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Willard, C. (1939). Internationale Zeitschrift für Psychoanalyse. Psychoanal. Rev., 26(2):230-251.
Psychoanalytic Electronic Publishing: Internationale Zeitschrift für Psychoanalyse

(1939). Psychoanalytic Review, 26(2):230-251


Internationale Zeitschrift für Psychoanalyse

Clara WillardAuthor Information

(Vol. 23, No. 1)

1.   Freud, Sigmund. Lou Andreas-Salomé.

2.   Symposium on the Theory of the Therapeutic Results.

(a)  Bergler, Edmund. The Theory of Therapeutic Results of Psychoanalysis.

(b)  Bibring, Edmund. A General Theory of the Cure.

(c)  Fenichel, Otto. The Efficacy of Psychoanalytic Therapy.

(d)  Glover, Edward. Principles of the Therapeutic Results.

(e)  Laforgue, René. The Curative Factor of Analytic Treatment.

(f)  Nunberg, Hermann. Contribution to the Theory of the Therapy.

(g)  Strachey, James. On the Theory of Therapeutic Results of Psychoanalysis.

3.   Alexander, Franz. The Problem of Psychoanalytic Technique.

4.   French, Th. M. Clinical Study of Learning in the Course of a Psychoanalytic Treatment.

5.   Searle, M. N. Queries on Principles of Technique.

1.   Freud, S. Lou Andreas-Salomé. An obituary of Lou Andreas-Salomé who died February 5, at Göttingen, aged seventy-six years.

2.   Bergler, E. Symposium on the Theory of Therapeutic Results:

(a)  The Theory of Therapeutic Results of Psychoanalysis. To this symposium Bergler contributes observations on five details which are grouped about what seems to him the cardinal point of the therapy, that is establishing a change in the ego and ridding it of anxiety. He notes the following: 1. That the confidence in the omnipotence of thought, in “magic thinking,” which all neurotics betray is shaken when the patient's fears that the wishes rendered conscious in the analysis may be carried out in deed are demonstrated to be unfounded. When, for example, a patient of the passive feminine type is brought to recognize his unconscious wishes he has anxiety and fears that he may become homosexual. However, when he finds that his wishes are not carried out in deed this experience produces a great reinforcement of the ego. 2. Proof of the reality of a protective element in the superego is established through the interest shown by the analyst. At the beginning of

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the treatment the unconscious attitude of the patient toward the analyst is, without exception, one of anxiety mingled with a longing for love, concealed perhaps by skepticism, indifference, irony, or distrust. The analysis is first set going when a part of the ego comes to realize that the analyst will not punish and has a benevolent attitude. A method by which the patient may be convinced that the analyst is “for him” is by holding the unconscious at a distance, making of it a sort of “phantom.” The physician in association with the patient undertakes the task of examining and influencing this “phantom.” This collaboration with the physician, at first painful, becomes a pleasure as the analysis progresses. Superficially a narcissistic satisfaction is produced; the patient is pleased to be “such an interesting case.” At deeper levels the need which the patient has for love is satisfied in the form of a conviction that the physician has interest for the patient; that is, loves him. The work on the “phantom” of the unconscious assumes the color of a sexual activity. The intrapsychic realization of the “sexual” sympathy of the analyst represents a reappearance of the infantile wish that the parents might show sympathy for his sexual needs and is of great therapeutic value in modifying the severity of the superego. At the termination of the treatment this sexual sympathy is sublimated. A peculiarity of these relations is that neither the physician nor the patient may force the ultimate outcome; the process is one which evolves unconsciously and automatically. 3. An unconscious accord with the logic of the physician is established. The suspicion and distrust with which the patient approaches the analysis gives way to unconscious assent to the interpretations of the physician and this becomes evident in unconscious revelations. 4. The progress through the identification series takes place. At first, in the transference situation both parts of the superego, the demon (you must not) and the ego-ideal (you must) are projected on the analyst. The progress of the analysis depends on the circumstance that the projection of the “demon” to the analyst progressively recedes in favor of the ego-ideal, and, following the evolutionary trend, a reintrojection takes place in the effort to ward off anxiety. 5. The unconscious feeling of guilt is vis a tergo in the psychoanalytic therapy. With Nunberg, Bergler believes that the patient seeks analysis because of the unconscious feeling of guilt as to the pre-œdipal and Œdipal wishes at the foundation of the neurosis. In the progress of the analysis the bound feeling of guilt becomes free-floating and attaches itself with intensity to the process of conscience in the form of the reproach “why are you not yet cured?,” evident in typical dreams to which Bergler gives the name “recovery dreams.” Opinions of other writers on these points are discussed.

(b)  Bibring, E. A General Theory of the Cure. Bibring notes that universally the object of the therapy is to substitute ego for id,

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to cause the repressed part of the id to become ego. The mutual relations between certain parts of the id and the ego must undergo changes to conform better to a normal standard, and this involves also a modification of the superego. In the process of rendering conscious the unconscious parts of the conflicts the synthetic function is mobilized in various directions. However the synthetic function is not the only principle active, at least in the beginning of the analysis. The process of analysis is permeated by pedagogic influences which serve to modify anxiety, to reduce repression, to reinforce the ego, etc. These influences, however, do not constitute the real analysis, are of preliminary character, and are finally displaced by the results of the real analysis. The ego of the patient, the main object to which the analysis is directed, is a weak ego exposed to infantile dangers, while that part of the ego which has retained some degree of strength may be regarded as the factor which promises return to health. In the analysis this part is progressively reinforced and unified, becoming more able to confront menacing situations.

