Gary Ahlskog, Ph.D.
Director
Pastoral Counseling Training Program
Postgraduate Center for Mental Health
138 East 26th Street
New York, NY 10010
Defines “faith” as the underpinning of every therapist’s choice of focus when responding to a specific client, reflecting the therapist’s belief that this chosen focus will contribute most to that client’s future well-being. Discusses seven of Freud’s recommendations for technique as based on the faith that these will maximize future benefit to clients. “Reclaims” these approaches in Freud’s name, since many modern-day techniques are reinventions of Freud’s original approach.
In light of the mental health establishment’s 100 years of hostility toward psychoanalysis, a welcome shift occurred at the turn of this century when the American Psychologist decided to publish a paper showing how modern advances in Clinical, Cognitive, Social, and Developmental Psychology actually reinvent many of Freud’s original insights (albeit using different terminology). This shift does not mean vindication of that peculiar “orthodoxy” prevalent among North American analysts from the 1920s to the 1960s, in which the analyst (usually a physician) was supposed to be invisible, silent, empty, and therefore imperious. This misrepresentation of Freud’s thinking may have arisen because American analysts not fluent in German could not read his complete writings–not until The Hogarth Press published Strachey’s English translations in a total of 23 volumes between 1953 and 1966. Before Strachey, the United States simply assumed that America’s psychoanalysts were speaking for Freud (which they weren’t). Nevertheless, their peculiar “orthodoxy” became so entrenched that, even after Strachey, few in the mental health establishment bothered to go back and read Freud anyway. America continued to dismiss Freud without knowing what he actually wrote. Thankfully, the American Psychologist awakened to this mistake and so, I trust, have others.
Some remarks in this article are based on an address to a joint conference of the Eastern Region of the American Association of Pastoral Counselors (AAPC) and the Council of Psychoanalytic Psychotherapists. Their topic, “What is Healing?” might have fostered a rousing battle between so-called modern therapists and old timers (it didn’t happen). I’m too young for Social Security, but I welcomed my role of designated “old timer” as an opportunity, neither to criticize nor to defend Freud, but to cite what he actually wrote. As regards the topic of healing, Freud invoked the medieval physician, Ambroise Pare, as giving the best explanation possible, namely, “I dressed his wounds, God cured him.” Freud’s treatment goal was for clients to maximize their capacities for enjoyment (of self, others, and the living of life) and efficiency (in solving problems and contributing to society’s further course): “Where id was, there ego shall be.” This goal was more important to him than debates among theoretical schools. “There are many ways and means of practicing psychotherapy. All that lead to recovery are good.” Throughout his life, he was less interested in defending theory than improving our ways of dressing wounds.
The phrase in my title, “Seven Articles of Faith,” does not refer to some seven sacred pieces of theory which “proper” therapists are supposed to endorse. I’m not sure there is even one piece of theory so sacrosanct that it deserves allegiance and discipleship. A close reading of Freud reveals that he authored seven distinct theories of masochism. Which one should be “believed”? Obviously none can be the truly holy view. Nominating the Oedipus Complex won’t do because of the need to specify “which Oedipus Complex”?–an indefinite and endless task, since variations of sexual, aggressive, social, and intergenerational conflict are as innumerable as there are individuals on the planet. How about the theory of the unconscious? No, because as Freud made clear, unconscious processes “are even incapable of carrying on their own existence,” which is to say that the unconscious as such doesn’t exist. The futility of emotional valences that can be attached to memory and preconscious organization allow us to conceptualize this motivational source as “the unconscious”–idiosyncratic to each client–but it is pointless to talk about “believing” (or “disbelieving”) in a theoretical construct purposefully used to stand for the unknown.
Another connotation associated with the concept of “faith” is not relevant here: I’m not invoking special reverence for a particular worldview or set of ideals. In the religious domain, faith in “the Covenant with Abraham,” the “Resurrection of the Body,” or perhaps the “essential goodness of all things” may well be strength. No need to question these here; we all probably operate with conscious and assumed ideals during daily life. Yet treatment in the consulting room is not based on a therapist’s personal allegiance to a particular version of reality or vision of the good. If so, we call it countertransference. This becomes clearer by remembering some ill-fated historical nominees in which the proper analyst was to suppose to believe: (1) the inexorability of heterosexuality, provided the analysis went on long enough; (2) the inevitable influence of penis envy, provided all resistances were truly overcome; and to be more radical, (3) the theory that every theme in adult life can be traced to repetitive efforts to resolve infantile needs, which–since it can’t be demonstrated one way or the other–must certainly be considered a “belief.” As a parallel in the modern era, any idealizing of the goodness of heterosexuality or the badness of penis envy would be as ill-fated as their theoretical predecessors.
