Szasz Thomas On Theorie of Analytic Treatement

(1957).

International Journal of Psycho-Analysis, 38:166-182

On the Theory of Psycho-Analytic Treatment17
Thomas S. Szasz, M.D.
I only want to feel assured that the therapy does not destroy the science. S. FREUD (31).
We are today anxiously aware that the power to change is not always necessarily good. J. ROBERT
OPPENHEIMER (62).
I
SCIENCE AND PSYCHO-ANALYSIS
Psycho-analysis is not, in my opinion, in a position to create a Weltanschauung of its own. It has no
need to do so, for it is a branch of science, and can subscribe to the scientific Weltanschauung. S.
FREUD (29).
The problem of the nature of psychotherapy has occupied a position of central importance throughout the
history of psycho-analysis. Nevertheless, the concepts upon which our theory of therapy restswhatever the
technique, goal and name of the psychotherapy might beremain essentially limited to those developed during
the first few decades of our science. Accordingly, certain concepts and terms are used by different workers to
describe different, sometimes even diametrically opposite, ideas and experiences. This state of affairs is
undesirable for a number of reasons. It may lead to misunderstanding among analysts; it may confuse and retard
the development of the earnest student; and it may lead to repetitious restatements of theoretical positions and
therapeutic orientations by various 'schools' of analysis without such interchange bringing about modifications in
the respective workers' existing orientations.
To the extent that the foregoing shortcomings exist, psycho-analysis fails to live up to the basic requirements
of a scientific discipline. For it is not enough to maintain that one is in search of 'truth' to qualify for the
adjective 'scientific'. The requirements of science include 'agreements' among colleagues about fundamental
concepts, adherence to certain well-defined methods of investigation and observation, and the unambiguous
communication of such observations to others so that they may share in the new experiences either by repeating
the observations themselves or through empathy. Further, a test of whether or not the foregoing criteria are in
operation may be found in the effectiveness and rapidity with which the reports of workers concerning new
observations are 'accepted'. Acceptance in this context does not signify agreement regarding the validity of the
new findings. It does mean, however, that the observations have been 'listened to', and it follows that they will
be either accepted as correct or the nature of the error will be rapidly demonstrated. The new finding is thus
either integrated into old knowledge, or drops out of sight. Scientific work is then ready to proceed onward in
its relentless and endless journey towards the achievement of fuller and better understanding.
Mathematics and modern physics supply our best models for such a concept of science (50). Indeed, our
concepts of the nature of science probably derive from our knowledge of how these disciplines operate (13).
Psycho-analysis deserves to be considered a science, since it fulfils several of its requirements: it has given us
certain well-defined concepts and has furnished us with a method of investigation and observation. This is well
known, and few would doubt that psycho-analysis has broadened the scope as well as the depth of our
understanding of human feeling, thought, and action. Its greatest weakness, it seems to me, lies in the fact that in
psycho-analysis we do not seem to have been able to formulate our work and our concepts in such a way as to
command the rapid 'test of adequacy' which characterizes other sciences. This
(Received 30 August, 1955.)

17 Presented in part at the Annual Meeting of the American Psychoanalytic Association in Atlantic City, New
Jersey, 7 May, 1955. Figures in brackets refer to the Bibliography; superior figures to the Notes, which
precede the Bibliography.
18 Professor, Department of Psychiatry, State University of New York, Upstate Medical Centre, Syracuse,
New York.
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has serious consequences, in that conflicting opinions, largely derived from different methods of observation,
continue to exist side by side. Furthermore, they all tend to use the same words and thus threaten usif the trend
continueswith an avalanche of misunderstanding which could easily put a halt to further advance in our field
along the lines now familiar to us.
The purpose of this paper is to re-examine some of the fundamental concepts underlying the theory of psycho-
analysis as a method of therapy in the hope of identifying some of the factors responsible for the foregoing
difficulties. I will devote particular attention to the theoretical implications of technical rules and to the concept
of the 'aim' of psychotherapy.
II
'TREATMENT' OR 'UNDERSTANDING'?
The history of science is science itself; the history of the individual, the individual. GOETHE (41).
the history of science assumes a new importance. It becomes, not the history of one among several
branches of human knowledge, but the essential clue to the process by which man achieves his
self-transformation from the animal to the human kingdom. B. FARRINGTON (20).
Psycho-analytic treatment is discussed so much and is written about so widely that detailed references to
previous works seem unnecessary. Moreover, even the most cursory review of the literature on therapy would
be so lengthy and complex that, within the confines of a single essay, its presentation would surely drown out
any new emphasis or point of view that one might wish to make.1
An accurate description of the therapeutic technique of psycho-analysis is one way in which the problem of
therapy may be approached. This means, in simple terms, that we try to ascertain exactly what the analyst and
the patient do and say in the analytical situation. One could immediately object and point to the words 'analytical
situation' as referring to something indistinct. What is the analytical situation? In order to answer this question, it
must be viewed in an historical perspective. In the beginning Freud described the manner in which he worked
that is, the ways in which he tried to observe, understand, and influence his patientsas the psycho-analytic
method. In this sense, as a primary definition, it was not further reducible to other experiences, and it was
particularly meaningful by virtue of its points of difference from hypnosis and catharsis. The latter methods
aimed at symptom-removal, as the logical goal of the contemporary physician. This was how the physician was
supposed to 'help' his patient.
One of the decisive steps in the development of psycho-analysis must surely be attributed to the fact that
Freud quickly realized that perhaps, after all was said and done, with the use of hypnosis and catharsis the
patient was not 'really helped' at all. He then turned his attention to trying to understand better the nature of the
patient's productions. The goal of helping the patient became subsidiary to the goal of scientific understanding.
Some people might object to such an interpretation of the events. However, we know that Freud was not
principally interested in being a physician and in 'curing patients', and that he was passionately devoted to the
pursuit of increasing his own grasp of understanding in numerous areas of thought (9), (51).
I would like to interrupt my presentation to comment briefly on this matter of 'helping people'. This seems
indicated since in our day and age there is once again a tendency to emphasize, with almost moralistic fervour,
that the primary aim of the physician and the analyst is to help his patient. Thus the intent to help sometimes
sincerely experienced, sometimes only officially avowedusurps the place of asking such questions as: 'I must
help the patientto do what?' and, 'If I so help him, what price will he (and I) pay for it?' (Cf. 18).
In Freud's day, though, much more than in our times, it was perfectly legitimate to be interested in trying to
understand the world about us without any practical gains necessarily deriving from such ventures. Indeed, the
men Freud admired mostGalileo, Copernicus, Darwinand his own teachers in Vienna, were characterized
by this spirit of 'pure science'.
The spirit of this endeavour is, of course, not gone. It is only muted, and particularly so in psychiatry.
Recently, J. Robert Oppenheimer has called our attention to the importance of this psychological fact concerning
'progress' in the following words: ' we also know how little of the deep knowledge which has altered the face
of the world, which has changedand increasingly and ever more profoundly must changeman's view of the
world, resulted from a quest for practical ends or an interest in exercising the power that knowledge gives. For
1 References to works most relevant to the thesis presented in this paper are given in the bibliography. See
particularly Nos. 6, 18, 26, 43, 48, 63, 71.
