THE THERAPEUTIC PERSONALITY, AS ILLUSTRATED BY

PAUL FEDERN AND AUGUST AICHHORN*

BY E ~ N S T ~ FEDER1NI, M.S.W.

This paper is the result of a casual remark made at a presenta-

tion of Paul Federn's ego psychology to the s:taff of Philadelphia
State Hospital in .September :[956. The writer said then that
Federn's personality may have contributed to his success in treat-
ing psychotic patients, while Freud's different personal approach
to these patients might explain his pessimism about their treat-
ability. It is a fact that not a few of Freud's followers were sur-
prised at how little Freud cared about treating people with severe
mental illness and how very doubtful he was that they could be
treated at all. He "did not exclude ''1 the [Link] that event-
ually a modified method would be fo.u~d f~or treating psychotics;
yet when Federn and others, notably Hollos, asked for his active
support of their efforts, he shielded himself behind old age and
illness--for Freud, hardly real reasons. [Link] of those close to
him felt that he was always more interested in the research aspects
of his work than in healing and helping. This attitude is also
apparent in his writings.
If one further considers that the result of mental illness is
impairment of abstract thinkiag and flattening of individual qual-
ities, it can easily be understood that psychotic patients hardly
present the intellectual challenge of neurotics. Similarly, the dis-
social person appears to be untrustworthy and a liar. Freud
had no use for weak characters, anyway. Neither the delinquent
nor the psychotic was the intellectually interesting patient whom
Freud alone considered the [Link] worthwhile .candidate for analy-
sis. But delinquency and psychoses are, .at least in Federn's opin-
ion, diseases of want; those who suffer from them must receive
mental nourishment before one can reason with them. One must
compare Freud's attitude with Federn's unending devotion and
even sacrifices for the treatment of psychotics--insignificant as
their individual per,sonalities may have been--to give full weight
to, the difference between Federn's a~d Freud;s views .on treat-
ment of the psychoses. This, in short~ was the essential idea be-
~This paper was delivered a t the F i f t h Annual I n s t i t u t e of Psychiatric Treatment~
Philadelphia, October 1957. A Germs.u-language version was printed in Svhwe~zerisohe
Ze~tsehr~ft f~r Psyohologie vng ~h~'e Anwendunge~, X I X : 2 , 117-131, 1960.
3(~ TI-IERAPEUT[C P E R S O N A L I T Y : F E D E R N AND AIC~I-iOlgN

hind the casual remark that Federn's and Freud's personalities

may have contributed to their success and lack of success with
psychotics. [Link] then medical director of the Philadelphia State
Hospital* became interested in another side of ~ e problem: How
far is any success with psycho~tics influenced by the therapist's per-
so nality? This question necessarily appeals to the practitioner who
cares less for theory than for therapeutic results.
Paul Federn and August Aichhorn were both greatly admired
for their therapeutic successes, which in the eyes of students and
analysands soon gained the appearance of the extraordinary and
the magical. One could not fail to be deeply impressed by Aich-
horn interviewing a silent and sullen youngster and winning his
confidence within less than an hour, or by seeing how Federn
wa,s able to treat schizophrenic and melancholic patients at home
at a time when no other psychiatrist dared to let them out of a
hospital.
It is, therefore, [Link] proper, in more than one respect, that
this paper should discuss the therapeutic personality of Aichhorn
as well as that of Federn. Although the writer does not believe
that extraordinary therapeutic personalities were the only rea-
sons for Federn's and Aichhorn's successes, he is convinced that,
for both of them, Freud's saying applies: "There are physicians
who possess the ability to win their patients' confidence in a t~igher
degree than others; the patient feels relieved a.s soon as he sees
the doctor entering his r,oom.''2.*
Federn and Aic~horn possessed this ability in such a measure
that even before the ends of their lives, and much more so after
their passing, "myths" were created which endowed them with
a magical, extraordinary power of healing. I shall mention only
two examples of such myths. A few months before Federn's death
a young psychiatrist said to me when he learned that I was
Federn's son: "Oh, you know what they say about your father;
he only needs to look at a schizophrenic patient in order to cure
him." I should like to report right here Federn's own reaction to
this (it will gain some importance later) ; he ~said: "I never cured
[Link]; I only diagno~sed them correctly."
About Aic~horn, I should like only to quote what some of the
social workers who were on his staff said about him: "When
~ I r v i n g l~osen, M.D.
~ P r e s e n t w ritei~'s translation.
Ea~ST FEDER~, ~.S.W. 31