(c)  Fenichel, O. The Efficacy of the Psychoanalytic Therapy. Fenichel, noting that in a short discussion the principles of analytic therapy can be presented only in schematic form, offers some reflections. A neurosis is an involuntary substitute avenue of release for accumulated tension. In the psychoneuroses this accumulation has arisen through a chronic defense on the part of the ego against an instinct. Therapeutically only the ego can be dealt with and there are two methods of influencing it. The ego may be enabled to carry out its repression more successfully, or the ego may be caused to cease the defense against the instinct or to adopt a more fitting form. While the first procedure may perhaps be within the limits of psychoanalysis, the second is the one most in keeping with its principles. Questions arise then as to the proper means for causing the ego to give up or modify the repression and as to how the changes which take place when the repressions are abandoned are to be regarded from a dynamic and economic point of view. The defense against the instinct and the establishment of the repression takes place because the instinct is regarded as a danger and gives rise to anxiety. This anxiety has lost connection with the total personality and has become unconscious. The problem is to connect the instinct and the accompanying anxiety with consciousness. This is possible from the circumstance that the repressed instinct gives rise to derivatives. When the purposeful ideas of the ego are excluded as far as possible, these derivatives become apparent. Every interpretation both of resistances and of elements coming from the id is in the direction of revealing to the reasoning part of the ego the true meaning of these derivatives. The analytic atmosphere, the attitude of tolerance which convinces the patient that he has nothing to fear from the repressed

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drives is not only indispensable for interpretation in the transference situation, but is a means of persuading the ego to admit what has been repressed, at least tentatively. While the transference, as advised by Freud, is to a certain extent used in the sense of suggestion, still the desired influence on the ego is better attained and preserved when the principal means employed for reducing the repression is by confronting the reasoning ego with the various form of his resistances and with their origins. As neurotics in their unconscious instinctive life have remained children or have regressed to this level, with infantile sexuality (or aggression) it might theoretically be expected that, when the pathogenic defense activities are overcome, perversions would be the result of the therapy. Experience shows that there is no such danger. The instincts have retained their infantile character only because they have been repressed and have lost contact with the total personality. If the energy bound up in the defensive conflict is again integrated with the personality it becomes connected with the condition of genital primacy.

(d)  Glover, E. T. Principles of the Therapeutic Results. Glover believes that a symposium on the theory of the therapeutic results should not be limited to a discussion of specific factors and that the value of all factors for the psychoanalytic situation should be defined and weighed; otherwise such a symposium becomes a special debate. Striking proof of the manifold factors at the root of therapeutic results is the outcome of a questionnaire which, a few years ago, was sent to all practicing English analysts. Naturally there are good and bad, experienced and inexperienced analysts. Too, it is well known that an analyst who is only weakly grounded in theory may be a good therapist. It was found that a number of well-informed practicing analysts, while following the general principles of psychoanalysis, differ in their methods of interpretation in all conceivable ways, in depth, in frequency, in the form, in the duration of the analysis. Glover believes that a symposium on the principles of the therapeutic results of analysis should have been preceded by a discussion on the analysis of these results. He believes that it would be useful if all branch societies would prepare for a new discussion by having questionnaires filled out similar to those submitted in England. As soon as the actual results of the various methods were ascertained as exactly as possible, it would be possible to approach a theory of the results with more confidence.

(e)  Laforgue, R. The Curative Factor of Analytic, Treatment. Laforgue finds that in psychoanalytic treatment four main factors are involved. There is the factor of the confidence of the patient in the physician and the influence which flows from this confidence, inclusive of the patient's suggestibility—a factor also present in ordinary psychotherapy. But in contrast with ordinary therapy the analyst does not use suggestion to repress or deny the symptoms, but, on the contrary,

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to teach the patient to accept them and understand the consequences. However the influence of the physician and the suggestibility of the patient may remain relatively ineffective in the absence of a second and more important factor, the ability of the patient to make conscious the tendencies springing from the id or the superego and to overcome resistances. A third therapeutic factor is also important, the will to get well. These three factors may combine and complement one another in any individual case. For example, the will to get well may be so strong that in spite of the great resistance which the ego opposes to admission of the unconscious conflicts, the analysis may be carried through with good results. On the other hand there may be little will to get well but the influence of the analyst may be so strong that the patient is carried along successfully. To these three factors a fourth may be added which is dependent on chance circumstances, namely a shock of some sort in the external world (loss of fortune or disgrace) to which the patient reacts with reinforced will to get well or with greater preparedness for the work of analysis. Far the most important of these four factors seems to be the receptive attitude of the patient and the ability to wage the struggle against the resistances. Laforgue describes the important role which falls to the analyst. The neurotic ego which has remained infantile or has regressed to this stage must, guided by the analyst, pass through the various stages leading to normal adult development, until finally it is able to undertake unaided the struggle against inner and outer reality.

(f)  Nunberg, H. Contribution to the Theory of the Therapy. Nunberg does not regard the problem of the neuroses as entirely solved, therefore every attempt at a theory of therapy must be incomplete and may present contradictions. Generally it may be said that in every neurosis the ego is at variance with the superego. The superego denies certain instinctive demands and the derivatives of these instincts are hidden from the ego. As the analysis progressively renders those thoughts and tendencies conscious which have encountered opposition, criticism, and threats from the superego, the patient stands in need of protection. He finds it in the analyst, on whom he leans and with whom he identifies himself. This process of identification is carried on chiefly in the superego, somewhat like a truce with the enemy, in the hope of rendering the enemy harmless. And in fact through this pact the superego becomes more tolerant. It admits thoughts and wishes and modes of satisfaction which were previously banned, resulting in a reconciliation between ego and superego. As the force of the compulsions weaken the transference identification fades of itself and the superego ceases to work against the reality function of the ego, so that a harmonious coöperation of all three psychic instances is established. Nunberg is in full agreement with the view that in the alteration of the superego, introjection and

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projection, reintrojection and reprojection take part. There is also a redistribution of destructive energy; the striving of the superego for mastery, the reaching out for power, is displaced to the ego which, thus reinforced, becomes better able to cope with the demands of instinct and of the outer world. As Freud has said “Psychoanalysis is an instrument for enabling the ego to conquer the id.”

(g)  Strachey, J. On the Theory of Therapeutic Results of Psychoanalysis. Strachey finds that one main determinant of therapeutic success in psychoanalysis is the process of interpretation, especially of the transference and comments that it seems possible to understand the results of these processes and their manner of operation only if sufficient attention is bestowed on the mechanism of introjection and projection.