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most of us, in most of those moments when we were most free of corruption, it has been the beauty of the world
of nature and the strange and compelling harmony of its order that has sustained, inspirited, and led us' (62p.
97).
I believe the foregoing considerations are most important, since it is often maintained that psycho-analytic
technique has evolved gradually and in such a way that its modifications have been steadily oriented to the goal
of 'What is best for the patient?' It is added that Freud was, after all, a physician and he was for ever trying to
perfect his ways of healing sick people. I personally think such a view may be nothing short of a sentimental
rewriting of the history of psycho-analysis. And I know that many analysts share my view regarding this point.2
What is the relevance of these comments to the nature of psycho-analytic technique? Simply this: that in so far
as the emphasis in analysis shifted from 'treatment' (in the narrow sense) to efforts to understand ever more
about the patient, the requirements expected of the method changed accordingly. The main requirement now
becameas in other branches of sciencethat the method be helpful in eliciting as much useful information as
possible and that it do not 'contaminate' what is observed any more than necessary. The making of constructions
and interpretations may thus be looked upon as the investigative tool, while many other features of the analytic
arrangement (e.g. the reclining position, free association, etc.) serve to ensure the clarity (and depth) of the field
of observation. All this has been said before. What I wish to emphasize in this connexion is the importance of
Freud's scientific attitude on the evolution of this whole matter and the difference between the notions of 'trying
to help a sick person' and 'trying to bring order and harmony' to the phenomena and relationships where there
was none before. I will return to this point later.
III
SOME IMPLICATIONS OF RESTRICTING PSYCHO-ANALYTIC TREATMENT TO THE
'ANALYTIC SITUATION'
The possibility of analytic influence rests upon quite definite preconditions which can be summed up
under the term "analytic situation"; it requires the development of certain psychical structures and a
particular attitude to the analyst. S. FREUD (33).
Perhaps the origin of the rules by which psycho-analysis is conducted accounts in large part for the
widespread feeling which has developed among analysts regarding their restrictive nature. In other words, it
was Freud himself who defined analysis as a procedure which can be applied only to some patients and under
certain circumstances. He excluded many psychiatric conditions of adults as well as children from the domain of
psycho-analysis in the restricted sense (i.e. the 'analytic situation').
It is my contention that this provided a challenge for others to enlarge and to adapt 'psycho-analysis' so that it
would include progressively broader areas of human behaviour. In this tendency analysts have acted as others
do who believe they are 'in the right'. The pressure of nationalism demanding ever-larger territorial dominance
or the ambition of religion to convert more people to the 'faith' are analogous phenomena. As psychologists, we
should remind ourselves that these pressures usually originate from an underlying feeling of doubt about one's
'rightfulness'; the vigour with which the 'movement' is spread drowns out this voice of uncertainty. I dwell on
this point, because in this phenomenon once again I see a discrepancy between the scientific attitude and some
aspects of psycho-analysis. A scientific method is characterized, among other things, by a high degree of
tolerance of neighbouring areas of problems and of knowledge in which work proceeds by essentially different
methods. Witness the coexistence of mathematics and physics or of optics and organic chemistry. Mathematical
physics, which at present is regarded as the most 'lofty' of the natural sciences, does not insist on calling all
these fields simply 'physics'. The clarification achieved by using different words for different activities is a
useful one, although it remains true that, to use our example, both optics and organic chemistry are reducible to
mathematical physics with regard to basic theoretical principles. A useful distinction is made, however, on the
basis of different methods of investigation and observation.
The situation in modern psycho-analysis, unfortunately, is just the opposite. We use the fact that certain
underlying theoretical concepts (in the mind of the psychiatrist) are 'psycho-analytic' to designate widely
varying methods of investigation and observation by one and the same word. Freud himself contributed to this
ambiguity. While at times he emphasized that psycho-analysis is restricted to the 'psycho-analytic situation' (by
which he clearly delimited
2 We have, of course, Freud's own views on this matter to draw on. He wrote: 'It is argued that psycho-
analysis was after all discovered by a physician in the course of his efforts to assist his patients. But that is
clearly neither here nor there. After forty-one years of medical activity, my self-knowledge tells me that I
have never really been a doctor in the proper sense. In my youth I felt an overpowering need to understand
something of the riddles of the world in which we live and perhaps even to contribute something to their
solution' (31pp. 207208). Naturally, it is not necessary to subscribe to an 'either-or' reasoning concerning the
foregoing two motivations (i.e. therapeutic intent and scientific interest); the two may, and obviously
frequently do, coexist. Perhaps this overdetermined motivation in Freud himself was one source for the many
different statements which he had made on the subject of psycho-analytic treatment, some emphasizing and
others minimizing the issue of 'treatment' (e.g. 29pp. 207208 and p. 238).
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it to Eissler's primary model technique), in other instances he used the word 'psycho-analysis' to denote other,
wholly dissimilar, situations. Other analysts have added greatly to this widened usage of the term. It must be
emphasized that this tendency was, and probably continues to be, motivated by the prestige-value attached to the
term 'psycho-analysis'.
We should also recall that Freud spoke of psycho-analysis not only as a science but also as a 'movement'.
Many of the issues which I am now considering, and which were ably discussed by others in connexion with the
differences between psycho-analysis and dynamic psychiatry (37), (64), (65), (67), (68), could thus be regarded
as the price which psycho-analysis (as a science) is paying for its conquest over psychiatry.
For the sake of economy of expression, I will use the word 'psycho-analysis' in the subsequent paragraphs to
designate the 'primary model technique of psycho-analysis' (18). If other procedures are meant, they will be so
described.
As I have tried to show, if we regard psycho-analysis as being 'limited' to certain conditions, or better, to
persons possessing a certain kind and sufficient degree of ego-development, ipso facto we bring about a
situation in which it behoves us to modify the technique. This may then lead to notions such as the technique
being thought of as 'routinized' or 'rigid' and therefore undesirable. This is simply the result of a false point of
view regarding the scientific function of such rules. Let us take an example, by the way of an analogy. Clocks,
scales, and measuring sticks were the chief methods of investigation and frames of reference for observation in
classical mechanics. No physicist would think of describing the methods of Newtonian physics as 'rigid'. The
physicist simply concludes that certain phenomena cannot be described within this theoretical framework. But
then, no framework promises to explain everything. By the same token, it must be noted that new methods and
concepts are always added to the old ones and do not supersede them(62). Certainly the failure of an
investigative tool and observational method in a new area cannot be used as evidence against its adequacy in the
old one. Moreover, to push this analogy further, it is not so much the failure of the method in some areas that
justifies deviations from it, but rather the creating of new, more suitable methods of inquiry. Accordingly, new
methods of psychotherapyin so far as they are to be compared to psycho-analysis as a method of
understanding (science)must be evaluated on some basis other than that of 'therapeutic success'. Since this
criterion is never mentioned, it illustrates further the insufficient differentiation in our work between psycho-
analysis as a scientific discipline (wherein the only criterion of 'success' is the explicatory power of the theory),
and psycho-analysis as 'applied science' (wherein its effectiveness may be measured by the power to bring
about change, by economic gain, or by prestige).
IV
THE CHESS MODEL OF THE PSYCHO-ANALYTIC SITUATION:
I. THE NATURE AND FUNCTION OF RULES
The scientific way of thinking has a further characteristic. The concepts which it uses to build up its
coherent systems are not expressing emotions. For the scientist, there is only "being", but no wishing,
no valuing, no good, no evil; no goal. A. EINSTEIN (15).
