"LINES OF ADVANCE IN PSYCHO-ANALYTIC THERAPY"

Originally planned for Breslau, the Fifth International Psycho-Analytical Congress—the first since the outbreak of the First World War—was eventually held on September 28 and 29, 1918, in Budapest, in the great hall of the Hungarian Academy of Sciences, with Karl Abraham presiding. It was there that Freud read this paper, which was published the following year.

Freud began by comparing the work of the analyst to that of the chemist, but warning against the idea proposed by some people that the analyst's task was somehow to create a new synthesis from the elements he successfully isolated. For "psycho-synthesis is . . . achieved during analytic treatment without our intervention, automatically and inevitably" (p. 161). The therapeutic way forward, therefore, was rather that "activity" on the part of the analyst which Ferenczi had advocated.

After recalling that "Analytic treatment should be carried through, as far as is possible, under privation—in a state of abstinence" (p. 162), Freud stressed that "we must see to it that the patient's suffering, to a degree that is in some way or other effective, does not come to an end prematurely" (p. 163), the danger being the weakening of "the instinctual force impelling him towards recovery" (p. 163). It was thus appropriate to put up "energetic opposition" to the substitute satisfactions that patients find in their various distractions, interests, activities, love affairs, and so on. Not to mention the satisfaction to be derived from the transference: "Any analyst who out of the fullness of his heart, perhaps, and his readiness to help, extends to the patient all that one human being may hope to receive from another, commits the same economic error as that of which our non-analytic institutions for nervous patients are guilty" (p. 164).

Likewise, and contrary to the approach promoted by the Zurich school, Freud argued that the analyst must resist the temptation to educate the patient or "to force our own ideals upon him" (p. 164)—even though, with most patients, "occasions now and then arise in which the physician is bound to take up the position of teacher and mentor" (p. 165).

As examples of "new lines of advance," Freud cited the active encouragement of phobics to confront their fears and the suppression of the compulsion of obsessionals to prolong their treatment ad infinitum.

But the broader prospect opening before psychoanalysis was the mass of patients barred from analytic treatment by reason of their lowly place in society—this despite "the vast amount of neurotic misery which there is in the world" (p. 166). The day would come, Freud felt, when society would acknowledge the importance of mental health and open free clinics "to which analytically-trained physicians will be appointed" (p. 167).

In that event, Freud speculated, "the large-scale application of our therapy will compel us to alloy the pure gold of analysis freely with the copper of direct suggestion" (p. 168)—even, as had been true in the treatment of the war neuroses, with "hypnotic influence." All the same, concluded Freud, "whatever form this psychotherapy for the people may take, whatever the elements out of which it is compounded, its most effective and most important ingredients will assuredly remain those borrowed from strict and untendentious psycho-analysis" (p. 168).

This text was rich in consequences. For several years, with respect to psychoanalytic practice, its approach underpinned the technical innovations of Freud himself (as when he terminated the treatment of the "Wolf Man") and above all of Sándor Ferenczi—innovations which, in conjunction with those of Otto Rank, would define deep divisions still felt in the early twenty-first century.

Indeed Ferenczi and Rank soon published a joint work, The Development of Psychoanalysis (1924/1925), which shook up the psychoanalytic world and instantly attracted the hostility of the Berliners, with Karl Abraham in the lead. With a view to simplifying psychoanalytic treatment and shortening its duration, Ferenczi and Rank presented, though in a more systematic form, proposals already made by Freud, among them the use of suggestion and hypnosis, and above all the setting by the analyst of a termination date for the treatment; these considerations were incorporated into Rank's almost simultaneous revival of the sharply contested idea of the "trauma of birth" (Rank, 1924/1929).

On another plane, Freud's venture into "social" issues was to have even more significant repercussions. As early as 1919, Max Eitingon and Ernst Simmel proposed to the Berlin Psychoanalytical Society that a polyclinic be established where the sort of free treatment that Freud had recommended at the Budapest Congress would be offered; a year later such an establishment was opened. Providing treatment naturally meant training more therapists, and the training institute soon set up in Berlin to meet this demand would become, roughly speaking, the prototype for all the similar institutes that were to follow.

The two great and opposing currents that as of 2005 continue to divide the psychoanalytical world—on the one hand research, codified communication, rigor, even orthodoxy, and on the other hand practical innovation, theoretical speculation, and the risk of counter-transference—had made themselves felt well before the 1918 Congress. But clearly Freud's observations, as he rediscovered a public audience at the close of the horrific First World War, contributed greatly to their renewed vigor and to their repercussions, which psychoanalysts still have to address in their day-to-day practice.

Alain de Mijolla

See also: Abstinence/rule of abstinence; Active technique; Berliner Psychoanalytisches Institut; Hietzing Schule/Burlingham-Rosenfeld School; Technique with adults, psychoanalytic; Psychotherapy.

Source Citation

Freud, Sigmund. (1919a [1918]) Wege der Psychoanalytischen Therapie. Internationale Zeitschrift für ärztliche Psychoanalyse, 5, 61-68; GW, 12, 183-94; Lines of advance in psycho-analytic therapy. SE, 17: 159-68.

Bibliography

Colonomos, Fanny. (1985). On forme des psychanalystes.-Rapport original sur les dix ans de l'Institut psychanalytique de Berlin 1920-1930.

Ferenczi, Sándor, and Rank, Otto. (1925). The development of psychoanalysis (Caroline Newton, Trans.). New York/Washington, DC: Nervous and Mental Disease Publishing Co. (Original work published 1924)

Rank, Otto. (1929). The trauma of birth. London: Kegan Paul, Trench, Trubner. (Original work published 1924)