Now if Freud’s “Seven Articles of Faith” do not refer to sacred pieces of theory or a vision of reality or the good, then what do I mean by “faith”? Faith is the motive force behind whatever you do when acting so as to try to have an effect on the future. Faced with a client sitting opposite, all of us must choose our responses in the faith that what we say will contribute to a better future for this person. Clients present manifest texts, such as, “I can feel my brain going soft,” or “I’m more and more afraid to go out of the house,” or “I find myself feeling guilty for little things that happened a long time ago.” In response, various professionals might believe that the most beneficial contribution should focus on (1) levels of serotonin; (2) guiding the client’s behavioral activities; or more psychoanalytically, (3) emotions and fantasies missing from the explicit text but still hinted at as unfinished business. A focus like any of these is not right or wrong, which is why it contains an act of faith. A therapist’s risk is not mainly of being wrong, but irrelevant; i.e., offering responses that were believed to contribute to future benefit but somehow did not. None of us escapes this act of faith, regardless of training or orientation. Whatever you offer a client when you open your mouth reveals your faith that what you are contributing will benefit this client in this situation as you have heard it this time. None of us knows this in advance. We operate out of a belief that to say this or do that will help. When a colleague says, “Oh, no, that’s not what you should say, here’s what I would do,” then you have entered into a faith dispute, not about knowledge, but about what each believes will lead to a better future for this client.
“Reclaiming Freud’s Seven Articles of Faith” means remembering key recommendations he put forth as essential in the treatment room, speech-acts a therapist engages in because of the belief that they will bring further benefit to the client (in the next minute, week, or later life). Freud’s thoughts on technique come mostly from his earlier writings, but this does not mean that they are relics. While he altered many aspects of his theories in later writings, he adhered to his basic way of practicing until the day he died. So here is my list of Freud’s “Top Seven Recommendations.”
Number 1. Freud recommended that treatment not proceed until the therapist had effectively engaged in establishing “rapport,” preserved throughout treatment by the use of tact. He put it several ways: Therapy “presupposes [not only] a great interest in psychological happenings but personal concern for the patients as well.” He envisioned that all would go well in the opening phase “if [the therapist] exhibits a serious interest in [the patient]…and takes up [the] standpoint of sympathetic understanding.” By using the word “exhibits” he left no doubt that actually showing the therapist’s humanity is a precondition of meaningful treatment. Nowadays, I celebrate rediscoveries of Freud’s original recommendation, no matter who else in modern times is claiming to have authored this approach.
Number 2. Freud advised against seeming to be too smart, sensitive, or wonderful a human being, specifically recommending against “bringing [the therapist’s] individuality freely into the discussion,” thereby “becoming more interesting than [the patient]” and “encouraging the patient to be insatiable” about everything but the patient’s own problems. He emphasized that the patient must be the one to “of himself…link the [therapist] up with one of the imagoes of the people by whom he was accustomed to be treated with affection.” I understand Freud to imply two corollaries here:
a. We are cautioned against putting ourselves forward as worthy in advance of special trust, wisdom, or sensitivity. Trusting in advance is a pretty good definition of psychosis. A therapist who expects a client to start by agreeing to trust in treatment (or the therapist) in advance of actual work together is already starting to drive the client slightly crazy. If a client says to me, “I’m thinking of something but I don’t know if I trust you enough yet to say it,” I’m likely to say, “Good! I’ve never asked you to trust me; it’s more important that you go by what actually happens here.”
b. A therapist must not become so enmeshed in the client’s problems that the client loses hope that someone else can help. Freud had been taken to task for his metaphor of surgeon-like “coldness,” a metaphor that has plagued psychoanalysis in the United States for decades. In context, I read him to mean that the surgeon must not become overwhelmed by the fact that a tumor exists. Too much enmeshment in the patient’s depression, doubt, or fear will require clients to counsel us. I learned this again recently after a client had been imprisoned unjustly. While recounting the danger, loneliness, hunger, cold, and loss of contact with the outside world, the pained expression on my face must have been enough for him to stop and reassure me: “Hey, it’s OK, I survived it, remember?”