The emphasis on the restrictiveness of rules is responsible for another misunderstanding about psycho-
analysis. I have in mind the notion that according to the 'primary model technique' of analysis, the behaviour of
the therapist is closely prescribed; it is as though he were bound to lose most of his spontaneity and
individuality, and sometimes he is even seen as a sort of disembodied carrier of the rules.
The reasons for the development of these and other similar notions need not concern us here. We may recall
that Freud compared psycho-analysis to a game of chess, and that he used this analogy in one of his early
attempts to explain psycho-analytic technique (28). Let us see what other inferences we might draw from the
analogy between chess and the primary model technique.
Chess, like other games, has a given set of rules. These determine how the game must be played, and at the
same time constitute the very definition of the game's identity. When it is stated that the rules determine how the
game is to be played, it might appear that this is a 'restriction', and that not too many possibilities remain for
expressing originality and skill. To what extent this is true depends upon the entire nature of the game. A game
of draughts, for example, is less complex and more constricted and constricting than a game of chess.
This brings us to the crux of the matter. If
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our focus is on the rules which govern chess play, we may get the idea of something that is limited. After all,
only a few figures are involved, and these can be moved only in a few predetermined ways. Yet, when we play
chess, we discover that the number of possibilities within the set rules is truly staggering. Moreover, with
greater proficiency, the freedom within the rules actually increases, inasmuch as one becomes capable of an
ever-increasing variety of ways of 'playing'. We use the term 'freedom', accordingly, to designate the
multiplicity of opportunities available to a person in a given situation. This will depend not only on the rules,
but also on what the person 'brings to the game' within himself.
Several aspects of psycho-analytic treatment, using interpretations as the sole technical device, are very
similar to the state of affairs encountered in chess.
1. Chess is restricted to those who know how to play the game. This excludes those who, by reason of
intellectual or cultural circumstances, 'prefer' other games, and particularly those who feel it is too
complicated and too taxing on the inner resources of the player. Analysis, similarly, requires a
relatively well-developed ego and a certain kind of ('scientific') orientation to problems of living.
(More will be said about this later.) Children and those with ego-deformations are excluded from
analysis, or are handicapped at benefiting from it.
2. Chess can be described in terms of a set of rules which, in their elementary components, do not appear
very complicated. The same is true of analysis, which is usually characterized by the rules (concepts)
of 'the analytic situation', transference, analysis of the transference, resistance, and the making of
constructions and interpretations. This may give the impression, especially to the uninitiated, of a
rather limited sort of situation. In this connexion the legend of the invention of chess may be recalled.
According to what is thought to be the oldest and most widely disseminated of these legends, the
philosopher who invented the game in ancient India was offered by the queen any reward for his great
gift to humanity that he desired. He merely asked that he be given some corn, the amount to be
calculated by placing one grain on the first square and doubling the number successively on each of the
sixty-four squares. At first glance this may appear to be an excessively modest requestas it did to the
queen in the storybut on actual calculation it turns out to be a very large number.3
3. The latitude within the rules, in chess as well as in analysis, is determined by what the participants
bring to the situation. The fact that some patients 'need' forms of treatment other than analysis does not
detract from its value to those who can utilize it any more than does the fact that many people enjoy
games other than chess detracts from the latter.
4. While the rules of chess are set and predetermined, the game proceeds in such a way that each player
influences the other continuously. Thus the same player plays differently against different opponents
even though he may have a persistent 'style' of his own. Further, for a game to be conducted in a
masterly fashion, it is necessary that both players be very good; a master cannot play well against a
beginner. These considerations apply strikingly to the primary model technique of psycho-analysis. The
patient's productions and behaviour are thus one of the determinants of the analyst's interpretation, and
the latter will influence the patient's next 'step' in analysis, and so on (36), (56). Some patients can be
analysed more easily and more rapidly than others, and this phenomenon depends largely on the patient
being attuned (even prior to analysis) to the task of utilizing interpretations (understanding) as a method
(rule) for conducting the 'game of living'.
5. The notions of 'rigidity' and 'flexibility' are not relevant to the rules of chess (or of other games) since,
if we propose to play chess, we take for granted that the players (and those who might wish to follow
the game) all agree to abide by the rules as a matter of convention.4 This does not mean that one cannot
legitimately ask, 'What would happen if we were to play the game by other rules?' However, the
pursuit of this question must be kept as clearly separate as possible from the problems encountered in
playing chess, or else hopeless confusion will result. The same considerations apply to the scientific
method in general, and to psycho-analysis in particular.
6. In all situations characterized by rulessuch as scientific methods, games, or psycho-analysisthe
rules structure the situation, but the participants determine the complexity and richness which may
develop therein. It follows therefore that when one is faced with difficulties of 'growing' within a given
structure, one may readily turn to another set of (easier) rules. This
3 According to Murray (58), this quantity of corn would cover England to a uniform depth of 38.4 feet. It may
be noted that the various legends regarding the origin of chess offer a fascinating subject for psycho-analytic
study. Most of the legends portray the game as a sublimated and humane outlet for the pleasures which
important men (rulers) derived from defeating their adversaries in warfare. The therapeutic value of the game
is quite apparent in these stories. Furthermore the therapeutic effect of the game is such that it is of benefit not
only to the players themselves but also to all those persons over whom they have control (i.e. the rulers and
their people).
4 These considerations are put forward to clarify what seems to me a persistent misunderstanding arising out
of the use of the term 'flexibility' in the psycho-analytic literature. This word has come to be used
synonymously with 'proper therapy' and with the notion of 'treatment so conducted that the therapist
understands the patient'. Conversely, fixity of rules tends to have the connotation of 'misunderstanding'
between therapist and patient. Actually, this situation arose, without much doubt, from attempts to apply the
unmodified analytic technique to individuals for whom it is not suitable; it then certainly leads to
misunderstanding and 'faulty communication'. But that is to be expected, and is in essence no different from the
persistent misunderstandings in numerous other areas of human contact where people with different
experiences speak to each other in different symbolic languages (24). However, it is precisely because of this
state of affairs that the creation and consistent use of explicit rules actually facilitates understanding, rather
than hinders it, provided that the rules of conduct are 'understandable' and usable by the prospective
participants in the particular situation (e.g. games, slang, scientific techniques and their respective idioms,
etc.). This shows, perhaps from a slightly different point of view, what has been emphasized repeatedly by
analysts, namely, the value of the analytic situation for effectively demonstrating (understanding) paratxic
distortions which, under other, less clearly defined circumstances, escape everyone's notice.
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could easily represent a regression, such as turning from chess to draughts. It could also be a valid shift
necessitated by the object of study. The latter case would invariably be characterized, however, not by
any simplification of rules, but rather by a change to another set of equally complex or even more
stringent rules than those that are being abandoned (e.g. the change from auction bridge to contract
bridge; or the shift in analysis from using interpretations focused solely on the transference [Strachey,
74] to a recognition of both transference and counter-transference).
7. The final goal of most games as well as that of science are given and are not a matter of choice for the
participants. In chess, for example, the final goal is for either player to checkmate the other or to play
to a draw. I will now try to show that a similar state of affairs obtains in psycho-analysis. The notion
of choosing different therapeutic aims for different patients is, in the context of psycho-analysis,
meaningless.