Aic~hhorn met a [Link] he, in one glance, understood him, his

parents and grandparents."
How much Aiahhorn's personality and ability to make a fast
contact wit:h the most difficult youngsters impressed his co-workers
is best conveyed by Kurt [Link] in Searchlights o4 Detinqv~e~cy2
As far as the patient's attitude is concerned I quote here a simple
Austrian peasant who. once said to my father: "Doc, your eyes
pass me through and through."
Since no one can deny that Federn and Aichhorn possessed
unusual therapeutic qualities the question whether .one can under-
stand theoretically what made them so successful is ju~stified.
A satisfactory answer would also help to end an often-heard
argument. This is that Federn'.s and Aichhorn's achievements can-
not be repeated. It is ai~med to refute tt~is argument here by
showing that, not only a personality factor, but: rather underlying
theories and methods, permitted Federn and Aichhorn to be suc-
cessful. It is this task which .has been set for this paper.
The [Link] will be based on Federn's theories and obser-
vations in the field of ego psychology and the treatment of psy-
chosi,s, and will refer to Federn's book4 or to the synopsis of it
in The An,nu~al Survey of Psychoanalysis, Volu~ne IV (Interna-
tional Universities Press). As far as Aichhorn is concerned, only
Wayward Y,oz~th is translated into English. His papers on tech-
niques in child .g~a~dance appeared only in German--and were
republished in 1959 (K~ber, Bern).
To talk about Federn'.s and Aichhorn's [Link] in one
presentation is appropriate for several reasons: Aichhorn, who
came to. Federn as a pupil, soon became his co-worker and life-
long friend. It must be left for another paper to. demonstrate
ho.w Aichhorn'.s methods with the [Link] and asocial [Link],s
can best be understood wit~ the help of Federn's concepts. As
different as the two men's backgrounds were, one, the grandchild
,of a rabbi and the ~son of a f'[Link] physician, Ithe o,ther, a. de-
scendant of an old Austrian peasant family, they had in co,m-
mon a desire to help the weak and miserable; they were "born
social workers."
Whereas Freud was never a politically active man and was
skeptical about the results of reform movement.s, Federn was
rather different, lie was a reformer and an active socialist. He
and his friend Friedjung were--to the best of the writer's knowl-
32 [Link] ~EIr FEDEtCN A1ND AICI41~0R~

edge--the only psychoanalysts who were ever elected members

of a parliamentary body. Federn, as district councilman, made
the first survey of housing conditions for janitors in the first
district of Vienna. IIe was a member of the hoard of the only
private .social agency in Vienna, The .Settlement I-Iouse, which his
mother had founded, and of which his sister was president. The
only official distincfio.n ever awarded to him was for having freed
the army prison in Vienna from lice. It was there, too, that he
got an intimate knowledge of criminals, which probably helped
him later in understanding and furthering Aichhorn's work.
Anecdotes and stories are numerous which show Federn as a
friend of the "common man," particularly in times of need. It
earned him the nickname of "Haroun al Raschid," the famous
Caliph of Baghdad in The Thousand and One Nights. Aichhorn,
similarly, was attracted as a teacher to the wayward, the aband-
oned, the so-called scum of tlle earth. Both men had a genuine
desire to help precisely these people. Federn frequently would
treat a mentally ill "hopeless" case without fee and would send
a wealthy neurotic to a colleague. Aichhorn's attitude toward the
so-called "lower classes" may be illustrated by his advice to. the
social workers in his ~seminar that if they criticized parents for not
being clean, they should never forget that dirt also kept out the
cold, and that washing was most unpleasant in an unheated room.
The writer hopes he has set the stage on which he can pre-
sent in [Link] scientific te,r~s than have been used so far, how
these two "healers" proceeded in their therapeutic work. A short
theoretical discussion will follow.
One of Federn'.s contributions to the treatment of people suf-
fering from "narcissistic neureses" was his observation thai they,
too, can develop, workable transferences and can sustain them if
the therapist uses a modified psychoanalytic technique2, 6 That
psychotics can establish a relationship to a therapist was a fact
known before and used in BurghSlzli and other modern mental
institutions. Federn maintained, however, that successes in such
places were, due to the fact that the psychiatrist, s did not use
classical analytical techniques, that most of the time they were
successful because they were not analytically trained.
Those who tried to. analyze the patient either lost him, or made
him worse by turning a latent psychosis into a manifest one. In
his ~book4 Federn indicates the signs that should tell a therapist
ERNST FED~m~, M.S.W. 33

