tion to have reached the stage in our psychoanalytic 
understanding where we are able to state plainly and 
simply what an individual may expect during analysis. 
To some of you who are contemplating analysis these 
considerations may cause you to feel that what lies be- 
fore you is a tremendous task, that the expectations are 
too great, and the anticipated upheavals too frighten- 
ing. It will be reassuring to know that your analyst ex- 
pects to work right along with you, and to put forth his 
besl effort to understand you and to help you reach your 
goal. 



185 



What Does the Analyst Do? 



KAREN HORNEY, M.D. 



1SYCHOANALYTICAL therapy is an exquisitely co- 
operative enterprise. It can succeed only if both patient 
and analyst do their share. In the preceding chapter, 
how the patient contributes to the work was described. 
Let us now consider the various ways in which the 
analyst tries to help the patient. 

The analyst responds to the patient's unreserved frank- 
ness with undivided attention. His attention is of a spe- 
cial kind. He does not merely strain to remember the 
exact sequence of the patient's associations or to com- 
pute the unknown quantity in the equation. He may at 
times make determined efforts of this kind but, if that 
were all, the results would be fairly barren and incon- 
clusive. The quality of his attention must be of a more 
productive nature; it can be productive only if he enters 
into the task completely and without reservation. He 
responds to the patient with all his acuteness of percep- 

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Are You Considering Psychoanalysis? 

tion, catching on spontaneously not only to the spoken 
words and their content but also to the emotional under- 
tones in the associations. He listens wholeheartedly, us- 
ing the knowledge he has acquired about the particular 
patient, drawing on his fund of experience with human 
beings, and letting his own emotional reactions come 
into play whether they be sympathy, humor, apprehen- 
siveness, impatience, or discouragement. 

While you may like the assurance that the analyst will 
give you his wholehearted attention, you may be dis- 
turbed by my statement regarding his emotional re- 
sponses. Perhaps you feel that his mind should be as un- 
ruffled as a mirror or as a lake on a quiet summer day. 
But are you not asking for the impossible? If the analyst 
is to enter into the analytic procedure with his whole 
self, how can he discard his feelings the most alive 
part of him? He could not possibly choke off his impa- 
tience or his discouragement without also inactivating 
his sympathy and blunting his sensitivity to what is go- 
ing on in you. 

Let us go a step further. Might not the "undesirable* 
emotional reactions of your analyst even have a certain 
value? Assume for instance that, without being in the 
least aware of it, you were bent on defeating your ana- 
lyst. Also assume you were to proceed under so skillful 
a screen of zest and eagerness that for a time your analyst 
would fail to notice your hidden strategies, would not 
his feelings more alert than his intellect give him a 
signal of warning? He would detect vague feelings of 
irritation or discouragement in himself. If he were to 
188 



What Does the Analyst Do? 



suppress these, they might imperceptibly dampen his 
effort. But if he is aware of such reactions he will begin 
to wonder whether perhaps the therapeutic progress is 
less satisfactory than he had thought. He will first ques- 
tion himself: Is his ambition driving him to effect a 
quicker cure than is actually possible? Is he affected by 
vestiges of claims for omnipotence? If your analyst does 
discover and analyze such traces of neurotic ambition in 
himself, it can only be to your advantage. He will be- 
come less concerned with his own glory and will be able 
to devote himself the more effectively to your problems. 
But he will also ask himself whether there is something 
in your attitude that might account for his dissatisfac- 
tion; he will no longer take your eagerness to co-operate 
at its face value and will thus become alert to your hid- 
den frustrating maneuvers. 

Such wholehearted attention is the condition for pro- 
ductive analytical work as it is for any work that is not 
mere mechanical routine. It is directed toward the two 
available sources of information: first, what the patient 
tells him about his relations with others both in the past 
and in the present, about his disturbances and difficul- 
ties, about his attitude toward himself, about his phan- 
tasies and his dreams; second, all the peculiar drives and 
reactions which the patient acts out inadvertently in the 
analytical situation itself his expectations for an easy 
solution of his problems, his claims for special atten- 
tion or love, his need to triumph over the analyst, his 
vulnerability to what he conceives as coercion or hu- 
miliation. 

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Are You Considering Psychoanalysis? 

It would be difficult to say which of these two sources 
of information is more important. Both are indispensa- 
ble. However, analysis of the attitudes appearing in the 
analytical situation itself has the greater therapeutic 
value for here the patient is confronted squarely with 
the irrationality of his neurotic drives. The analyst may 
point out, for example, his compelling need to be ad- 
mired, citing as evidence data the patient has given him 
about his life such as his feeling easily slighted, or his 
surrounding himself exclusively with people who admire 
him. The patient may remain unconvinced, arguing that 
his friends are people whom he happens to like, that he 
simply is superior and that his irritation at slights is 
absolutely justified each time. But if he is shown that 
in the analytical situation, too, he is merely bent on 
presenting himself as a superior person and that in so 
doing he is actually defeating his own purpose, he can 
hardly escape the realization that an irrational force is 
operating within himself. 

Accordingly these very attitudes, if overlooked or in- 
sufficiently analyzed, have the greatest power to retard 
the analysis and may even entirely frustrate the efforts of 
patient and analyst both. Such feelings may appear 
openly in conscious claims for love or special considera- 
tion, in undisguised anger, or in attempts to berate the 
analyst. They may appear in disguised form in dreams or 
within the train of associations. 

Thus one of my patients, during a period of blockage, 
recalled how he had to wait in a harbor for the boat 
that was to carry him to an island near the shore. There 
190 



What Does the Analyst Do? 



was no telling when the boat would leave. It might take 
two, three, or four hours until the freight was stored 
away. In the meantime he could do nothing but sit 
around and wait. The memory expressed most accurately 
what he felt at the time in reference to the analysis. He 
had relegated all the work and responsibility to me; he 
was just a passenger waiting for me, the captain, to make 
a move. 

The patient's attitudes may, finally, determine the 
spirit in which he presents his associations. Thus he may 
say everything that comes to his mind but in a spirit of 
docility, defiance, bravado, or arrogant superiority to 
the analyst. 

You may wonder how the analyst can make sense of 
the jumble of the patient's free associations. He proceeds 
on the assumption that elements appearing in sequence 
are connected with each other though they may seem 
incoherent. Instead of going into detail * I shall only 
mention some important clues. The analyst constantly 
has in mind the question: why does this particular mem- 
ory, thought, feeling, phantasy, or dream come up just 
now? Thus an embarrassing early experience may be 
recalled by the patient because he feels humiliated at 
having to face his present weakness. Snakes, witches, or 
gangsters may appear in his dreams because his own hid- 
den aggressiveness is beginning to disquiet him. The 
analyst will often get the proper perspective on the 
meaning of associations by connecting them with the 

* You will find several examples illustrating the meaning of trains of 
associations in Karen Horney, Self -Analysis, Chapter IV (W. W. Nor- 
ton and Company, 1941). 

191 



Are You Considering Psychoanalysis? 

subject approached by the patient in the previous ana- 
lytic session. 

For instance, in one session a patient may have come 
close to seeing exploiting tendencies in himself. In the 
following one he dwells on incidents in which he has 
been cheated: He also mentions a relative who is said 
to have been harmed by analysis. He considers the de- 
sirability of having a thorough physical checkup. What 
he is actually expressing in various versions is his fear 
of having to face his exploiting tendencies. As he sees it 
he never exploits anyone but is constantly being cheated 
and taken advantage of by others. He voices his concern 
that analysis will harm him. Here again, without being 
aware of it, he refers to his fear that analysis will spoil his 
image of himself as a good, upstanding person by expos- 
ing his exploiting tendencies. When the analyst questions 
his desire for a physical checkup, the patient tries to 
brush this aside: "Oh, I've been wanting one for a long 
time." "Let us see, nevertheless," the analyst insists, 
"why this old wish of yours emerges just now." And it 
may then become apparent that the idea of a medical 
examination, rational in itself, covers up the patient's 
aversion to examining himself psychologically. He is un- 
consciously attempting to solve his real predicament by 
playing around with the hope that his troubles might 
not be psychic at all. 

A clue often lies in the recurrence in variations of one 

and the same theme in the course of a session. Another 

clue can be found in the patient's involving himself in 

contradictions. Changes of mood occurring in or be- 

192 



What Does the Analyst Do? 



tween analytical hours point to unconscious emotional 
reactions to matters discussed. Sometimes a clue lies not 
in what the patient says but rather in what he omits. He 
may, for instance, dwell only on the shortcomings of 
others and never mention his own share in difficulties 
that arise. Finally, the analyst may be struck by con- 
tradictions between the patient's reports about his deal- 
ings with others and the way the patient behaves toward 
him. In his reports he may appear as one who is unfairly 
treated despite his goodness and generosity; in his be- 
havior toward the analyst he may be berating and dom- 
ineering. 

I have dwelt on the quality of the analyst's attention 
and understanding because all the help he can give the 
patient follows from his understanding. Allowing for 
some exaggeration, analysts would need no books on 
analytical technique if their understanding were com- 
plete. Actually, of course, it never can be complete. Each 
patient confronts the analyst with problems which he 
has not encountered before in that specific form and 
combination. A line of approach that was profitable with 
four patients may be ineffective with the fifth. There is 
no blueprint to guide us. We cannot hold the patient 
responsible for our temporary failure to understand or 
to help him by ascribing it to his "resistance." Such an 
approach would be as futile as any shifting of responsi- 
bilities. What is needed is more and more understanding. 

Assuming now that the analyst has arrived at some 
understanding of the patient's character, how does he 
utilize it toward helping the patient to understand him- 

193 



Are You Considering Psychoanalysis? 

self and to change on the basis of the insight gained? 
To begin with, the analyst gives interpretations that is, 
suggestions as to the possible meanings of what the 
patient has expressed. The aim of interpretations is to 
uncover unconscious processes. They may concern the 
patient's unconscious compulsive needs such as his neu- 
rotic need for affection, for control, or for triumph. These 
processes may concern an unconscious conflict between 
the patient's need for independence and his equally 
great need to shirk responsibility. They may concern his 
attempts at solving conflicts by creating an idealized 
image of himself, by keeping at a distance from people, 
by resigning himself to a humble place in life, by dis- 
carding reality and living in phantasy and so forth. Un- 
conscious processes may concern the ways in which 
the patient's neurotic trends, conflicts, or attempts at 
solution operate in his life, in the analytical situation, 
or in his dreams. They may concern the inner needs that 
compel him to cling tenaciously to his particular neu- 
rotic solutions. Most important of all, they may concern 
the cramping influences that all neurotic formations have 
on the patient's life, on his self-confidence, on his hap- 
piness, on his work, on his love life, and on his social 
relations. They may, finally, concern the ways in which 
all these factors contribute to create and maintain the 
patient's symptoms and manifest disturbances the 
bearing they have on his phobia, his insomnia, his tak- 
ing to drink, his spells of migraine, or his inhibitions 
about work. 

Despite what you have read in preceding chapters it 
194 



What Does the Analyst Do? 



may still strike you as incongruous that I mention, at 
the tail end, interpretations which provide an under- 
standing of the manifest disturbances. You may still have 
the feeling that the unraveling and eventual removal of 
symptoms is your main reason for considering analysis. 
Despite better knowledge, you may still cherish the 
belief that if it were not for your depression or your 
inhibition about work you would be quite all right. But 
the earlier you relinquish this illusion the better it is 
for you. If you are organically ill it is self-evident to you 
that your pain, your cough, your fever are not your ill- 
ness but are merely signs that there is some disorder in 
your lungs, your intestines, your joints, etc. You are also 
aware of the fact that the diseases to be feared most are 
those which, like certain forms of cancer or tuberculosis, 
insidiously affect bodily organs without giving you any 
warning signal in the form of pain or which give it only 
when it is too late to do anything about the disease. 
Exactly the same is true of your psychic disturbances. 
Your irritability, your fatigue, your sleeplessness are not 
the disease; they, too, are but alarm signals warning you 
that there is some hidden disorder in your personality. 
You should regard them as friends who persistently re- 
mind you that it is time to examine yourself. A young 
patient who was sent to me much against her will be- 
cause she suffered from epileptic fits, later on almost 
blessed these fits because they were instrumental in 
making her face her conflicts and thus ultimately saved 
her from wasting her life. 