Number 3. Freud recommended that all of his other recommendations be disregarded if the patient in the room is in a psychotic state, a panic, a toxic depression, or facing a dangerous symptom (he cited anexoria as an example). He realized that in such cases, merely benign openness (the proverbial blank screen) would do no good, possibly harm. Today I worry that we make students so afraid of being criticized by a teacher or supervisor that they’re afraid to follow Freud’s advice (to ignore his other advice). I’ve gotten used to having supervisees in psychoanalytic training look at me strangely when I say that a client in a panic or too depressed to speak must be talked to–say anything at all that makes contact. They look at me more strangely when I assure them that they are to do this in the name of Freud’s own recommendations.
A corollary here is Freud’s understanding that the therapist “must be prepared for a perpetual struggle with [the] patient to keep in the psychical sphere all the impulses which the patient would like to direct into the motor sphere,” in which case premature outside actions could “invalidate [the] prospects of recovery.” Lisa’s so mad at real estate developers that she’s planning to use a modest inheritance to buy 120 acres of wilderness in the Canadian tundra, where developers will never get their hands on it. She wants to act before thinking and talking. Her therapist will have to actively, effectively, and quickly convince her that, minus these funds and no job prospects in sight, she will be unable to live, let alone receive treatment. Freud’s sophistication is lost on therapists who adhere to a one-dimensional style which either (a) routinely waits for “deeper” associations, or (b) routinely strives for “change” (as when following directives from Managed Care or HMOs who, God forbid, want clients to take any sort of action whatever, as if premature acting means “cure”). Freud eschewed both of these one-dimensional styles–routine waiting or routine striving. Either routine will alienate Lisa, whose life then will begin to spiral downward outside the reach of help.
Number 4. Early in his work, Freud (with Breuer) put forth his faith in “using words to combat the problem.” He was linking all therapeutic work to his model of dream interpretation, in which waking words reverse the regression of fantasies or mnemic images and restore the crucial capacity for thinking about life’s problems–a thinking task which clients usually prefer to bypass (as we all do from time to time). Similarly, “[Problems] permanently disappear…when the patient had described [the situation] in the greatest possible detail and had put the affect into words.”
My faith wavered when working with an alexithymic woman who, from age 9 onward had resolved to kill herself on her 30th birthday. As the date approached, and with nothing but despair in sight from the work we’d done so far, what do I do to try to bring a better future? Shift course and call the police? Refer her to five more psychiatrists instead of the three she had already seen? Call her family? Or, as an act of faith, hold on to my chair and keep using words to combat the problem? This faith-dilemma is not minor when you realize that, if anything does go wrong, government and/or civil litigants will fault you and you alone for not following 50 other hypothetical procedures in hindsight.
For Freud’s answer, let’s go to Number 5, his recommendation that the analyst “turn his own unconscious like a receptive organ towards the transmitting unconscious of the patient.” Much has been written about this remarkable phenomenon, which Freud first brought to life in helping us understand The Interpretation of Dreams, especially his 232 pages of Chapter 6 (which is hardly read at all these days). This “bending” may well include the possibilities of ESP, thought transference, and untold implications for spirituality. Understanding another person doesn’t depend on logic, but on nuances of connotation, affect, pun, memory, joke, syllogism, and an indefinite, idiosyncratic factor (call it the “unconscious”), whether we happen to be speakers or hearers. Freud went to great lengths to spell out this elusive situation, but he never claimed to explain it. He wrote volumes to professional therapists in the hope that they’d realize that client material wasn’t conventionally logical. Critics then mistakenly accused him of being a 19th century “logical positivist.” No, he tried to spell out in words the myriad ways that psychic functioning is uncanny, while remaining convinced that the most important matters in the client’s own life fall outside rational explanation. Psychic determinism does not mean that the past causes the present, as if billiard balls were knocking around a table causing one to move another, then another. No, it means that each individual psyche is active in determining how life events are experienced by that individual—which makes the therapist’s tasks of listening and choosing responses a brand new undertaking each day with each client.