of a latent psychosis, and warn him to abstain from using class-

ical analysis. He holds that the functional psychosis is a disease
of the ego, due to deficiencies in drive cathexes, the drives being
libido, mortido and probably a third one, that of self:preservation.
It has created confusion in the past, and will continue to. do so
in the future if we do not clearly understand that the term "ego
disease" as used by Federn makes sense only if [Link] accepts it on
the basis of his concept of the ego. One can express it most
simply in the mental phenomenon that is not further explain-
able, in which we can say: " I feel myself." Though the infant
cannot say it, Federn postulates that observation of a baby'ts
behavior allows us to infer that it, too, feels itself.
One must leave undiscussed here whether Federn was justified
in calling this phenomenon "e~o" and whether our whole ego
psychology may not eventually need to be completely rewritten.
Unfortunately, we have not reached that stage yet, and we must
be aware of the disturbing fact that there are today about seven
different ego-concepts among analysts who consider themselves
good Freudians. It is his own particular phenomenologieal ap-
proach that is the basis of Federn's saying that psychotic patients,
latent or manifest, suffer from an impairment of the mental phe-
nomenon which he calls the ego. The .situation is like that of
breathing, of which one takes notice only if it is impaired or if
one's attention is called to it, as in an order by a physician to
breathe deeply.
Federn's diagnostic skill was such that he detected ego impair-
ments very quickly. IIe would then change his attitude and inter-
viewing techniqtm immediately from those he initially employed,
thus conveying to the patient the idea that his particular suffer-
ing was understood. Instead of withdrawing from analyticM work,
and changing to a supportive technique, as a classical analyst
would do on detection of an underlying psychosis, Federn would
proceed with an analysis .of the ego-disturbance, following his
maxim: "In neurosis, we want to lift repression; in psychosis we
want to create re-repression. TM We then see here a combination
of diagnostic skill with an immediate giving of help and under-
standing, a combination not too frequently found (and at present
almost lost in a division of labor among specialists). Often, even
months may elapse today between [Link] and start of treat-
ment. Federn's treatment me~hod requires the co-operation of the
3~ TTd[[Link]~SO~ALITY: FEDERN A~D AICt:s

family and a woman helper, and is designed to give the patient

the feeling of being protected against the threatening disintegra-
tion of his personality as soon as possible. Federn also felt. that
any psychotic patient must be given extraordinary attention by
the therapist who must 'be available at any time. If one adds to.
this Federn's attitude toward weak, ill, or [Link] [Link]
people--an attitude which has been described--it can be under-
stood how, as a therapist, he supplied the. libido-deficient person
with new psychic energy.
It seems necessary here to clarify an important problem: In
his paper "Limitations of Psychoanalytic Therapy," in 1943, 7 Nun-
berg states in italics: "The outcome of the psychoanalytic treat-
ment will depe,n~d on. the ability to strengthen the relatively weak
ego." This appears to be almost identical with what was just said
about Federn, but is, in fact, quite different. The difference lies
in the two concepts of the ego. For Nunberg, the ego is that of
Freud, although Nunberg discovered some of it.s most important
functions and qualities, notably that of synthesizing id-strivings
and super-ego controls. According to Nunberg, the eg:o must be
strong, endowed with psychic energies, to fulfill this function. Ac-
cording to Federn, the ego. is a mental phenomenon which has an
infinite nmnber of boundaries, and its strength depends 'on their
cattmxes wi~t~ energy. Whenever Federn spoke of strengthening
the ego, he mean:t direct provision of energy for the insufficiently
catheeted boundaries, either by increasing the supply of energy
or by diminishing the demand. Nunberg meant the facilitating
of the release of energy that is bound by neurotic conflicts.
This is not a mere theoretical differentiation. For Federn, his
concept served as a basis for his new method of treating patients
who had been considered untreatable before. The differences of
ego [Link] are, therefore, of great practical consequence.
How then did Federn use his method for the goal of re-repres-
sion? This question has been posed often before, and, because of
the scarcity of Federn% published case material, a ,brief answer is
not easy. A careful study of Federn'.s papers is at present still
the best way to learn h,i~streatment method.
The ego of the normal or neurotic person, Federn held, is suf-
fieiently endowed with psychic energy to ward off unpleasant
strivings and to accept pleasant ones without having to change
the whole ego..state with all its cathected ,boundaries. Such a change
ERNST FEDERN, M:.S.W. 35

