time distort reality. All the defense mechanisms
operate actively and involuntarily, without the per-
son’s awareness.
The basic ego defense isrepression.Thiscanbe
described as the banishment from consciousness of
highly threatening sexual or aggressive material. In
some instances, the process operates by preventing
the offending impulse from reaching consciousness
in the first place.Fixationoccurs when the frustration
and anxiety of the next psychosexual stage are so
great that the individual remains at his or her pre-
sent level of psychosexual development.Regression
involves a return to a stage that earlier provided a
great deal of gratification; this may occur following
extensive frustration. Reaction formation is said to
occur when an unconscious impulse is consciously
expressed by its behavioral opposite. Thus,“Ihate
you” is expressed as “I love you.” Projection is
revealed when one’s unconscious feelings are attrib-
uted not to oneself but to another. Thus, the feeling
“Ihateyou”is transformed into“You hate me.”
From Theory to Practice
As mentioned earlier, Breuer’s experiences with
Anna O. led to the discovery of the “talking
cure.”This in turn became transformed into free
association during Freud’s work with Elisabeth.
Free associationmeant simply that the patient was
to say everything and anything that came to mind
regardless of how irrelevant, silly, dull, or revolting
it might seem. Freud also realized that Anna had
transferred onto Breuer many of her feelings that
really applied to significant males in her life. This
notion oftransferencewould eventually become a
valuable diagnostic tool during therapy for under-
standing the nature of the patient’s problems—
especially the unconscious ones.
Through hypnosis, Freud learned that patients
could relive traumatic events associated with the
onset of the hysterical symptom. In some cases,
this reliving served to release formerly bottled-up
energy. This became known ascatharsis—a release
of energy that often had important therapeutic ben-
efits. In his work with Elisabeth, Freud also wit-
nessedresistance—a general reluctance to discuss, to
remember, or to think about events that are partic-
ularly troubling or threatening. He viewed this as a
kind of defense, but later he also analyzed it as
repression—the involuntary banishing of a thought
or impulse to the unconscious. Theunconscious,of
course, is the area of the mind inaccessible to con-
scious thought.The Role of Insight
The ultimate goal of psychoanalytic intervention is
the removal of debilitating neurotic problems. But
the unswerving credo of the traditional psychoana-
lytic therapist is that, ultimately, the only final and
effective way of doing this is to help the patient
achieveinsight. What does insight mean? It means
total understanding of the unconscious determi-
nants of those irrational feelings, thoughts, or beha-
viors that are producing one’s personal misery.
Once these unconscious reasons are fully con-
fronted and understood, the need for neurotic
defenses and symptoms will disappear. All of the
specific techniques described later in this chapter
have as their ultimate purpose the facilitation of
insight.
An analysis culminating in insight is slow,
tedious, and often very lengthy. An orthodox anal-
ysis is not measured in weeks or months but in
years. This is because the patient is not simply
informed, for example, that unconscious feelings
of hostility and competitiveness toward a long-
departed father are causing present outbursts against
friends, a boss, or coworkers. At an intellectual
level, the patient may readily concede this interpre-
tation. But the unconscious is not likely to be much
affected by such sterile information. The patient
must actually experience the unconscious hostility.
This may happen through the transference process;
early experiences associated with the father may be
relived as competition with the therapist begins to
occur. The analyst begins to seem like that father
of years gone by, and all the old reactions start
flooding back. As the therapist comes to stand for
someone else (the father), old emotions are re-
experienced and then reevaluated. From this
comes a deeper insight.PSYCHOTHERAPY: THE PSYCHODYNAMIC PERSPECTIVE 349