Accordingly, try not to be impatient if your analyst 

195 



Are You Considering Psychoanalysis? 

does not seem to be too interested at first in your street 
phobia or whatever plagues you, and pries instead into 
all sorts of things you feel are irrelevant and none of his 
business. Naturally you would prefer to have your pho- 
bia removed without having to go through the painful 
process of changing. Perhaps you will reread the chap- 
ter What Is a Neurosis? and you will understand that 
it cannot be done this way. You can be reasonably sure, 
however, that as you understand and overcome your 
neurotic attitudes, the phobia, too, will gradually recede. 
The fact that your analyst wants you to become inter- 
ested in yourself and not merely in your phobia does not 
mean, however, that he loses sight of it. Whenever he 
sees a connection between your neurotic trends or con- 
flicts and your presenting complaints, he will point it 
out to you and, as the analysis progresses, you will come 
to see such connections of your own accord. 

Since a major and chronic disturbance has several 
roots in your personality, the analyst will have to search 
for all of them and present them to you as they become 
accessible. Let us assume, for instance, that what dis- 
turbs you most is your inhibition toward productive and 
creative work. At some stage of the analysis, the analyst 
may realize that you behave toward it as a schoolboy 
behaves toward an assignment he is forced to do. He 
will suggest that you feel it as a coercion. At first you 
consider this ridiculous because you really wish to write 
the particular paper that is causing you difficulties. But 
gradually you come to understand the meaning of your 
reluctance on this score. Although you wish to write the 
196 



What Does the Analyst Do? 



paper, you did not anticipate the work it would entail. 
The ideas should simply flow from your pen. Maybe 
they do at the beginning. But then you actually have to 
formulate, to organize, to check whether you are really 
expressing what you want to say in short, you have to 
work. And you rebel at just that. Your analyst may recog- 
nize at a later time that it is not only your neurotic ver- 
sion of freedom that makes you rebel but also that you 
feel it as an insult, as a positive humiliation that you, 
the mastermind, should have to do laborious work. 
Again, later he finds out that you are much more alert 
when you are with somebody who stimulates you or 
with whom you can argue and prove your superiority, 
that you get listless at the point when this exciting game 
of "who defeats whom" stops and you are left to your 
own resources. He may have arrived at this conclusion 
from observing you act similarly in the analytical situa- 
tion. 

In order to be effective, interpretations must not only 
be to the point but they must also be given at the proper 
time. An interpretation, however pertinent, may be 
meaningless to the patient if it is not correctly timed. 
Under the circumstances it would neither help nor harm. 
It may happen, though rarely, that a premature inter- 
pretation upsets the patient without benefiting him. A 
well-timed interpretation will set the patient thinking 
along constructive lines; it will help him to get out of 
blind alleys; and it will give him a better understanding 
of himself. 

Sometimes the analyst can proceed only by trial and 

197 



Are You Considering Psychoanalysis? 

error. But the more comprehensive his knowledge of 
the patient's character structure, the clearer he will be 
in his mind about the sequence in which unconscious 
forces should be tackled. He cannot, for instance, tackle 
a patient's fear of being rejected or despised or his fear 
of being "phony," as long as the patient visualizes him- 
self as a saint or as a supreme lover. The analyst will 
avoid pointing out to the patient his need to exploit and 
berate others, as long as he views himself primarily as a 
helpless and innocent victim. 

Sometimes the analyst is not in a position to offer even 
a tentative interpretation. He may merely feel that the 
whole situation somehow lacks clarity, that the patient 
is moving in circles, or that the specific problem under 
discussion is not yet satisfactorily solved. He may have 
all these impressions without being able to put his finger 
on the source of the trouble. Under these circumstances 
he can do no more than observe as accurately as possible 
and convey his impressions to the patient. This is by no 
means unimportant, because it helps the patient to be- 
come aware of the existing difficulty and elicits his in- 
centive to look for the cause. It disturbs a spurious con- 
tentment with the progress of the analysis or with a 
particular solution and thereby calls upon untapped re- 
sources. 

After making an interpretation, the analyst observes 
with utmost care how the patient responds to it. Some- 
times the truth may strike immediately and forcefully. 
In such a case the patient will feel that the interpreta- 
tion "clicks" and things will occur to him which confirm 
198 



What Does the Analyst Do? 



it. New avenues of investigation will open up. In other 
instances the patient's associations may lead to modifica- 
tions or qualifications of what has been suggested. But 
his readiness to accept an interpretation may also be 
deceptive. He may still be too eager to please the ana- 
lyst. He may accept the interpretation glibly, enjoying 
its intellectual subtlety without in the least applying it 
to himself. He may also be all too glad to follow the 
analyst's suggestion because it diverts attention from 
more painful and hidden subjects. 

But it is not only the question of acceptance or re- 
jection of an interpretation that counts. All kinds of 
emotional reactions may ensue. For instance, the pa- 
tient may merely feel that it was foolish of him to have 
exposed himself that much and become angry at the 
analyst for having found him out. He may feel unjustly 
accused and go on the defensive immediately, bending 
all his energies toward disproving the suggestion. He 
may feel nothing but humiliation because the analyst 
has pointed out a factor that contrasts with his ideal- 
ized image of himself. Instead of testing out whatever 
truth there may be in the suggestion, he will become 
vindictive and try to frustrate the analyst or to humiliate 
him in turn. Such reactions often put the analyst's skill 
to a test because they are usually expressed indirectly. 
The patient may be entirely unaware of them. He may 
try to consider things rationally and become blocked 
because the existing unconscious feelings prevent him 
from being productive. If the analyst recognizes emo- 
tional reactions of this kind, he usually finds them valua- 

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Are You Considering Psychoanalysis? 

ble for they help him determine along what lines he 
should proceed. 

The ultimate aim of interpretations is to bring about 
changes in the patient. Such changes may be conspicu- 
ous or even dramatic. They are usually the result not 
only of one interpretation but of the preceding work as 
well. Anxiety may suddenly abate; a depression may lift; 
a headache may disappear. But there may be other 
changes, less obvious, yet no less important. The pa- 
tient's attitude toward others or toward some particular 
person may change; he may take a different view of a 
neurotic factor in himself; he may become interested 
in a problem of which he had not previously been aware; 
he may begin to observe himself better and to catch on 
to a neurotic reaction of his own accord. You will learn 
more about these changes in the next chapter. 

The analyst, hence, pays attention not only to the 
measure with which the patient accepts or rejects an 
interpretation, not only to the ensuing emotional reac- 
tions, but also to the kind of changes that take place. He 
will be particularly alert to the absence of any changes 
and, if none occur, he will point this out to the patient 
and search with him for the factors that are still inter- 
fering with the possibility of changes. 

The analyst's task comprises more than the mere un- 
covering of unconscious processes. Integrated with and 
essential to the analytic process are two additional ways 
in which he helps the patient. One is a kind of philosoph- 
ical help, an intellectual clarification of issues that are 
200 



What Does the Analyst Do? 



important for living; the other is what I shall call a gen- 
eral human help. 

At one time or another during his analysis, the patient 
will become interested in questions such as these: what 
are ideals and what is the value of having ideals? How 
do they differ from compulsive neurotic standards? What 
exactly does it mean to assume responsibility for one- 
self? What is inner independence? Of course many pa- 
tients have thought about these questions; some may 
even have thought about them a great deal; others have 
taken them for granted; again others have discarded 
them as meaningless. In any case the patient will become 
interested in them or renew his interest when he begins 
to find out that, without knowing it, his thinking in this 
regard has been muddled. It has been confused not be- 
cause he lacked intelligence but because in the matter 
of values he was driven in opposite directions. Thus he 
often confounded authentic ideals with imposed duties, 
self-reliance with self-accusation, self-acceptance with 
self-indulgence, freedom with license, love with depend- 
ency, and so on. 

When the patient realizes how contradictory his atti- 
tudes on this score have been and how many unconscious 
pretenses he has developed in order to blind himself to 
the existence of these contradictions, he begins to strug- 
gle for intellectual clarity. The analyst, then, will help 
the patient to clarify his goals in life. He will say in 
essence: "You speak in glowing terms of independence. 
Fine! but merely doing as you please, being cynical or 

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Are You Considering Psychoanalysis? 

unconventional does not make you independent. True 
independence entails being resourceful, assuming re- 
sponsibilities, living by your convictions. Of course it is 
up to you to decide whether you really want independ- 
ence. But if you do, you will have to examine and even- 
tually overcome all those factors within yourself which 
interfere with this goal such as expecting too much of 
others, putting the blame on others, and so forth." 

Such a discussion of values differs from the reading 
of books or from a talk with a friend in that it is com- 
bined with a scrutiny of the personal emotional prob- 
lems involved. 

When I speak of general human help I mean the way 
the analyst helps the patient not through his interpre- 
tations but through his attitude toward the patient. This 
includes his willingness to understand, his unflagging 
interest in the patient's growth, his faith in the patient's 
existing potentialities, his firmness that permits him to 
view the patient's suffering with concern without let- 
ting himself be crushed by them, to remain unswayed by 
the patient's admiration and undaunted by the patient's 
aggressive demands or hostile attacks. The value of such 
an attitude is underrated by some and overrated by 
others. Freud understood the task of the analyst as pri- 
marily an intellectual one. The less the analyst's per- 
sonality was involved, the more effective the therapy 
would be. The advice he gave on this score was in nega- 
tive terms : the analyst should not be condemnatory; the 
analyst should not yield to the patient's neurotic de- 
mands. At the other extreme are some modern analysts 
202 



What Does the Analyst Do? 



who contend that the very friendship the analyst extends 
to the patient is essential in curing him of his disturb- 
ances in human relationships. Such notions, while flat- 
tering to the analyst and pleasing to the patient, may 
easily blur the fundamental issue, namely that patient 
and analyst come together in order to do work. 

You may wonder at this point whether the relation- 
ship between patient and analyst is not a kind of friend- 
ship. In a sense, it is friendship at its very best but I 
always hesitate to regard it as such because it does, after 
all, lack the measure of spontaneity and mutuality es- 
sential to real friendship. The question was clarified for 
me by the distinction John Macmurray makes between 
personal and functional relationships: 

This is the characteristic of personal relationships. They 
have no ulterior motive. . . . They do not serve partial and 
limited ends. . . . Friendship, fellowship, communion, love 
are all in one way or another liable to convey a false or par- 
tial meaning. But what is common to them all is the idea of 
a relationship between us which has no purpose beyond it- 
self; in which we associate because it is natural for human 
beings to share their experience, to understand one another, 
to find joy and satisfaction in living together; in expressing 
and revealing themselves to one another, f 

According to Macmurray, all relationships that have 
a purpose over and beyond personal friendship are func- 
tional. Thus, when you join others in a scientific or 
political group your association with them is determined 

f John Macmurray, Reason and Emotion. D. Appleton-Century 
Company, New York, 1938. 

203 



Are You Considering Psychoanalysis? 

by the purpose of discussing scientific or political mat- 
ters. In this sense the relationship between patient and 
analyst is essentially a functional one. Your analyst and 
you may mutually like and respect each other. Yet you 
enter into the relationship for a definite purpose : to free 
you from your neurotic shackles and thereby create bet- 
ter conditions for your future growth as a human being. 
This definition is also satisfactory in that it leaves the 
emphasis where it should be, namely on the work to 
be done. 

It remains true, however, that the human help which 
the analyst gives the patient is important and even indis- 
pensable within the framework of the analytic process. 
I am thinking here primarily of the analyst's consistent 
emphasis on what he believes to be the patient's best 
interests. In principle this is the attitude every good 
physician has toward his patient. But the difference lies 
in that the analyst's task is infinitely more comprehen- 
sive. The surgeon's job is usually circumscribed. The 
analyst's work on the other hand involves no less than 
the patient's whole future development as a human be- 
ing. The questions he has in mind regarding his patient 
are somewhat comparable to the questions raised by a 
good educator: what furthers or hinders his develop- 
ment into a good, constructive human being? How can 
he best develop his potentialities, whether these be spe- 
cial talents or such general qualities as strength, courage, 
considerateness, or kindness? 

You may feel unpleasantly reminded here of the 
"mother knows best what is good for you" attitude. 
204 



What Does the Analyst Do? 



There are, however, significant differences between the 
mother-child situation and that in analysis. The patient 
is no longer a child but is able to evaluate by himself 
where his best interest lies when he is helped to see the 
issues clearly. Moreover, the analyst is not authoritative 
but endeavors to find out together with the patient in 
what manner he is blocking his own way. 