V
THE CHESS MODEL OF THE PSYCHO-ANALYTIC SITUATION
II. THE COMPLEMENTARY NATURE OF RULES (PRINCIPLES OF CONDUCT) AND AIMS
The scientific method would not have led anywhere, it would not even have been born without a
passionate striving for clear understanding. Perfection of means and confusion of goals seem, in my
opinion, to characterize our age. If we desire sincerely and passionately the safety, the welfare and the
free development of the talents of all men, we shall not be in want of the means to approach such a
state. Even if only a small part of mankind strive for such goals, their superiority will prove itself in
the long run. A. EINSTEIN (14).
The question, 'What is the aim of psycho-analysis?' has received considerable attention in the psycho-
analytic literature. The interlocking nature of the aim and of the technique is generally appreciated. Balint (4)
has emphasized the ways in which both the aims and techniques of analysis have changed in the past and
apparently continue to change through the present.
Currently there is considerable agreement among analysts regarding the aim of therapy when this is
formulated in general terms, such as 'emotional maturation' or 'unhampered personality development'.5 At the
same time, there is widespread disagreement on specific points, such as whether one should aim at 'structural
change', 'interpersonal harmony', 'good communication' or 'successful adaptation to the environment', etc.
Clearly, the problem of the aim of psycho-analysis is a weighty one. It may confuse us particularly in so far
as it may touch on the age-old philosophical question of 'What is the purpose of life?' In view of these
considerations, it might be helpful if, instead of offering goals of our own, we were first to examine precisely
what we mean when we speak of the goal of psycho-analysis.
We have little difficulty in understanding the meaning of the word 'aim' in everyday speech. For example, in a
situation such as that of a marksman aiming a gun at a target, we speak of hitting the target as being the aim. But
even here we might ask whose aim this is. There are at least two answers to this question. (i) We could say that
it is the marksman's aim to hit the target; (ii) we could also say that the notion of hitting the target is set, i.e.
predetermined. The marksman simply makes this goal, given by the situation, his own and experiences it as his
goal.
Let us examine another example, closer to the problem of therapy. A patient is suffering from pneumonia. We
give him penicillin. Our aim, in this case, is to restore him to a state free from infection.
The crucial issue in both these situations, and in other similar instances, is the matter of choice. It is assumed
that the marksman has a choice as to whether he wishes to hit the centre of the target or whether to shoot in some
other direction. Assuming that he selects the first alternative, he may then be more or less successful in
achieving his desired end (aim, goal, purpose). Similarly, it is assumed that the physician has a choice between
giving the patient penicillin, not giving it, or even doing something that is directly harmful. These considerations
form the focus of discussions on problems such as euthanasia and the application of medical procedures to
politically determined 'aims'. In other words, the concept of a specific aim has real meaning only in a context
of choice. If there is no choice, then there is no 'aim' in the sense in which the word is used in the foregoing
examples.
In so far as this applies to a therapeutic situation it has further implications. The notion of aim here is
meaningful only if its referent is the patient or something about the patient. I can illustrate this as follows. We
have a patient
5 It is not unimportant to be aware of the danger inherent in the use of such idealistic terms, since when we
speak of 'maturity' and 'development' we obviously make it impossible for anyone to negate or disagree with
these propositions without his being ipso facto 'wrong'. This state of affairs characterizes ethical beliefs rather
than scientific propositions. Accordingly, the possibility to disagree reasonably and safely must be inherent in
any formulation if it is to merit its inclusion in the domain of science rather than that of religion or politics.
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suffering from an hysterical conversion. In such a case, we might discuss the aim of the treatment in terms of
whether we should remove or otherwise alter the symptom, or whether we should try to effect some change in
the underlying character-structure. All these ideas about aim refer, as was noted, to the patient. Their logical
corollary is that there is a choice on the part of the therapist, who is potentially free to decide to pursue one aim
or another and to select a course of action accordingly (67). The choice among various goals presupposes that
the nature of the interaction between patient and therapist is essentially 'free', i.e. not governed by any rules.
Suppose, however, that instead of focusing attention on the patient, we centre our interest on the technique of
the procedure employed (i.e. on the nature of the interaction). If we are skilful at this, and so desire, it is
possible to describe the techniqueor, in other words, to furnish a set of ruleswhich will meet every
possible contingency.6 Now we recognize that this is precisely what we mean when we speak of a set of rules
by which a game must be played. This takes us back to the analogy between psycho-analysis and chess. Let us,
therefore, ask 'What is the aim of chess?' This question is to a large extent meaningless, since the aim of the
game is inherent in its rules, albeit this is not explicitly stated. However, unless we understand and agree (and
assume) that the aim of the game is for one side to checkmate the other, the rules would be senseless. The rules
of the game and its aim are thus complementary concepts(11). Neither one alone, no matter how clearly
specified, can adequately describe and impart its proper identity to the game.
Let us apply similar considerations to psycho-analysis as a method of treatment. I believe we are justified in
reaching the following conclusions. The more accurately and unambiguously we describe a process in terms of
the operations which go into it, the more rigidly will these operations determine the final outcome of this
process. If this analysis of the problem at hand is validand acceptedit follows that the notion of what the
aim of a particular process should be will be meaningless in direct proportion to the predetermined
(unalterable) set of rules (operations) by which the process must be carried out. Accordingly, given a certain set
of rules for the technique of psycho-analysis, we shall have to ask not what the analyst's or the patient's aims or
aspirations are, but what aim may have been 'built into' the therapeutic procedure by its very operations. I
propose to discuss this question presently.
Before doing so, however, I wish to show that my foregoing thesis, namely, that a comprehensive definition
of rules usually embodies within itself certain consequences, which are often thought of as 'aims', does not rest
solely on the analogy with chess. As a matter of fact, the whole new technology of 'purposeful machines'
illustrates this thesis. Modern missiles which 'seek out' their targets are called 'purposeful' by virtue of
anthropomorphic considerations. One could well say that they are 'more' purposeful to the layman, who does not
know how they work, than to the mathematician and engineer who build these machines and to whom they may
not seem purposeful at all, but simply 'built that way. '. The construction of the machine predetermines its
'purpose'.7
Anatol Rapoport (69) has recently described with great lucidity that the notion of ethical judgementssuch
as the question, 'What is good?'is meaningful only if we have a choice. If there is no choice, if the outcome of
a set of events is determined with reasonable rigidity, than it is meaningless to entertain such a question as 'Is
this outcome good or bad?' Similarly, we should conclude that we can speak about the purpose, aim, or goal of a
set of actions if, and only if, the nature of the actions is not clearly determined and restricted to certain
possibilities (or, if we are ignorant of these rules, which is perhaps the same thing). Or, to put it differently, the
more we are free to vary what we do, the more variable the outcome of our actions will be and, accordingly, the
more shall we be able to conceive of having a choice among these diverse 'aims'. (It seems likely that from the
point of view of scientific method, this problem may ultimately disappear into the realization that freedom of
aims is a measure of our ignorance of the rules by which the alleged aims are achieved.)8
VI
THE MEDICAL MODEL OF PSYCHO-ANALYTIC TREATMENT
I have assumed, that is to say, that psycho-analysis is not a specialized branch of medicine. I cannot
see how it is possible to dispute this.
