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ON THE PSYCHOTHERAPY OF HYSTERIA (INTRODUCTION, 1, 2, 3)
Sigmund Freud (1893-1895)

Summary:
In our research into the etiology of hysterical symptoms, we discovered an effective therapeutic method that pleasantly surprised
us
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In addition, we sought to understand how our method produced these effects
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Now, we will try to explain in detail the scope, technique, and difficulties of this method, although inevitably there will be
repetitions due to the information contained in the previous clinical records
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We do not claim to have eliminated all hysterical symptoms with the cathartic method, but we believe that the obstacles were
circumstantial and not fundamental
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We will analyze the drawbacks and advantages of the procedure and address the failures of this
origin in the future
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The cathartic method retains its value despite being symptomatic and not causal
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It is particularly effective in cases of residual symptoms
following an acute hysterical paroxysm
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In cases where the hysterical production has passed and only residual symptoms remain, the cathartic method is satisfactory
and achieves lasting successes, especially in the sexual sphere
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It is necessary to wait
and establish favourable conditions for the patient
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Eliminating pre-existing symptoms helps restore
the patient's resilience
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We recognize the apparent contradiction between admitting that not all symptoms are psychogenic and maintaining that they
can all be eliminated by the cathartic method
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As for other symptoms, they may be dragged down by
psychogenic symptoms or depend on indirect psychic causation
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We will list and point out these aspects without developing them in detail
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I cannot delve into
the psychic mechanism of a hysteria in a person that I find vulgar or unpleasant, but I can treat patients with tabes or rheumatism
regardless of my personal feelings towards them
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Some patients may escape treatment by glimpsing its direction, while others may
develop an excessive personal relationship with the doctor
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Although it is
emphasized that the use of hypnosis does not lead to harm, the problems that arise during the treatment have other causes
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In addition, combining cathartic psychotherapy with a resting cure has been shown to be effective in both the
physical and psychological improvement of patients
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In attempting to extend the application of Breuer's method to a wider radius, I encountered
the difficulty that some patients were not hypnotizable, despite showing symptoms of hysteria as diagnosed
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As a result, he had
to find a way around this difficulty
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I observed
that in some patient’s resistance manifested itself even before the attempt at hypnosis
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Although I am not sure of the validity of this conception, I needed to find a
solution without relying on hypnosis
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During the first interview,
some patients claimed not to remember the first occasion of their symptom, while others offered dark memories that they could
not follow
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Some patients began to remember more under this suggestion, even without hypnosis
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This resistance, which is related to the
defense of the self, prevents the conscious recall of pathogenic representations
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Before applying pressure to the patient's forehead, I assured them
that they would see a memory in the form of an image or thought and that they would communicate it to me
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In conclusion, this method allowed me to access pathogenic memories and advance the treatment of patients
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We have just praised with such fervour the achievements of this auxiliary procedure which consists in the pressure on the forehead,
but we have entirely neglected the point of view of defence or resistance
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The patient's resistance manifests itself in a variety of ways and is often hidden
behind singular subterfuges
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This can manifest itself in expressions of disappointment on the part of the patient, stating
that nothing relevant or meaningful occurs to them during the pressure process
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To overcome this resistance, one must arm oneself with patience and use different strategies
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Explaining how the mind works and how thoughts are related can help
the patient understand the importance of exploring their deepest thoughts
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This may involve building a trusting relationship between the patient and the therapist, where the patient feels
comfortable sharing their most intimate and vulnerable experiences
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The patient may be
more willing to open and explore their deepest thoughts if they trust the doctor's experience and judgment
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Once this is accomplished, the doctor has little
else to do to correct or cancel the symptoms
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Given the technical difficulties we have exposed and the more challenging cases we have analyzed, the question arises about the
efficacy of focusing on hypnosis or limiting the cathartic method to highly suggestible patients
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Although we have been successful in some cases, we continue to find examples of therapeutic disobedience even in this state,
which supports our idea of seeking a quantitative relationship between cause and effect in the psychic realm
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This generates pathological symptoms, turning the repressed representation into
the cause of the disease, which we call "defense hysteria"
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However, my experience leads me to conjecture that even in these forms of hysteria there may be elements of defense operating
in the background, although I do not yet have definitive conclusions on this
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Although I find this topic fascinating, I understand that it may not arouse the same
interest in those who have not yet done a similar analysis
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I hope that the psychic properties revealed here may be valuable in the future for understanding the
dynamics of representations
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Therefore, it is simply a matter of
removing the resistances that block their access
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The situation is rarely as simple as it presents itself in individual cases, as it usually involves a set of linked symptoms rather than a
single traumatic memory and a single pathogenic representation
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In addition, the pathogenic material can have multiple cores, further complicating its organization
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We make use of a few similes here, although they are limited in their similarity and do not reconcile with each other
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Therefore, we continue to use these comparisons in the following pages, even though they may be questionable
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In fact, the term "narrowing of
consciousness" makes sense to the doctor who performs this type of analysis
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It is then the task of the therapist to reconstruct the organization from these fragments, like
putting together a jigsaw puzzle
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It is necessary to start
in the periphery and allow the patient to move freely, overcoming slight resistances with the pressure procedure
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It is important to
let the patient reproduce this material without interfering too much, even though it may seem disjointed, as it provides the basis
for future discerned connections
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It is important not to underestimate the importance of these weak points, as they can reveal the plot threads
being sought
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In such cases, we abandon the thread and assume another, continuing in this way until
one can advance directly to the core of the pathological organization
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We are astonished to convince ourselves that it is impossible to influence the patient about things that he does not know or to
anticipate the results of the analysis to generate expectations
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When I was right in my forecasts, multiple