It is the analyst's consistent focus on the patient's best 
interest that eventually helps him to gain the latter's con- 
fidence. Of course, the patient would never have de- 
cided to work with the analyst if he had not had some 
confidence in him to begin with. But his initial con- 
fidence, though based on a good intuitive feeling, is not 
built on especially solid ground. After all, most of us 
are aware of the difference between an intuitive trust- 
ing of another person and the repeated, concrete evi- 
dence of his reliability. For the neurotic, however, this 
difference is considerably greater. With all his anxieties, 
suspicions, and defensive hostilities conscious or un- 
conscious he needs proof after proof before he can 
dare take the risk of really trusting someone. 

As for the analyst's nonauthoritative attitude, I prefer 
to define it in positive terms as an endeavor to place 
the patient under his own jurisdiction. The analyst firmly 
believes in the desirability of every person taking his 
life into his own hands, as far as possible, and assuming 
responsibility for himself. He respects individual dif- 
ferences and knows that each person can ultimately de- 
cide only in accordance with his own wishes and his 
own ideals. Hence he sees his main task as helping the 

205 



Are You Considering Psychoanalysis? 

patient to recognize his own wishes and find his own set 
of values. 

This attitude is responsible to a large degree for the 
analyst's reluctance to give advice. Another perfectly 
good and simple reason for his reluctance on this score 
is that in most cases he feels incapable of giving advice. 
Being more aware of the complexities of the human mind 
than most people, he has developed an attitude of real- 
istic humility that allows him to be fully aware of his 
own limitations. Naturally he will express his opinion 
whenever it is clear to him that the patient is about to 
act against his own interest. Furthermore, if certain of 
the patient's symptoms point to the possibility of an 
organic disorder, he will suggest a physical examination. 
He may definitely advise against a major decision if he 
is convinced that the patient is acting under the pressure 
of irrational emotional factors. 

Although you will agree that such an attitude on the 
part of the analyst is helpful in making you more inde- 
pendent, you may not always like it. You may want 
guidance. You may expect at the beginning that the 
analyst will solve all your problems by making a deci- 
sion for you. You may insist that he has answers for 
everything, but is withholding them for some mysteri- 
ous reason. Try to remember, then, that he can often be 
more helpful to you by trying to understand the back- 
ground of your question or indecision. 

Another way in which the analyst helps the patient is 
his attitude of accepting him as he is. What does this 
mean and why is it important? It may mean scientific 
206 



What Does the Analyst Do? 



objectivity. Freud expected the analyst to look at the 
patient with the eyes of a scientist and to eliminate value 
judgments. This, however, necessarily creates an arti- 
ficial situation because no one can exclude his set of 
values when human behavior and motivations are in- 
volved. Actually, the patient himself does not believe in 
such objectivity but assumes that it is adopted for the 
sake of therapy. 

It may mean tolerance. Tolerance is, of course, impor- 
tant in view of the self-condemning attitude harbored 
by most patients. Although the patient may distrust this 
attitude, too, it is actually genuine by virtue of the ana- 
lyst's understanding. 

It means, finally, that the analyst is interested in the 
patient as a human being who is engaged in the process 
of development and that he appreciates the patient's 
every move ahead. In order to help you to understand 
the value of such an attitude I must tell you something 
that may surprise you. When he begins analysis, the 
patient as a rule is not interested in himself as he is. He 
is constantly concerned with what he should be and 
blames himself for his shortcomings instead of tackling 
them realistically. Naturally this has to be analyzed. But 
it is also the analyst's consistent interest in him as he is 
and as he could be that helps the patient to develop a 
constructive interest in his real self. 

The analyst can have this positive attitude because 
he believes in the constructive forces within the patient 
which will eventually enable him to resolve his neu- 
rotic conflicts. Is this a blind optimism on the part of the 

207 



Are You Considering Psychoanalysis? 

analyst, or is it a realistic faith in the existence of such 
forces or at least in existing potentialities? On the basis 
of our experience it is a most realistic faith. Initially, the 
patient's constructive, forward-moving forces may lie 
buried under illusions, hopelessness, and destructive- 
ness. But with rare exceptions we see them come to life 
during analysis. 

As he gains insight into the workings of his mind, the 
patient gradually comes to feel: '7 can do something; / 
can have feelings other than mere irritation and fear; I 
can like somebody; / can enjoy things. / can want." And 
with each taste of freedom and of strength his incentive 
to gain more of it grows. The analyst's belief in and clear 
recognition of the patient's potentialities helps the pa- 
tient to regain his faith in himself. This is particularly 
important at those periods in analysis when the patient 
loses faith in himself or when it dawns upon him how 
little of it he has ever had. 



The analyst thus takes a most active part in the ana- 
lytical process. He observes and examines the patient's 
every move, the flow of his associations, his reactions to 
interpretations, the variety of ever-changing attitudes 
toward the analyst and toward the analytical situation, 
the changes that take place in his relations to others and 
toward himself and in his set of values. But the analyst 
does not merely follow the patient. Through his interpre- 
tations, explanations, and questions, he influences the 
course of the analysis. He helps the patient out of blind 
208 



What Does the Analyst Do? 



alleys and suggests scrutiny along more profitable lines. 
He encourages the patient to persist in working at a 
problem even though he is caught in the clutches of 
some emotional reaction. By means of these activities 
the analyst actually conducts the analysis. And this is as 
it should be. For while analysis is a co-operative enter- 
prise between patient and analyst, it is the analyst who 
for many reasons carries the greater responsibility. 



209 



How Does Analysis Help? 



MURIEL IVIMEY, M.D. 



OUR EXPERIENCE shows that many people who are 
interested in psychoanalysis and believe in its therapeu- 
tic value have no clear idea of exactly how it helps, what 
the results are, and how results come about. "Is it suffi- 
cient for a person to become aware of his neurotic trends 
and conflicts?" is a question that is frequently brought 
up in discussions. No, it is not enough. In addition to be- 
coming aware of his neurotic trends, a person needs to 
become aware of their purposes and aims, the forces in- 
volved, and the interrelations, interreactions, and reper- 
cussions of neurotic elements and forces. He also needs 
to discover the constructive forces within himself which 
make it possible for him to bring about necessary 
changes. Awareness of the existence of neurotic trends 
is only the first step toward extricating oneself from 
neurotic patterns of living. Another question frequently 
raised is: "When you know what is wrong with you, 

211 



Are You Considering Psychoanalysis? 

what do you do?" This question will be answered in this 
chapter. The ultimate goal in analytic treatment is to 
bring about changes in the personality which enable the 
individual to dispense with neurotic trends, to resolve 
inner conflicts, to find and develop his real self, his real 
values and goals, and to start on a new way of life. 

Neurosis and the disturbances and complaints that 
bring the individual to analysis are the consequences of 
unresolved inner conflicts. While he has made various 
attempts to solve his inner conflicts, he has not really 
succeeded. He cannot resolve them realistically and in- 
cisively as long as basic anxiety that is, feelings of help- 
lessness, isolation, and hostility lies in the depths of his 
personality. For these feelings force him to persist in all 
his irreconcilable compulsive ways. In order that con- 
flicts may be truly resolved, the internal conditions 
helplessness, isolation, and hostility must change. In 
the process of analysis these conditions do change and 
basic anxiety diminishes. The patient discovers that he 
can do something for himself, that he does get into bet- 
ter and more realistic rapport with others, and that he 
becomes less hostile. This is brought about through 
analysis of neurotic elements in the personality, leading 
to the formulation of problems for the patient's consid- 
eration. When he finds that it is possible to tackle a prob- 
lem and to effect a change in his ways, his basic anxiety 
is reduced simultaneously. As basic anxiety lessens pro- 
gressively, the patient becomes stronger within himself, 
less isolated and less hostile, and his capacity to over- 
come compulsions increases proportionately. He can 
212 



How Does Analysis Help? 



gradually dispense with the neurotic ways which have 
been the components of inner conflict. Thus, little by 
little, inner conflict is resolved. 

What is really meant by analysis of neurotic tenden- 
cies? It means the thorough investigation of all elements 
in the highly complex structure of neurosis, one by one, 
collecting and organizing evidence and seeing the ex- 
tent to which they ramify throughout one's life. Analysis 
reveals the overpowering grip they have on you; how 
indiscriminate and inappropriate your neurotic impulses 
are; how upset, desperate, anxious or panicky you be- 
come when you are blocked or frustrated in satisfying 
neurotic needs. Analysis helps you to discover how you 
have been attributing distorted and exaggerated values 
to your neurotic ways and that you have not established 
true values positively and realistically. It also helps you 
to see the connection between your neurotic ways and 
their consequences how they affect your feeling about 
yourself, how they affect your relationships with others, 
and how they have influenced the course of your life and 
will continue to influence it along the same lines if you 
persist in them. All these data, organized clearly and 
concretely, shape up as a problem. 

This comprehensive analysis of neurotic elements 
helps the patient to see his position so clearly, logically, 
and with such emotional conviction that there is no es- 
caping the conclusion that something has to be done. 
Each neurotic trait is analyzed according to these steps 
and in the same detail, so that the process as a whole 
consists of the formulation of many specific problems in 

213 



Are You Considering Psychoanalysis? 

sequence. The total, massive problem of the neurosis as 
a whole is broken down into parts which can be dealt 
with bit by bit. 

So far, analysis has helped in clarifying problems. As 
each difficulty is formulated in these terms, the patient's 
rational judgment can come into play. When rational 
judgment is available, the question arises: can he do 
something to change? This is a turning point. In our 
experience, constructive forces which lie latent and un- 
tapped now make themselves felt. The patient finds 
himself able for the first time to do something that is dif- 
ferent from his accustomed automatic, compulsive be- 
havior to act according to rational and realistic consid- 
erations rather than according to the dictates of neurotic 
needs. 

Let us give you an example of the analysis of neurotic 
trends belonging to one of the main categories. This 
piece of analysis is not in any sense complete but it will 
serve to suggest what is involved and what the patient 
experiences. An intelligent woman of forty-five in analy- 
sis was beginning to become aware of her tendencies to 
comply and yield to the wishes of others, of needing to 
be liked, to be agreeable, to keep the peace, to do things 
for others, to save them trouble, and to keep her own in- 
terests and rights in the background. It was suggested 
that she pause and consider these tendencies in detail. 

Many examples were found, and evidence piled up 

from different periods of her life. As a young girl she 

had always been the one to step into the breach and take 

over in emergencies, until she took it to be the accepted 

214 



How t)oes Analysis Help? 



thing even under ordinary circumstances and so did 
those about her. She did not go to college because she 
did not want to make an issue of her interests and 
wishes. She married her suitor because he pleaded so 
persistently, although she was not in love with him. She 
thought love would come later. Although she was miser- 
ably unhappy, she did not want to "make trouble" by 
bringing matters to open discussion with her husband. 
She decided on divorce and it went through. She then 
settled down to devoting her life to her son, repeating 
the same pattern. It was an agonizing thought to her 
that there was no love and understanding between her- 
self and her son. He became extremely dependent on 
her, egocentric and defiant; otherwise, by and large, he 
shut her out of his life. 

As the patient's more recent life and present day-by- 
day events were explored, it appeared that the same 
trends were also present in her relationships with other 
members of the family, with men she had met since the 
divorce, in social affairs, and with people in her job situa- 
tion, in casual encounters with people as she went about 
the city, in buses, taxis, and shops, and when she went on 
vacations. Under all circumstances she was agreeable, 
overmodest, yielding, and appeasing. Certain sensitivi- 
ties came to light. She was uncomfortable whenever dis- 
agreements arose or when anything approaching an ar- 
gument or a fight appeared imminent. She was sensitive 
to displeasure or anger in others; if someone failed to 
greet her cordially, she would fear he had taken a dislike 
to her, 

215 



Are You Considering Psychoanalysis? 

She was unable to stand up ^or herself. Not only was 
she too forebearing with her son and with one or two 
egocentric and aggressive members of her family but she 
sometimes submitted to real injustice. Recently an old 
friend had accused her of something she did not do. She 
let the matter go by. She thought to herself that her 
friend was always doing that kind of thing, especially to 
her; the friend was high-strung and irresponsible; she 
was neurotic and had problems of her own. The patient 
thought it would cause trouble if the matter were chal- 
lenged. Perhaps it would disrupt their friendship, and 
this she could not stand. She felt the same way about her 
son; he had problems and, if she made an issue of any- 
thing, it would disturb their relationship. Following the 
incident with her friend, she felt upset and depressed; 
later she developed a splitting headache and did not 
sleep that night. 