3.   Alexander, F. The Problem of Psychoanalytic Technique. Alexander believes that the general principles of the standard technique depend on consistent adaptation to the psychological processes which are observed during treatment; that is the phenomena of transference, resistance, the patient's increasing ability to verbalize material previously unconscious and the gradual removal of infantile amnesia. In the procedures that deviate from the standard either one or another of these phenomena is overrated from the standpoint of therapeutic significance and is dealt with isolated from the others. The controversy is always centered around the therapeutic evaluation (1) of emotional abreaction, (2) of intellectual insight, (3) of the appearance of repressed infantile memories. This overemphasis is based on an insufficient insight into the dynamics of therapy. The dynamic formulation that the energy which was bound in the symptom, after treatment, takes up a new dynamic allocation needs qualification. The new appropriation of energy in voluntary innervations must be in harmony with the forces already residing within the ego. If this condition is not fulfilled, a conflict is created within the ego which inhibits the free disposal of the formerly symptom-bound energy. This harmonizing or integrating function of the ego, however, is generally considered a faculty on which the analyst has to rely but to which he cannot contribute much by his therapeutic activity. This limits the indication for psychoanalysis to patients who possess an ego of sufficient integrating power, because the process of integration and its end result, a conflictless disposal of formerly symptom-bound energy must be left to the patient himself. Nunberg subjected this integrating or synthetic function of the ego and its role in therapy to a careful investigation and showed that the process of a repressed content's becoming conscious itself represents an integrating process. The aim of the therapy can thus be defined as the extension of conscious control over instinctual forces which were isolated from the conscious ego's administrative power, either as symptom or as neurotic behavior. All three factors, abreaction, insight, and recollection are

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required to obtain the goal of psychoanalytic procedure. Ferenczi and Rank believed that insight was possible without recollection, merely through the understanding of the different transference situations which are modeled upon the forgotten conflictful childhood experiences. These technical experiments can be classified as abreaction therapies, in which the element of insight, that is to say the process of integration is neglected. Another technical trend is represented by Reich's resistance analysis—based upon a similarly artificial and schematic distinction. Kaiser attempts to achieve dramatic abreaction by a merely intellectual procedure, by convincing the patient of the irrationality of his resistant behavior and resistance-ideas. Obviously here the fascination of the analyst by the fire-works of emotional rockets is what leads to such a distortion of the analytic technique. Probably the only effective way of permanently overcoming resistance consists in helping the ego to integrate, that is to say, to understand new material. Nunberg's thesis that the psychoanalytic treatment is not only an analytic, but simultaneously a synthetic process as well, is fully valid.

4.   French, T. A Clinical Study of Learning in the Course of a Psychoanalytic Treatment. French describes in detail the analysis of a case and comments that this analysis makes it plain that the patient is dealing with a single problem in external adjustment, that of overcoming his fear of the analytic task and of adapting himself to the analytic situation. The overcoming of his fear was made possible by his learning to take advantage of the difference between the understanding, tolerant atmosphere of the analysis and the repressive, threatening aura with which patient had surrounded the memory of his father. Thus, as in most learning processes, the solution of the patient's problem depended upon his acquiring the ability to act upon a discriminatory insight. The insight made possible the diminution of the intense ambivalence that was the cause of the fear. To summarize the factors contributing toward the solution of this problem: The analysis provided him an attainable goal. Pavlov's and Koehler's experiments have shown most beautifully that when an individual or animal is pushed to take a step in learning that is beyond its capacity, its attempts at learning tend to be replaced by reactions of frustration or by stereotyped reactions which may be compared to human neuroses. Neuroses probably in every case represent a permanent fixation upon frustration reactions of this sort, resulting from traumatic situations in emotional development in which the patient was unable to take the step that was required of him. Such a concept of a neurosis as the product of a disturbed learning process suggests the principle upon which therapy must be based. Since the step that life demands of the patient is too great, the treatment must somehow manage to divide this one long step into a number of smaller ones. Psychoanalysis attempts to do this by providing

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a situation in which impulses that are forbidden in real life are met with understanding and a certain amount of encouragement. Thus the analysis facilitates the learning process by substituting a more attainable goal, that of adjusting to the analytic situation itself, in place of the goal which the patient has been unable to reach, that of adjusting to the problems of real life. Every step in learning involves the substitution of a new method of obtaining gratification for an old one. Realization that an old method of gratification is unsatisfactory does not lead to immediate acquisition of a new one, but merely initiates a period of experimentation. The first experiments are apt to be unsuccessful. Consequently the experimentation tends to be punctuated by periods of frustration and despair. It is during this period that the facilitating influence of the tolerant analytic atmosphere is of the most crucial importance. Thus, as Alexander expressed it, one of the most important tasks is to keep the intensity of the transference at a certain “optimum level.”

5.   Searle, M. N. Queries on Principles of Technique. See Psychoanalytic Review, to follow.

(Vol. 23, No. 2)

1.   Freud, Sigmund. Analysis Terminable and Interminable.

2.   Jones, Ernest. The Future of Psychoanalysis.

3.   Federn, Paul. The Undirected Function of the Central Nervous System.

4.   Klein, Melanie. On the Psychogenesis of Manic-Depressive States.

5.   Reik, Theodor. The Anxiety Attack.

6.   Schilder, Paul. Clinging and Balance.

1.   Freud, S. Analysis Terminable and Interminable. Freud considers the question of shortening the analysis, and also the probabilities of permanent cure and of prevention of mental illness by prophylaxis. The success of therapeutic work, he says, depends (1) on the presence or absence of trauma as the causative factor of the neurosis, (2) on the relative strength of the instincts to be mastered, and (3) on something called the modifiability of the ego. The etiology of all neurosis is indeed a mixed one; either the patient's instincts are excessively strong and refuse to submit to the restraining influence of his ego or else he is suffering from the effects of a premature trauma, that is a trauma which his immature ego was unable to surmount. Generally there is a combination of the two factors—excessively strong instincts (the constitutional factor) and trauma (the accidental factor). There can be no doubt that, when the etiology is traumatic, analysis has a far better chance. Only when this factor predominates can one look for that

