Many facts in the present article emerged in a Swedish context. Nevertheless, they are of great international importance, and they are not referred to elsewhere as often as they deserve.
In the autumn 2006 the medical journal of The Swedish Medical Association devoted an entire issue to a survey of all variants of psychotherapies applied in Sweden. But no more than two passing remarks mentioned negative side-effects and both asserted (falsely) their absence.
Hans Bendz is head physician at Lund University Hospital. He wrote a criticism in which he called attention to the methodological error of ignoring negative side-effects. He also stated that he had for a life-time seen such effects in his own patients, and he had likewise experienced them as a patient. (In Sweden every psychiatrist must undergo psychodynamic therapy, or else he will get no licence.)
I continued the debate, but emphasised that psychotherapists do not always deem negative effects to be undesirable. The overwhelming majority of talking therapy is based on psychoanalysis. However, I shall start with Nils Haak (1957). The reason is that he has openly stated many things in public print, which most other psychoanalysts consider it wise to conceal.
Haak was an ego-analyst. During three periods he was the chairman of the Swedish Association of Psychoanalysis. He could not have held this position, if his colleagues did not have much confidence in him. He asserted that the patient shall not receive from the treatment what he wants (e.g., symptom removal). Instead he shall have something else, which he is not in the least interested in. This other thing is called by Haak “psychic health”. Haak goes on to say that the endeavour to give the other thing to the patient will often, as a perfectly normal outcome, lead to nervous breakdown and suicide attempts.
Certainly a strange form of psychic health.
The ethical aspects should not be overlooked. A psychoanalyst could not pursue such a policy, unless most patients were deceived into believing that he did indeed work toward the patients’ aims. But Haak evidently thinks that he and his colleagues have the right to deceive their patients.
Jill & David Scharff (1994) are object relation psychoanalysts. They have published a case-study of a female patient called “Freda”. Both treated her for 15 years. As for her ailments when the treatment started we are only told that she, who had experienced two Caesarean sections, felt pain during intercourse. As for profits at the end of the treatment we are told nothing at all. However, after some years of psychoanalysis Freda had to be admitted to a hospital and be given heavy doses of anti-depressive medicine.
Just like Haak, Scharff & Scharff consider this to be a normal effect of the treatment. In addition, none of them expects to be compromised by providing such strange information.
A digression may be appropriate. What would a competent and honest therapist have done? There are two obvious solutions. First, a specific coitus stool has been invented for fat men, who might otherwise press too heavily on the woman. This simple aid might well have prevented Frida’s pain. – Second, the coitus position could be changed. Note that when change is needed for medical reason, there are more positions to choose from, than those described in manuals for couples who merely want variation.
I am aware that some women would rather abstain from sex than accept anything else than the missionary position. But exactly in the case of Freda, Scharff & Scharff have proved their skill for persuasion. They persuaded her to believe that her coitus pain was hardly caused by the Caesarean sections but primarily by sexual abuse by both her parents. During the abuse her father would dress in the mother’s clothes including her bra, which he would fill with her stockings. And after some ten years the therapists made Freda “confess” to her husband and children what the grandparents “had done” to her.
We do not know if Freda was averse to anything else than the missionary position. But if she was, it could not have been difficult to change such an attitude, for therapists who are capable of producing such variety of abuse “memories”.
Back to the main subject. Hanns Sachs who was trained by Freud said to E.G. Boring (1963) that if a patient did not have a neurosis when he started psychoanalytic treatment he would develop a neurosis.
Many people undergo psychoanalysis, although they are not sick. But I can name some persons who never took any sedatives before the start, but who eventually took a continually increasing dose in order to stand the treatment.
Suicide was frequent among patients treated by the first generation of psychoanalysts; in particular among those who were treated by Anna Freud and Paul Federn (Bénesteau, 2002). Far from all were disposed in advance. Later, Jacques Lacan has produced many suicides. But this fact has not diminished his prestige among French psychoanalysts (Tallis, 1997).