S. FREUD (31).
It is a waste of time to force comparisons where they do not exist and constitute an obstacle to our
special branch of knowledge.
THEOPHRASTUS (20).9
6 This is achieved partly by limiting what can happen and partly by a definition of rules in an abstract rather
than concrete manner. In other words, the rules provide guidance as to conduct according to certain
'principles', rather than furnishing itemized commands of 'do this', 'do not do that'. This is an important matter,
as is shown by the current misunderstandings as to what constitute the 'rules' of analysis. The difference
between concrete and relatively more abstract 'direction' may be easily pictured by the following example. If
we wish to tell someone how to get from place A to place B, we can: (i) Give him a set of directions, which
read something like this. 'Out on street X, right here, left there, three blocks down the street on the left side.
etc.'; or, (ii) we can send him a map showing the location of A and B as well as the roads, bus lines, and
important places which help one to identify one's position in strange surroundings. Specific 'commands' as to
where to turn, what mode of transportation to take, and so forth, must be abstracted from this map by the
traveller himself, and must, so to speak, be given to himself. The concept of the 'primary model technique' of
analysis is a map. How many times a week a patient is seen is a direction. The two are not on the same level
of concepts and cannot be 'compared' (cf. Knight, 53); (Reichenbach, 70).
7 This consideration has important bearings on Freud's statement about the treatment of children, criminals,
and others not amenable to the unmodified technique, having the same purpose as that of analysis (33). Such a
view may be no more than a wish and, if so, would have to be dispensed with as a basis for scientific work.
The importance of this matter rests on the fact that a wide variety of techniques of human interaction are today
labelled psycho-analytic precisely on the basis of their alleged aspiration to the same goals as those of
psycho-analysis.
8 The foregoing comments must not be interpreted as being essentially an attack on the concept of 'free will'.
This concept is only partly amenable to logical analysis and partly it refers to a psychological phenomenon, a
'state of mind', which requires explanation along different lines. We cannot pursue this matter further in this
connexion (cf. Knight, 53); (Wlder, 78).
9 Pupil and successor of Aristotle. Theophrastus (373287 B.C.) is said to be the founder of the science of
botany, having focused his attention on the differences between plants and animals at a time when others
stressed those features which these two categories had in common in contrast to inanimate objects (20).
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When we consider the question, 'What is the goal of psycho-analytic treatment?' we are confronted by the
whole problem of the influence of medicine on psycho-analysis. That psycho-analysis as a method of therapy
was modelled on the pattern of medical treatment is familiar to us all. The implications of these influences are
far-reaching and amply deserve a separate study. A detailed consideration of this topic will have to be omitted,
since this would carry us too far afield from our chief interest in this paper, which is the nature of the
psycho-analytic process and its resultant effects. The constructive influences of medicine on psycho-analysis are
generally appreciated. I will take these for granted and will say no more about them. My comments will be
restricted to those aspects of the medical model of analysis which seem to obscure and to hinder our thinking
about our work.
Many analytic concepts have been borrowed from medicine. Noteworthy are the notions of 'illness' and
'treatment'. These terms are generally regarded as very useful. Particularly is this true for the concept of 'mental
illness'. Sometimes it is even thought that when a patient (or other physician) realizes, or 'accepts' (as we
sometimes say), that a disability is due to 'mental illness', half the battle of psychiatry is won. I believe much too
little attention has been paid to how these concepts may cause us difficulties in scientific work (12).
There is general agreement among analysts on the following two propositions.
1. The primary model technique of analysis requires that the analysand should possess a relatively mature,
strong, and unmodified ego. If he is not so constituted, he cannot enter meaningfully into the analytic
situation. (This could be compared to the patient having to know the 'language' by means of which
communication takes place in this situation. 'Language' here denotes not only linguistic language, but
also language used in the sense of symbolic logic (i.e. the idiom of a science) [69], [70].
2. The aim of the 'treatment' is, among other things, to bring about those conditions which favour the fullest
development of the ego's potential capabilities. In other words, the aim of the treatment is to permit
'unhindered growth'.
Ambiguities arise from the following sources. (i) How can we speak of 'treatment', 'improvement' and 'cure'
if we start out with 'material' which is, according to our own criteria, relatively good? (ii) How can we evaluate
'results' if the criterion by which we assess therapeutic change (outside of the patient's behaviour in the
analytic situation) is the patient's own (potential) development?
These considerations are, of course, hardly novel. However, while analysts may have long realized these
ambiguities, our theory and terminology thus far have not developed to clarify these issues. It is my impression
that these ambiguities will be difficult, if not impossible, to resolve so long as the medical model of treatment
governs our thinking. In medicine, illness denotes a condition existing in a person which is (usually) absent in
others considered 'well' (e.g. an infection, a fracture, a tumour, etc.). Treatment and cure are aimed at
reestablishing the disease-free model of normality and are usually completely devoid of any implications of
'growth' (i.e. being more complex, more mature, more learned, than prior to illness). In psychiatry, the notions of
'adaptation' and 'social adjustment' are similar to the foregoing model of 'health'. Thus, in so far as
psychotherapy aims at social (including interpersonal) adjustment, the analogy with medicine may be valid and
helpful. However, since psycho-analysis tends towards bringing about progressive differentiation, the analogy
with medical treatment clearly fails, and if persisted in, becomes misleading (45), (49).
The foregoing considerations clarify the apparent paradox contained in the following two propositions,
which are subscribed to by most analysts at the present time.
i. The patient is 'sick'. This follows from his being 'treated' (by psycho-analysis), his being called
'patient', his 'improvement' and his 'cure'.
ii. The patient is healthy. This follows from his having a relatively well developed ego so that he can
enter into the analytic situation and can utilize the relationship for 'learning', in the widest sense of that
term.
The first proposition clearly derives from the medical model of analysis as 'treatment', from the analyst being
a physician, the patient having 'symptoms', and many other aspects of the situation. The second proposition, on
the other hand, derives from the fact that while the patient is not as 'well' as he could be, or perhaps as he was at
some previous time, he is nevertheless both actually and potentially 'healthier' than most of the population in
which he lives. The apparent contradiction of these propositions is
10 This line of thought is consistent with the results of a recent survey of the American Psychoanalytic
Association regarding the social, professional and economic background of patients undergoing treatment by
members of the Association and by advanced students in accredited Institutes. The survey showed a diversity
of diagnostic categories and a reasonable diversity of economic status among the patients. The most striking
common denominator among the patients appeared to be, at least to me, that most of them were professional
men and women, and students; that is to say, they were persons who were all characterized, irrespective of
personal differences, by an orientation to life based on thinking and understanding (at least more so than the
population at large).
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greatly favoured by the medically derived terms, 'sickness', 'treatment', etc. A comparison of the analytic
situation with that prevailing in education is in this respect more pertinent, since in the latter sphere also those
who are most strongly oriented to education seek it, rather than those who are most ignorant.10
The concept of 'ignorance' would thus take the place of the concept of 'illness' as the factor which can be
most meaningfully related to the analysand's state, with regard to both his orientation to himself and to a
comparison between himself and others. When we speak of ignorance, however, we must distinguish sharply
between two fundamentally different categories.
i. We say that A is 'ignorant' if he does not know something that B or C know.
ii. We also speak of 'ignorance' if A wants to know something, that is, whenever A asks himself a
question. In this sense of the term, the concept of ignorance has nothing to do with whether anyone else
knows what A wants to know or not; nor, indeed, with whether the question is meaningful for anyone
else.