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most masterly achievement of psychoanalysis, namely such a reinforcement of the ego that a correct adjustment takes place of that infantile solution of the patient's early conflict which proved so inadequate. Only in such a case can one speak of a definitive end to his analysis. If the patient who has made such a good recovery never produces any more symptoms calling for analysis it still remains an open question how much of this immunity is due to a benevolent fate which spared him too searching a test. The factors which are prejudicial to analysis and may cause it to be so long drawn out as to be really interminable are a constitutional strength of the instincts and an unfavorable change sustained by the ego in the defensive conflict, a change comparable to a dislocation or crippling. The essence of the analytic situation is the modification of the ego. If the instincts are excessively strong the ego fails in its task, although it is now mature and has the support of analysis, just as it failed in earlier days in its helpless state. Both in therapeutic and character analysis two themes are met with which give the analyst an extraordinary amount of trouble. These are, in women, envy of the penis, the striving after the possession of a male genital, and, in men, the struggle against their passive or feminine attitude towards other men (castration). In no phase of one's analytic work does one suffer more from the oppressive feeling that all one's efforts have been vain than when one tries to persuade a female patient to abandon her wish for a penis as impossible, and to convince a male patient that a passive attitude towards another man does not always signify castration and that in many relations in life it is inevitable. One often feels that when the penis-wish or the masculine protest has been reached all the psychological strata have been penetrated and “bedrock” has been struck, marking the accomplishment of the psychoanalytic task. And this is probably correct for in the psychic field the biological factor is really rock-bottom. Whether one has succeeded in mastering this factor in an analysis is hard to determine, but one can console himself with the certainty that everything possible has been done to rouse the analysand to change his attitude in this respect. A normal ego, like normality in general, is an ideal fiction, therefore the “attainment of normality” cannot be used as the sole indication for terminating the analysis. The analyst must usually be satisfied with improvement of the disturbing symptoms. It almost looks as though were the third of those “impossible” professions in which one can be sure only of unsatisfying- results. The other two, as has long been agreed, are the bringing-up of children and the government of nations.

2.   Jones, E. The Future of Analysis. Jones discusses the future of psychoanalysis as a profession. Experience has shown that from whatever source of interest people study psychoanalysis at first hand, whether anthropological, philosophical or educational, the vast majority endeavor

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to enter on therapeutic practice. However psychoanalysis may be regarded, therefore, as a pure science, which may be applied for various purposes, in actuality it nearly always proves to be a form of psychiatry—using this word in its etymological sense of the healing aspects of psychopathology. Jones believes that the profession of psychoanalysis, the most special of all the medical specialties, should strive to maintain a close contact with the general medical profession. At the same time he is opposed to dogmatic exclusiveness in the matter and has constantly favored the admittance of non-medical members of special gifts, in special circumstances and with the special regulations about practice proposed by Professor Freud himself. In Jones’ opinion the general standing of psychoanalysis as a profession will in the future depend less on distinguished personalities than on the quality of what may be called the rank and file of the analytical practitioners. He gives a few suggestions as to the directions in which future progress may be attained: The selection of candidates could well be stricter, the duration of the training could be even longer than at present, and the laudable habit of what may be called post-graduate analyses might with advantage be put on a more organized basis. One theme in relation to the future of psychoanalysis is of paramount interest, namely, the scientific progress in the subject itself. In this matter dependence will have to be placed on the gifts of fortune in the shape of those personalities who have the happy flair for the significant new or the capacity to elucidate confused data by apprehending what is essential. In the field of technique no revolutionary change is to be expected in the near future. In the field of theory, on the other hand, very considerable changes may be anticipated in the course of the next twenty years or so. As to the main question concerning the future of psychoanalysis, whether its importance will be maintained, will extend or diminish, Jones is incapable of imagining this mass of valuable insight and knowledge as vanishing from the earth so long as any sort of civilization endures or that it will cease to play an increasingly central part in all studies and activities that have to do with the unfolding of man's mind and the determination of his well-being.

3.   Federn, P. The Undirected Function in the Central Nervous System. The question which interests Federn is less the coördination of the excitable elements of the central nervous system than the wakening of the previous ego-conditions. Modern schools of psychology, among them the Gestalt psychologists, maintain that there is more in psychic phenomena than the mere excitability of nervous centers and the efferent and afferent conduction and mutual interplay of impulses. He describes repressed experiences as those which have become inaccessible to undirected stimulation and cites the invention of symbols or of novel uses of symbols as examples of undirected function. He sets forth in detail

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the evidence of psychic manifestations pointing to undirected and total function, showing particularly how directed function consists in the mere choosing and finding of correct engrams or fitting associations and how creative work is done through undirected processes by way of symbols. Correct, dynamically strongly cathected mental images will find thus in undirected way what does justice to wishes, to questions, to the desire to express oneself. Often this is in the form of a far-distant goal. In other cases the unconscious undirected work has led to a result different from all previous phantasies and without any aim; it has condensed different things to a new form, has created something new. In every mental process, be it apperception, presentation, or true productive work, achievement through the will alternates with achievement through inspiration and imagination. It seems that will consists in a transition of one or several undirected excitations, tending along a coordinated path to the directed function; that is why the will is always felt to be a psychical act which influences the body. The undirected function is the essence of the psyche. The directed function is the physical side of the psychical and the psychical side of the physical life. In reference to telepathy he says that parapsychology, if proved in a single instance, would be an argument for the probability of his hypothesis; a happening that expresses itself through action par distance, perhaps over whole continents, can only be a mental phenomenon proceeding undirectedly.

4.   Klein, M. On the Psychogenesis of Manic-Depressive States. Melanie Klein, in this paper, deals with depressive states in their relation to paranoia, on the one hand, and to mania, on the other. She emphasizes the direct influence of the early processes of introjection in determining both paranoia and depression. Even the very earliest incorporated objects form the basis of the superego and enter into its structure; understanding of the subject's relations to his internalized and external objects and of the defence mechanisms developed by the ego are of the utmost importance in dealing with anxiety situations. If this view of the superego is accepted its relentless severity in melancholia becomes more intelligible. The persecutions and demands of “bad” internalized objects; the attacks of such objects upon one another (especially that represented by the sadistic coitus of the parents); the urgent necessity to fulfill the very strict demands of the “good” objects and to protect and placate them within the ego, with the resultant hatred of the id; the constant uncertainty as to the “goodness” of the object, which causes it so readily to become transformed into a bad one—all these factors combine to produce in the ego a sense of being a prey to contradictory and impossible claims from within, a condition which is felt as a bad conscience. That is to say the earliest utterances of conscience are associated with persecution by bad objects. The very word