Further discussion revealed how relentless these im- 
pulses were. The patient began to see that rather than 
following a natural inclination, as she was used to think- 
ing of it, she was compulsively driven to behave in the 
same way with all people and under all circumstances, 
and that she could not act otherwise. The more she con- 
sidered it, the more clearly she realized that she was in 
the grip of powerful forces that controlled her. 

Analysis then focused on another aspect of these tend- 
encies that is, her subjective values for them. She 
was firmly convinced that she was perfectly right, that 
her behavior was necessary and desirable, and that it 
showed fine, high-minded qualities. "I am only being a 
216 



How Does Analysis Help? 



good mother, a good sister, a good friend, a responsible 
member of society. . . . This world would be a better 
place if people were more considerate." As a matter of 
fact, she said, if everyone looked out for himself, every- 
body would be fighting everybody else. It would be dog 
eat dog. It would be indecent and immoral if she be- 
haved differently than she did. 

Other aspects of her compliancy trends were brought 
to light. She was out for the satisfaction of needs to sac- 
rifice her own interests for those of others. But what 
were the actual results in her relationships with others 
and how had her behavior affected the course of her life? 
It appeared that the balance was far over on the debit 
side. She took some satisfaction in the fact that certain 
people turned to her in trouble and asked her advice 
but she took no pleasure in helping them and had no 
feeling of warmth, closeness, or sympathy. She com- 
mented on how people took her for granted, how little 
they thought of her and her needs. It was pointed out 
that this might be the result of her not letting her inter- 
ests and needs be known. An especially painful part of 
this phase of analysis was the consideration of the effect 
her compliant and self-effacing behavior had upon her 
relationship with her son. It was painful because the 
compliant and self-sacrificing qualities she cherished so 
highly were part of her idealized image of herself which 
was analyzed somewhat later. For the time being the 
focus was kept on the connection between these trends 
and her son's dependency and his demands on her. 

The situation with her friend was considered in more 

217 



Are You Considering Psychoanalysis? 

detail. The patient had said nothing when she was ac- 
cused unjustly. The incident served as evidence of a 
rather severe inhibition in standing up for herself. While 
it was being turned over arid considered from various 
angles, many questions arose. What was she hoping to 
gain by letting herself be stepped on? She expected ap- 
preciation and loyalty. What did she get? Did she really 
like this alleged friend? Was she motivated by genuine 
consideration for her friend and by understanding fore- 
bearance or was she forced by her own inner compulsive 
needs to cling to the relationship? Was she not paying a 
high price for this relationship, in headaches and sleep- 
lessness, in humiliation and in letting herself be the butt 
of hostile remarks? 

Analysis clarified the nature of these trends, their 
aims, their ramifications throughout her life, their in- 
discriminateness, their compulsiveness, the values she 
had for them and their consequences. These factors, so 
organized, presented a problem. The patient began to 
get interested in herself; there was some relief in having 
something definite concerning her difficulties to think 
abojat. She began to reconsider and revaluate. While she 
was in the process of doing this, she met her old friend. 
They had luncheon together, in the course of which the 
friend came out with a caustic and unjustifiably critical 
remark. The patient had been thinking about the rela- 
tionship; she had been seeing herself and her friend in a 
new light. To her surprise, she rose to the occasion and 
refuted the statement in no uncertain terms. The friend 
was taken aback and made a lame apology. 
218 



How Does Analysis Help? 



In recounting the incident in a subsequent analytic 
session, the patient said she felt wonderful. True, she 
had trembled all over, her heart had beat fast, and she 
had been sarcastic and self-righteous. These observa- 
tions were put to one side for the time being. As a result 
of this change in behavior, the patient felt for the first 
time that she could do something about herself. This 
meant the beginning of changes in internal conditions 
which had hitherto forced her to adhere to her neurotic 
compliant pattern. She felt less helpless, less dominated 
by her compulsive appeasing tendencies, less enslaved 
in her relationship with her friend, and she was encour- 
aged at having taken a step toward standing up for her- 
self. She felt less in awe of her friend and more natural 
although she said there was something about her own 
behavior that was not yet quite right. However, she felt 
that there was a better understanding in as far as she 
had come out with her real feeling. She felt less lonely, 
somewhat stronger, and more self-respecting. She said: 
"I guess I'm not such a lovely character think of me 
fighting!" 

She started to work at her compliancy trends seriously 
and with determination. In the course of time the auto- 
maticity of her conciliatory, submissive impulses less- 
ened. She came to be sincere, direct, and effective in her 
helpfulness and willing to confide in reliable friends 
when she was in difficulties. 

Next, tendencies of a different nature were taken up 
for consideration. In the course of our discussion of com- 
pliancy trends, aggressive tendencies were noted from 

219 



Are You Considering Psychoanalysis? 

time to time. Focusing on these brought up many in- 
stances of needs to direct and control others, to make 
excessive demands, to insist on being first, to be suspi- 
cious of ulterior motives in others that might put her at 
a disadvantage. Although these needs and expressions 
of them had been in the main rigidly repressed, they had 
nevertheless been felt whenever she was prevented from 
getting the upper hand. They had been expressed quite 
openly in close relationships, as with her former hus- 
band and her son. In the latter case she had rationalized 
aggressive tendencies as perfectly natural and laudable 
maternal concern for his welfare and development. 

Frequent resentment and spells of rage, which she 
tried to control, stemmed from frustration when others 
opposed her. In addition, the repression of aggressive 
trends forced her to dam back even legitimate, self- 
assertive impulses lest she reveal any vestige of self- 
interest. This resulted in submission to others in quite 
self -abasing ways. She was enraged at those whom she 
permitted to exploit her and triumph over her and at 
herself for being weak and spineless. These hostile im- 
pulses had two-fold repercussions: they enhanced her 
fears of the hostility of others toward her, and they 
tended to lower her self-esteem and thus added to her 
self -recriminations and to her feelings of inner weakness. 

Aggressive trends were analyzed along the same lines 
and in the same detail as were compliancy trends. By 
this process they took shape as problems which came 
within range of the patient's capacity to judge and re- 
consider. When they were seen in a new light, her in- 
220 



How Does Analysis Help? 



terest in tackling the problems they represented was 
aroused and she found she could cope with one situa- 
tion, then with another, in rational and appropriate 
ways. She felt further improvement in inner strength, 
better rapport with others, and less hostility. Her rela- 
tionships with others became better; she was less prone 
to dictate to them and manage their lives. She became 
less suspicious and could appreciate the rights of others 
and their positive qualities. She saw her own part in 
situations in which others reacted with tension, resent- 
ment, and counterattack. She began to see that much of 
her so-called helpfulness actually constituted an attempt 
to dominate and that much of the lack of appreciation 
she encountered was not unjustified. She saw also that 
the very manner of her yielding to others was often ac- 
tually designed to put them in the wrong and to make 
them suffer the consequences. 

Tendencies to withdraw, to avoid emotional involve- 
ment with others, quite marked in this patient, were 
analyzed much later. They were deeply buried but work 
on trends of the other two categories cleared the way for 
their emergence. Withdrawal trends were manifested in 
being cold and distant; in preserving her independence 
to an extreme degree; in attempting to be self-sufficient 
in order not to be under obligations; and in generally 
avoiding any closeness to others. These tendencies were 
clarified and brought within range of the patient's com- 
prehension and ability to make changes. When she un- 
derstood her aims, the enhanced values she had for them 
and their consequences, she was able gradually to come 

221 



Are You Considering Psychoanalysis? 

closer to people, to experience her own emotional reac- 
tions, to be responsive to the feelings of others. Her ex- 
cessive independence and self-sufficiency loosened up. 
She continued to work at these tendencies with the re- 
sult that her loneliness disappeared; she felt herself be- 
coming a part of the life around her. 

Analysis of and work on trends that we have discussed 
so far does not actually proceed in a strictly methodical 
way nor do the results occur in as orderly and satisfying 
a fashion as is suggested. One short paragraph in this 
chapter covers weeks and sometimes months of work on 
one group of trends, rarely steady and uninterrupted. 
Material comes up that necessitates turning aside from 
the topic at hand for a few sessions or for a longer period. 
However, as consistently as possible, but with no rigid 
insistence, analysis concentrates on one problem at a 
time. Results are achieved and inner changes are felt 
little by little. As a rule, astounding revelations and daz- 
zling bursts of insight do not take place. There are times 
when something becomes very clear and the patient 
feels a great sense of relief and finds he can do something 
that had formerly been impossible. This occurs from 
time to time in the process as a whole and should be 
taken in context with the whole job of analysis of a very 
complex structure. Changes are gradual, including the 
moments of greater clarification and release. Improve- 
ment is slow. 

In the course of discussions, many contradictions and 
inconsistencies came to light and, from time to time, the 
patient's attention was called to them. Frequently she 
222 



How Does Analysis Help? 



regarded them blandly and casually, showing that she 
felt there was nothing unusual about them; at times she 
showed irritation or anxiety. These observations led to 
scrutiny of the ways in which she managed to avoid see- 
ing discrepancies in her personality and to considera- 
tion of what defenses were endangered when she be- 
came irritated or anxious. 

The patient had developed an idealized image of her- 
self of phantastic proportions. To put it briefly, she 
thought of herself as being perfectly considerate, gentle, 
and long-suffering (compliancy trends); all wise and 
foreseeing in guiding others (directing and controlling 
trends); and entirely objective and immune to feelings 
which would obscure her sense of duty and her best 
judgment (withdrawing trends). Analysis of this ideal- 
ized image was partly accomplished little by little while 
her enhanced and distorted values for the qualities asso- 
ciated with each neurotic trend were investigated. As 
work on the trends proceeded, she came to see how her 
glamorized version of herself had prevented her from 
recognizing discrepancies in her personality. Another 
consequence of her self-idealization was that in her com- 
pulsive allegiance to this goddesslike image, she uncon- 
sciously regarded herself as beneath contempt and ut- 
terly worthless. She derogated her real abilities; she 
loathed and despised her real weaknesses and failings. 
It was understandable that she never could face them, 
much less begin to free herself of them as long as she 
entertained high-flown illusions about herself. Still an- 
other consequence of her self-idealization was that she 

223 



Are You Considering Psychoanalysis? 

held herself in a strait jacket of self-imposed demands 
and she actually tried to live up to her own impossible 
dictates. Since she was subject to human weaknesses, 
she was constantly disgusted and enraged at herself. 

In the course of time, she came to understand more 
clearly the significance of her self-aggrandizement, her 
arrogance, and her complete lack of a realistic estimate 
of her positive qualities and potentialities as well as of 
her faults. Work on this problem brought her to a 
sounder footing with herself; she was able to dispel her 
illusions, to accept herself, and to work realistically 
toward becoming a better human being. This made still 
further inroads on her basic anxiety. As a perfect person, 
there would be no reason why she should become 
stronger whereas, as a fallible human being not omnipo- 
tent but with real abilities, she could strive to lift herself 
out of her state of helplessness and to become stronger. 
As a perfect human being, she would have very little in 
common with ordinary people and would thus per- 
petuate her isolation from them whereas, as an ordinary 
mortal, she could feel closer to others and more tolerant 
of their shortcomings, while striving at the same time to 
improve herself and to help others. As a superwoman, 
she would be constantly offended by the lack of defer- 
ence she felt entitled to whereas, when she brought her- 
self down to earth, these exorbitant claims evaporated 
and she could appreciate the regard she did receive. Her 
relationships with others improved and so did her rela- 
tionship with herself. 
224 



How Does Analysis Help? 



The patient's tendencies to externalize her difficulties 
were manifest in her preoccupation with other people's 
problems. In this way she could avoid awareness of her 
own inner problems, her neurotic ways, and her contra- 
dictions and inconsistencies. Analysis of these tenden- 
cies clarified her compulsive concern about helping 
others and directing them in the way they should go. It 
showed her how this way of blinding herself to inner 
conflicts reinforced her needs to do things for others 
(compliancy trends) and to manage their lives (aggres- 
sive trends). It showed her that frequently the qualities 
and faults and motivations, which she was so convinced 
existed in others, did not actually exist in them but were 
the reflection of parts of herself. She saw how ineffectual 
she was, for her absorption in other people's problems 
amounted in large part to ruminations only, in some part 
to "fussing" about minor practical issues, and in general 
contained no element of genuine, active, and construc- 
tive interest in essentials. 