From the very beginning psychoanalysts have asserted that they are very careful not to influence the patient. They go on to say that the psychoanalytic situation is markedly similar to the experimental laboratory. The absence of influence of the psychoanalyst guarantees that the causes of the patients’ reactions derive from the patient him- or herself.
Unfortunately, the truth is that psychoanalysis has always been a persuasion therapy and an aversion therapy. Persuasive techniques have been applied in order to produce belief in the interpretations. And specific enraging techniques have been used to produce outbursts of impotent rage. Until recently all psychoanalysts agreed that such outbursts constitute a necessary experience for the patient on the road toward psychic health. Therefore they constitute a necessary effect of the treatment. Today some psychoanalysts may in public contexts pay lip service to the view that such outburst are neither necessary nor frequent. But what they say in public may be no indication of what they do in the secrecy of the consultation room.
No one has described the enraging techniques better than Jay Haley (1963).
Just like his colleagues, Edmund Bergler (1958, 1971) claims that the treatment is free from any danger. He also claims to behave in a friendly manner toward his patients and to be “an innocent bystander”. Moreover: “In analysis, you are confronted with an unusual situation – nobody is in reality unjust”.
At the same time Bergler quotes many of his own aggressive statements, such as “You have the mind of a blackmailer.”
Besides, at least until the last decade most psychoanalysts have been blind to the aggressive and contemptuous nature of Freud’s (1941, 1964) scoldings of his 18-year-old patient Dora.
Admittedly, the persuasive and enraging techniques applied today are much more sophisticated. But the goal has not changed.
Stronger than most other psychoanalysts L. S. Kubie (1960) and Heinz Hartmann (1959) have emphasised the absence of influence. But they are well aware that they were not telling the truth. Scharnberg (2007) has exemplified Hartmann’s distortions. And when the 15-year-old son of Hollywood producer Leland Hayward’s dropped out of school, the father took him to Kubie (the father’s own psychoanalyst). Kubie locked up the son in a clinic, and he was given the choice between the ice water torture and “voluntary” psychoanalysis. For the rest of his life the son hated his father because of those four years of imprisonment Kubie had given him (Farber & Green, 1993)
Perhaps we should not forget Psychotherapy for Better or Worse. The Problem of Negative Effects by Strupp (1977) and his co-workers. They do document many negative outcomes. But few of their examples are at the level of those patterns I have presented here.
For 40 years I have emphasised that audio-recordings of psychoanalytic dialogues constitute the best evidence about what happens in the consultation room. If patients come to believe in the interpretations despite the absence of persuasive techniques, and if they have aggressive outbursts despite the absence of enraging techniques, then both these facts will be seen from the audio-recordings.
This is the kind of evidence that would have convinced critics, if it existed. But psychoanalysts have wisely abstained from presenting such evidence. And I take for granted that no contemporary psychoanalyst would attribute any evidential power to Lindner (1944) and Berg (1946). Admittedly, Gill & Hoffman (1989) have published audio-recorded entire sessions. And these dialogues are indeed interesting, because they illustrate the absence of any psychoanalytic phenomena – except by hair-splitting and twisting interpretation such as the following:
“[…] the session contains an interesting example of associations that probably allude to the transference via displacement and identification at the same time. […] in speaking of her feelings about being rejected by her first boyfriend, the patient may be alluding simultaneously to her fear of rejection by the therapist (displacement) and to her suspicion that he feels rejected by her (identification).”
Gill & Hoffman think that Freud had established the principles of psychoanalytic technique already in 1898. I shall not object. But Wilcocks (2000) scrutinised all Freud’s papers on technique and rightly concluded:
“The ‘Papers on Technique’, given their intended audience, are probably among the most damaging and reprehensible that Freud ever wrote.”
At the same time extremely few critics of psychoanalysis have published such recordings. But Scharnberg (1996) belongs to these. Twelve chapters are devoted to the examination of eleven audio-recorded psychoanalytic sessions. The analyst, who is a medical doctor, is called Lambdason, and the patient is called Deltason. However, it is not my view that all psychoanalysts behave like Lambdason; and neither that coarse aggression is what primarily injures patients.