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“gnawing” of conscience testifies to the relentless “persecution” of conscience and to the fact that it is originally conceived of as devouring its victim. The paranoiac, like the depressive, has also introjected a whole and real object, but has not been able to achieve a full identification with it or, if he has got as far as this, he has not been able to maintain it. The writer mentions a few reasons which are responsible for this failure: the persecution anxiety is too great; suspicions and anxieties of a phantastic nature stand in the way of a full and stable introjection of a good object and a real one; in so far as it has been introjected, there is little capacity to maintain it as a good object, since doubts and suspicions of all kinds will soon turn a loved object again into a persecutor; the subject's relationship to whole objects and to the real world is still influenced by his early relation to the internalized past objects and faeces as persecutors and may again give way to the latter. Thus the suffering connected with the depressive position thrusts the subject back to the paranoias position. The sense of omnipotence is what first and foremost characterizes mania and further mania is based on the mechanism of denial—that is to say on the denial of psychic reality. In mania, denial is associated with overactivity, although this activity often bears no relation to any actual results achieved: there is utilization of the sense of omnipotence for the purpose of controlling and mastering objects; there is also disparagement of the object's importance and a contempt for it. There are two ways in which the ego attempts to make an end to all the sufferings connected with the depressive position, namely (a) through “flight to the good internalized object” (the result of such a flight may be denial of psychic and external reality and the deepest psychosis); (b) by a flight to external good objects as a means to disprove all anxieties, internal as well as external, which is a mechanism characteristic for neurosis and may lead to a slavish dependence on objects and to a weakness of the ego. Thus it may be seen how a failure to maintain identification with both internalized and real loved objects may result in the psychotic disorders of the depressive states, or of mania, or of paranoia.

5.   Reik, Th. The Anxiety Attack. Reik discusses the chapter of Anna Freud's book on “The Ego and Defence Mechanisms,” which deals with identification with the aggressor as a defence. This identification, according to Anna Freud, is a normal step in the superego development; introjection of the criticizing authority puts the ego in a position to project its forbidden aim and to condemn others; such an ego learns what must be condemned but helps itself against the pain of guilt and self-criticism by the defensive process of identification. According to Reik's view this identification is not a step in superego development, but a hyperdevelopment of superego. Therapeutic measures in such cases is to require less from the self, but to trust the self more.

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6.   Schilder, P. Clinging and Balance. Schilder agreeing with Hermann as to the significance of clinging in the psychic life of human beings (Internat. Zeitschr. f. Psa., Vol. 22, page 348; see Psychoanal. Rev., Vol. 26, page 122) adds some observations. He notes the relation between the grasping reflex and sucking and indicates the localizations and innervations of these two phenomena. He also emphasizes the immediate clinical significance of these mechanisms in the understanding of anxiety neurosis and shows the connection between loss of balance and dreams of flying, gliding, etc., which are nearly always associated with the feeling that one of the parents has not shown enough love (contact, support).

(Vol. 23, No. 3)

1.   Fenichel, Otto. The Concept of “Trauma” in the Contemporary Psychoanalytic Neurosis Theory.

2.   Wittels, Fritz. The Criminal Psychopath in the Psychoanalytic System.

3.   Katan-Angel, Anny. The Rôle of Displacement in Agoraphobia.

4.   Hitschmann, Eduard. Remarks on Agoraphobia and Other Neurotic States of Anxiety.

5.   Jacobssohn, Edith. Courses of Development of the Female Super-Ego.

6.   Balint, Michael. A Contribution to Fetishism.

7.   Kielholz, A. The Judgment of a Case of Pedophilia.

8.   Knight, Robert P. Dynamics and Treatment of Chronic Alcoholism.

1.   Fenichel, O. The Concept of “Trauma” in the Contemporary Psychoanalytic Neurosis Theory. Fenichel questions the validity of the distinction usually made between traumatic neurosis and psychoneurosis, namely that in traumatic neurosis the organism is overwhelmed by a quantity of energy exceeding possibility of normal discharge, and that in the psychoneurosis the capacity of the organism to discharge energy is reduced. He finds that practically a neurosis represents a combination of these two possibilities. The so-called real traumatic neurosis, producing anxiety and other vegetative disturbances even up to epileptic reactions and, besides, repetition phenomena, is certainly never wholly uninfluenced by disturbances of instinct in the person affected. Experiences with the war neuroses furnished sufficient examples to show that earlier infantile sexual conflicts were awakened by the trauma; the trauma was unconsciously received as a castration, which destroyed the equilibrium between repressed instincts and defenses or set in activity unconscious sadistic drives. On the other hand psychoneurosis may in general be regarded as a variety of traumatic neurosis, as the motive

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for the non-satisfaction of instincts, particularly sexual, and for the accumulation of undischarged energy in the organism is always in the last analysis anxietyanxiety resulting from a judgment that a danger threatens, which itself arises from the memory of a disaster once experienced. There is one type of psychoneurosis which reveals in a particularly marked manner this combination with traumatic neurosis, namely, those in which the rejection of normal sexual activity has been brought about by definite sexual trauma—real seduction or by witnessing the primal scene. In this type of psychoneurosis there is not only a condensation of castration ideas and ideas of loss of love with anticipation of the dreaded state of tension, but also a breaking through of repressed instincts and a continued repetition of the trauma, the function of which is by repeated experience to gradually reduce the tension. Those who suffer from such a neurosis, which may be designated as a combination of psychoneurosis and traumatic neurosis, are worse off than those who suffer from a simple traumatic neurosis, because of the physiological factors resulting from the sexual excitement. One suffering from a trauma from the outer world without involvement of an instinct, for example from an automobile accident, cannot for a time get into an automobile again, trembles at the sight of an automobile, etc., until such time as the accumulated energy is “abreacted.” Then the disturbance disappears. Thus the “tremblers” so frequently seen after the war have all disappeared from the streets. If, however, the trauma is of such sort that the ego is forced to condemn all sexual activities as dangerous, this judgment prevents any release of sexual tension, which is then accumulated and floods the vegetative paths and thus the error of the ego concerning sexual activity is reinforced and a vicious circle is established. The circumstance that sexual excitement, as soon as it is released, is renewed again, prevents a state of rest from ever being attained, and a spontaneous recovery without analytic help can never be anticipated.