would entail a loss of orientation in the world of reality. The

eompulsive neurotie or the hysteric ~s able to find, in his symp-
toms, a compromise which permits him to remain in his existing
ego state. Although his ego is impaired, his reality testing is in-
tact. When the symptom formation does not suffice to ward off!
the overwhehning onslaught of tile id, an anxiety attack may occur
with the effect of a temblor on a "quakeproof" house--the founda-
tion and the walls remain intact, the damages are minor.
Not so with the ego-diseased person! In him, the deficient libid-
inal [Link] do not support the ego boundaries strongly enough
to prevent a collapse; the boundaries are withdrawn to earlier
states where less energy is required to keep them eatheeted. The
id strivings, which have been warded off by the previous eathexes,
now are seen to be outside the ego boundaries and thus become
real. What has been an idea, pressing against a counter-cathected
ego boundary, suddenly becomes a reality~outside the ego. A death
wish against a parent, for example, may turn to the certainty that
the parent has been killed by the patient.
A ease will be cited here, of which unfortunately little material
can be revealed. This patient, diagnosed beyond doubt as suffer-
ing from paranoiae ideas, frequently conceived of his wife as a
man, making his relationship with her a homosexual one. IIe was
several times very close to killing her. By a rather simple tech-
nique, the therapist was able to convince tile man that his wife
was not a male, but a selfish and driving woman. The therapist
succeeded in this with the help of an excellent transference. At
the same time, the patient met a very motherly type of wo~nan,
a fact which reduced his homosexual striving. A realistic solution
could be found, and a paranoiac outbreak was prevented. There
was one particular interview in which it could clearly be seen
how the id was on the verge of overwhelming the ego. The id
did not succeed because the therapist's help enabled the patient
to perceive clearly that he had equated "masculine woman" with
~ I n a i l . ~'
Federn described this method as a repeated and continuous
application of "[Link] aid measures," like the help given to a nearly-
drowned swimmer, whose breathing can only be revived by arti-
ficial respiration. Similarly, in the ego-diseased patient, libidinal
cathexes must be again and again reinstalled on their respective
ego boundaries. Although this example is entirely insufficient to
36 THERAPEUTIC PERSOI~IALITY: :FEDERN AND AICI-IttORN

d o justice to, the subtle and complicated mental phenomena in-

volved, the writer hopes that it gives some idea of Federn's
method. One can then turn to another very important element of
Federn's therapeutic work: the quick establishment of a strong
transference.
I t is known that transference is only possible where, one person
submits to the protection of another. The question will be dis-
cussed later, and this is only a reminder here that transference
is the repetition o3 an earlier dependency ~of the child on the
parent. Any therapist~ who, by his personality, can make this
submission to a parent figure pleasurable has a therapeutic per-
sonality. Federn could do t ~ s all the better, as his outer appear-
ance was that of a ,strong man; in his younger days he once was
the model fer a statue of Moses; in his older days he looked even
more like a patriarch. Once a patient compared him with Sven-
gali, the magician. This appearance, however, contrasted strik-
ingly with his great sensitivity and kindness. Thus the patient
who consulted him was thrown at first into fear--like the child
in front of the Wizard o~ Oz--only to find behind the threaten-
ing surface a gentle and helping parent.
And there was another quality: Federn was a man of great
courage; he, who. was Freud's most trusted co-worker and per-
sonal deputy, reversed some of his master's teachings and con-
tinued to go his own way against the ideas of most of his colleagues
and friends. Hi,s courage was also shown when in the late 1920's
he placed a homicidal young schizophrenic man in the butcher
shop of a hospital. Courage comes from strength and has a great
effect on the weak, who see in it a .source of help, a further step
to the establishment of a workable transference.
One may now tara to Aichhorn and see whether similar traits can
be found in him. Instead ef trying to describe the real magic which
emanated from Ai~hhorn, a tranMation (the present writer's.) will
be presented of an interview first published in Zei~schrift fi~r
[Link] Piidogogik, Vol. VI, 1932. The interview took
place in the guidance clinic of the Psyahoanalytic Institute in
Vienna. A society woman from a foreign country had come for
help for her 18-year-old daughter, who, the mother said, was
suffering from melancholia. She described the .symptoms in such
a way as to lead one to expect a serious illness. In ~spite of this,
Aichhorn consented to see the girl. Here is the interview:
ERN'ST FEDEtlN~ M.S.W. 37

