Comments on Therapeutic and Counter-therapeutic Factors in Psychoanalytic Technique

Many patients come to us with symptoms for which they seek a cure—or at least for an alleviation of suffering of one sort or another, and we would be deceiving ourselves if we did not accept the fact that therapy is a major aim of psychoanalysis. Yet, paradoxically, analysis is best conducted if we do not attempt to analyse symptoms or ‘pathological’ character traits unless (or until) they present themselves within the analytic relationship in the shape of a central resistance to the analytic work. I think here, for example, of the phobic patient who transfers phobic anxiety to the analytic situation where it may show itself as a transference resistance. Experience tells us that it is therapeutic to wait for the pathology to appear in the transference and then to deal with it analytically.

I shall, in what follows, take the view that what is therapeutic in analysis is that which facilitates and aids the aims of analysis, and that what is countertherapeutic is that which hinders these aims. But what are the aims of analysis? We can formulate these in a variety of ways—analysis aims at making the unconscious conscious, at replacing id by ego, at helping the patient to find less painful compromise formations, at increasing the autonomy of the ego and diminishing the rigidity of the defences, at working through the depressive position, at achieving mature object relationships, at helping the patient to accept his projections back into his own self, and so on. Obviously there is considerable overlap between such different formulations, and my own preference is to say that we aim, in our analytic work, to bring about the psychic change necessary to enable the patient to reach new and therapeutically desirable solutions to his or her central conflicts instead of the old unsatisfactory and painful ones (I am very much in agreement here with Anna Freud who has pointed out that the essential conflicts never change: only the solutions do). By a new and desirable solution I mean