Recommendations to Physicians Practising Psychoanalysis
"RECOMMENDATIONS TO PHYSICIANS PRACTISING PSYCHOANALYSIS"
"The technical rules which I am putting forward here have been arrived at from my own experience in the course of many years, after unfortunate results had led me to abandon other methods" (1912e, 111). Thus began Sigmund Freud's "Recommendations to Physicians," which is, together with "The Handling of Dream Interpretation in Psychoanalysis" (1911e) and "The Dynamics of Transference" (1912b), among the rare technical essays that resulted from Freud's 1908 attempt to write a "general methodology," a project he abandoned in 1910.
Freud went on to specify that these recommendations were the result of his own methods and that it was possible that another physician would assume a different position. But he insisted on their common goal, which was to establish for the analyst conditions that paralleled the "fundamental rule" imposed on the patient. It was in line with this that he recommended an attitude of "evenly suspended attention," the use of "unconscious memory" rather than notes, the absence of a preconceived research "plan," and therefore the adoption of an attitude of "distance" similar to that of a surgeon.
"The doctor should be opaque to his patients and, like a mirror, should show them nothing but what is shown to him" (1912e, p. 118). We know the fate of this metaphor, as we do that of the other metaphor that Freud would later return to: "To put it in a formula: [the analyst] must turn his own unconscious like a receptive organ towards the transmitting unconscious of the patient. He must adjust himself to the patient as a telephone receiver is adjusted to the transmitting microphone. Just as the receiver converts back into soundwaves the electric oscillations in the telephone line which were set up by sound waves, so the doctor's unconscious is able, from the derivatives of the unconscious which are communicated to him, to reconstruct that unconscious, which has determined the patient's free associations" (1912e, p. 115-116). It was to Ludwig Binswanger, who was surprised at a recommendation so similar to telepathy, that, on February 22, 1925, Freud made the following comment: "The statement that the unconscious of the analysand must be seized with one's own unconscious, that we must so to speak hold out the unconscious ear as a receiver, was one I made in an unassuming and rationalistic sense, although I grant that important problems are concealed behind that formulation. I simply meant that one must eschew the conscious intensification of certain expectations and so set up in oneself the same state one requires of the analysand. All ambiguities disappear once you assume that, in the sentence in question, the unconscious is meant purely descriptively. In a more systematic formulation, unconscious must be replaced with preconscious."
In order for this balance to occur, the analyst must first undergo an "analytic purification." This is the inception, by Freud himself, of the "training analysis," intended to help the analyst avoid the temptation of using his own life as an example or trying to educate the patient.
It is clear from this essay that Freud is responding indirectly to the errors that the first psychoanalysts inevitably made in their eagerness to understand or heal. It also shows how difficult it was for physicians to adopt the psychoanalytic attitude when, as a result of their training and professional experience, they had developed an active attitude, if not that of a miracle worker, the very attitude that characterized Freud in the Studies on Hysteria. Have the times really changed? Freud's "Recommendations" has continued to be read and, as Freud wrote to Ludwig Binswanger on May 28, 1911, "In truth there is nothing for which man's disposition befits him less than occupying himself with psychoanalysis."
Alain de Mijolla
See also: Question of Lay Analysis, The.
Freud, Sigmund. (1912e). Ratschläge für den Arzt bei der psychoanalytischen Behandlung. Zentralblatt für Psycho-analyse, II: 483-489; GW, VIII: 376-387; Recommendations to physicians practising psycho-analysis. SE, 12: 111-120.
Freud, Sigmund, and Binswanger, Ludwig. (1992 [1908-1938]). The Sigmund Freud-Ludwig Binswanger Correspondence 1908-1938 (Gerhard Fichtner, Ed.; Arnold J. Pomerans and Tom Roberts, Trans.). New York: Other Press.