The girl enters, sits down, facing Aiehhorn without saying a word. For
several minutes no one speaks. Aichhorn then says : "It's going to be boring
if we are to be sitting opposite each other without talking. I under-
stand very well that you do not want to tell anything to a complete stranger
right away." The girl does not answer and does not seem to participate.
" I will make you a suggestion," Aiehhorn says. "Think of something that
happened some time ago. Don't tell it to me. That cannot do any harm.
Do you want to?"
"Yes."
"Think about something which occurred abo~t two years ago. Do you
have something?"
"Yes."
"You don,'t need to tell me. But between these two happenings must
be some connection. You could not just remember whatever you liked.
Did you find such a connection?"
"No."
"Oh yes."
"No, I say."
" I would like to know who is right, you or me. Would you tell me
what came to your mind?" ("I try hard," says Aichhorn, "to get the girl
to talk.")
"What were the two ideas that came to your mind?"
"Six weeks ago my uncle's secretary told me that her daughter is sex-
ually a very cold girl. And two years ago a young man wished to kiss
me and I pushed him away."
"There is a connection between these two happenings."
"Which one?"
"The sexually cool daughter of the secretary and you, the girl who does
not want to be kissed."
"The secretary did not come to my mind because of her daughter, but
because I had to settle an account with her."
"Are you employed by your uncle?"
"No,--I just mail money orders for him [money orders take the place
o~ checks in Vienna], and then settle the account with the secretary."
"Do you get paid for it?"
t~No."
"Do you get an allowance from your uncle?"
"No, I have no money at all. I am in debt."
"To whom do you owe money?"
"To my girlfriend."
"How much?"
"Three hundred shillings [the corresponding rate in New York City to-
day would be about $500].
38 THERAPEUTIC P E R S O I ~ A L I T Y : FEDERIq A N D AICHHOR1V

"For what did you need the money?"

"For a doctor's bill."
"Why did you not make the putative father help you with paying for
the abortion?"
The girl becomes terribly upset over this question and asks in great
fright: "How do you know?'"
"You just told it to me yourself."
"I did not say a word about it."
"But sure; a girl from your social class, who borrows 300 shillings
from a girlfriend and does not dare to tell at home that she needs a doctor's
consultation can only mean that you needed to consult a gynecologist."
Under heavy sobbing, followed a complete confession. The story was
that the affair and its consequences had gone uneventfully. But after
some months the girlfriend asked for repayment of the money. The girl
did not know where to raise it and considered taking it from the money
she carried to the post office to pay for money orders--and pretending
she had lost it. She could tell this lie to the uncle, but knew that the
secretary would not believe her.
[Link] makes the c o m m e n t t h a t the case was settled to every-
one's satisfactio.n. He did n o t w a n t this interview to be used as
a kind of "recipe" for dealing with adolescents, b u t he h o p e d t h a t
similar examples would h e l p find a general technique. The w r i t e r
does n o t k n e w w h e t h e r one has been f o u n d yet.
A l t h o u g h this interview m a y serve as an excellent illustration
of A i c h h o r n ' s method, two p o i n t s m u s t be m a d e which are n o t
f o u n d in the text. One is the diagnostic skill of A i c h h o r n who
recognized, when looking at the girl, t h a t she was not a melancho.-
liac. He knew if he could only g e t her to speak, he would also
learn about her troubles. One recognizes .here w h a t was seen in
F e d e r n : the skill of a g r e a t diagnostician. L e t us ask w h e t h e r
the second p a r t of the necessary combination, the offering of help,
also applies to this interview. A i c h h o r n attacks the p o i n t of the
girl's g r e a t e s t suffering: h e r conflict between w i s h i n g to a d m i t her
delinquent act to h e r parent.s and f e a r i n g she would c o m m i t a n o t h e r
delinquent: act (theft). He take.s recognition of this conflict by
asking her to r e m e m b e r unspecified events, and by u s i n g a tech-
nique of f r e e association in a p l a y f u l m a n n e r . The technique of
p u t t i n g the question is beautifully g e a r e d to the girl's state of
conflicting ego-cathexis.
The solution itself was simple enough, the m o m e n t A i c h h o r n
got the girl to talk at all; b u t offering it with the effect o.f a shock
:ERN'ST FEDERN~ ]V[.S.W. 39

