object:1.02 - What is Psycho therapy?
book class:The Practice of Psycho therapy
author class:Carl Jung
subject class:Psychology
class:chapter
II
WHAT IS PSYCHO THERAPY? 1
[28]
It is not so very long ago that fresh air, application of cold water, and
psycho therapy were all recommended in the same breath by well-
meaning doctors in cases mysteriously complicated by psychic symptoms.
On closer examination psycho therapy meant a sort of robust,
benevolently paternal advice which sought to persuade the patient, after the
manner of Dubois, that the symptom was only psychic and therefore a
morbid fancy.
[29]
It is not to be denied that advice may occasionally do some good, but
advice is about as characteristic of modern psycho therapy as bandaging of
modern surgery that is to say, personal and authoritarian influence is an
important factor in healing, but not by any means the only one, and in no
sense does it constitute the essence of psycho therapy. Whereas formerly it
seemed to be everybodys province, today psycho therapy has become a
science and uses the scientific method. With our deepened understanding of
the nature of neuroses and the psychic complications of bodily ills, the
nature of the treatment, too, has undergone considerable change and
differentiation. The earlier suggestion theory, according to which
symptoms had to be suppressed by counteraction, was superseded by the
psychoanalytical viewpoint of Freud, who realized that the cause of the
illness was not removed with the suppression of the symptom and that the
symptom was far more a kind of signpost pointing, directly or indirectly, to
the cause. This novel attitudewhich has been generally accepted for the
last thirty years or socompletely revolutionized therapy because, in
contradiction to suggestion therapy, it required that the causes be brought to
consciousness.
[30]
Suggestion therapy (hypnosis, etc.) was not lightly abandonedit was
abandoned only because its results were so unsatisfactory. It was fairly easy and practical to apply, and allowed skilled practitioners to treat a large
number of patients at the same time, and this at least seemed to offer the
hopeful beginnings of a lucrative method. Yet the actual cures were
exceedingly sparse and so unstable that even the delightful possibility of
simultaneous mass treatment could no longer save it. But for that, both the
practitioner and the health insurance officer would have had every interest
in retaining this method. It perished, however, of its own insufficiency.
[31]
Freuds demand that the causes be made conscious has become the
leitmotiv or basic postulate of all the more recent forms of psycho therapy.
Psychopathological research during the last fifty years has proved beyond
all possibility of doubt that the most important aetiological processes in
neurosis are essentially unconscious; while practical experience has shown
that the making conscious of aetiological facts or processes is a curative
factor of far greater practical importance than suggestion. Accordingly in
the course of the last twenty-five or thirty years there has occurred over the
whole field of psycho therapy a swing away from direct suggestion in
favour of all forms of therapy whose common standpoint is the raising to
consciousness of the causes that make for illness.
[32]
As already indicated, the change of treatment went hand in hand with a
profounder and more highly differentiated theory of neurotic disturbance.
So long as treatment was restricted to suggestion, it could content itself
with the merest skeleton of a theory. People thought it sufficient to regard
neurotic symptoms as the fancies of an overwrought imagination, and
from this view the therapy followed easily enough, the object of which was
simply to suppress those products of imagination the imaginary
symptoms. But what people thought they could nonchalantly write off as
imaginary is only one manifestation of a morbid state that is positively
protean in its symptomatology. No sooner is one symptom suppressed than
another is there. The core of the disturbance had not been reached.
[33]
Under the influence of Breuer and Freud the so-called trauma theory
of neuroses held the field for a long time. Doctors tried to make the patient
conscious of the original traumatic elements with the aid of the cathartic
method. But even this comparatively simple method and its theory
demanded an attitude of doctor to patient very different from the suggestion
method, which could be practised by anyone with the necessary
determination. The cathartic method required careful individual scrutiny of the case in question and a patient attitude that searched for possible
traumata. For only through the most meticulous observation and
examination of the material could the traumatic elements be so constellated
as to result in abreaction of the original affective situations from which the
neurosis arose. Hence a lucrative group treatment became exceedingly
difficult, if not impossible. Although the performance expected of the
doctor was qualitatively higher than in the case of suggestion, the theory
was so elementary that there was always the possibility of a rather
mechanical routine, for in principle there was nothing to prevent the doctor
from putting several patients at once into the relaxed condition in which the
traumatic memories could be abreacted.
