Story of Psychology - Morton Hunt [111]
The essential aspect of the process, however, was not what Freud did with his hand but what the patient agreed to do. As he later explained:
I assure [the patient] that, all the time the pressure lasts, he will see before him a recollection in the form of a picture or will have it in his thoughts in the form of an idea occurring to him; and I pledge him to communicate this picture or idea to me, whatever it may be. He is not to keep it to himself because he may happen to think it is not what is wanted, not the right thing, or because it would be too disagreeable for him to say it. There is to be no criticism of it, no reticence, either for emotional reasons or because it is judged unimportant. Only in this manner can we find what we are in search of, but in this manner we shall find it infallibly.18
What came forth was very rarely a forgotten painful memory but usually a link in a chain of associations that, if pursued, slowly led to the pathogenic idea and to its hidden meaning. In Studies Freud called this process “analysis,” and the next year, 1896, began using the term “psychoanalysis.”
Freud soon concluded that the pressure technique, which was only another form of suggestion, was inadvisable, because it was reminiscent of hypnosis and also made the doctor too vivid a presence at a time when the patient was trying to focus on memories. He abandoned it by 1900, relying thereafter on verbal suggestion.19
Thus, by 1900 the basic elements of the method consisted of relaxation on the couch,* the therapist’s repeated suggestion that free association would yield useful ideas, the patient’s agreeing to say whatever came to mind without any holding back or self-censorship, and the unconscious associations this process revealed in the patient’s memories and ideas. The method proved applicable not only to hysteria but to other neuroses. Freud tinkered with the technique for decades, but its fundamentals, aimed at achieving curative insight by looking into the psychodynamic unconscious, had all been established within a dozen years of the time he first treated a patient without using hypnosis.
There is, of course, a great deal more to psychoanalytic technique than this, much of it arcane and complex. Since we are concerned primarily with the development of psychological science and only to a limited extent with the treatment of mental disorders, we need not linger here over the details of psychoanalytic therapy or the variants devised by followers of Freud who came to disagree with his theories and therapeutic methods. But we must take note of two other elements of psychoanalytic therapy that Freud worked out, since they are central not only to his treatment of patients but to his use of psychoanalysis as the investigative method by which he made his major psychological discoveries.
The first is the phenomenon of transference. Freud had mentioned this briefly and in a limited sense in Studies, but five years later, in 1900, a failed treatment led him to make much more of it. At that time he began treating an eighteen-year-old girl identified in his case report as Dora. He and she traced her hysterical symptoms back to a sexual approach made to her by Herr K., a neighbor, and to her conflicting feelings of repulsion and sexual attraction to him. But Dora broke off treatment after only three months, just as she was making good progress. Freud, stunned, pondered long and deeply about why she might have done so. Re-examining a dream of hers about leaving treatment—an analogue of her fleeing