Further consideration of this subject is not germane to our present topic. Suffice it to say that the differences
between these two concepts of 'ignorance' are of far-reaching importance. The first notion of ignorance is
situational or relative to others. In this, it is similar to the medical concept of illness. The second notion of
ignorance, however, relates to one's own development and is more closely allied to the motives activating the
person who is seeking, and is suitable for, analysis. The age-old saying about the wise and learned man
becoming more humble about his 'ignorance' refers to 'not knowing' of the second type only. The confusion and
misuse of these concepts is often employed as an argument and weapon against man's aspirations along
scientific lines.11
There is another aspect of the concept of 'treatment' which is particularly misleading when it is applied to
psycho-analysis. The term 'treatment' is generally used to denote the activity of but one person (or system) in an
interactional process. For example, we speak of surgical treatment or penicillin treatment; we also speak of
'treating' certain inanimate substances with chemicals, etc. The conceptual model in these situations is that A
does something to B. B's response, or activity, in the situation is kept out of focus; whatever it may be, it does
not alter the fact of the 'treatment'. Thus, irrespective of the patient's co-operation, antagonism, recovery, or
death, surgical treatment remains surgical treatment. This concept is patently false when used for the psycho-
analytic situation. Here, the notion of 'treatment' presupposes certain activities on the parts of both A and B in an
interactional process. Accordingly, no matter what the analyst doeshowever much he may wish to conduct an
analysisif the analysand's behaviour does not meet specified requirements psycho-analytic treatment will not
take place. I realize that the foregoing considerations are familiar to analysts. Repetition may be justified,
however, on the grounds that this matter has the profoundest bearing on the nature of the psycho-analytic process
and on the so-called evaluation of its results (8), (10), (39), (40), (60). Moreover, it seems to me inevitable that
the notion of 'treatment', modelled after the traditional doctorpatient relationship, should provide a persistent
source of confusion about one of the most essential features of the analytic situation.
The exact nature of the (inner) psychological activity of the analyst, of the physician, and of others in their
respective work-functions requires much further study. As analysts we know that action in work is an important
function for the human ego (46), (55). We also know that the psychological processes involved in the conduct of
analysison the part of the analystare significantly different from those processes which characterize the
work of the specialist in internal medicine or surgery. Yet we hardly even have tentative formulations regarding
these finesses of ego-functions. I think we should take as our starting-point the important difference between
new creation (the search for order) and the application of scientific discoveries (the exercise of 'knowledge').
The discovery of penicillin or of other novel biological agents illustrates the process of new creation (in the
medical sphere), whereas the activity of the physician who administers these agents to the sick patient with
pneumonia illustrates the phenomenon of application. This distinction is particularly meaningful for the problem
of psycho-analytic treatment, since, it seems to me, analysis proper can never be (nor can it ever become) a
process of application. Each analytic situation requires an interest and effort in a new creation on the part of the
analyst (as well as of the patient). I have suggested elsewhere (76) that development to a higher level of
psychological complexity of both analysand and analyst is a requisite of
11 It is possible to stress either man's aspirations for rational, progressively more complex understanding, or
his regressive striving toward denial, confusion, and belief. Freud emphasized both. However, in relation to
analytic treatment he seemed often to have leaned toward a greater emphasis on the regressive component of
the dualism. Thus, Freud 'is alleged to have said, however we try to treat the patient, he wants to treat himself
with transferences' (Gill, 35). While this is often true for everyone, and always true for some patients, there
are many others who want to be treated by interpretation alone. Since psycho-analysis has focused principally
on the patient's 'resistances', this important fact has either been overlooked or has not received much attention.
In addition to one's clinical experience with such persons, the most obvious theoretical argument in support of
the importance of many persons' wish and readiness to be treated by the primary model technique could be
said to lie in the very development and existence of this concept and technique. After all, are we not justified
in regarding all such human achievements as reflecting corresponding 'needs'?
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success for every analysis. By the same token, 'psychotherapy' (as application of knowledge gained elsewhere)
may become progressively less 'scientific' (in the sense of science constituting a source of new knowledge).
This of course does not mean that such therapy will not be 'effective'. Perhaps it will be more effective than
anything that we know today, just as the giving of antibiotics is effective, irrespective of the state of mind of the
physician who prescribes them. It is not my intention, in suggesting the foregoing distinction between science as
new creation on the one hand, and its application (technology, 'therapy') on the other, to exalt the former and to
depreciate the latter. Instead, I hope this distinction will be viewed as an explanatory notion which might help
us to understand the many different ways in which human beings can affect each other.
VII
THE SCIENTIFIC ATTITUDE: THE COVERT AIM OF PSYCHO-ANALYTIC TREATMENT
Religion, superstition, fantastic Biblical world-history, were not demolished by "discoveries"; they
were outgrown by the European mind. Again the individual life shows in microcosm the pattern of
human evolution: the tendency to intellectual growth, in persons as in races, from dreamlike fantasy to
realistic thinking. S. LANGER (54).
For science can only ascertain what is, but not what should be, and outside of its domain value
judgements of all kinds remain necessary. Religion, on the other hand, deals only with evaluations of
human thought and action; it cannot justifiably speak of facts and relationships between facts. A.
EINSTEIN (17).
We are now ready to consider the question, 'What is the final goal of psycho-analytic treatment?' It was
implied in our earlier discussion that this final goal may not be a matter of choice for either analyst or patient,
but may be inherent in the rules of the process.
To clarify this problem, we must distinguish between intermediary goals and a final goal. Although this is a
simple differentiation and is familiar to us from the analysis of other processes it has not been generally applied
to psycho-analysis. Gitelson has tried to define the essential difference between psycho-analysis and dynamic
psychotherapy in terms of a distinction between intermediate and final goals. He pinpoints the problem we are
considering in the following way:
One of the as yet unsolved problems of psycho-analysis is concerned with the essential nature of
psycho-analytic cure. It is not insight; it is not the recall of infantile memories; it is not catharsis or
abreaction; it is not the relationship of the analyst. Still, it is all of these in some synthesis which it has
not yet been possible to formulate explicitly. Somehow, in a successful analysis the patient matures as
a total personality. Somehow, a developmental process which has been halted or sidetracked,
resumes its course. It is as though the person, re-experiencing his past in the transference, finds in the
new conditions a second chance and "redevelops" while he is reliving (37p. 285).
Gitelson then compares the therapeutic situation to a chemical reaction which tends toward a final state of
dynamic equilibrium with many intermediate reactions on the way to this end-state. Psycho-analysis is oriented
toward attaining the final end-point in the interaction, whereas dynamic psychotherapy settles on 'any point of
stability' as an end point. According to Gitelson the psycho-analytic 'end point' is reached with the resolution of
the transference neurosis.
While I am in partial agreement with this analogy because of its lucidity and explanatory power, I suggest
that we should regard the resolution of the transference neurosis itself as an intermediate rather than a final goal.
My reasons for this, briefly stated, are the following.