Not only did her tendency to externalize blind her to 
her own problems but she tended to demand that others 
change their attitudes toward her and their treatment of 
her as a cure for her unhappiness. This was manifested 
particularly in her insistent focus on her son's problems; 
if he would only change toward her, her own problems 
would be solved. An interesting by-product of analysis 
of her tendencies to externalize was her understanding 
of one of her symptoms, one which she had taken for a 
minor, innocent eccentricity. This was her compulsive 

225 



Are You Considering Psychoanalysis? 

neatness. She was exquisitely sensitive to any sort of ex- 
ternal disorder and was always compulsively tidying up 
and straightening out things about her. Further light 
was thrown on this behavior in the detailed analysis of 
other elements in her personality. When externalizing 
tendencies were seen as a defense against facing and 
coming to grips with real difficulties in herself, she was 
able to turn her attention inward and make more prog- 
ress toward solution of her own problems. 

Other major defenses against awareness of inner con- 
flicts were analyzed in turn. She had been blinding 
herself to discrepancies by convincing herself that her 
tendencies to sacrifice herself and to yield to others con- 
stituted her main, or only, characteristics. She saw why 
she had had to attempt to wipe out aggressive impulses 
or force them into the background, why she was so ex- 
aggeratedly conciliatory and appeasing: the discrepan- 
cies were so great that she did not dare allow herself to 
experience them. It was impossible to reconcile them by 
any means so she had arbitrarily to convince herself that 
one side of the conflict did not exist. Identification and 
analysis of aggressive trends, as well as compliancy 
trends, started her working toward the reduction of each 
one of these irreconcilable elements. She had also uti- 
lized the device of detaching herself from inner feelings 
of any kind in order to avoid awareness of conflicting 
compulsive drives. While working on her withdrawal 
tendencies she saw how they had also served to blind 
her to contradictions in her personality. She was now 
able not only to come closer to people, but also to know 
226 



How Does Analysis Help? 



her own feelings and to become aware of contradictions 
in herself. 

Throughout analysis subsidiary devices by which the 
patient managed to blur and befog issues relating to con- 
tradictory elements in her personality were picked up. 
She was strongly addicted to claiming arbitrary right- 
ness for practically all her opinions and every position 
she held. She would take contradictory stands on one 
issue and stick quite tenaciously to both of her positions. 
For instance, she was just as positive that the younger 
generation is inconsiderate, cynical, arrogant, and irrev- 
erent and that the right attitude toward younger people 
is to let them decide everything for themselves, to leave 
them untrammeled by the experience or prejudices of 
former generations and free of obligations and responsi- 
bilities toward older people. Since she felt she was ab- 
solutely right in both these opinions, it was impossible 
for her to distinguish between her hostile attitudes and 
her conciliatory and self-effacing approach. 

Another device she used to avoid awareness of contra- 
dictions in her feelings and impulses was to keep them 
all under rigid control by sheer will power. There were 
many examples of damming back intense feelings 
longings for companionship and intimacy with others, 
anger, impulses to take charge and push others out of 
her way, and the fears, panics and psychic pain she fre- 
quently suffered. She bottled up such feelings and at- 
tempted to preserve a stoical calm. However, she suf- 
fered considerable strain and profound fatigue, partly 
due to the effort such control required. She would occa- 

227 



Are You Considering Psychoanalysis? 

sionally reach the breaking point, when she would hide 
in her room and give way to uncontrolled emotional out- 
bursts which seemed to come from nowhere. 

Other defenses included much ingenious rationaliz- 
ing. She was very prone to evade attempts to clarify 
issues by cleverly slipping away from a subject. One 
technique was to disappear behind a cloud of generali- 
ties and to reappear unexpectedly with a totally differ- 
ent topic. Another was to shift subtlely from one guise to 
another from the guise of the martyred innocent to 
that of the philosophical idealist to that of the practical 
manager and family executive. She would resort to this 
sort of thing, for instance, when the discussion touched 
on the consequences of her compliancy trends. In dis- 
cussing her values, concerning which she was so positive, 
she took refuge, surprisingly, in a general cynicism. In 
this way she attempted to dismiss all consideration of 
her moral values and goals in life and to avoid the neces- 
sity of making any revision. 

Work on these defenses helped her to straighten out 
her thinking processes, clarify issues, see the real point 
of some difficulty and get on with further changes in her 
personality. As she gradually dispensed with these de- 
fenses, feelings of inner strength increased. She became 
less dependent on false reasoning, evasions, and rigid 
opinionatedness, and hence could be more direct, more 
flexible, more honest and courageous, more confident 
in herself. The tensions precipitated by excessive control 
of her feelings eased up and she was able to be herself 
without fear of uncontrollable emotional outbursts. As 
228 



How Does Analysis Help? 



her cynical attitudes loosened, she was able to be defi- 
nite as to what she believed was valid and valuable in 
life and what was not, and as to what kind of person 
she really wanted to be. 

Throughout analysis deep-seated hopelessness and 
despair gave way imperceptibly, but nonetheless surely, 
with each bit of work successfully accomplished. She 
became progressively stronger inwardly and more 
straightforward and realistic in her dealings with people 
and in her handling of external situations. The feeling of 
being inextricably caught in insoluble conflicts was grad- 
ually dissipated and her wry and somewhat bitter atti- 
tude toward others who were enjoying life softened. 

I have discussed briefly how this patient began to 
change. I have taken the case of one individual as an 
example of how work in analysis is done, what results 
occur, and how they occur. As far as the method is con- 
cerned, this holds true in general for the analysis of any 
neurotic personality, according to our present practice 
and experience. But each individual presents his own 
particular problems and special difficulties. Certain as- 
pects of neurotic development are more strongly em- 
phasized and more highly elaborated in one individual 
than in another. There is a wide margin for modifica- 
tions in procedure; flexibility and ingenuity are exer- 
cised according to these special factors in the individual 
patient. Nevertheless, the tasks for which the analyst is 
responsible and those for which the patient is responsi- 
ble remain the same. 

The main objectives during analysis are that the pa- 

229 



Are You Considering Psychoanalysis? 

tient establishes himself on a firm basis of awareness of 
and confidence in his own inner capacity to do something 
about himself, that he loses the sense of isolation and 
estrangement from other people and instead feels him- 
self to be on common ground with them as a human be- 
ing, and finally that his blind, diffuse, and terrifying 
hostility disappears. In addition, within the period of 
analysis his relationships with others will become more 
natural and discriminating and he will be guided by ra- 
tional considerations and freer emotional response. He 
can form warm, friendly and intimate relationships; he 
can take care of himself in the presence of real danger 
and hostile attack from others; and he will be able to 
experience himself apart from others and to cultivate his 
individual interests and gifts independently. 

Generally speaking, analysis helps him to see that his 
values were dictated by neurotic considerations and that 
they were essentially inappropriate and inconsistent 
with his true interests and his dignity as a human being, 
that his ideals were mainly empty abstractions rather 
than ideals which he really believed in and strove to 
attain. By discarding false values and spurious goals he 
finds real values and ideals and goals to serve as guiding 
principles for his development and growth and for the 
future direction of his life. 

I have said something about the forces involved in 
neurotic development. Let us look at analytic treatment 
as a whole and at the process of change in the person- 
ality from the angle of the forces in operation in the 
patient. One set of forces compels the patient to main- 
230 



How Does Analysis Help? 



tain his neurotic structure as a whole and in all its parts. 
In analysis these forces operate in reactionary ways and 
retard progress. They are expressed in the patient's fight- 
ing with every ounce of energy to maintain the status 
quo. His capacity for rational judgment and constructive 
efforts are practically unavailable. The discovery and 
mobilization of constructive forces in the patient is the 
crux of psychoanalytic therapy. 

At the beginning of treatment, the balance of power 
is on the side of retarding forces, while the constructive 
forces have little or no influence. Nevertheless, they exist, 
as witness the patient's decision to consult the physician 
and undertake analysis. Positive efforts are sustained to 
the extent of attending analytic sessions regularly and 
producing material, although a patient may sometimes 
feel that even this is too arduous and questionable in 
value. On the whole, forces compelling the maintenance 
of the status quo dominate the situation. The patient's 
hopelessness is likely to add to the handicap, since it 
robs him of incentive and tempts him to be lackadaisical 
and inert. 

It has been customary to refer to expressions of re- 
tarding forces as resistance to analysis on the part of the 
patient. Nowadays we focus on the play of inner forces 
of both kinds, the obstructive as well as the constructive 
forces. When we do this, we get a better understanding 
of problems of so-called resistance. In the analysis of 
any neurotic element in the personality, many defenses, 
justifications, evasions, etc. come into play. Transference 
reactions are also factors of very great importance in the 

231 



Are You Considering Psychoanalysis? 

patient's maintaining the status quo. These factors all 
point to a tenacious prejudice to remain as he is. He is 
stubborn and argumentative, ingratiating and appeal- 
ing, sly, or totally noncommittal anything to hold his 
own against change. We regard this not essentially as 
opposition or resistance to therapy, although this is the 
effect. The patient desperately wants to get help. But he 
must cling to his established ways because he has noth- 
ing else. 

If this is understood, if this understanding is conveyed 
to the patient, and if all other aspects of neurotic ele- 
ments are thoroughly analyzed, especially transference 
reactions, the patient comes to a more realistic view of 
his position. He applies himself to the task of reconsider- 
ation and revaluation and finds that there are possibili- 
ties of coping with life in other ways. He finds that he 
has other resources besides his neurotic devices. He finds 
that he can exercise rational choice as to how he will 
behave and what he will do and that he can act upon 
his choice. Analysis of so-called resistance is thus ef- 
fective in helping the patient to explore his potentialities 
for constructive efforts, with which he will be able to 
overcome obstructive, retarding forces that have hith- 
erto had the greater power over him. Constructive forces 
gradually gain the ascendancy. The patient can then di- 
rect his energies actively and effectively along with 
the analyst's efforts in his behalf toward constructive 
goals. 

In our experience, as in the experience of physicians 
in other fields of medicine, the patient's natural, healthy 
232 



How Does Analysis Help? 



resources are available to the extent to which it is pos- 
sible for them to operate. Even though these resources 
have been overwhelmed by too powerful forces of dis- 
ease processes, they are nevertheless ready to be mobi- 
lized while there is still Me, provided that the physician 
is able to assist in shifting the balance of power. The 
constructive forces we count on in psychoanalysis exist 
in all human beings, although many are not aware of 
them. They are felt as impulses to be a whole person, to 
live fully, to be free and effective. They operate in the 
neurotic individual's struggles to make himself whole by 
means of his pseudo solutions of conflict, but he suffers 
too many disadvantages as a result of this crude patch- 
work with its multitudinous secondary bolstering mech- 
anisms. He remains fundamentally shaky and insecure. 
Analysis guides the neurotic person toward undoing the 
elaborate patchwork and becoming strong from the 
ground up. His impulses to be whole are implemented 
by rationality, will power, determination, and by the ca- 
pacity to judge intellectually and morally and to make 
efforts to fulfill his real wishes. Analysis affords the pa- 
tient the opportunity and provides the experience of be- 
coming a whole and soundly integrated person. 



233 



How Do You Progress After Analysis? 



KAREN HORNEY, M.D. 



1 HE VERY suggestion that you might still have prob- 
lems to cope with after your analysis is terminated may 
arouse protest. Many of my patients were upset when I 
pointed out to them that they would have to continue 
working with themselves. They had expected to emerge 
from analysis as "finished products/' Theirs would be a 
paradise of untroubled serenity where problems and 
conflicts did not exist and where the power to create 
and enjoy was absolute. 

Such expectations are illusory. It is true that analysis 
is a means toward outgrowing your personality diffi- 
culties and developing your potentialities. And when we 
speak of potentialities we have in mind not only your 
innate talents or gifts but even more your latent power 
to become more direct, more wholehearted, more alive, 
and more effective in your human relationships and in 
your work. Your growth as a human being, however, is 

235 



Are You Considering Psychoanalysis? 

a process that can and should go on as long as you live. 
Hence analysis as a means of gaining self-knowledge is 
intrinsically an interminable process. Analytical therapy, 
while it helps you to disentangle yourself from the web 
of conflicts and to develop on a sounder basis, only ini- 
tiates this development; it does not and cannot com- 
plete it. 

This raises a difficult question. If our growth as human 
beings is interminable, and if analytical therapy merely 
sets this process in motion, when does the patient reach 
the stage where he no longer needs treatment? 

