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It is the fundamental rule of psychoanalytic treatment that the analysand repeat aloud everything that comes into his mind. This rule is necessary if one is to understand what is preoccupying the conscious and unconscious mind of the patient. There are, however, cases in which strict application of the rule is inadvisable. It is the purpose of this discussion to define a line of conduct for the application of the rule based on the author's experience.
Every rule of therapy demands an intelligent elasticity in its application; otherwise it may achieve a very different effect from the one desired. Any rule in its strict application can be reduced to an absurdity. When a patient obeying the fundamental rule expresses what comes into his thoughts, he necessarily makes a choice. He may not be deliberately concealing something, but involuntarily he does not always tell everything. Sometimes long afterwards he will realize that he has omitted or forgotten an idea that he had intended to repeat to the analyst. This does not matter; it even enables one to note the resistances which certain associations of ideas set up in the mind of the patient. In forcing himself too systematically to repeat everything he thinks, the analysand may become a slave to the obligation he feels to let no thought pass unformulated, and such a state of mind is not at all favorable to the free flow of ideas. With these patients the fundamental rule does not have the desired result.
There are two types of patients which present difficulties in the application of the rule: (1) those who are prevented by the symptoms of their neurosis from adhering to it, and (2) those who consciously refuse to submit.
In the first class may be placed certain obsessional cases, and certain anxiety neurotics, particularly patients who are excessively