The Mode of Operation of Psycho-Analytic Therapy1

All forms of psychotherapy are based on the spontaneous tendencies to self-cure active in every individual. The differences in the various methods arise from their each making use of different tendencies to self-cure and to guiding and correcting these in different ways.

The psychotherapist is able temporarily to take the place of the super-ego because he brings about a situation in which he alone offers protection against anxiety. In hypnosis, for example, the childhood-conditions of sleeping are reinstated and thus the pavor nocturnus which is never absent in childhood is revived. The hypnotist takes upon himself the rôle of the parents who alone offered protection against the imaginary fears of the night. This protection is purchased at the expense of complete submission, which is masochistically libidinized.

If the psychotherapist is content to bind the anxiety in the relation to himself, the neurosis will become manifest once more after this is broken off. He will only achieve more permanent results if he uses his power to effect an alteration in the psychic economy, for example, by enabling the patient to exchange his symptoms for others of a less disturbing nature or by offering him suitable means for mastering anxiety and guilt. The processes of cure on these lines exploit obsessional-neurotic and phobic mechanisms.

The psychotherapist can furthermore intervene in the struggle for repression and strive to secure a better adaptation by suppression of the symptoms or more successful repression of the instinctual trends causing the conflict. He can also try to decide the conflict in favour of greater instinctual freedom, either by encouraging the spontaneous tendency towards abreaction and projection (by stimulating free expression in phantasy, speech and play, or by means of the cathartic method, etc.) or by tolerating forbidden instinctual trends. This can be attained directly by sanctioning trends which, although conscious,