The formal end of the analysis means that there is a dissolution of the analytic situation. Yet, there is general
agreement that, in a broader sense of the concept of analysis, this is not the 'end' of the process. The analysand
continues to undergo ego-transformations; he changes. It seems to me that the notion of 'the final goal of analysis'
should tell us something about this state. A comparison with education suggests itself. A student may be
evaluated in one of two ways. In school, his performance is judged by examinations, including a 'final
examination' (this may be compared to the resolution of the transference neurosis). The 'final goal' of the
educational process, however, is also to prepare the student for life (profession, etc.) after leaving school. Thus,
he can also be judged on the basis of his later performance. This may be (and in fact is) a more difficult task,
since the frame of reference of 'good performance' is no longer clearly defined (social success, money, wisdom,
happiness, etc.).
The existence of this double orientation, to the process in the situation and afterwards, must
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be kept in mind constantly in attempting to 'evaluate results'. Furthermore, the greater ease with which rational
judgements can be arrived at within the 'situation' (in school, in analysis) has favoured definitions based on
concepts anchored in the frame of reference of analytic treatment. Accordingly, we have such concepts as the
resolution of the transference neurosis, the working through of paranoid and depressive anxieties (52), the new
beginning (6), (7) the corrective emotional experience (3) and others. These concepts have all been designated
as constituting the 'goal' of the treatment; they have all been formulated in terms of technical manoeuvres.
While I am not passing judgement on the adequacy of these concepts, I would like to call attention to the
following shortcomings inherent in them. First, as mentioned, these notions are formulated in such a way that
their relevance is restricted to the analytic situation. This has an advantage in terms of scientific clarity as long
as the person is in analysis. But by the same token, it becomes a source of confusion when he is not. Secondly,
most of these concepts (except for that of the 'new beginning') have an implication of finality. Unfortunately this
connotation is attached even to the most useful of the views which have been mentioned, namely, to the
resolution of the transference-neurosis. Since there is general agreement that there is something inherently
unending about analysis as a process (not as a situation), would it not be helpful if the final goal of treatment
were formulated so that it were to be consistent with this viewpoint?
In accord with the foregoing considerations, I believe that the final goal of analysis should be stated neither
in the frame of reference of technique, nor in that of social or interpersonal adaptation, but rather in general
terms which pertain to the person's (ego's) orientation to his past and present inner life (objects) as well as to
his outside life experiences. How can we describe this final state and do justice to all the requirements
mentioned? The answer to this question may be found in Freud's writings, although he did not formulate it as
explicitly as I will state it now. According to this view the final goal of psycho-analytic treatment is the
establishment of a never-ending, ever-deepening scientific attitude in the patient towards those segments of his
life which constitute the sphere of psycho-analysis. The sphere of analysis (in this sense) consists of man's life
history, his internal objects, and his ever-changing life experiences.
A few explanatory comments are probably in order. It must be remembered that a definition of the final goal
of analysis, as stated above, does not supersede the several intermediary goals, described by Freud and others.
Rather, the concept of the final goal must be added to some of our previous concepts in order to arrive at a more
comprehensive theoretical synthesis of what constitutes analytic treatment.
One might also ask, 'What exactly is meant by the term "scientific attitude"?' A thorough examination of this
question seems to me an absolute necessity for further progress in our field (77). For the present it will suffice
to say that I refer to the same phenomenon which was described by Wlder (78) as the ability to differentiate
between the possible and the real. The same concept is also taken up by Eissler (18). It is of interest to note
that this psychological feature of the scientific attitude has long been recognized by mathematicians and
physicists. Oppenheimer has put it as follows: 'Thus, to the irritation of many, the assertions of science tend to
keep away from the use of words like "real" and "ultimate"' (62p. 6). Apparently, man has found it far easier to
take such a detached view of his physical environment than of his 'object-environment'. At least this appears to
be a logical inference which can be drawn from the longer history and far greater explanatory power of the
physical sciences than of the psychological sciences.
It remains for me to demonstrate how the final goal of analysis is inherent in the technique of the therapy (as
this was suggested in the comparison with chess). This task can be combined with another, namely, to show that
Freud's view of the final goal of analysis was essentially the same as that suggested in this paper.
The realization that some of the events observed during the course of analysis were determined by the
procedure itself could not come until the procedure was held relatively constant. Macalpine (57) recently
described with great precision how the so-called classical technique leads to regression in the patient's ego-
orientation and is in itself partly responsible for bringing about the transference-neurosis. What seems most
valuable in Macalpine's paper is not so much the novelty of her observations, but rather their clear ordering
according to a deterministic scheme. She called attention, however, only to how the analytic technique
determines what in chess is called the middle portion of the 'game'. I would like to pursue
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this further in relation to the end of the analysis.
In connexion with discussions of termination and the aim of analysis, Freud made various statements in
different contexts. As I commented earlier, throughout his life he based many of his ideas about psycho-analytic
treatment on a rather steady parallelism with treatment in various branches of medicine. Whenever Freud freed
himself from the medical model of psycho-analysis, he used the model of scientific work. He assumed that the
patient, or a part of him, was interested from the very beginning in undertaking a scientific exploration of his
own personality. Like other scientific work, this would lead wherever the evidence carried one. Its aim was
'truth':
Finally, we must not forget that the relationship between analyst and patient is based on a love of
truth, that is, on the acknowledgement of reality, and that it precludes any kind of sham or deception
(26pp. 351352).
And, again, in 'Constructions in Analysis', he wrote:
we conduct ourselves upon the model of a familiar figure in one of Nestroy's farcesthe man-
servant who has a single answer on his lips to every question or objection: "All will become clear in
the course of future developments"
(27p. 367).
In other words, while it is well known that Freud's chief interest was a 'scientific' one, it is generally
assumed that in addition he was also interested in another process, and that this consisted of 'helping the
patient'. One of my aims in this essay is to show that there are not two separate processes, but that 'helping the
patient' evolved into the goal of the patient's adopting a progressively more scientific attitude towards himself
and his relationships with others. Indeed, in one passage Freud asserts quite passionately that to use psycho-
analysis for any other aim would serve an 'ulterior purpose' (34p. 402).12
The view that the ultimate 'aim' of psycho-analytic treatment is a scientific attitude in the patient toward
himself and his relationships with others is, of course, not at variance with a formulation of therapy in terms of
analysis of the transference and 'corrections' of current relationships coloured by distortions based on childhood
experiences. The latter conceptions refer, in part, to the actual operations(13) which lead, under favourable
circumstances and in varying degrees, to the scientific attitude; and, in part, these conceptions also refer to
phenomena which are the results (or manifestations) of the development of a scientific attitude in the patient
(i.e. the relative 'objectivation' of relationships previously more heavily coloured by 'transferences'). The two
descriptions are complementary and not mutually exclusive.
Several interesting inferences may be drawn from the thesis that the final goal of analysis is to bring about a
scientific attitude (with respect to certain segments of life) in the patient, and that this goal is inherent in the
technique of analysis and is not a matter of choice for either analyst or patient. I want to comment briefly on two
topics only, namely, on the alleged differences between therapeutic and training analysis and on the problem of
the termination of analysis. Acceptance of the thesis set forth in this paper leads to certain conclusions regarding
both of these issues.