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unexpected reminiscences proved me right, so there is no need to be afraid to express any opinion about the approaching nexus;
This is harmless
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Memory images
never emerge without any relevance, for each one has its meaning
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The
length of time a memory remains in the patient's consciousness is related to its meaning; A lingering image demands attention,
while a reminiscence never returns if it has been fully processed
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The symptom reappears or intensifies as soon as the region of the pathogenic organization related to that symptom is
addressed, accompanying the work with characteristic fluctuations
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This phenomenon has a practical drawback, as it is impossible to analyze a symptom in one go or distribute breaks that coincide
with moments of rest at work
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However, one must adapt to this situation, as it is impossible to manage it any other way
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It is also important to consider the patient's general condition during the analysis
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Every time a new aspect is clarified, or progress is made in the
work, the patient feels relieved, anticipating the liberation that is approaching
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It often happens that at first the work becomes coarser and more complicated as one penetrates the layered psychic products
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However, remission of pathological symptoms cannot be expected until each single symptom has been
fully analyzed
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When the test uncovers a memory or pathogenic link that was previously outside the patient's consciousness, the patient's reaction
may vary
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The
patient's acceptance of the new acquisition depends on the stratum of the analysis from which it comes
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In conclusion, during analysis, thoughts can be pursued from the conscious to the unconscious and vice versa, without altering the
very nature of the thought
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Finally, I must address a topic that plays a disproportionately influential role in the execution of a cathartic analysis of this nature
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However, there is a third case that represents an external obstacle: the disturbance
of the bond between the patient and the doctor, which is the most annoying obstacle that can be found in the analysis
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If this relationship is disturbed, the
patient's disposition is denied
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In particular, the transfer of embarrassing representations about the physician can become a significant obstacle
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However, once this obstacle was understood and addressed, the work was able to continue progressing
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In the process of psychoanalytic analysis, it is crucial to face the resistances that arise to achieve a successful outcome
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In some cases, such as that of one patient, resistance manifested itself during the pressure procedure, revealing unconscious ideas
that hindered treatment
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In other cases, resistance was not directly shown, but was discovered by redirecting the patient to the moment of origin
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At first, these situations could be awkward, but over time I learned to understand the process better
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Patients also learned to understand that these transfers to the doctor would dissipate at the end of the analysis
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In psychoanalytic analysis, facing the resistances that arise is critical to achieving a successful outcome
...

In some cases, such as that of one patient, resistance manifested itself during the pressure procedure, revealing unconscious ideas
that hindered treatment
...

In other cases, resistance was not directly shown, but was discovered by redirecting the patient to the moment of origin
...

At first, these situations could be awkward, but over time I learned to understand the process better
...

Patients also learned to understand that these transfers to the doctor would dissipate at the end of the analysis
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In short, confronting resistance is crucial in psychoanalytic analysis
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Explanation and conclusion:
The text describes an investigation into the etiology of hysterical symptoms and an effective therapeutic method discovered during
the study
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It is observed that this process allows repressed affect to express itself through
speech, leading to its associative rectification and integration into normal consciousness
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It is recognized that the method does not
eliminate all hysterical symptoms in all cases, but it is considered valuable in resolving residual symptoms, especially in chronic
cases
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The complexity of psychoanalytic analysis is addressed and the technical difficulties and strategies to overcome the patient's
resistance during the therapeutic process are highlighted
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Finally, it is concluded that facing resistance is essential to achieve a successful outcome in psychoanalytic analysis
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Main Ideas:
- Discovery of an effective therapeutic method to treat hysterical symptoms
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- Recognition of specific limitations and circumstances in the elimination of all hysterical symptoms
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- Need for favourable conditions and time to apply the cathartic method
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- Detailed description of the process of psychoanalytic analysis, including overcoming resistance and the importance
of making obstacles conscious
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- Observations on the importance of the doctor-patient relationship and the impact on the therapeutic process
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