Originally, when Freud made his first discoveries 
concerning the unconscious factors that cause neuroses, 
this question was easily answered. The treatment was 
terminated when the symptom, on behalf of which the 
patient had sought help, had disappeared. This delight- 
fully neat solution has proved to be fallacious. Even 
though the "symptom," for instance hysterical paralysis 
of an arm, is removed, the person remains hysterical in 
his way of dealing with life. Furthermore, a subsequent 
upset may cause the development of another symptom 
such as hysterical blindness. 

Since psychotherapy as it has now developed deals 
with personality structure as a whole, it is more difficult 
to decide when treatment should be terminated. Our 
question would be: has the patient's personality im- 
proved to the extent that he can safely be dismissed 
from treatment? 

We have tried in discussions to formulate basic cri- 
teria for such an improvement. Briefly, we arrived at 
236 



How Do You Progress After Analysis? 

formulations like these: before terminating an analysis 
the patient should become less rigid, less vulnerable, less 
arrogant, more assertive, more warmhearted, more co- 
operative, more honest, more realistic. Such improve- 
ments, however, while undoubtedly desirable are too 
relative to serve as the sole criteria. A patient's grandiose 
notions about himself may have diminished consider- 
ably in the course of the analysis but certain areas in his 
life may still be governed by wishful thinking rather 
than by realistic considerations. It would be difficult 
therefore to say exactly how realistic he should be be- 
fore terminating his treatment. 

Moreover, if we were to release our patient solely on 
the basis of what has been accomplished in the way of 
personality improvements, this might entail a certain 
danger for there would always remain some unsolved 
problem, some fears that could be diminished, some sen- 
sitivities that could be lessened, some inhibitions that 
are still disturbing. Thus if both patient and analyst 
focused their attention entirely on what remained to be 
done, they would be tempted to go on and on forever. 

These criteria must be complemented, therefore, by 
another consideration: at what stage of his development 
is the patient ready to continue on his own? Of course, 
only those analysts will raise this question who trust 
that it is possible for a patient to proceed on his own, 
and who have relinquished the belief that the patient 
cannot overcome his difficulties without the analyst's 
help. Hence the broad question of termination becomes 
more precise: when can the patient deal constructively 

237 



Are You Considering Psychoanalysis? 

with his own problems? What capacities must he have 
acquired to be able to do so? 

To begin with, he must have clarified his goals in life 
and he must have a clear recognition of his own values. 
It is not necessary or even feasible that he attain his 
goals during analysis he can never do more than ap- 
proximate them but he must know in what direction 
he wants to develop. As long as he is still driven com- 
pulsively toward some goal which he considers the solu- 
tion to all his neurotic problems, he cannot proceed by 
himself, for he will be interested merely in analyzing 
the factors which prevent him from attaining his partic- 
ular neurotic goal. He will certainly not be willing to 
examine the goal itself. 

The attempts at "self-analysis" made by Simon Feni- 
more in Somerset Maugham's Christmas Holiday exem- 
plify this kind of approach. It is Simon's driving life am- 
bition to attain a huge vindictive triumph over others. 
He analyzes and changes in himself those qualities that 
might deflect him from his role as the future Gestapo 
chief in a totalitarian state and in the same manner he 
singles out and develops those tendencies which will 
enable him to become more efficient and destructive. 
With such a goal in mind he could not possibly be inter- 
ested in analyzing his incapacity for love, his asceticism, 
or his cynicism. Similarly a woman who believes in "love" 
as the magic solution to all her distress could not pos- 
sibly touch upon her hidden aggressiveness, her morbid 
dependency, or her lack of resourcefulness. She would 
analyze in herself only those factors that render it more 
238 



How Do You Progress After Analysis? 

difficult for her to find or to attach to herself a man who 
would fulfill her magic expectations. In other words the 
patient must have abandoned his neurotic goals or at 
least have questioned their validity. 

Secondly, the patient must have his feet sufficiently 
on the ground; he must be interested in seeing himself 
as he is and could be instead of trying to live up to a 
phantastic notion of what he should be or of seeing 
himself merely as the superior being he is in his imagi- 
nation. 

Finally, the patient must have gained sufficient in- 
centive to continue working with himself; he must have 
overcome the pervasive feeling of hopelessness and the 
paralyzing inertia resulting from it, expressed by the "I 
can't" attitude. He must have largely overcome his tend- 
ency to make others responsible for his difficulties, and 
he must realize instead that heaven and hell are within 
himself. 

Is it possible, then, to estimate in analysis when these 
conditions are fulfilled? I believe that one can be fairly 
accurate about the time when the patient is no longer 
obsessed by neurotic goals. The two other conditions, 
being more comprehensive, are more difficult to gauge. 
The following criteria would be important. Does the 
patient have a more spontaneous interest in facing his 
problems and working at them? Has he become more 
capable of observing and understanding himself outside 
the analytic sessions? Has he become more honest with 
himself? Has he become more co-operative in his rela- 
tions with the analyst? 

239 



Are You Considering Psychoanalysis? 

But in spite of such criteria the evaluation will remain 
tentative. And the analysis should be terminated with a 
clear understanding of the tentative nature of the step. 
While the patient should be prepared to work by himself 
and to try to find the solutions to his problems without 
leaning on the analyst at every opportunity, he should, 
nevertheless, feel secure in the knowledge that he can 
always discuss matters with his analyst should any prob- 
lem prove too difficult for him. 



How are you to proceed from here? You go on exam- 
ining yourself; if a difficulty arises, you try to recognize 
your share in it; you learn from experience; in short 
you analyze yourself. I need not delve here into the 
polemics concerning the possibility, feasibility, and lim- 
itations of self-analysis. Though it has not yet been de- 
termined how many people can analyze themselves suc- 
cessfully and to what extent they can do it without 
previous treatment, there is no doubt whatever that self- 
analysis is feasible after analytical treatment. 

It would not be appropriate within the framework of 
this book to discuss at length the procedure of self- 
analysis. I prefer, therefore, to present an example which 
will illustrate some of the most important points. My 
illustration will demonstrate that self-analysis, far from 
being superficial, can penetrate to deeply repressed neu- 
rotic drives, if we are sufficiently bent on finding the 
truth about ourselves. It will also show that what counts 
240 



How Do You Progress After Analysis? 

in the procedure is our attitude and the spirit in which 
we go about it. 

The example is presented in very condensed form it 
omits many minor difficulties and abortive erroneous 
pursuits and points out only the highlights in a piece of 
self-analysis extending over a period of nine months. 
Although I have tried to present it as simply as possible, 
it may be difficult for you to understand the amount of 
work done and to follow its sequence because it touches 
upon problems with which you may not be familiar. But 
for more than one reason it may be worth your while 
not only to read it but to make a thorough study of it. 
It constitutes a particularly successful piece of self- 
analysis on the part of an interior decorator, Eileen, who 
had gone through a short but rather successful analysis 
some years earlier. Certain inhibitions in her work and 
an overdependent attitude toward her husband had 
greatly diminished. 

Before Eileen arrived at the stage of self-analysis 
presented here, she had already recognized to what an 
extent she was glorifying her appeasing, conciliatory at- 
titude. Although she had known for a long time that 
these trends were mostly conditioned by fears, she had 
nevertheless registered them at their face value and un- 
consciously credited herself with being an unusually 
good person. This "halosickness" as she herself called it 
had been very much under cover and it had taken her a 
long time to unearth it. 

Eileen, then, began to investigate her "putting up 

241 



Are You Considering Psychoanalysis? 

with too much." She found that she was tolerating fairly 
flagrant impositions and insults. In many instances she 
was not even aware of being unfairly treated or became 
aware of it only much later. Instead she would react to 
the offender with an increase of appeasing endeavor. 
She had noticed this weakness before, but could not 
approach it realistically until the analysis of her "halo- 
sickness" had dispelled much of her eagerness to appear 
better than she was. 

She now observed many isolated instances in which 
she was putting up with such impositions, and this led 
her to the discovery that she actually reacted to such 
occurrences with rage. This rage had hitherto been hid- 
den under spells of paralyzing fatigue. Her reactions still 
remained delayed for some time. She would wake up 
in the middle of the night enraged at someone by whom 
she had felt badly treated. She had done that before 
but she could now connect her anger reaction with spe- 
cific situations in which she had been insulted, imposed 
upon, or disregarded. She also discovered that she had 
no such reactions whenever she had been able to assert 
herself. 

She then discovered that her anger was directed not 
only against the offender but even more against herself. 
She arrived at a clearer understanding of the nature of 
her anger when she observed a change in her attitude 
toward "nice" people. Formerly she had tended to like 
them indiscriminately; now she became more and more 
alert to their appeasing strategies and would designate 
them in her mind as "doormats/' thus expressing her 
242 



How Do You Progress After Analysis? 

contempt for their cringing attitude. In this roundabout 
way she became aware of the angry contempt she had 
for her own cringing. 

Eileen now began to wonder why her anger reactions 
were so intense. She observed that their intensity was 
usually not warranted by the occasion. Comparatively 
trivial matters upset her greatly. An un appreciative or 
overly demanding customer, an impolite taxi driver 
might throw her completely out of gear. This observa- 
tion was disturbing, because it undermined rationaliza- 
tions and pointed to an unknown disorder within her. 
Was there an explosive force powerful enough to be 
touched off by the slightest provocation? At the same 
time the realization was promising because it aroused 
her interest to find out about the nature of these uncon- 
scious forces. 

For months she tried in vain to find an answer. She 
asked herself whether she was not perhaps more ag- 
gressive than she believed; whether she was actually 
motivated by a desire to triumph over others and felt 
disgracefully defeated whenever she could not even de- 
fend herself. These were very sensible questions but they 
did not strike the right chord in her; they remained spec- 
ulative and theoretical. Perhaps she tried to solve the 
problem too directly or too intellectually, instead of sim- 
ply continuing to observe herself. To call this a period of 
resistance would be misleading. Actually another prob- 
lem had to be tackled before this one could become ac- 
cessible. 

I dwell on this uneventful period because temporary 

243 



Are You Considering Psychoanalysis? 

impasses like this one are bound to occur in every analy- 
sis and may easily lead to feelings of discouragement 
unless it is kept in mind that one cannot unlock the suit- 
case in a closet without first unlocking the closet. 

An accidental experience finally supplied the missing 
link. Eileen fractured her leg in an automobile accident. 
Since no private rooms were available in the hospital, 
she was placed in the general ward. At first she felt this 
to be quite unbearable and verged on despair. She urged 
her husband repeatedly to obtain a private room for her. 
Then the thought flashed through her mind: "Maybe 
some patient who has a private room will die and I can 
move into her room." Just for a flicker of a moment this 
thought startled her; for a flicker of a moment she real- 
ized dimly that she was reacting disproportionately to 
the situation and that there was violent anger behind 
her despair. Apparently she was not yet quite ready to 
grasp the meaning of this thought, but it showed that 
something was working in her and probably prepared 
the way for the insight she arrived at two days later. 

By then she had overcome the first shock. She had 
grown familiar with the other patients and their suffer- 
ing. It was then that she asked herself: "Why should I 
insist on being better off than these people?" And shortly 
thereafter a more precise question emerged: "Is there 
something in me that makes me feel entitled to special 
privileges?" The thought came to her with the utmost 
surprise because she had always considered herself the 
very opposite of demanding and arrogant. But now she 
was too keenly aware of it to push it aside. She realized, 
244 



How Do You Progress After Analysis? 

then, that she had always felt entitled to special consid- 
eration and attention and that initial despair grew not 
so much from the fact that she had to lie in a ward but 
rather from the frustration of her claims. The annoyance 
she had felt at first had actually had the character of 
indignation indignation at being exposed to what she 
felt was improper treatment. 

With this insight her irritation vanished; she became 
patient, friendly with the others, and even began to like 
life in the ward. The insight opened up a vast field of 
hidden naive expectations. She discovered that she had 
always felt entitled to good luck and favorable circum- 
stances: timetables should be convenient; her sarcastic 
remarks should be taken in good grace; the weather 
should be fair when she went on an excursion; and so 
forth. Furthermore, she had always harbored the secret 
belief that she would never age or die. Now for the first 
time in her life she could think calmly and realistically 
that some day she would die, like everybody else. 