3.   Angel, K. The Rôle of Displacement in Agoraphobia. Katan Angel describes processes in women which take place at puberty and are of importance for the understanding of street-phobias. At this developmental period the girl raises defences against those instinctive drives which are connected with incest phantasies. Normal resolution of the conflict demands acceptance of the sexual instinct, but with change of object, that is the instinct must be directed toward an object in the world outside of the family. The ego, in this process, makes use of the mechanism of displacement, which, according to the writer's experience proceeds at first tentatively and uncertainly toward an object

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but always in the same direction, away from the incest object. This state of things was particularly illustrated in the case of a young girl who since three and a half years of age had been under analytic guidance. Up to the age of fourteen years she confided all her experiences freely and affectionately to the analyst. At this time she fell in love with a youth and her confidences ceased, indicating a normal displacement of the libido (flight from the incest object as represented by the analyst, but without denial of the libidinous instinct). Another case is cited, of a neurosis in the form of agoraphobia dating from the same period of life, fourteen years. The girl in this instance had witnessed the primal scene which had acted as a trauma; later she had established a strong attachment to the father. Puberty with instinctive drives resulted in attacks of anxiety associated with the sexual relations of the parents. The incest wish threatened to break through but the patient displaced the conflict to a person outside the family circle—to a teacher. This defense, however, was not successful; the teacher strongly resembled the father and it was necessary to make a more fundamental displacement. Her thought took the form: No, no, not in the bedroom of the parents should she indulge her forbidden desire for the father (and the accompanying death wish for the mother). I must attract men of quite other sort, as street-walkers do. This now became her wish against which she defended herself with anxious tension resulting in fear to go on the streets which continued to increase until she became practically a recluse. This patient was in conflict with both direction and object. She went so far as to exchange the incest object for a strange one, but because of the resemblance to the father the instinct was not released. If in this patient, the instinct had been set free she would probably have become a street-walker like the patient described by Franz Cohn, who actually became a prostitute. Normal freedom for the instinct at puberty results when the object chosen is of such character as to preclude disturbance by incest wishes and the direction is taken toward objects wholly beyond the danger zone. In agoraphobia the process takes place in distorted form.

4.   Hitschmann, E. Remarks on Agoraphobia and Other Neurotic States of Anxiety. Hitschmann describes five forms of neurosis, pavor nocturnus, animal phobia, compulsive fear of death of the parent of like sex, and agoraphobia. The factor common to all these forms is that they can all be traced to the aggression in the Œdipus complex. Aggression for the parent of the same sex is always accompanied by libido for the parent of the opposite sex; they form an inseparable pair. In the neuroses of childhood which always precede these neuroses in adults, the compromise formation between instinct and defense has not yet been completed, the “conscious” and “unconscious” are not yet separated, and they are differentiated only quantitatively. Their relative

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quantity, according to Freud, is decisive for or against continuation of the neurosis in the forms in which they are manifested in adults. In the interval between pavor nocturnus and animal phobia, on the one hand, and the other three disease pictures, on the other, the superego has been fully formed and the idea of death has emerged; punishment from without, from a burglar or a devouring animal is no longer feared and for these fears a painful sense of guilt as threat of revenge on the part of the superego has been substituted. The anxiety has become an inner signal which announces the approach of evil instincts (inner enemies) which are condemned by the superego. The ego, identifying itself with those against whom its aggression had earlier, in the Œdipus complex, been directed may now, from the sense of guilt, turn the aggression against the self and make of masochism an orgy of instinct in the form of masochism. Differences manifested in the individual cases of these neuroses are due to the relative predominance of different elements, as aggression, libido, repression or other forms of defense, or to differences in levels of development. In agoraphobia these combinations are very obvious, making it one of the most interesting of the neuroses.

5.   Jacobssohn, E. Courses of Development of the Feminine Superego. Edith Jacobssohn finds that the development of the feminine superego is much more complex than has been generally assumed. Freud and others give as reason for the less stable ego-formation in women, the absence of a real “castrationanxiety. Women, however, develop melancholia more often than men and melancholia has been found to be a result of an inexorable severity of the superego. Women patients often come for treatment whose superego is weak, whose only moral standards are borrowed from the environment and who nevertheless have developed melancholia traceable to cruel superego impositions. Jacobssohn emphasizes processes in the development of the feminine superego which she finds significant in explaining these seemingly contradictory facts. In the earliest years the little girl has a fear of bodily injury, genital injury included, not different from that of the boy. She comes to believe in an invisible inner penis. Fear of injury to the illusory member is condensed with pregenital fear of bodily injury. Following this period there is one when, realizing the absence of the penis, she believes she has been robbed and cheated, the period of disappointment in the mother. Jacobssohn thinks that a superego may first be recognized when it has reached a stage of consistent and consolidated structure. In the little girl this seems to occur earlier than in the boy, at about the third year, while she is still in the phallic phase, but when anxiety is increased by growing doubts as to her normal condition, and when she begins to blame her defect on the mother. The first stage of the feminine super-ego might be designated as “an inheritance of the

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negative Œdipus complex.” The formation of the superego continues and seems to receive a sudden impetus when the child accepts as a fact that she is without the member; i.e., “castrated,” the content of ideal morality in women being determined by this acceptance of “castration” as a fact. When later the father relation is established, he becomes the central point of all object libidinous, as well as of all narcissistic, drives. The phallic self-centered narcissism of the girl succumbs to the object libido, with the result that the father's superego becomes her own. Due to these conditions the feminine uneasiness of conscience, from this point on, becomes to a certain degree secondary to “social anxiety.” The moral standards are first of all the judgments and opinions of the love-object, which, like the penis, can always be taken over from him. In oral masochistic types the acceptance of the father and the incorporation of his qualities leads to such complete acceptance of his standards and views that any further independence of the superego is impossible. Therefore it is not surprising that women, with an organization of this sort, notwithstanding an apparently weak superego, should so frequently develop melancholia. Their oral organization disposes them to it. The original infantile superego against which, through characteristic projective-introjective mechanisms, defenses had been set up, returns to them and the ego is cruelly overwhelmed with archaic anxiety.