[34]
As a result of this more exhaustive treatment of the individual case it
could no longer be disguised that the trauma theory was a hasty
generalization. Growing experience made it clear to every conscientious
investigator of neurotic symptoms that specifically sexual traumata and
other shocks may indeed account for some forms of neurosis, but not by
any means for all. Freud himself soon stepped beyond the trauma theory
and came out with his theory of repression. This theory is much more
complicated, and the treatment became differentiated accordingly. It was
realized that mere abreaction cannot possibly lead to the goal, since the
majority of neuroses are not traumatic at all. The theory of repression took
far more account of the fact that typical neuroses are, properly speaking,
developmental disturbances. Freud put it that the disturbance was due to the
repression of infantile sexual impulses and tendencies which were thereby
made unconscious. The task of the theory was to track down these
tendencies in the patient. But since by definition they are unconscious, their
existence could only be proved by a thorough examination of the patients
anamnesis as well as his actual fantasies.
[35]
In general the infantile impulses appear mainly in dreams, and that is
why Freud now turned to a serious study of the dream. This was the
decisive step that made modern psycho therapy a method of individual
treatment. It is quite out of the question to apply psychoanalysis to several
patients at once. It is anything but a mechanical routine.
[36]
Now whether this form of treatment calls itself individual
psychology with Adler or psychoanalysis with Freud and Stekel, the fact
remains that modern psycho therapy of whatever kind, so far as it claims tobe medically conscientious and scientifically reliable, can no longer be
mass-produced but is obliged to give undivided and generous attention to
the individual. The procedure is necessarily very detailed and lengthy.
True, attempts are often made to shorten the length of treatment as much as
possible, but one could hardly say that the results have been very
encouraging. The point is that most neuroses are misdevelopments that
have been built up over many years, and these cannot be remedied by a
short and intensive process. Time is therefore an irreplaceable factor in
healing.
[37]
Neuroses are stillvery unjustlycounted as mild illnesses, mainly
because their nature is not tangible and of the body. People do not die of
a neurosisas if every bodily illness had a fatal outcome! But it is entirely
forgotten that, unlike bodily illnesses, neuroses may be extremely
deleterious in their psychic and social consequences, often worse than
psychoses, which generally lead to the social isolation of the sufferer and
thus render him innocuous. An anchylosed knee, an amputated foot, a long-
drawn-out phthisis, are in every respect preferable to a severe neurosis.
When the neurosis is regarded not merely from the clinical but from the
psychological and social standpoint, one comes to the conclusion that it
really is a severe illness, particularly in view of its effects on the patients
environment and way of life. The clinical standpoint by itself is not and
cannot be fair to the nature of a neurosis, because a neurosis is more a
psychosocial phenomenon than an illness in the strict sense. It forces us to
extend the term illness beyond the idea of an individual body whose
functions are disturbed, and to look upon the neurotic person as a sick
system of social relationships. When one has corrected ones views in this
way, one will no longer find it astonishing that a proper therapy of neuroses
is an elaborate and complicated matter.
[38]
Unfortunately, the medical faculties have bothered far too little with
the fact that the number of neuroses (and above all the frequency of psychic
complications in organic diseases) is very great and thus concerns the
general practitioner in unusually high degree, even though he may not
realize it. Nevertheless his studies give him no preparation whatever in this
most important respect; indeed, very often he never has a chance to find out
anything about this subject, so vital in practice.
[39]
Although the beginnings of modern psycho therapy rest in the main on the services of Freud, we should be very wrong if weas so often happens
identified psychological treatment with Freudian psychoanalysis pure
and simple. This error is certainly fostered by Freud himself and his
adherents, who, in most sectarian fashion, regard their sexual theory and
their methodology as the sole means of grace. Adlers individual
psychology is a contri bution not to be underestimated, and represents a
widening of the psychological horizon. There is much that is right and true
in the theory and method of psychoanalysis; nevertheless it restricts its truth
essentially to the sexual frame of reference and is blind to everything that is
not subordinate to it. Adler has proved that not a few neuroses can be more
successfully explained in quite another way.
[40]
These newer developments of theory have as their therapeutic aim not
only the raising to consciousness of pathogenic contents and tendencies,
but their reduction to original simple instincts, which is supposed to
restore the patient to his natural, unwarped state. Such an aim is no less
praiseworthy than it is logical and promising in practice. The wholesome
results are, when one considers the enormous difficulties in treating the
neuroses, most encouraging, if not so ideal that we need wish for nothing
better.
