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Freud's paper ‘Lines of advance in psychoanalytic therapy’ is well remembered for his introduction of the ‘principle of abstinence’ that guides psychoanalytic treatment, and for the famous phrases in which he compared the ‘pure gold of analysis’ to the ‘copper of direct suggestion’. But the context in which these ideas were presented is less well remembered and is particularly relevant to the subject of brief psychotherapy. Freud's 1919 paper was a response to several proposed innovations in psychoanalytic therapy, most notably Ferenczi's ‘active technique’. Using the concept of abstinence as a guide, Freud very cautiously accepted Ferenczi's technical suggestions as long as they were in the service of insight, and roundly rejected those of Jung and Putnam as controlling and manipulative. Placing these proposed technical innovations in the context of a vast public health need for psychotherapy, Freud concluded with a bold prediction which, he acknowledged, ‘may seem fantastic to many of you’:
Now let us assume that by some kind of organization we succeeded in increasing our numbers to an extent sufficient for treating a considerable mass of the population. On the other hand, it is possible to foresee that at some time or other the conscience of society will awake and remind it that the poor man should have just as much right to assistance for his mind as he now has to the life-saving help offered by surgery; and that the neuroses threaten public health no less than tuberculosis, and can be left as little to the impotent care of individual members of the community. When this happens, institutions or out-patient clinics will be started, to which analytically trained physicians will be appointed … It may be a long time … [but] some time or other … it must come to this.
We shall then be faced by the task of adapting our technique to the new conditions … we shall need to look for the simplest and most easily intelligible ways of expressing our theoretical doctrines … It is