Returning now to my suicidal patient, we had two weeks left before her ominous birthday. She asked if I would speak at her funeral. All my training and conscious intents were preparing to utter a professional cliché, the routine “No.” Yet without knowing why ahead of time, I found myself instead saying “Yes.” Then with no conscious roadmap as to where I was headed, I found myself adding, “I’ll tell you what I’m going to say: ‘Go home folks, don’t worry, the joke’s on you, she wanted it this way.’” I had no idea where my words were leading us. “Oh, shit,” she said, “when you put it that way, it isn’t the way I’m thinking of it.” To which I then said, “Oh, shit, it is the way you’re thinking of it–you do want it this way–and if you do kill yourself, we’ll both know I’m right.” To my astonishment she said, “I don’t like it, but I have to admit it’s the truth.” She gets the credit for such “working-through,” defined by Freud as her being willing to continue using words “in defiance” of her urges to act. From these crazy mixed-up words between us came more words, and a life that’s intact today.
Number 6. Freud recommended that therapists treat as of equal weight the importance of bringing impulses to light and the importance of bringing resistances to light. Awakening to our capacities for self-deception is every bit as crucial to recovery as awakening to our desires. Freud already noted that during psychic conflict “it is never possible to calculate toward which side the decision will incline: whether toward the removal of the repression or toward its reinforcement…incapacity for meeting a real erotic demand is one of the most essential features of a neurosis. If what [neurotics] long for the most intensely in their phantasies is presented to them in reality, they nonetheless flee from it.” In other words, Freud was well aware of the importance of objects and object-relations. The client is the one who resists and takes up the position of disinterest in objects. Given the client’s (problem of) disinterest in object-relations, Freud says that treatment needs to be “aimed directly at finding out and overcoming the ‘resistances.’” In other words, a therapist proceeds in the faith that gain will come, not from guiding, cajoling, or manipulating the client into relatedness, but from exploring self-deceptions, thereby enabling clients to recognize how issues are being sidestepped in the world of other living beings and relegated to the sterile realm of private fantasies.
Here is a short, obvious example. Mike reports a minor squabble with his wife, who was upset with him for teaching their 4-year-old son how to open a childproof bottle. He then mentions his “dramatic gesture”–going off to sleep in the spare bedroom–and goes on to explain to me that he had to get up early anyway, this would help their routine in dealing with the boy’s occasional nightmares, and besides, his wife would sleep better before her big meeting with the boss. In Mike’s version of self-deception, he resists acknowledging the feelings behind his gesture and complexities in his relationship with his wife. But how can I know this? That is, where do I find the faith to offer a relevant contribution without being arbitrary, guessing, or pasting psychoanalytic theory onto the story I am hearing? The answer is I can’t. Only when Mike goes on to say that he found his wife’s complaint about the childproof bottle her “dramatic gesture” toward him can I proceed in the faith that I have accurately heard his resistance to his own conflict, because he unknowingly pointed to it via his repetition of a key signal (his recurring reference to “dramatic gesture”).
We work in the faith that the most valuable contribution to a better future for Mike consists of our speaking, not to child rearing, household debates, or bottlecaps, but speaking to his repetitive method of distracting himself–from personal feelings and relational complexities–distracting himself by adopting a defensive position (in this case rationalization) at the expense of owning his feelings, owning his role as agent, and interacting in the world of other objects. This was always Freud’s view of the treatment process. This leads directly to Number 7, known as transference. We work in the faith that how the patient “is” in the room is more important than overt topics, and ultimately the most valuable clue to growth and change. Freud understood transference as virtually always drawing upon realistic aspects of the interaction: “Over and over again when we come near a pathogenic complex, the portion of that complex which is capable of transference is first pushed forward into consciousness and defended with the greatest obstinacy.” In other words, “capable of transference” means that realistic aspects of the therapist or the interaction are routinely used to distract from more important but elusive problems. The room really is too hot or too cold; the therapist’s lilt in her voice really was like the patient’s mother’s; a father really did sound the same way when the therapist clears his throat. (Patently unrealistic comparisons would expose the client’s underlying defensive position.) Faith requires us to accept the validity of these client responses while simultaneously treating them as substitutes (distractions) from more troubling material. Transference is the client’s tactic aimed at obscuring an underlying problem, not the problem itself. So when Mike goes on to explain himself to me in the best possible light in an attempt to coopt the superego into giving spurious approval of his impulses, it is simultaneously true that this repeats his lifelong reality (since childhood), and that his tactic in the room with me signals his ongoing masculine protest, which has plagued him since pre-school days: his fear that uncertainty spells automatic humiliation, flexibility spells automatic detumescence, and error spells automatic castration. In attempting to disentangle this underlying issue–Mike’s need to rationalize ordinary aggressiveness plus his dread at ever saying “I’m lost” or “I’m needy,” to his wife or to me–we draw upon all the faith and artistry we can find, including a little luck.
