On Freud's "On Beginning the Treatment"

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Like his other papers on technique, Freud's 1913 essay "On beginning the treatment" had an enduring influence on psychoanalysts for generations to come, providing them with a solid and worldwide-accepted conceptual basis on how to initiate psychoanalytic treatments. After a century of clinical experience and theoretical research, are all of Freud's rules and advice still valid today?Christian Seulin and Gennaro Saragnano have asked ten eminent analysts to comment upon this seminal paper of Freud's, each of them focusing on one of the fundamental issues originally propounded by the "father of psychoanalysis". The result is an overall and careful view on the actuality of the technical bases of analysis, in what can be considered a good introduction to contemporary psychoanalytic theory and practice.

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1. “On beginning the treatment”: a contemporary view

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Theodore Jacobs

Like his other papers on technique, Freud’s 1913 essay on beginning an analysis had an enduring influence on psychoanalysts for generations to come. Although he took pains to make clear that the precepts that he set down were meant not as rules to be slavishly followed, but as recommendations that in individual cases might need to be modified or dispensed with altogether, the authoritative manner in which he stated his positions, combined with his role as the father of psychoanalysis and fount of ultimate knowledge in our field, has caused his followers to view his recommendations in precisely the way that he cautioned them not to. That is, as rules of technique that defined the attitudes to be taken and the methods used by practitioners when beginning a new treatment.

It took many years, a great deal more clinical experience, and the waning of the influence of the émigré analysts, many of whom were close to Freud, for his contributions to be assessed and re-evaluated. Contemporary ideas concerning the beginning phase of treatment reaffirm a number of Freud’s ideas while augmenting, modifying, and correcting others. I am speaking here from the perspective of analysts working in the traditional or Freudian model. As an analyst trained in a classical institute and who utilises an approach that has been termed modern conflict theory, I will be writing from what is essentially a traditional Freudian point as modified by newer findings with regard to the influence of countertransference, enactments, nonverbal behaviour, and the interactive dimension of the psychoanalytic situation.

 

2. From past to present: what changes have occurred in the acceptance of the conditions for psychoanalytic treatment and its setting?

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Marie-France Dispaux

Any careful reading of Freud’s paper “On beginning the treatment” (1913c) cannot but prove once again how astonishingly modern some of his ideas were. The clinical aspects of that paper are particularly striking; it begins with the well-known metaphor about “the noble game of chess” (p. 123), which reminds us of the difficulties encountered whenever an analysis is being envisaged.

My present task is to explore the ways in which, in contemporary psychoanalytic practice, the ability of the patients who seek our help to accept the conditions and setting of the treatment has changed over time. There are several levels on which we could investigate this matter. First of all, we must ask ourselves if we have become aware of significant changes in the initial stages of psychoanalytic treatment and, if so, attempt to discover the underlying reasons for these. Have these changes to do with modifications in the pathology of the patients who seek our help? What impact have changes in society had on the possibility of accepting the conditions for psychoanalytic treatment? Why, and in what way, does that question seem more of an issue today than it was before? I shall try to answer these questions.

 

3. Transference and associativity, psychoanalysis, and its debate with suggestion

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René Roussillon

“On beginning the treatment” (Freud, 1913c) is one of three papers that Freud wrote on the technique of psychoanalysis between 1913 and 1915, the other two being “Observations on transference love” (1915a [1914]) and “Remembering, repeating and working-through” (1914g). Taken together, they are the most effective of Freud’s attempts to define the essence of the psychoanalytic situation and the work of psychoanalysis.

By 1913, he already had sufficient experience of the practice of psychoanalysis to be able to take stock of its strategy and essential characteristics. He was refining his conception of narcissism in a way that would open up a new chapter in the exploration of the mind and its workings,1 laying the foundations for what, in 1921, would be the analysis of the ego without falling into the trap of mere self-reference. As he was working on his theory of narcissism and the way in which this would help to identify narcissistic patterns, he undertook a series of reflexive and reflective reappraisals not only of the history of psychoanalysis (Freud, 1914d) but also of its practical and theoretical aspects; this led him to envisage undertaking the colossal task of writing the fifteen papers on metapsychology that would provide an overall view of psychoanalysis and of its underlying theory.

 

4. The person of the analyst and role of intersubjectivity in beginning the treatment

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Lewis Kirshner

Among the factors which influence the prospects of analytic treatment and add to its difficulties in the same manner as the resistances, must be reckoned not only the nature of the patient’s ego but the individuality of the analyst.

Freud, 1937

“Say as little as possible to the patient at the beginning of the treatment. Do not interfere with the patient’s thoughts. Let it unfold.” Probably no candidate today would receive this advice, as I did thirty years ago, to refrain from participating actively in the analytic process. My training followed Freud’s comment in “On beginning the treatment” that “one lets the patient do nearly all the talking and explains nothing more than what is absolutely necessary to get him to go on with what he is saying” (Freud, 1913c, p. 124). Since that time, however, the psychoanalytic situation has changed enormously. More than the familiar set up and enduring rituals of clinical practice might suggest, the notion of a standard technique applied by a well-analysed expert to an ill patient has given way to a more interactive conception of psychoanalytic treatment. In particular, our ways of understanding the nature of the analyst’s participation in the process and our notions of what is therapeutic about it have shifted toward a more shared and co-constructed model. In this chapter, I focus on two aspects of this conceptual change: the presence of the analyst as a “real person” and the influence of the perspective of intersubjec-tivity on the treatment relationship.