[41]
Reduction to instinct is itself a somewhat questionable matter, since
man has always been at war with his instincts that is to say, they are in a
state of perpetual strife; hence the danger arises that the reduction to
instinct will only replace the original neurotic conflict by another. (To give
but one example: Freud replaces the neurosis by the so-called transference
neurosis.) In order to avoid this danger, psychoanalysis tries to devalue the
infantile desires through analytical insight, whereas individual psychology
tries to replace them by collectivizing the individual on the basis of the herd
instinct. Freud represents the scientific rationalism of the nineteenth
century, Adler the socio-political trends of the twentieth.
[42]
Against these views, which clearly rest on time-bound assumptions, I
have stressed the need for more extensive individualization of the method
of treatment and for an irrationalization of its aimsespecially the latter,
which would ensure the greatest possible freedom from prejudice. In
dealing with psychological developments, the doctor should, as a matter of
principle, let nature rule and himself do his utmost to avoid influencing the
patient in the direction of his own philosophical, social, and political bent.Even if all citizens are equal before the law, they are very unequal as
individuals, and therefore each can find happiness only in his own way.
This is not to preach individualism, but only the necessary pre-condition
for responsible action: namely that a man should know himself and his own
peculiarities and have the courage to stand by them. Only when a man lives
in his own way is he responsible and capable of actiono therwise he is
just a hanger-on or follower-on with no proper personality.
[43]
I mention these far-reaching problems of modern psycho therapy not,
indeed, to give an elaborate account of them but simply to show the reader
the sort of problems which the practitioner comes up against when his
avowed aim is to guide the neurotic misdevelopment back to its natural
course. Consider a man who is largely unconscious of his own psychology:
in order to educate him to the point where he can consciously take the right
road for him and at the same time clearly recognize his own social
responsibilities, a detailed and lengthy procedure is needed. If Freud, by his
observation of dreamswhich are so very important therapeuticallyhas
already done much to complicate the method, it is rendered even more
exacting, rather than simplified, by further individualization, which
logically sets greater store by the patients individual material. But to the
extent that his particular personality is thereby brought into play, his
collaboration can be enlisted all the more. The psychoanalyst thinks he
must see his patient for an hour a day for months on end; I manage in
difficult cases with three or four sittings a week. As a rule I content myself
with two, and once the patient has got going, he is reduced to one. In the
interim he has to work at himself, but under my control. I provide him with
the necessary psychological knowledge to free himself from my medical
authority as speedily as possible. In addition, I break off the treatment
every ten weeks or so, in order to throw him back on his normal milieu. In
this way he is not alienated from his world for he really suffers from his
tendency to live at anothers expense. In such a procedure time can take
effect as a healing factor, without the patients having to pay for the
doctors time. With proper direction most people become capable after a
while of making their contri butionhowever modest at firstto the
common work. In my experience the absolute period of cure is not
shortened by too many sittings. It lasts a fair time in all cases requiring
thorough treatment. Consequently, in the case of the patient with small
means, if the sittings are spaced out and the intervals filled in with thepatients own work, the treatment becomes financially more endurable than
when undertaken daily in the hope of (problematical) suggestive effects.
[44]
In all clear cases of neurosis a certain re-education and regeneration of
personality are essential, for we are dealing with a misdevelopment that
generally goes far back into the individuals childhood. Accordingly the
modern method must also take account of the philosophical and
pedagogical views of the humane sciences, for which reason a purely
medical education is proving increasingly inadequate. Such an activity
should in all cases presuppose a thorough knowledge of psychiatry. But for
adequate treatment of dreams a plentiful admixture of symbolical
knowledge is needed, which can only be acquired by a study of primitive
psychology, comparative mythology, and religion.
[45]
Much to the astonishment of the psycho therapist, the object of his
labours has not grown simpler with deepened knowledge and experience,
but has visibly increased in scope and complexity; and in the clouds of the
future the lineaments of a new practical psychology have already begun to
take shape, which will embrace the insights of the doctor as well as of the
educator and all those whose concern is the human soul. Till then,
psycho therapy will assuredly remain the business of the doctor, and it is to
be hoped that the medical faculties will not long continue to turn a deaf ear
to this plea addressed to the doctor by the sick. The educated public knows
of the existence of psycho therapy, and the intelligent doctor knows, from
his own practice, the great importance of psychological influence. Hence in
Switzerl and there is already a fine body of doctors who stand up for the
rights of psycho therapy and practise it with self-sacrificing devotion,
despite the fact that their work is often made bitter for them by ridicule,
misinterpretation, and criticism, as inept as it is malevolent.
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