Psychoanalysis as Talking Cure: The Problem of the Patient's Reality*

Just over a century ago, Josef Breuer fled from Bertha Pappenheim. Until that time, he had achieved much success during what she had called her “talking cure” or “chimney sweeping” (Freud & Breuer, 1978). Breuer had learned that as a result of talking with his patine, changes occurred in her symptoms. She began to think and feel differently, and accordingly, her experience of herself and others changed. Breuer's report of the case, simply titled “Fraulein Anna O.,” did not describe the turning point, however, when the reality portrayed by the 21-year-old woman provoked him. We learn elsewhere (Jones, 1953) that Breuer found it difficult to understand the love she expressed for him, but more important, he could not tolerate the implications and consequences of her claim that he had fathered her child.

Freud's investigation into the case allowed him to move further into Bertha Pappenheim's experience. He did so utilizing the concept of transference, and he reasoned that her experience was a fantasied distortion of reality (Miller, 1983). Pithy, poignant fantasies blinded her actually and metaphorically to the real nature of things, including Breuer's genuine role and intentions. Under the press of fantasy, the doctor became her illusory paramour.

Freud emphasized the importance of gaining sufficient distance to recognize the impersonal structure of unconscious processes. While the idea of transference provided that needed emotional distance, allowing