I close with this puzzle: After we’ve really helped, really made a difference, how come we can’t repeat this in the next session or with the next patient? Freud was pessimistic about any such thing as complete healing, some final prophylactic that would prevent an “alteration of the ego.” Why should this be? Behold, I tell you this mystery: Every treatment, especially the deepest and most successful, eventually unmasks a dreaded secret, namely the instability of individuation: Individuation is unstable because cathexis of a new other will change it tomorrow. We can indeed bring competence and artistry to dressing the wounds of childhood conflict, abuse, and trauma; we can resolve the transference neurosis and the repetition compulsion. But we cannot even touch, let alone control, the newness that will befall the former patient tomorrow, for good or ill, including, as Freud continually noted with special respect, the vagaries of accident (e.g., winning the lottery or getting hit by a bus). Our final faith, truly faith in things unseen and unforeseeable, must be faith, not in achieving health, but in the unprovable worthwhileness of the choice to struggle toward recovery after recovery.
The Journal of Pastoral Care, Spring 2001, Vol. 55, No. 2
FOOTNOTES:
Phebe Cramer, “Defense Mechanisms in Psychology Today,” American Psychologist, 2000, Vol. 53, No. 6, pp. 637-646.
I am indebted to Margaret Emery for alerting me to the implications of these dates. New York City, April 10, 1999.
Sigmund Freud, “Recommendations to Physicians Practicing Psycho-Analysis,” The Standard Edition of the Complete Psychological Works of Sigmund Freud. James Strachey, Trans. (London: The Hogarth Press, 1958). Vol. XII, (1912a), p. 115. Hereafter all citations of Freud’s writings will be taken from The Hogarth Press’ publications of Strachey’s translations of this Standard Edition (abbreviated as S.E.). Freud, “The Dissection of the Psychical Personality,” New Introductory Lectures on Psycho- Analysis. S.E., 1933 [1932], Vol. XXII, p. 80.
Freud, “On Psychotherapy,” S.E. (1904), Vol. VII, p. 259.
7Francois Roustang, Dire Mastery. Ned Lukacher, Trans. (Baltimore and London: The Johns Hopkins University Press, 1976).
Freud, “The Unconscious.” S.E., (1915), Vol. XIV, p. 187.
For a thorough examination of this issue, see the paper by Alan Bass, “Sigmund Freud: The Question of a Weltanschauung and of Defense,” in P. Marcus and A. Rosenberg (Eds.), Psychoanalytic Versions of the Human Condition (New York, NY: New York University Press, 1998), pp. 412-446.
Guy Thompson, The Truth About Freud’s Technique: The Encounter with the Real (New York, NY: New York University Press, 1994).
Freud, “On Beginning the Treatment (Further Recommendations on the Technique of Psycho-Analysis I,” S.E. XII, (1913), p. 139.
Freud, “The Psychotherapy of Hysteria,” Studies on Hysteria. S.E., 1893-1895, Vol. II, p. 265.
Freud, op. cit., (1913), pp. 139-140.
Freud, op. cit., (1912a), pp. 117-118.
Freud, op. cit., (1913), pp. 139-140.
Freud, op. cit., (1912a), p. 115.
Freud, op. cit., (1904), p. 264.
Freud, “Remembering, Repeating, and Working-through (Further Recommendations on the Technique of Psycho-Analysis II.” S.E., 1914, Vol. XII, p. 153.
Freud and J. Breuer, Studies on Hysteria. S.E., (1893-1895), Vol. II, p. 7, n. 1. Ibid., p. 6.
Freud, op. cit., (1912a), p. 115.
Freud, (1900), Vol. IV-V.
Freud, S.E., (1914), p. 155.
Freud, op. cit. (1904).
Freud, Fragment of an Analysis of a Case of Hysteria. S.E., (1901 [1905]), Vol. VII, p. 110.
Freud, “The Future Prospects of Psycho-Analytic Therapy,” S.E., (1910),Vol. XI, p. 144.
Freud, “The Dynamics of Transference,” S.E., (1937), Vol. XXIII, p. 104.
Freud, “Analysis Terminable and Interminable,” S.E., (1937), Vol. XXIII, p. 240.
Discussed extensively by Francois Roustang in Psychoanalysis Never Lets Go. Ned Lukacher, Trans. (Baltimore and London: The John Hopkins University Press, 1980)