6.   Bálint, M. A Contribution to Fetishism. In fetishism an extraordinary value is ascribed to something which is relatively worthless. Balint points out that the thing to which the unusual value is attached is something inanimate and nearly always something what can be put on and worn. He finds that with this view parallels can be established between fetishism, on the one hand, the kleptomania and transvestitism, on the other. In the first perversion the main accent is placed on possession; in the second it is placed on the act of putting something on the body. Clinical experience furnishes support of this theoretical view.

7.   Kielholz, A. The Judgment of a Case of Pedophilia. Called upon to render an opinion as to responsibility in a case of pedophilia Kielholz decided that, in this instance, the conduct was not due to perversion, but to infantilism. The act for which the accused had been arrested was only one of many symptoms, exhibitionism, voyeurism, masochism, autoerotism, cunnilingus. Kielholz found that the man was polymorphous perverse. Besides, organic evidence of infantilism was present in the form of cryptorchism. The hopelessness of both punishment and therapy is pointed out. The man himself, after his release from prison, voluntarily placed himself under guardianship.

8.   Knight, Robert. Dynamics and Treatment of Chronic Alcoholism. As to the etiology of alcoholism, Knight says, that it is to be

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regarded as a symptom rather than as a disease. The roots of the disease itself is to be sought in the deepest levels of the unconscious, in the parental constellation. Alcoholism represents a regression to an oral level and is an attempt to return to the early passive state of dependence on the mother. Two main classes of alcoholics may be distinguished for the purpose of prognosis: the alcoholic personality in whom there is “fixation addiction” and the reactive type. The difference can be established only by analysis. The prognosis is more favorable in the last type. For the first type complete abstinence is the only hope for cure.

(Vol. 23, No. 4)

1.   Freud, Sigmund. Constructions in Analysis.

2.   Deutsch, Helene. Induced Insanity.

3.   Lampl De Groot, Jeanne. Masochism and Narcissism.

4.   Benedek, Therese. Defense Mechanisms and the Ego Structure.

5.   Van Der Hoop, J. H. The Objectivity of the Analyst.

6.   Lehrman, Philip R. Some Unconscious Components in Murder.

7.   Schilder, Paul. The Psychoanalysis of the Effect of Benzedrine.

8.   Bychowski, Gustav. Psychoanalysis During the Hypoglycemic State.

9.   Spitz, Rene. Family Neurosis and the Neurotic Family.

10.  Loewenstein, Rudolphe. Remarks on the Theory of the Therapeutic Process in Psychoanalysis.

11.  Sachs, Hans. Remarks on the Theory of Psychoanalytic Technique.

1.   Freud, S. Construction in Analysis. Freud prefers the term construction to interpretation in psychoanalysis. He likens the work of the analyst to that of the archaeologist who from the ruins and fragments brought to light by excavation constructs the life of earlier cultures and civilizations. The word construction is less likely to incur the criticism often brought that the views of the analyst are arbitrarily and forcibly imposed on the patient. In order to avoid error and not to defeat the cure by wrong constructions, they should at first be treated as tentative frameworks and in some fashion be submitted to the patient for assent or rejection. A direct assent to the construction by the patient is ambiguous. It may have no significance or it may be a form of resistance, the ironical acceptance of the construction serving further to hide the real truth which the patient is withholding. The assent has value only when it is followed by indirect confirmation, as when the patient produces new remembrances in immediate connection with his “yes.” The “no” of the patient is equally ambiguous. Rarely is it a direct dissent. Incomparably more often it is the expression of resistance

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called forth by the content of the construction. Various indirect methods of determining the patient's acceptance or rejection of the construction are described, as his conduct, associations, dreams, etc. One form of evidence that the patient is convinced of the truth of the construction is particularly referred to, as it offers a perspective: As reaction to the communication of the construction, lively memories often arise which the patient himself recognizes as over-detailed and over-vivid, and of which it would have been impossible for the analyst to have had knowledge. These memories might be called hallucinations. They suggest that in the hallucinations of psychotics there may be a trace of historical truth and that in the recognition of this kernel of truth a common ground may be found for therapeutic approach to the psychoses. Psychotic phenomena may be attempts at explanation and revival which, under the conditions of the psychosis, leads only to a restitution of fragments of the past to replace the reality which is denied. The discovery of the ultimate relation between this past which had long been repressed and has now reappeared, and the reality which is denied might well become the object of study in individual cases.

2.   Deutsch, H. Induced Psychosis. Deutsch describes four instances of folie à deux. In the first instance three members of a family developed pseudologia phantastica, the central feature of which concerned conscious and unconscious wishes shared by all three. In the second instance a girl suffering from schizophrenia adopted the delusion of a halfwit who stood in no affective relation to her but whose delusion of being the crown prince was in accord with her own infantile phantasies. In the third instance mother and daughter, one being psychotic and the other neurotic, developed the same delusion. In the fourth instance two sisters entertained the same paranoid idea, both having had the same infantile and developmental experiences, the results of which became manifest in one sister earlier than in the other. Deutsch makes a wide distinction between hysterical and schizoid induction. Neither in suggestion nor in schizoid induction, however, is anything accepted which is foreign to the ego.

3.   Lampl De Groot, J. Masochism and Narcissism. The manifestations of masochism met with most frequently in analytical practice, Lampl de Groot notes, are complicated psychic processes. As feminine and moral masochism they belong to the class of secondary masochisms derived from the primary erogenous. The role of the instincts as source of this masochism may be formulated: The elements of the destructive instinct which in the form of aggression is originally directed against the outer world may, secondarily, be directed to the self and here produce secondary masochism with trend to self-punishment. To illustrate one way in which a desire for pain or self-punishment becomes established

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she cites a masochistic phantasy in a girl under her treatment. The source of this phantasy was the effort to reduce the injury to narcissism caused by the discovery that she did not possess a penis. This narcissistic injury aroused anger and rage which could not be vented on the outer world and which, therefore, was directed inward toward the self with the result that she found pleasure in self-inflicted pain; she thus forestalled the more distressing punishment of violence to her narcissism. This same mechanism is encountered in very many cases of moral masochism; the need for punishment originating in the Œdipus complex receives reinforcement from the element resulting from narcissistic injury. In order to bring the patient to renounce this masochistic attitude it is not only necessary to confront him with the situation, but also to teach him to endure the violence to his narcissism. The repeated discovery of cases of this type disproves the validity of objections brought against the importance of penis-envy in women. Depending on the successful or unsuccessful elaboration of the penis-envy as the central point, the little girl develops to normal womanhood, or toward some type of neurotic disorder, that is, toward the masculine complex, or, as in the case referred to in this paper, to a masochistic attitude toward life.

