0.2 Sigmund freud  (Page 31/37)

Discussion Question: Have you ever analyzed your own dreams? Were you able to discover any revelations after considering a dream in greater depth, even though it made no sense at first?

The Therapeutic Process

Initially, Freud began with a fundamental belief in the effectiveness of catharsis, the discharge of pent-up emotion that follows the recall and re-experiencing of traumatic memories (see Jarvis, 2004). If only a patient can recognize the unconscious association between an early traumatic event and their current symptoms, then the symptoms should be relieved. As Breuer and Freud noted in the introduction to their book:

For we found, at first to our great surprise, that the individual hysterical symptoms disappeared immediately and did not recur if we succeeded in wakening the memory of the precipitating event with complete clarity, arousing with it the accompanying affect, and if the patient then depicted the event in the greatest possible detail and put words to the affect. Remembering without affect almost always fails to be effective… (pg. 10; Freud and Breuer, 1895/2004).

One can see from this description, however, that the process of psychoanalysis is not easy. There must be a clear recognition of the initial traumatic event, in detail, with all of its original emotional impact, and the patient must then be willing to talk about the event in relation to their current problems.

As we have already seen, the first obstacle is resistance, the patient’s reluctance to experience the anxiety associated with recovering repressed material. The more severe the symptoms, the more severe the resistance is likely to be. Even when a little trick is successful, such as pressing on the forehead to break the patient’s concentration and allow free association, in serious cases the self remembers its intentions (which are often unconscious motives) and resumes its resistance (Freud&Breuer, 1895/2004). Because of this challenge, Freud believed that the therapist must be patient. Resistance that has been constituted over a long period of time can only be resolved slowly, step by step. In addition to the intellectual role of the therapist, there is an important emotional role as well. In some cases, Freud found that only the personal influence of the doctor could successfully break down the patient’s defense mechanisms.

A large part of the reason that psychoanalysis can be so difficult has to do with how the unconscious mind exists. Freud believed that memory of a traumatic event exists as a pathogenic nucleus within multiple layers of pathogenic psychical material of varying resistance. The outer layers may be easy to uncover, but as one progresses into the deeper layers, resistance grows steadily. Adding to the challenge, the associations between layers do not simply go deeper, they can travel at odd angles, in something of a zigzag fashion, or branch out in multiple ways (Freud&Breuer, 1895/2004). Because multiple associations may exist between a patient’s neurosis and the underlying traumatic event, it is critical to address all of the psychical material that comes to bear on the current condition of the patient. Even if the therapist rightly knows the basis for the patient’s problems: