Psychotherapies Without Feeling
by Dr. Arthur Janov
Posted June 2005 on primaltherapy.com
Chapter 8: Freudís Theory as Therapy: The Talking Cure That Doesnít Heal
The Aim of Psychoanalysis
In Outline Of Psychoanalysis, Freud asks, "Is it too bold to hope that it must be possible to submit the dreaded spontaneous illnesses of the mind to our control and bring about their cure?" Freud conceived the task of therapy to be one of control -- of getting the illness to submit. Later, he uses the metaphor of war to describe the alliance of the patient and analyst against the illness:
The analytical physician and the weakened ego of the patient...are to combine against the enemies, the instinctual demands of the id, and the moral demands of the superego.
Freud is saying that patients must exist in a state of permanent warfare -- cold warfare, perhaps -- and that the analyst must join the battle as an ally to help the ego in its task of "keeping down the instinctual claims of the id." The chief armament is the intellect, both the patient's and the analyst's:
Our knowledge shall compensate for his ignorance and shall give his ego more mastery over the lost provinces of his mental life.
Unfortunately, neurosis is not an illness of ignorance, and the business of therapy is not compensation -- especially not in the currency of "our [the analyst's] knowledge." Neurosis is an illness of feeling, and the patient has his own knowledge to discover through his feelings. No amount of received information will make up for what he can recover from his own unconscious. Furthermore, "the lost provinces" is what has made him unwell in the first place. Therapy must be a voyage of discovery. A patient must never lose his curiosity or the thrill of self-discovery. If the dialectical process of Pain and liberation, agony and discovery is not addressed, than a "cure" will remain elusive.
The cognitive focus of psychoanalysis is made plain in the Outline. So is the canonization of the analyst as a beneficent provider of health-giving wisdom. No matter how knowledgeable and wise the analyst, his wisdom is not curative. No amount of his acquired learning is as valuable to the patient as the patient's own history and feelings. Only the patient's own natural processes can bring him health.
Freud wrote in the Outline:
The new superego (analyst as substitute father) now has an opportunity for a sort of after-education of the neurotic; it can correct blunders for which his parental education was to blame.
The method by which we strengthen the pa-tient's ego has as its starting point an increase in the ego's self knowledge. Thus the first part of the help we have to offer is intellectual work...
(We are) in a position to conjecture the nature of his repressed unconscious material and to extend, by the information we give him, his ego's knowledge of his unconscious.
From all this we learn that analysis works from the premise that the problems and solutions to neurosis lie in the thinking brain -- and more often than not, in the thinking brain of the analyst. We also get an idea of how Freud saw his own role in therapy: "We serve the patient in various functions as an authority and a substitute for his parents, as a teacher and educator..." Add to these interpreter, sage, restorer, ally, corrector, critic, detective, historian, persuader and superego, and we have quite a formidable figure. Certainly Freud's followers took their cues from this vantage point.
For many, the Freudian therapist is too presumptuous, and condescending, shrouded in the veil of his own fund of esoteric knowledge; knowledge which was itself intellectually obtained like a catechism. The analyst's attitude is built into the theory, for the analytic process assumes the omniscient, all-powerful authority figure therapist. Her presence should not intrude upon the patient nor obscure the patient's own light.
Since the patient is suffering from a disease of feeling, it is erroneous for the analyst is treat him with intellectual medicine. The power of the process must be shifted from therapist back to patient. The principal task is to provide an environment in which a patient can stop intellectualizing and start feeling. A restrained, intellectual, "proper" analyst exudes and circumscribes the kind of atmosphere in which the patient behaves. A stiff-tie, starched-shirt milieu is not conducive to feeling. It is no different for a child with his parents. If they are free, warm and feeling, the child automatically becomes feeling without one word said about liberty and freedom. The atmosphere is absorbed by a child who lives inside it with no particular awareness. The same is true in the therapistpatient relationship. Humility is built into that relationship when the ultimate power and knowledge reside in the so-called "sick" one.
As Freud wrote in his History of the Psychoanalytic Movement, "The history of psychoanalysis proper...starts with the technical innovation of the rejection of hypnosis." Hypnosis was discarded for a number of reasons, including the realization that patients could not recall repressed, unconscious material when fully awake. Further, it became clear to Freud that trauma, though repressed, permeated the psyche in a total way, leaving no train of thought unrelated or unimplicated. This recognition formed the basis for the psychoanalytic technique of free association. Free association now replaced hypnosis as the central probing device of the mind.
In the words of A. A. Brill, Freud persuaded his patients "to give up conscious reflection and abandon themselves to calm concentration, follow their spontaneous mental occurrences and impart everything to him. It was the job of the analyst to discover the connection between traumatic memory and the associations provided in this way."
Sulloway points out that intrusion might be a better translation of the original German than association. Freud viewed free association as a process whereby ideas intruded upon waking consciousness. That the unconscious (the instincts) could not be directly experienced. The only way to know it was through its derivative ideas. Psychoanalysis thus became confined to the level of ideation -- to concept and language. It became the "talking cure." Derivative ideas were made conscious by using free association techniques, having the patient ramble on and on until something significant (to the therapist) was said. This was supposedly a breakthrough of unconscious material, after which the analyst would help the patient gain insight into the connections between the associations and the original trauma.
So, the patient talked and the analyst talked because it was assumed that language was the only means by which we could have access to consciousness. And what is more, in the classical Freudian approach, the analyst said very little, never betraying his own feelings to the patient. His role was to be the silent observer, the donor of insights, and a model of rectitude for the patient. In his Outline to Psychoanalysis, Freud stated this position plainly:
There is no hope of our being able to reach (the real state of things) since everything new that we deduce must nevertheless be translated back into the language of our perceptions from which it is impossible for us to set ourselves free.
It was certainly important to realize that the unconscious could be probed directly via language; that language could do a detective job on itself, pinpointing traces from the unconscious. But in restricting himself to the medium of words, Freud was inevitably led to the conclusion that the knowable unconscious was linguistic in nature. To some extent it is, but that is by no means the whole picture, for the principal role of the unconscious is to code and store suffering and other emotions. A child doesn't suffer from intellectual conflict with her parents. She suffers because her emotions had to be buried in order to get along at home
Although unconscious content permeates language, language cannot alone fully express the unconscious. This is because the unconscious is primarily comprised of non-verbal elements, particularly Pain. And because of this the linguistic approach achieves the opposite of its intent: it buries feelings deeper and deeper.
Remember, there are hundreds of millions of years of evolution between the sensate-feeling brain and the human rational one. That is why when one is cut-off from one's feelings one can discuss the most incredible events with no emotional content to the language.
The non-verbal elements lying behind the gates of Pain in the unconscious are knowable in their own ways -- through their own "language" -- through the feelings and sensations which are the "raw material" of the unconscious process.
There is a tautology inherent in the Freudian concept of consciousness. We only know what is knowable, and what is knowable is only what can be ascertained through intellect and language. According to Freud and the Freudians, the unconscious is not knowable directly. If knowledge is viewed as the exclusive property of the intellect, then anything beyond the scope of ideas and language cannot be known. What's more, any further discovery of knowledge is limited to the use of these conceptual tools. This would be fine if experience were mediated purely by intellect, yet quite clearly it is not. As the colloquialism goes, there are some things that you just can't put into words.
If Freud hadn't perpetuated the demonology of the 19th century, he would have delved into the unconscious. As it was, he thought such probing to be deleterious to mental health. Freud's discoveries were mediated through the brilliance of his intellect. It is no wonder that he gave such kudos to the intellect (and language) in developing psychoanalytic therapy. It is interesting to note that, although Freud challenged many of the entrenched beliefs of his day, he implicitly accepted the intellectual boundary to knowledge. The unfortunate legacy of this assumption is a psychotherapy in which self-knowledge is attainable only through intellectual activity. By awarding the proprietorship of self-knowledge to the uppermost parts of consciousness, the knowledge gained becomes more and more detached from the reality it supposedly explains. Ultimately, knowledge limited to one level of consciousness reinforces the mind-body split which is itself the essence of neurosis.
The great paradox of psychoanalysis is that we can know ourselves in such a way as to preclude true knowledge of ourselves:
Reality will always remain "unknowable." What scientific work elicits from our primary sense perceptions will consist in insight into connections and interdependencies in the external world, which can somehow or other reliably be produced or reflected in the internal world of our thoughts.
What the above explains is how insight and knowledge of oneself can be used as defenses. Analysis and interpretation of the information provided by the process of free association is where the psychoanalytic method truly fails. The analyst makes the whole business more complicated than it need be. Since he thinks the unconscious will always be a mystery, he pursues off-track approaches rather than going directly to the source. It is intricate work to have to apply principles from the fund of psychoanalytic theory to individual experience. It assumes that the answers to personal experience lie in someone else's head. It distrusts the intelligence of feeling, puts too much faith in mental understanding, and is blind to the fact that traumatic memories and neglected needs are straining to become conscious.
Abandoning yourself to thought is a contradiction in terms. Patients need to abandon themselves to feeling. If they are unable to abandon their unreal defensive selves to find the real pained self, then they must indeed rely upon another's interpretation of their experience.
And therein lies the rub.
Defense against feeling is precisely what makes neurosis a matter of mystery and confusion. That the patient cannot be trusted to arrive at his own answers seems to be a self-fulfilled prophecy in the sense that he is prevented from feeling his long-repressed feelings -- the true source of elucidation. And since the therapist doesn't trust the patient to go where he must, the patient doesn't go there and the analyst assumes that the patient cannot be trusted.
Freud recognized that in allowing free association he was also inviting freedom of defense, or "resistance," as it was termed. This resistance had to be dissolved by the analyst's interpretations. Primarily, resistance is what "opposes and blocks the analytic work by causing failures in memory," although it also included the patient's criticism of his own associations. Freud believed that analyzing this resistance provided even more insight than the original associations, as follows:
The associations which people wish to suppress in this way proves without exception to be the most important, to be decisive for the discovery of the unconscious thought. Resistances invariably confront us when we try to penetrate to the hidden unconscious thought from the substitute offered by the dream element."
Freud needed to take this observation one step further. It is not an unconscious thought that the patient resists, but the threat of overwhelming Pain. Pain makes the thought intolerable; and it is the Pain that must be dealt with. The thought is only a cognitive abstraction, neutral in itself, until it is connected to the Pain that forged it.
What Freud did not perceive was that getting the patient to intellectually accept the analyst's interpretation of his resistance did not in fact remove the resistance; it merely changed its form. It is merely a substitution of thoughts, and no matter how accurate the newly supplied ones may be, disconnection is actually maintained.
Analyzing resistance is still a major part of the psychoanalytic method used today. The patient's resistance is worked on as a problem in itself. Freud believed that analyzing the resistance would eventually lead to the unconscious origin of the neurosis when in fact. analyzing the resistance is itself resistance. Analyzing the resistance keeps the person detached from the very feelings that could liberate him. It mobilizes the cortex in the service of repression, locking up the unconscious contents even tighter.
There is nothing to analyze about resisting Pain. Resistance is just one more mechanism of survival, a biological shutdown in the face of overwhelming danger. Ultimately, resistance is fear, and fear comes from threat, not thought. The system automatically resists more Pain than it can integrate. Resistance is normal and a survival function. To say to the patient, "You are resisting this or that" can make him feel guilty for acting normally. Resistance doesn't evaporate until the Pain does. Then there is nothing to resist against.
In addition to free association, Freud used dream analysis to treat neurosis. In fact for Freud, the interpretation of dreams was "the via regia [royal road] to the unconscious." In his Interpretation of Dreams, published in 1899, he described how he came upon the similarity between dreams and neurotic symptoms:
If a pathological idea of this sort can he traced back to the elements in the
patient's mental life from which it originated, it simultaneously crumbles away
and the patient is freed from it...My patients were pledged to communicate to me
every idea or thought that occurred to them in connection with some particular
subject; amongst other things they told me their dreams and so taught me that a
dream can be inserted into the psychical chain that has to be traced backwards
in the memory from a pathological idea. It was then only a short step to
treating the dream itself as a symptom and to applying to dreams the method of
Freud applied his free association to interpreting dreams. In fact, he came to realize that dreams were often the best material for analysis. Since one is asleep (i.e., unconscious) while dreaming, there is little censorship from the ego so that the dream provides the purest possible presentation of the unconscious.
Freud's theory of dreams centered on one main concept: wish fulfillment. He believed that unconscious wishes from infancy and childhood animated all adult dreams. Since "dreams contain the psychology of the neuroses in a nutshell," unravelling their meaning via free association would also unravel the neurosis. Thus, the patient once again reclines on the couch in a relaxed, self-observant manner while producing associations to each part of the dream. Importantly, Freud believed it essential for the analyst to structure the dream for the patient:
If I say to a patient who is still a novice: "What occurs to you in connection with this dream?" as a rule his mental horizon becomes a blank. If, however, I put the dream before him cut up into pieces, he will give me a series of associations to each piece...
These associations, when properly interpreted, would reveal the infantile wishes that actually motivated the dream material in the first place.
Freud broke important ground with his work on dreams, for dreams were generally regarded as nonsense by his contemporaries. Just recognizing that dreams were meaningful was a major breakthrough for psychology. The problem is that his views -- which were again a beginning -- have remained unexplored, unchanged, and unexpanded by his successors. Ernest Jones writes that the conclusions Freud made public in his Interpretation of Dreams "have experienced only a minimum of modification or addition in the half century since the book was published. Of very few important scientific works can this be said." Jones viewed the lack of change as an indication of Freud's accuracy and thoroughnesswhereas others see it as an indication of his successors' rigidity and compliance.
Based on Freudís theory, dream analysis is unfortunately another intellectual exercise that negates feeling. Dreams appear to contain images of something more profound. Until real causes are released from below the gates of consciousness/awareness, dream analsysis remains intellectual guesswork. In precipitating real change, mind games are not helpful. What is helpful when using dreams in therapy is asking a patient to relive the dream in order to get to the feelings and imprints that gave rise to them. The symbols, images, and stories often reflect imprinted memory. Too often, intense dreams represent early non-verbal imprints remote from the dream itself. To understand an image and its theoretical underpinnings has nothing to do with cure. Only feelings can bridge the gap, and only Pain can lead to feelings. It is feeling that is the royal road to the unconscious; feelings are what is unconscious.
Contrary to Freudís theories, neurotic dreams, particularly recurrent dreams, are attempt to deal with imprinted pain. Monsters, chaos, and catastrophes all depict the condition of the dreamer's feelings rather than the fulfillment of the dreamer's wishes. In the dream, no matter what the story, there is often a feeling of impending doom; the same feeling that arises just before a patient slips into a devastating pre-verbal primal.
While some dreams may contain wish fulfillment, it is definitely not the essence of dream material. Dream material is woven out of the concrete events of waking realities. If Pain is the chronic ingredient of that reality, it likewise will be the prime mover of dream activity.
Wish fulfillment is a seductive concept that again veils Pain behind a dangerous illusion of insight. Worse, it rarefies the unnecessary Pain of deprivation into an inevitable conflict of infantile desires.
Freudians use language, words, and ideas as the main tools of unravelling. Freud believed that when traced back to its origin, a neurotic idea would "crumble" and the patient would be "freed from it." Unfortunately, intellectual tracing seems quite limited because the neurologic system allows us to go only so far before barring the gates. Ideas can alter, deny, distort, and repress feelings, but they cannot crumble them. Feelings don't "crumble." They are felt and resolved. And with that resolution goes the ideas which were used to defend against them.
Dreams utilize the first and second levels of consciousness -- primarily the second -- and are another type of language. They use scenes, pictures, sounds, scents, and images to portray feeling. While dreams are still symbols for the feeling, they are closer than third-level ideas to the inner reality. Making associations -- interpreting dreams -- thinking about meaning, just results in more symbols to cover the feeling
Analyzing dreams is the same as analyzing an idea and finding flaws in its logic. You can analyze a paranoid idea -- "people are laughing behind my back," for example -- all day long and not change it one bit. When one succumbs to the feeling of the dream, then one is directly experiencing the unconscious. That means giving into the feeling -- which might be one of terror or blind panic -- and riding the feeling to wherever it leads in the unconscious.
Structuring the Dream
Freud's dream work model requires that the analyst structure the dream for the patient. This action in itself modifies the dream, for the analyst can only superimpose his own view and theory. The dream will have a Freudian slant in psychoanalysis, and a Jungian slant in Jungian analysis. The theory is a preconceived set of ideas laid onto the dream in order to make sense of it. However, no theory is necessary at all, because the memory-imprint is all that is needed to make sense. The dream when felt will lead precisely to the time and place of the trauma. No theory need intervene. The analyst cannot possibly know more about the patient's unconscious than the patient himself. And even if his guess is correct, his insight communicated to the patient will not alter the problem within the patient. It will only give him one more idea to think about, and one less reality to feel. Only the dreamer, not the analyst, knows for sure what a dream means, but he won't know until Pain opens the gates and diminishes repression.
Let's take one of the examples Freud used to show how the application of his technique explained the dream.
A lady related that as a child she very often dreamt that God had a pointed paper cap on his head. How are you going to understand that without the help of the dreamer? It sounds quite nonsensical; but the absurdity disappears when the lady says that as a little girl she used to have a cap like that put on her head at table, because she wouldn't give up looking at the plates of her brothers and sisters to see whether any of them had been given more than she. Evidently the cap was meant to serve the purpose of blinkers; this piece of historical information was given, by the way, without any difficulty.
The interpretation of this element and, with it, of the whole short dream becomes easy enough with the help of a further association of the dreamer's: 'As I had been told that God knew everything and saw everything, the dream could only mean that I knew and saw everything as God did, even when they tried to prevent me.' This example is perhaps too simple.
For Freud it was "easy enough" to see the historical parallels between the dream symbols and the dreamer's past. The patient as a little girl was made to wear the cap, so in her childhood dreams she puts the same cap on God -- she saw the plates of food "even when they tried to prevent me." And Freud believed that arriving at an "accurate" understanding or interpretation in this way was sufficient to undo the trauma.
There is a certain intellectual satisfaction in arriving at such a neat and clear parallel. In fact, Freud felt that "this example is perhaps too simple" because the meaning was so easily discerned. We have found that no matter how simple and transparent the meaning of the dream is, experiencing its feeling is, without exception, never "simple." While the intellect can view the connections as a well-fitted package, the body experiences the connections only through confusion, fear, and finally, agony.
What matters in this dream is the Pain that drove this little girl to her compulsive behavior, and the further Pain of her parents' reaction to it. Beneath her insistent need to see if her brothers and sisters had been given more could be the Pain of rejection and neglect. The dinner food was only a symbol for the love she wasn't getting. It would have been best left to her to tell us what it means, which she could have done had she been encouraged to sink into the feelings in the dream, feeling the Pain of that little girl as a little girl at the dinner table. She must re-experience the rejection and the lack of love; she must feel the Pain that drove her compulsive glances. She must feel the even deeper hurt inflicted by her parents. Not only did they not recognize her desperate need, they punished and humiliated her for it
The Talking Cure that Doesn't Cure
The reader will recall that Freud discarded his seduction theory in favor of one which focused not on real trauma but on heredity and instinct and sexual impulses. The great loss that psychology suffered as a result of Freud's abandonment of the seduction theory lay in the fact that it robbed patients of vital dialectical truths: that neurosis is the product (synthesis) of buried Pain generated by actual trauma (thesis) and its repression (antithesis); that repressed Pain is accessible to the adult mind; and that to allow the ascendance of Pain is curative. Instead, psychoanalysis finally did become "the talking cure" as Anna O had coined it, and thus was no cure at all. Rather it was a third line "cortical" treatment. A rearrangement of cortical ideas, where with new ideas to explain one's every move the patient could feel better.
With this talking cure, based on ideas and insights, the patient ostensibly gets well "in his head." But he later develops migraines or ulcers. His body is still sick, and he can't imagine why. After all, psychoanalysis has helped him "understand" his problems.
A great number of decades, millions of words, and tremendous resources have been spent tracking neurosis to false origins. Freud's talking cure is the predominant model of what happens in psychotherapy today. Be it in five-day-a-week psychoanalysis for a number of years or a much shorter treatment course in another psychotherapy, over 200 talking cures today compete for the 10-15 million Americans trying to talk their way to psychological healing. According to Dr. Frederick K. Goodwin, the National Institute of Mental Health director during the Clinton years, "There is no real evidence that it [classical psychoanalysis] works." The theories and techniques of Freud's talking cure have cast a long shadow over psychotherapy and have served to reinforce rather than cure neurosis.
Becoming Conscious In Therapy: A Matter of Degree
Freud knew that the process of becoming conscious was a total event. He wrote that "becoming conscious is no mere act of perception, but is probably also a hyper-cathexis, a further advance in the mental organization." Yet Freud limited the "hyper-cathexis" to mentation. This is why he believed it was enough to connect mentally to past traumas. He did not know that the traumas are disconnected from their source and neurophysiologically imprinted throughout the entire organism. Nor did he see that inherent in this very disconnection is the means to effect re-connection.
Freud's treatment of neurosis through free association and understanding may have increased his patients' awareness, but it did not increase their consciousness. For the neurotic, only Pain can offer that service. Awareness is a cognitive process, our objectified view of what happened, the mind's perception cut off from the body's reaction. Consciousness is a multi-level process; it is the entire state of the organism. We can become aware of an experience as a defense against being fully conscious of it, with awareness holding down consciousness. The woman with the "pointed cap" dream mentioned above became aware that "the dream could only mean that I knew and saw everything as God did," but she did not become conscious of it on the deeper feeling levels. It remained a cognitive speculation -- "the dream could only mean" -- rather than an interconnected reality -- "the dream was."
Where awareness is a moment-by-moment process, consciousness is an ongoing state of being. A leader is aware that people are being killed and maimed by the bombs he ordered dropped, but he is not conscious of the horror he is inflicting. The neurotic may be aware of all his past traumas -- he may be well able to recall them -- but he is not conscious of them, because pain/repression blocks the route.
The excavations of psychoanalysis may bring past events into awareness; the method of free association appreciates this possibility. But if therapy remains at the level of recall, the experience is a limited one no matter how vivid the scenes recaptured. To merely talk about a distressing scene and pinpoint its relevance to current problems offers an enticing yet false immunity to the strong feelings bound up with it. Freud's agenda included a fixed, immutable unconscious pouring out demons until it was stopped by various defensive means. The better the defense, the healthier the person. We see that defenses are by and large neurotic; they are among the countless ways of defending against Pain. Remove the Pain and the defenses are no longer needed.
Freud made an important step in recognizing that it was useless for the analyst to supply the connection; that the patient had to experience this link up for himself for it to really mean anything. What he did not fully appreciate is that recall and insight, even if arrived at by the patient, are not the same as reliving; for what is truly in the unconscious is the agony component of recall and memory.
Back to Table of Contents | Next chapter >>
Translated by James Strachay (New York: W.W. Norton), 1949.
Freud, Outline, p. 106.
Outline of Psychoanalysis, p. 122.
Interpretation of Dreams, pp. 132-133.
Life and Work of Sigmund Freud, p. 229.
Outline of Psychoanalysis, p. 124.
citation?? (p. 126, v. 4)