Her relief was so profound that she believed for a 
while that she had already solved the whole problem 
of special claims. Actually, a great deal of work remained 
to be done. Nevertheless this first reaction was by no 
means altogether unjustified. In the first place she had 
managed to penetrate to a problem which for her appar- 
ently was crucial and which had been deeply repressed. 
For in her actual behavior she had been leaning over 
backwards to please others, she had been overapprecia- 
tive, contented with little and had seen the wishes and 
rights of others much more clearly than her own. In the 

245 



Are You Considering Psychoanalysis? 

second place she had actually dispensed with the special 
claims that were involved in this particular situation. 
The illusory part of Eileen's reaction was the belief that 
the whole problem was solved for good and all. 

Such illusions sometimes occur in analysis. They can 
be tenacious and may then present an obstacle to further 
progress. It may possibly have delayed progress in Ei- 
leen's case, too, but the fact is that she resumed work- 
ing at the problem in subsequent months. We could 
make light of the reaction by saying that everybody 
would overrate an important finding in his first joy of 
discovery. But the reason I make these remarks at all is 
to point to a more powerful factor. As so many pa- 
tients do in similar situations, Eileen indulged in wish- 
ful thinking. She would have liked to be rid of her dis- 
turbing claims without having to make the necessary 
effort to eradicate them. 

Because she was in such a hurry to settle her problem 
of special claims, Eileen missed out on one important 
detail namely, the flash of hope that somebody would 
die so that she would have the benefit of privacy. This 
would have revealed a certain callous aspect of her per- 
sonality of which she was totally unaware. It would have 
been of special importance in this connection if she had 
reconsidered this momentary hope after she had gained 
insight into her special claims, for it might have revealed 
to her the intensity of the claims and their absolute ego- 
centricity. 

Eileen's taste of freedom during this period, short- 
lived as it was, nevertheless had its great value. In all 
246 



How Do You Progress After Analysis? 

likelihood it gave her an additional incentive to resume 
work on the problem of special claims. For she knew 
now, with an inner certainty that only experience can 
provide, that her work would be rewarded. 

As she resumed her ordinary routine of life in subse- 
quent weeks, she came up against some of her old dif- 
ficulties. Each time this happened, she re-examined her 
special claims and thus gradually gained new insights. 
She came to understand more about the nature of her 
claims. The claims she had noticed while at the hospital 
concerned outside circumstances. Now she discovered 
additional ones of a different type: she felt entitled to 
special consideration, to being singled out, to being 
exempt from criticism and from doing what others ex- 
pected of her. 

Since none of these claims had ever been felt con- 
sciously or asserted openly she could discover them only 
in indirect ways. She realized that she sometimes felt 
greatly abused only to find a day or two later that the 
situation was but half as bad. After observing this se- 
quence several times she arrived at the only possible 
conclusion, namely, that her initial reactions were ex- 
aggerated. Gradually she grew skeptical toward them. 
Finally she was able to question the validity of her 
reaction in the midst of feeling profoundly abused. 

This was a difficult and, if I may say so, a brave step 
to take. For while she was feeling abused, her reaction 
seemed absolutely real to her and, hence, absolutely 
justified and logical considering the monumental wrong 
done to her. To question her own reaction, despite the 

247 



Are You Considering Psychoanalysis? 

seemingly overwhelming evidence that she was in the 
right, was by no means easy but it was rewarding: she 
was now able to understand that her excessive reaction 
resulted from the frustration of her special claims. 

Actually, although Eileen was not yet aware of it, 
this piece of analysis undermined her whole "putting 
up with too much" complex. She had seen before that 
her own compliance made her defenseless, that she hated 
others for being aggressive and herself for being com- 
pliant. This proved to be a true but incomplete observa- 
tion. What she had not seen and actually could not see 
before tackling her unconscious claims for special privi- 
leges was that she overreacted to "aggression" and that 
the intensity of her ensuing anger was largely due to her 
humiliation at having her claims punctured. 

Eileen also came to understand more clearly how she 
had rationalized her claims. These had appeared under 
harmless and rational screens. For instance, she had felt 
entitled to help from others because of her own helpless- 
ness; she had made demands on others under the guise 
of "love"; she had consistently dodged responsibilities 
toward others because she had so little time or was over- 
worked. 

A short comment on this latter piece of analysis : it was 
correct but it lacked depth. Only later, following the seg- 
ment of analysis described here, did Eileen begin to 
realize the full implication of these findings. By resort- 
ing to helplessness and a lovable appearance she was 
persistently putting a check upon her resourcefulness 
and her inner independence and thereby undermining 
248 



How Do You Progress After Analysis? 

her self-confidence. Moreover, this attitude made her 
dependent on others and forced her into being compliant 
and ready to play up to others. Most important, by re- 
sorting to helplessness and lovability she actually en- 
tangled herself in an irreconcilable conflict. For although 
she felt entitled, unconsciously, to all sorts of special 
privileges, she actually got very few of them and had to 
ingratiate herself with people for what little she did get 
thus the source of gnawing humiliation was constantly 
renewed. This was really the main conflict underlying 
the whole complex of "putting up with too much." 

Eileen herself did not see these implications at the 
time because the appeal she could make to others on 
the basis of helplessness and "love" was too important 
to her as an implement with which to assert her claims 
in a hidden, indirect way. Nor was she yet ready either 
to relinquish her claims or to assert them in other 
ways. 

Also she had by now lost sight of the problem of "put- 
ting up with too much." She did return to it, though, 
with her next finding which concerned one of her main 
claims. Briefly, she realized that she expected others to 
give her everything she felt entitled to without having 
to assert herself, to express a wish or even to be clear 
in her own mind what she wanted. Merely by appear- 
ing "nice" or friendly she would be entitled to every- 
thing. Accommodating and appeasing techniques had 
thus acquired an almost magic power. She now saw that 
her lack of assertiveness had compelled her to develop 
this particular claim. And she made an even more per- 

249 



Are You Considering Psychoanalysis? 

tinent discovery, namely, that this claim, once estab- 
lished, actually perpetuated her weakness. A kind of 
magic gesture would make any self-assertion on her 
part unnecessary. It was even beneath her dignity to 
assert herself or to fight for or against anything. This, 
by the way, was the reason why, despite her endeavors, 
she had not been able to get at her aggressive trends. As 
long as she felt that even the most legitimate kind of 
aggression was undesirable, she could not possibly be 
interested in unearthing whatever aggressive tendencies 
she had. She saw how her claim for special considera- 
tion actually resulted in her "putting up with too much." 
She also found a more complete explanation for the in- 
tensity of the ensuing anger. It was not only anger at 
her own weakness as she had originally assumed but 
also an expression of feeling frustrated in her special 
claim. 

This last insight revealed her "putting up with too 
much" in a new light. We can see here how, despite 
honest self-scrutiny, it is sometimes impossible to give 
an accurate description of a particular disturbance. 
Hitherto, Eileen had thought of her "putting up with 
too much" only in connection with instances in which 
she really was taken advantage of or unduly disre- 
garded. Now she saw that she had not only exaggerated 
in her own mind the wrong done to her but that she had 
often reacted similarly to situations in which she was not 
wronged at all. These were situations in which people 
failed to live up to her unrealistic demands. 
250 



How Do You Progress After Analysis? 

Let me summarize the segment of analysis just re- 
ported. Essentially it concerned Eileen's unassertive- 
ness. She had first seen how glorification of her existing 
core of weakness gave her the illusion of being purely 
good-natured. When analysis undermined her uncon- 
scious pretenses of "goodness," she was able to face her 
unassertiveness directly. She reacted to this realization 
with violent anger at others and at herself but felt unable 
to change. Strangely enough she made no real efforts to 
become more assertive in her everyday life, although she 
smarted under her compliance. And here she made her 
crucial discovery, namely that her desire to become 
stronger was paralyzed by her unconscious feeling of be- 
ing entitled to a soft and easy life. Others should guess 
her wishes, should help her, yield to her, and fight her 
little battles without any effort at assertion on her part. 
Naturally, this bit of expected magic did not work. Time 
and again she was merely confronted with reality. Only 
after she had recognized and relinquished her special 
claims could she feel free to make efforts in her own 
behalf. 

Such discoveries are not arrived at easily. On the con- 
trary, I can assure you from experience that they are ex- 
tremely difficult to make even with the help of an ana- 
lyst. It is true that many questions were left unanswered. 
Eileen had yet to discover many of the roots of her spe- 
cial claims on life and to find out why they had been so 
deeply repressed. But it is true of any piece of thorough 
analysis that, as some problems are satisfactorily solved, 

251 



Are You Considering Psychoanalysis? 

others begin to be discernible. Eileen's was a real 
achievement and her success has greatly strengthened 
my confidence in the amount of analytical work that 
can be done alone. 



What made it possible for this patient to attain such 
comparatively good results? Or, in other words, how 
can Eileen's experiences benefit your efforts at self- 
analysis? 

Eileen's quiet determination to recognize and go to 
the roots of the factors in herself that blocked her way 
was of paramount importance. Her determination was 
apparent in the consistency of her efforts. You may pro- 
test here that there was no system in her attempts, that 
in fact they appear to have been quite sporadic, that 
months passed between one trial at self-analysis and 
another, months in which nothing apparently happened. 
True enough. But I am sure that even during this time 
more must have gone on in Eileen's mind than she re- 
ported or was aware of. 

Certainly there was no regularity of conscious effort in 
the sense that she set apart an hour every day in which 
to analyze herself. When I spoke of her consistent deter- 
mination to reach a certain goal, I was not thinking of 
a regular working schedule. I am not in favor of such 
planned regularity. Self-analysis pursued in this manner 
can too easily become an aim in itself art for art's sake 
instead of a living struggle with concrete difficulties. 
Besides, the resolution to analyze oneself day by day at 
252 



How Do You Progress After Analysis? 

a fixed time cannot be carried out anyway. External 
matters may interfere or you may not be in the proper 
frame of mind. Your intentions will easily peter out or 
your resolution to analyze yourself will become an inner 
obligation which you stick to under duress. As a result 
your work is in danger of turning sterile because you are 
likely to feel it as a self-imposed yoke and revolt against 
it. If, on the other hand, you analyze yourself when you 
really feel like doing so, your incentive will be fresh and 
spontaneous. 

If you analyze your difficulties as they arise, you will 
gladly turn to analysis as you might turn to a friend 
when you are in distress. This is exactly what Eileen 
did. She tackled her problems whenever she felt in need 
of clarification, and she pursued them as far as she could 
each time. Only once when she actually reached an im- 
passe did she try to force a solution, but in so doing, 
accomplished nothing. Then her problem would seem- 
ingly lie dormant for a time. But when another difficult 
situation arose or when she was caught once more in the 
grip of neurotic disturbances, her energies were mobi- 
lized and she would make another attempt at under- 
standing her difficulties. 

Eileen's consistent determination to come to grips 
with herself expressed itself in another way as w r ell: she 
never grew discouraged. Even when she came to an 
impasse w r hile analyzing her "putting up with too much" 
attitude, she did not show any marked signs of despair 
or impatience. Rather, she let the problem lie dormant 
until a new approach to it opened up. She did not expect 

253 



Are You Considering Psychoanalysis? 

miracles; she was fully aware that analysis is a slow 
process. But she also knew that every finding would 
contribute to an eventual solution even though it might 
not yield immediate tangible results. Recall the time 
when she believed that her entire problem was now 
solved. Even when she understood that this belief had 
been partly illusory, she was not discouraged. She sim- 
ply realized that more work remained to be done. 



A further way in which Eileen expressed her consist- 
ent determination has already been touched on. What 
Eileen actually tackled from various angles throughout 
the whole period described was her feeling of being 
abused by others. You have probably experienced such 
a feeling and know therefore how tempting it is to im- 
merse yourself in it and respond with self-pity or rage 
against others. Before her analytical treatment, Eileen, 
too, had had profound spells of despairing self-pity. Dur- 
ing this period of self-analysis, however, her temptations 
to deal with the problem through rage or self-pity were 
but short-lived. Time and again we see her going straight 
to the point of searching for her own share in the dif- 
ficulty. 

You may still expect me to discuss technical details 
regarding self-analysis. But remember that I am not 
dealing here with self-analysis in general but with the 
more specific subject of self-analysis following analytical 
treatment. When you have been analyzed you will be 
familiar with the fundamentals of the procedure. More- 
254 



How Do You Progress After Analysis? 

over, just as every patient behaves differently in anal- 
ysis, so each one will evolve his particular ways of 
analyzing himself. As I gather from inquiries concerning 
self-analysis, many people seem to harbor the illusion 
that technical rules would supply them with a magic key 
opening the gates to self -recognition. What is of crucial 
importance, however, in analysis as elsewhere, is the 
spirit in which it is done. 