 

5. Swimming one’s way up to the fundamental rule

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Antonino Ferro

In the history of psychoanalytic technique “the fundamental rule” has been of immeasurable importance because it effectively establishes the mental setting within which the patient has to orient himself. “The analysand is asked to say what he thinks and feels, selecting nothing and omitting nothing from what comes into his mind, even where this seems to him unpleasant to have to communicate” (Laplanche & Pontalis, 1967).

In Freud (1913c) the injunction to “say everything that comes into one’s head” is followed by the metaphor of the passenger on a train who describes the changing scenery to his fellow-travellers. Thereafter comes the request for sincerity, followed by a number of other suggestions.

I think that when psychoanalysis came into being and its method was still largely unknown it needed to have a set of regulations and simple and unambiguous rules of conduct, and for this reason these recommendations were absolutely necessary.

I remember that when I began working as an analyst I used to provide my patients with these recommendations. Then over the years I simplified them more and more. Now, however, I tend not to supply these rules—and for a number of reasons.

 

6. How Emmy silenced Freud into analytic listening

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Patrick Miller

When to the sessions of sweet silent thought,
I summon up remembrance of things past, …

Shakespeare, Sonnet 30, 1966

In analysis “silent thought” is the negative condition for the repetition actualised in transference of old ways of being and thinking and also for the eventual tentative emergence of new ones. But, in analysis, silent thought is rarely sweet as it summons up the sound and the fury of the repressed past, primary and oedipal love and hatred.

In his “Observations on transference love” Freud (1915a [1914]) highlights the ethical and scientific aspects of analytic technique as opposed to the common sense morality of ordinary conversation1. When the sound and the fury of transference love appear on the analytic stage “to urge the patient to suppress, renounce or sublimate her instincts (is) not an analytic way of dealing with them, but a senseless one.” It is based on fear, which is none other than the analysts fear of what his own method sets in motion: “It is just as though, after summoning up a spirit from the underworld by cunning spells, one were to send him down again without having asked him a single question” (ibid., p. 164).

 

7. The work that leads to interpretation

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Rogelio Sosnik

The aim of this chapter is to share my reflections on the construction of interpretations. Interpretations are part of our mental activity as human beings, based on our need to make sense of the world that we inhabit, as well as the experiences that we live all along throughout our life. As psychoanalysts there is a specific activity that we need to accomplish, the building of interpretations when we have to play our role with our patients. One of my first questions was: is there something specific about an interpretation that makes it psychoanalytic? And, if it is, how can we determine its specificity? And what is the mental work that we have to do to reach it?

To explore these questions, I will first outline the issues involved, then comment on the evolution of psychoanalytic ideas on the subject in Freud and then through the contributions of Wilfred Bion. Finally, I will offer my view, following Bion, that the work of the interpretation is the result of a co-creation, and is not solely the analyst’s product. I will also attempt to demonstrate why this is so.

 

8. Interpretative function: two characters in search of meaning

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Alice Becker Lewkowicz & Sergio Lewkowicz !

Phrases! Phrases! As if there was not a comfort to all,
In face of a fact we cannot explain,
In face of an evil that consume us,
To find a word that doesn’t mean anything
But that calm us!

Luigi Pirandello (1922)

Even though in “On beginning the treatment”, of 1913, Freud’s recommendations seem to be restricted to the opening of the analytic game, we consider that in that work there is an extensive and profound revision of the analytic technique used by Freud up to that moment. From issues related to the therapeutic contract and to the establishment of the setting, he goes through the study of interpretation and reaches the mechanism of cure in analysis. This is probably the work that Freud devoted most to the subject of psychoanalytic technique. The paper begins with the much praised metaphor of the chess game, describing that only the openings and end-games admit an exhaustive systematic presentation (Freud, 1913c). In his remarks on psychoanalytic technique he poses questions that still remain current.

 

9. How to modify the unconscious: a transformational–modular approach and its implications for psychoanalytic psychotherapy

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Hugo Bleichmar

Psychoanalytic psychotherapy has evolved since the first works of Freud, influenced by the increasing knowledge contributed by generations of analysts regarding the structure and function of the psyche, especially concerning: a) multiple sectors of the unconscious; b) complex relationships between conscious knowledge and therapeutic change; c) forces opposed to therapeutic change; and d) types of interventions capable of promoting change or the opposite—reinforcing pathology.

The discovery that conscious knowledge does not necessarily produce the desired change if unconscious resistances are not overcome is one of the themes of “On beginning the treatment” (Freud, 1913c), a subject raised again in “The unconscious” (Freud, 1915e) not as a simple technical problem but as a result of the psyche’s organisation into differentiated sectors. In today’s terms, we could say that Freud always conceived of the psyche as consisting of systems or modules, his first topographical model and later the structural model, each with its own origin and development, interacting and influencing each other reciprocally. Not encapsulated modules, as considered by Fodor (1983), but rather the product of a process of modularisation through interactions with other modules.

 

10. Conflicting forces: on the beginning of the treatment

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Norberto C. Marucco

Introduction

Our analytic work places us in the role of a very particular kind of researcher who must constantly reflect upon himself, his therapeutic task, the theory he supports, the cultural context in which he thinks and acts, the vicissitudes of the scientific field he belongs to, and the relation the latter has with the rest of scientific disciplines. I personally understand the psychoanalytic method as a proposal of self-knowledge implying the analyst’s will to know his patient and himself, as well as the modes of psychic structuring and functioning, constantly coming and going between the theory and the clinical work. His goal is to search for the truth. This truth will be gradually revealed by patient and analyst alike in sometimes erratic approaches with no guarantees or reassurances, and does not belong to either of them. And all this will happen in the course of a dialogue of desires structured by the transference, a dialogue in which any statement is only temporarily true. I would like to quote here Maud Mannoni (1980):

 

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