It is generally asserted by analysts that there is no difference in principle between therapeutic and training
analysis (44), (66). At the same time, however, it is maintained that it is more difficult to conduct the analysis of
a potential analyst properly than that of a lay person. I realize that this is a complex matter and one with which I
have had no actual experience except in the rle of the analysand.13 It seems to me, however, that the difference
between these two phenomena rests on a social distinction, that is to say, on whether the analysand proposes to
earn his livelihood by the practice of analysis or through other means. Viewed in the framework of analytic
theory, not only should there be no difference between the two processes, but indeed, if the trainee is properly
selected, he should be more, not less, amenable to analysis than the majority of lay persons.14 The criteria for
'proper selection' are inherent in the concept of the primary model technique: the potential candidate must have
an essentially unmodified ego so that he can participate with benefit in the analytic situation (38). In addition to
this, I would add that it might be helpful if he had a scientific interest in how man lives, with himself and with
others.15 Both of these criteria are, in actual fact, quite independent of some of those features of the potential
analyst on which much current emphasis is placed. In other words, competent medical training, good social
adjustment, and an interest in general psychiatry and in treating people can all be present in candidates with or
without the necessary ego structure and scientific orientation mentioned
12 Compare this with the scientific position according to which 'pure science' aims only at discovering ever
more about how nature works. In so far as this knowledge is applied in order to gain some practical advantage
in daily living, it is considered no longer 'pure science' but 'technology'. Perhaps the devaluation of applied
science derives from the deeply felt appreciation of the potential dangers inherent in it. Certainly, Freud's
emphasis on the need to protect the patient from the influence of the analyst's 'personality' reflects this
awareness in the sphere of the science of human interaction. In the following passage, for example, Freud
explicitly disowns any specific therapeutic goal which might be set for the patient in the name of analysis. (So-
called 'practical' solutions for problems of living are always derived from implicit philosophical orientations
about human values, professions, marriage, child-raising, etc.) 'Our honoured friend, J. J. Putnam, must
forgive us if we cannot accept his proposal either, namely, that psycho-analysis should place itself in the
service of a particular philosophical outlook on the world and should urge this upon the patient in order to
ennoble him. I would say that after all this is only tyranny even though disguised by the most honourable
motives' (34p. 399). Clearly, the only legitimate goal in Freud's mind was that of discovering and imparting
knowledge and understanding to the patient. Greenacre has recently re-emphasized this important point. She
states: 'Freud emphasized that his own interest in the truth, in his case his original interest in the "living
pathology" of the patient, was the greatest therapeutic safeguard to the patient; and this seems to me so basic
and so sound that I think we should consider it in setting up or planning to set up any system involving a review
of results of treatment. It seems to be so simply true as to be elusive, that the worker whose goal is the
essential verity of his scientific work may in some instances take unnecessary detours of exploration, but by
and large will contribute most to the science and to his patients' (43).
13 My thoughts on this matter thus derive from (therapeutic) analytic work with psychiatrists, physicians, other
professional people and students who were more or less familiar with psycho-analysis and who had varying
inclinations towards scientific work, and from reading and thinking about the nature of human interaction. 'We
now realize, with special clarity', said Einstein, 'how much in error are those theorists who believe that theory
comes inductively from experience. Even the great Newton could not free himself from this error ("Hypotheses
non fingo")' (16p. 72).
14 If the analyst plays any rle in the life of the analysand other than that inherent in the analytic situation
(primary model technique)to that extent his influence on the analysand (and vice versa) will rest on
processes other than those of psycho-analysis (science). The fact that the training analyst often does play such
a non-analytic rle (e.g. determining the trainee's progress and acceptance as an analyst) has been held by
many as the chief complicating factor of these analyses. I think a consistent application of the principles
inherent in the primary model technique necessitates that we recognize such 'real-life' situations for what they
are; that is to say, they are not 'analytic', which, however, does not mean that they are necessarily 'bad'. At this
point value-judgements enter into the situation, for the solution of which scientific considerations may be of
little or no value. Here again an analogy with physics presents itself. The analytic situation proper might be
compared to creative work in physics, such as the work leading to the availability of explosives or nuclear
energy. The so-called 'real-life' interactions between analyst and trainee (or the whole matter of selection), on
the other hand, may be compared to the physicist's participation in social and political 'real-life' matters, such
as how to use (or not use) nuclear energy.
15 Cf. A. Einstein: 'But science can only be created by those who are thoroughly imbued with the aspiration
towards truth and understanding' (17p. 26).
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above. Obviously, selection, treatment, and evaluation of results would all have to be carried out within the
same theoretical framework if the inferences made from one of these processes is to be relevant to the others.
With regard to the termination of analysis, we know that ideally the analytic process never ends. Instead, it
should set in motion ego transformations of a continuing character (48), (78). In this respect the parallel with
science is particularly apt and striking. Science is never finished; it is infinite. In our present age we have even
become sophisticated enough to learn that it is not meaningful to ask where science leads. We must be satisfied
with the answer that it leads to ever-greater understanding of, and mastery over, man's environment (physical
and human).16 We have learned gradually to conceive of science along the pattern of the infinite series of
mathematics. Man's first major scientific abstractionthe concept of integers (numbers)has paved the way
for such an idea, however greatly this may differ from our biological destiny, which is so emphatically finite. In
view of this, it might be more appropriate if we were to regard the analytic process as interminable not because
of a defect either on the part of the patient or on the part of our technique, but instead were to regard this fact as
a feature indicative of the particular ancestry of our technique. For this notion to be meaningful, however, it will
probably be necessary to establish more clear-cut distinctions (and appropriate words with which to designate
them) between medical treatments and psycho-analysis. Perhaps the two expressionsthe psycho-analytic
situation and psycho-analytic influencefirst used by Freud (33) himself, would be of value in this direction.
The first of these is in fairly general use. The expression 'psycho-analytic influence' would seem preferable to
the term 'treatment' for two basic reasons. The first of these was described earlier: it relates to the fact that the
word 'treatment' ordinarily refers to the activity of but one person in a situation or interaction with another
person (or persons); whereas in psycho-analysis, the proper meaning of 'treatment' depends upon the activity of
both analyst and analysand and, accordingly, in this context it refers to a process which includes and abstracts
the activities of the participants in it. Secondly, 'influence' is a neutral term, free of the value judgements
invariably connected with the notion of healing. Adoption of the expression 'psycho-analytic influence', in
preference to 'treatment', would be consistent with the scientific spirit which was responsible for the origin of
psycho-analysis.
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of the observed. This statement, although valid and commanding wide agreement, is so general that it is of
little value in telling us anything specific about a particular branch of science. Thus we cannot dispense with
the specific, operational descriptions of nuclear physics, or organic chemistry. In these fields we describe our
aims by notions such as wishing to find out about the mass and electrical charge of elementary particles, or
aiming at the discovery of the structure and synthesis of complex molecules. Similarly, in analysis, the notion
of the 'scientific attitude' as an ultimate goal of the process cannot take the place of such explanatory concepts
as the resolution of the transference-neurosis. Clearly, both the value and shortcoming of the concept of
'understanding' derives from its being abstracted out of a specific situation (analysis, special branches of
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Article Citation [Who Cited This?]
Szasz, T.S. (1957). On the Theory of Psycho-Analytic Treatment17. Int. J. Psycho-Anal., 38:166-182

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(1957).

International Journal of Psycho-Analysis, 38:166-182

(Received 30 August, 1955.)

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