What were the practical results of Eileen's self-analysis 
during the period outlined above? To begin with, a dis- 
turbing symptom disappeared: the spells of fatigue, 
which had already diminished as a result of previous 
analytical work, now vanished for good and all. She be- 
came less tense in her relations with others; she felt less 
easily abused and whenever feelings of impotent rage at 
being "victimized" did emerge, she was quick to detect 
them and could then deal with the particular situation in 
a more sober and matter-of-fact way. She became more 
discriminating toward others. Since her expectations 
had become less exorbitant and undercurrents of hos- 
tility had diminished, she could see other people more 
realistically than before. She was also able to participate 
more spontaneously in discussions at professional as 
well as social gatherings. Formerly she had felt like a 
bystander; her efforts to contribute her share had, at 
best, been strained. This latter change may seem insig- 
nificant but I regard it as an evidence that Eileen felt 
less apart from others. Since she felt less unique in a 
fictitious way she was able to enter into closer relations 
with others. 

255 



Are You Considering Psychoanalysis? 

At the same time she felt more capable of defend- 
ing herself whenever necessary, of expressing her own 
wishes and opinions and standing up for them. In other 
words, she felt less "chosen by God" and could thus be 
more of a real person. 

I have described the results of this segment of analy- 
sis in such detail because it permits of a generalization. 
Of course not every piece of analysis will result in the 
disappearance of a symptom as in this case the rem- 
nants of neurotic fatigue. Moreover, the nature of the 
symptom that does diminish or disappear varies from 
case to case. But the more subtle character changes 
resulting from the thorough analysis of any problem are 
essentially similar. Supposing, for example, that the prob- 
lem concerned a person's insatiable hunger for success 
and triumph, analysis of this entirely different situation 
would similarly result in a diminution of vulnerability 
and isolation. 

In the light of absolute achievement, the practical re- 
sults of any piece of analysis are not at all impressive. 
"What is the use of making all these efforts toward self- 
recognition," you may say, "if they result each time 
merely in a little less of this and a little more of that?" 
Is not analysis, then, an endless road toward a destina- 
tion it never reaches? True. And because it is true we 
had better face it. But this outlook is discouraging only 
as long as we are captivated by the vision of absolute and 
ultimate attainment. 

It is certainly necessary to be aware of our goals 
lest we flounder aimlessly. But what really matters is the 
256 



How Do You Progress After Analysis? 

actual process of living and the actual steps we take 
toward our goals. Whether we take these steps alone 
or with the help of an analyst, the result each time is a 
gain in inner strength and freedom. 



257 



Adler, Alfred, 38 ff; theoretical 
concepts, 48; emphasis on social 
feelings, 49; definition of uncon- 
scious, 49; goal of therapy, 50 

Alcoholism, and psychoanalysis, 
21; as neurotic manifestation, 90 

Analyst-patient relationship, 26, 
29, 32, 136, 203; attitudes 
toward patient, 202, 205 ff; 
change of patient's role, 160; 
educative obligations, 204; im- 
portance of analyst's under- 
standing, 194; intensity of, 172 

Analytic procedure, 104; explana- 
tion of resistance, 231; meaning 
of transference, 231; mobiliza- 
tion of constructive forces, 231; 
understanding of retarding 
forces, 231 

Analytic sessions, frequency of, 
163 

Analytic situation, appeasing atti- 
tudes, 190; associations, 191, 
192; behavior in, 169; contra- 
dictions, 192; gradual develop- 



ment, 168; omissions, 193; pa- 
tient's attempts of escape, 179; 
reactions to, 166; resistance, 
170; responsibility, 166; signifi- 
cance of topic choice, 170 

Analytic techniques, 45; consist- 
ency of analyst, 222; develop- 
ment by Ferenczi, 160; evalua- 
tion of trends, 179; free associa- 
tions and dreams, 59; isolation 
of trends, 179; methods, 230; 
and understanding of patient, 
194 

Association for the Advancement 
of Psychoanalysis, 7 

Auxiliary Council, 7 

Basic anxiety, 69, 91, 212; en- 
vironmental influences, 72; and 
neurotic trends, 75; see also 
Childhood experiences 

Breuer, 159 

Childhood experiences, and basic 
anxiety, 76; development of, 
259 



Index 



Childhood experiences (Cont. ) 
27; and inferiority feelings, 69; 
influences, 67; parental atti- 
tudes, 68; and personality struc- 
ture, 65 

Combat fatigue, and psychoanaly- 
sis, 15 

Compartmentalization, 83 

Compulsive attitudes : glorification 
of, 24 

Darwin, 57 

Defense mechanism, according to 

7 O 

Freud, 43; maintenance of 
status quo, 232; reaction forma- 
tion, 44; repression, 43; tech- 
nique, 228 

Depression, 88, 139 

Detachment, 81 

Disturbance in functioning, 20; 
concealing of, 20; evidence, 20; 
means of extraneous relief, 21 

Dreams, analysis of, 175; and free 
association, 45, 171, 175, 176, 
180; value of, 174 

Drug addiction, as neurotic mani- 
festation, 90 

Externalization, 79; see also Fear 

Fear, of dependency on analyst, 
133; of going insane, 130; of 
exposure, 87; externalizing of, 
87, 88; of loss of equilibrium, 
87; of undergoing analysis, 95, 
116, 127 

Ferenczi, 160 

Free association, 167; analysis of, 
175; clues to meaning, 191; and 
Freud, 45, 59; value of, 174; see 
also Dreams 

Freud, Sigmund, 38 ff, 59, 92, 
260 



146, 160; as founder of psycho- 
analysis, 38; in perspective of 
his time, 57; his fatalism, 34 

Freudian psychology, 22; ortho- 
dox approach, 39 

Freud's technique, 45; free asso- 
ciation, 59, 159 

Freud's theoretical concepts: atti- 
tudes toward patient, 202, 206; 
childhood experiences, 27, 143; 
death instinct, 42, 48; emphasis 
on sexuality, 47, 131;- erogenous 
zones, 40; fixation, 42; id, ego, 
superego, 43; interpretation of 
dreams, 46; libido theory, 39; 
Oedipus complex, 41, 45; re- 
pression, 43; statements on neu- 
rotic difficulties, 46, 47; task of 
therapy, 42; termination of 
treatment, 230; transference, 44, 
132; traumatic experiences, 42 

Fromm, Erich, 56 

Group therapy, 106, 107 

Hypnoanalysis, 105, 106 
Hypnosis, 159 

Image, idealized, 80, 223 

Indecisiveness, toward analysis, 
138 

Inferiority complex, 20 

Inhibitions, as clues to repressed 
trends, 78; as neurotic manifes- 
tation, 88 

Inner conflicts: neurotic attempts 
at solution, 78, 79, 82; elusive- 
ness, 83 

Jung, Carl Gustav, 38; theoretical 
concepts: anima-animus, 55; 
archetypes, 54; definition of 
complexes, 53; dream symbols, 



Index 



45; mythological symbolism, 54; 
persona, 54; structure of psyche, 
53; task of therapy, 53, 55 

Libido theory, 39, 40 

Macmurray, John, Reason and 

Emotion, 203 
Maugham, Somerset, Christmas 

Holiday, 238 

Narcism, according to Freud, 39, 
45 

Narcosynthesis, 106 

Neuroses, development of, 61; 
definition, 62; environmental 
influences, 112; origin of, 63; 
positive value of, 118; present- 
day theory, 92; role of sexuality 
in, 22 

Neurotic attitudes, and physical 
disturbances, 196 

Neurotic conflicts: attempts at so- 
lution, 77 ff; awareness of, 226; 
consequences, 213; defenses 
against recognition, 226; grad- 
ual resolving, 212; recognition, 
213; unresolved, 84, 87 

Neurotic character structure, 77; 
consequences, 83; egocentricity, 
85; hopelessness, 86; intricacy 
of, 181 

Neurotic difficulties: core, 19; 
Freud's statements on, 46, 47 

Neurotic disturbances, indications, 
24 

Neurotic needs: dependency on 
analyst, 133; operating forces, 
230; tactics, 73 

Neurotic manifestations: behavior 
toward analyst, 173; depression, 
88; externalized fears, 86, 87; 



inhibitions, 88; sleeplessness, 88 

Neurotic pattern of living: aware- 
ness of, in analysis, 211 

Neurotic personality: remedies, 
according to Adler, 55; Freud, 
55; Homey, 59; Jung, 56; Rank, 
55 

Neurotic symptoms as self-decep- 
tive device, 30; in analysis, 29 

Neurotic tendencies in analysis, 
213; sadism, 86 

Neurotic trends, characterization, 
71; consequences, 74; defini- 
tion, 71; evaluation, 179; isola- 
tion of, 215; predominance of 
one set, 77; as safety device, 75, 
81, 87 

Oedipus complex see Freud's theo- 
retical concepts 

Personality disorder, 16 

Personality structure, childhood 
development, 65; concept, 63; 
discrepancy between healthy 
and neurotic, 64; influences, 67; 
parental attitudes, 68; psycho- 
logical conditions, 66 

Psychoanalysis, analyst-patient 
relationship, 25; attempts of, 
110; attitudes toward, 18, 19; 
change of analyst, 104; clarifica- 
tion of problems, 214; concepts, 
37; concerns of, 17, 18; defini- 
tion, 28; development, 17, 56; 
distance from analyst, 100; 
doubts about, 93 ff ; as educa- 
tion, 27, 99; effectiveness of, 
107; expenses, 9, 94; fears be- 
fore, 95, 116, 127; financial ar- 
rangements, 162; function of, 
32; goal of, 33, 34, 178, 212; 

261 



Index 



Psychoanalysis (Cant.) 

importance of, 152; indication 
for, 19; interference with faith, 
123; interference with personal 
life, HOff; interruptions of, 
101; length of, 9, 98; main ob- 
jectives, 230; manifestations of 
progress, 184; misconceptions, 
25 ff; preparation for, 9; as pre- 
ventive help against personality 
disorder, 17; psychotic episodes 
in, 130, 131; purpose, 13, 129; 
severity of, 98; short cuts in, 
104, 106; sources of disbelief, 
110; task of, according to Hor- 
ney, 59, 205; time factors, 9, 
96, 97; trial arrangements, 103; 
unconscious motives for, 31; see 
also Selection, Termination 

Psychoanalytic literature, during 
analysis, 163 

Psychoanalytic therapy, aims, 27; 
analyst's response to patient, 
187; goals, according to: Adler, 
50; Freud, 42; Homey, 56, 59; 
Jung, 53, 55; as initiator of in- 
ner growth, 236; sources of in- 
formation, 189, 190; require- 
ments, 187; value of emotional 
reactions, 188 

Psychosis, 130; see also Psycho- 
analysis 

Psychosomatic disturbances, 21; 
as alarm signals, 195; symptoms 
of, during analysis, 181 

Pyle, Ernie, 75 

Rank, Otto, theoretical concepts, 
28; creative tendencies, 50, 51; 
contrast to Freud, 50, 52; need 
for illusions, 53; Will Therapy, 
50,53 

262 



Repressions, results of, 46; see also 
Defense mechanism 

Sadism see Neurotic tendencies 

Selection of analyst, criteria: 
135 ff; age, 153; experience, 
154; general considerations, 
146; importance of psychoana- 
lytic theory, 155; irrational 
fears, 145; medical qualifica- 
tions, 150; neurotic motivations, 
144; prejudices, 146, 148; sig- 
nificance of sex, 140, 141 

Self-analysis, achievements, 256; 
attempts at, 241 ff; elimination 
of neurotic goals, 238; goals of, 
256, 257; illusions about, 246; 
limitations of, 256; procedure, 
240, 252; recognition of real 
self, 239; requirements for, 237; 
wishful thinking in, 246 

Self-expression in analysis, 26 

Sullivan, Harry Shack, 56 

Termination of analytical treat- 
ment, criteria, 237 ff; Freud's 
concept of, 236; and procedure 
in self-analysis, 240 

Transference reactions, see 
Freud's theoretical concepts 

Traumatic experiences, impor- 
tance of, according to Freud, 
42; according to Jung, 54 

Unconscious, the, according to 
Adler, 49; according to Jung, 54 

Unconscious problems, and dream 
symbols, 54; and physical symp- 
toms, 21; recognition of neu- 
rotic forces in, 161; and sexual 
functioning, 22