4.   Benedek, J. Defense Mechanisms and Ego Structure. Benedek describes seven cases to show the dynamic role played by narcissism (narcissistic cathexis) in types of resistance met with in the analysis. In one group of cases the narcissism is concentrated in the superego and causes resistance in the sense of introversion. In another type the narcissism of the ego is stronger than that of the superego, bringing about defense mechanisms in the sense of projection. There are many instances, however, which do not fit into these groups. For example there are cases which produce superficial material not in keeping with the general structure of the disease picture. Here the fear of the superego is so great that a superficial defense is set up, which is really a reaction of flight. In these defense mechanisms, aggression which swings back and forth between ego and superego is involved, being directed either against the ego or against the environment. By observation of the narcissistic investment within the psychic structure, as it is repeatedly revealed in the typical defense mechanisms, methods for overcoming the resistance may be devised.

5.   Van Der Hoop, J. The Objectivity of the Analyst. Van der Hoop explains that in the field of psychology objectivity does not mean the exclusion of all subjectivity. On the contrary it signifies an open mind for all the possible forms of subjectivity, as well for the errors of mankind as for his highest aspirations and for all the different ways in which the ego seeks to integrate experience into unity and harmony. In contrast with this desired form of objectivity there is one form

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which is characterized by intellectual pride. Here the analyst imposes his ideals and values on the patient. Freedom from prejudice may in some cases be the most important factor in understanding others. Goethe is quoted as saying that he could think of no crime which he would not himself be capable of committing, yet with this open attitude he attained a comfortable adjustment with his Id.

6.   Lehman, P. Some Unconscious Components in Murder. Lehman gives the history of a murder committed by a paranoid schizophrenic, which clearly indicated the unconscious determinants of the deed. Experiences related by the accused, oral erotic dreams phantasies and anxieties led to the conclusion that the murder in this case of schizophrenia represents regression to the early oral level of devouring. While this tendency is not actually followed, it was present in the unconscious and with continued oral deprivations, the demands for satisfaction became more insistent. The victim seems to represent the very earliest undifferentiated object of the oral drives and this special element complicates the psychotic murder with suicide trends. In this undifferentiated ego-object relationship the victim represents both murderer and the person murdered. This feature was represented in the phantasies and fears of the accused.

7.   Schilder, P. Psychoanalysis of the Effect of Benzedrine. Schilder's observations in Bellevue Hospital are evidence of the astonishing effects of benzedrine, a sympathetico-mimetic preparation, on sleeping conditions and cataplexy. With understanding of the pharmacological effects of benzedrine from a psychoanalytic point of view it will probably be possible to use it in the treatment of neuroses. While it will not cure the neurosis it may be of service in influencing the symptoms and its use may serve to bring to light important material useful for the analysis. Apparently the effects of benzedrine do not depend on the drug alone, but also on the personality of the patient. If benzedrine is given without due consideration of the patient's condition, while fatigue, lethargy and inhibition may be banished, a restlessness may be developed which is more distressing than the original symptoms.

8.   Bychowski, G. Psychoanalysis During the Hypoglycemic State. In Bychowski's opinion the most important change in the personality produced by insulin shock has to do with the transference. The pathologically distorted infantile ego seems to be flooded with narcissistic energy as well as influenced by strongly cathected destructive trends derived from the death instinct. Hypoglycemia, which suspends the functioning of the entire central nervous system, weakens the pathological ego and renders it accessible to influences from without; the tendency to reject, toward negativism, in a word toward denial of reality,

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inclusive of the immediate environment, is reduced. In this way it becomes possible to establish the positive transference. Parallel with the improvement in the transference situation the entire delusional structure is weakened. Insight which had been walled off, by the pathological pseudo-superego, or rather had become blinded by deceptive formations, again asserts itself and the patient becomes receptive to normal impressions. Topologically regarded, it would seem that the pathological tendencies are thrust back and that their place is taken by reality, which, during the disturbance, had been excluded from consciousness. The pathological ego is now replaced by a normal one which assumes its proper function and continues to keep the pathological formations in the background. The standards of the normal superego also become effective, cathexis is withdrawn from the delusional ideas, which may be regarded as arising from an infection of the Id.

9.   Spitz, R. Family Neuroses and the Neurotic Family. Spitz gives a report of the 9th Congress of French Psychoanalysts at Nyon on April 10, 1936, at which Laforgue, Leuba and others discussed the problem of familial neuroses. Their views are compared with those of Aichorn expressed at Vienna, two weeks later.

10.  Loewenstein, R. Remarks on the Theory of the Therapeutic Process in Psychoanalysis. Loewenstein deplores the lack of precision in the statements of the problems confronting psychoanalysis and the uncertainty with which the theories of analytic therapy are set forth. All the attempts to explain the neuroses from a single feature (for example Rank's birth trauma) have failed. To the writer it seems that any single theory for the cure to be applied in all the different types of neuroses, such as that the therapeutic process is simply the reverse of the pathogenic, is likewise destined to failure. In any therapeutic procedure a great number of complicating factors, incapable of being reduced to a unitary system, must be recognized and taken into consideration.

11.  Sachs, H. Remarks on the Theory of Psychoanalytic Technique. Sachs insists that discussion of the theory of technique in psychoanalysis should be based on experiences and observations, not on theoretical systems. Otherwise there is danger that an unbridgeable chasm may open up between technique as really applicable and refined and sterile theories. Only by comparison of individual experiences in treating different types of neurotic disturbances will it be possible to arrive at a consistent theory of technique of real practical value.

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Article Citation

Willard, C. (1939). Internationale Zeitschrift für Psychoanalyse. Psychoanal. Rev., 26(2):230-251

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