Loose, Tight, and Free Associations

I first heard of “loose” associations during my first year of residency training about thirty-five years ago. Loose associations included hebephrenic, garbled, or “silly” speech; primary process thinking; predicate thinking; obsessive ruminating; flight of ideas; ego syntonic garble; rambling disassociations; ecolalia; clang formations; compulsive rhyming; confabulations; magical incantations; invented languages; pressured productions; thought disorder; language disorder; neologistic speech; and still more. Some of these, especially compulsive rhyming, eventually inspired me to write a story called Lisa and David. Many of these forms of thought and speech and feelings they represent overlap and coexist. They crisscross nearly all diagnostic categories established at that time as well as those designed and organized by the current DSM 3.

We were warned at that time to absolutely avoid free associative therapy of any kind with patients demonstrating significant “looseness.” The “couch,” with implications therein contained, was seen as highly dangerous to these patients. We were told that lying on the couch and associating freely would exacerbate already damaged reality contact and contribute to further autistic flights from reality. The real danger was seen as getting lost in what I can describe as an autistic web of ever more entangling, labyrinthlike associations, extrication from which would become impossible. This danger of flying inward into a self-made hell of free associative ensnarements became quite vivid to me. I felt that the imposition of my presence for these patients was absolutely mandatory in keeping them from getting lost in themselves through “free” associations. This, plus the belief in the so-called “weak ego,” “strong id,” and inability to “transfer” precluded attempts to “analyze” these special people at that time.

With time, experience, training, and quite different influences my ideas in this area changed considerably. In passing I would like to