introduced the therapeutic element. To understand this, one must

speculate on the impression thi,s youngster had of the interview;
one must consider it from the point of view of the girl. She is
brought in for what she kno~vs is a grave misdeed, a double delin-
quency. Having had premarital intercourse and undergone an abor-
tion, she is about to add embezzlement to her record. Aiahhorn,
a man with authority, will find out, and she will be lost. She
meets a man instead, who was once described by the Reverend
Oskar Pfister as, '% simple, jovial, self-confident person, in whose
company one felt comfortable. ''8 The writer may add that to one
who spoke to him face to face, a wonderfully sparkling look from
mischievous eyes ,seemed to say: "Don't worry, I am just as bad
t~S rOLl a r e . "
Like Federn, Aichhorn based his therapeutic method on the
psychoanalytic concept o.f "libidinal economy." Socially malad-
justed people suffer from an imbalance of libido and mortido. Aich-
horn's method calls for the therapist to lend, as it were, from his
own energies to keep the libido-economy in balance. The difference
from Federn is that, while with psychotics one has to deal with
a deficiency of libido ca:[Link]; one finds, with the socially mal-
adjusted group or persons with primary behavior disorders, a dis-
[Link], instead of a [Link] of libido cathexes. This must
suffice as illustration for a thesis that would require a separate
paper.
One can observe in Aichhorn what was recognized earlier in
Federn: The classical psychoanalytical method has been given up
in the [Link] stage of treatment. Instead .of moving slowly, the
therapist gets into action immediately by giving help to an im-
paired ego..* It wa,s said many times that Federn and Aichhorn
were not really .using Freudian p,syeboanalysis. This applies, how-
ever, to. the question of technique only. Federn and Aichhorn were
true Freudians in their use o~f transference and in the acceptance
of psychoanalytic libido theory.
The ~hird quality of a ,great therapeutic personality which was
found in Federn can be .seen also in Aichhorn. He, too, was a
man .of great courage, in whom the patient found the rare com-
bination of mental strength and great kindness.
*& va,rlation of the same idea is expressed in Kurt Eissler's paper: Egopsyeho-
logicM implication of psychoanalytic treatment of delinquents. In: Psychoanalytic
St,~l,dy of tl~e Child. Vo] V.
.40 THERAPEUTIC PERSONALITY: FEDERI~ AND AICHHORI~[

In conclusion, some theoretical remarks are indicated. In Nun-

berg!s "Theory of Psychoanalytic Therapy,'" there is the follow-
ing sentence: "The essential difference between all of these [other
psychoanalytical] methods and our own consists in that in other
methods, the patients ,have to assimilate something imposed upon
the~m from the outside, whereas with our method, through painful
self-mastery, they have to take into their ego and unite with it,
something that is in their own." Nunberg .here enlarges upon an
early idea of Freud, expressed in his paper "On Psychotherapy. ''1
"There is actually ~he greatest possi~ble antithesis between sugges-
tive and analytic technique--the same antithesis that, in regard to
the fine arts, the great Leonardo da Vinci smmned up in the form-
ulas: per via di pvrr, e and per via c~i levare. Painting, says Leon-
arrdo, works per via di porte, for it applies a s~bstancc particles of
color where there was nothing [Link], on the colorless canvas;
sculpture, however, proceeSs per via d i levare, since it takes away
from the rough stone all that hides tile surface of the statue con-
tMned in it."
Federn and Aichhorn worked partially per via di porte, which
sometimes gave their work the quality of uniqueness .and subjec-
tivity, while the classical analytical technique is closer to a .scien-
tific and objective method. But for patients and wayward young-
sters who ,are not willing to enter the contract required for ana-
lytic treatment, who are not able to participate in any kind of
scientifically "clean" method, Federn and [Link] have found
one which comes nearest t~o st~ch a method, by combining an anal-
ysis of ego-impairment with the use of transference.
I-Iow this is made possible is best illustrated by another quota-
tion from Nunberg :9 "Every ill person, be he [Link]]y or psy-
c'hically ill, is helpless, like a little child. In this helplessness, he
is passive and ready to accept help from anybody who promises
relief. IIe craves reassurance and c~omfort from his therapist (no
m a t t e r who he may be) like a child who actually needs for his
survival protection by father or mother." The writer does not think
that he can emphasize strongly enough that where such feeling of
helplessness did not exist, neither Federn nor Aichhorn were suc-
cessful. Their therapeutic personalities were effective insofar as
they immediately detected and correctly diagnosed the nature of
the illness and the externalization of the conflict--the illness diag-
nosed as the impairment of the ego. In the example of the girl
ERNST FEDERN~ M.,S.W, 4]_

treated by Aichhorn, for instance, the conflict between admitting

a past delinquency and committing ,a new one was clearly taking
place within the ego.
A f t e r having done some "adding," of ego energy to strengthen
the transference, F e d e r n and Aichhorn would t u r n abruptly to an
analytic method of using what. is left of libidinal caf~exes, and,
in psychotics, would help a d j u s t the ego boundaries, or, in the
dis,social, the libido ~balance.
One more quality which Aichhorn emphasized repeatedly as
essential for the good therapist .deserves a brief discussion h e r e :
empathy. A n interview t h a t A i e h h e r n reports in the Zeit:schrift
fiir Psychoanalytische Piidogogik, V, will serve as an illustration.*
A .six-year-old girl w a s b r o u g h t to the Child Guidance Clinic
because she repeatedly r a n a w a y from home. The r u n n i n g away
began after the family had moved to a new housing development.
The girEs mother .had been unable to learn f r o m the ehild the
reason fo.r running away and b r o u g h t h e r d a u g h t e r to Aiehhorn.
This is the interview:
A pretty girl, looking older than her age, has intelligent eyes and a
happy expression on her face. In her hair, she wears a big, dark red bow.
Aichhorn asks :
"Who gave you this beautiful bow?"
"My mother."
"Do you have more of those bows?"
"Yes, one is blue and one is white."
"Which do you like most?"
"The red one,"
"Do you like red things very much?"
"Yes."
"Do you have other red things in your house?"
"Yes, in the garden we have red roses and red carnations."
"Are you much in the .garden?"
"Yes."
"What are you doing there?"
"I play."
"With what?"
"With my dolls."
"How many do you have?"
"Three."
"How are they called?"
"t{ansi, Fritzi and Toni."
*Trans][Link] l*y Ernst Federm
~2 TI-IEI~APEUTIC PEI~SONALITY : F E D E R N A N D A I C H H O R N

"Which is the smallest?"

"The Toni."
"Which is the biggest?"
"The Fritzi."
"Which is the naughtiest?"
"The Fritzi."
"What do you do when she is bad?"
"I spank her."
"What did she do wrong?"
"She always runs away."
"Why does she run away?"
"Because it is so boring."
It seemed to Aichhorn that this was the answer to the child's
own situation. He suggested to the mother t~hat she find some:
playmates fo.r the girl, which the mother did. During the [Link]-
ing six months, periodic check-ups with the mother [Link] that
the girl never ran away again. Without analyzing the theoretical
questions raised by this interview, it [Link] the miracle which
can he observed again and again whenever empathy enables two
people to understand each other in the way Aichhorn understood
this little girl. Empathy is usually understood to be projecting
one's self into another person's feelings, ,so that one is capable
of feeling, not wi~0h him, which would be sympathy; or for him,
which would be pity; but like him. It could be expressed in the
words: "I know exactly ho.w you feel."
Federn's concept of the ego is [Link] in explMning this phe-
nomenon. Empathy would then not be a projection into another
person's ego but a synchronizing of one'.s own cathexes with those
.of the other person. T,he therapist thus cathects, with libido, the
same ego boundaries as the patient. Sympathy, on the contrary,
would mean that only the ego boundary which deals with the
patient, is cathected with libido. Pity would mean that this bound-
ary is cathected with libido a~d mortido.
Further research in these theoretical questions may throw light
on practical problems :such as the ~ho~ce of therapists, and .on the
broad aspects of therapists' training arid education.
In summary, Federn's and Aichhorn's therapeutic personalities
ma$ be formulated thus : a combination of .strength with kindness,
diagnostic skill with therapeutic zeal, scientific objectivity with
the gift of empathy. Therapeutic success will always be the greater
ERNST ]~'EDERI% M.S.W. 43

where one finds these qualities highly developed, because, being

opposite poles, they produce the effect of an emotional shock on
a patient who comes between them.

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Cleveland iHeights 18, .Ohio
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5. Bromberg, Walter: Man Above Humanity; a tIistolT of Psychotherapy. Lippin-
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~6.. Wolberg, Lewis: The Technique of Psyclmtherapy. Grune & Stratton. New York.
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