Deltason is serious ill, and Lambdason has in print stated that it is not at all the aim of psychoanalysis to cure neurotic symptoms. In contrast to Deltason, Lambdason is perfectly aware of the existence and efficacy of behaviour therapy. But it never occurred to him to refer the patient to a different kind of a therapist. The audio-recordings clearly reveal his aim: to induce Deltason to believe in psychoanalysis and, foremost, to believe that he himself is sick only because he wants to suffer.
Lambdason begins the contact with a monologue of four minutes. He states that Deltason is still ill at the present time solely because he had actively sabotaged his former therapists’ endeavour to help him. Consequently, Lambdason must be very careful not to say anything that could offend him. Because then Deltason will immediately run away and fancy that he had got one more proof that nobody would help him.
Apart from the fact that Lambdason knew nothing about the patient’s previous therapies, it is noteworthy that Lambdason did not realise that this monologue is conspicuously offensive. But during the entire audio-recorded treatment he is completely blind of his own aggressions. He is so even when he shouts his interpretations with intense rage. One example of his blindness.
L: I am going to tell your doctor that Mr. Deltason he cannot keep his thoughts together because he is a little loony.
D: It is nice that you can see it in that way.
L: Once more you are again there with your aggressions!! Don’t you realise how you are provoking me!?
Deltason took a large but unchanging dose of medicine. But after four sessions of psychoanalysis he had quintupled his dose. Lambdason did not consider this a reason to change his behaviour. However, in the case-notes he wrote that the increased dose was an act of aggression against the analyst.
And when Deltason says that non-analysts have found no masochism and hostility in him, Lambdason shouts the following answer.
L: They do not grasp anything at all about such things. Analysts are used to consult their counter-transference, the others are not. They are so bloody ignorant. They just talk rubbish. It is quite possible that they do not feel that you are a masochist but how would they be able to help you then?
Lambdason definitely satisfies the rule that the treatment should provide something that the patient is not interested in. And apart from his blindness of his own aggressions, he postulates a super-human infallibility for himself. However much psychotherapists may admit in public contexts that their interpretations have merely “narrative truth”, in the secrecy of the consultation room they will, more often than not, apply them as absolute truths, which at any cost must be forced upon the patient.
Bénesteau, Jacques (2002): Mensonges freudiens. Histoire d’une désinformation séculaire. Sprimont, Belgique: Mardaga.
Berg, Charles (1946): Deep Analysis. London: Allen & Unwin.
Bergler, Edmund (1958): Counterfeit-Sex. New York: Grune & Stratton.
Bergler, Edmund (1971): Homosexuality – Disease or Way of Life? New York: Collier Books.
Boring, E. G. (1963): Was This Analysis a Success? in: Rachman, Stanley (ed.): Critical Essays on Psychoanalysis. 16-23 Oxford: Pergamon Press.
Farber, Stephen & Green, Marc (1993): Hollywood on the Couch. New York: William Morrow. S. 77ff.
Freud, Sigmund (identical prints of many years): Bruchstück einer Hysterie-Analyse. Gesammelte Werke, Band V. London: Imago [or] Frankfurt a. M.: S. Fischer
Freud, Sigmund (1964 or later identical reprints): Fragment of an Analysis of a Case of Hysteria. The Standard Edition of the Complete Psychological Works of. Vol. VII. London: Hogarth. (transl.: James Strachey)
Gill, Merton M. & Hoffman, Irwin Z. (1989): Analysis of Transference. New York: International Universities Press.
Haak, Nils (1957): Comments on the Analytical Situation. International Journal of Psychoanalysis, 38:183-195
Haley, Jay (1963): Strategies of Psychotherapy. New York: Grune & Stratton.
Hartmann, Heinz (1959): Psychoanalysis as a scientific theory. in: Hook, S. (ed.): Psychoanalysis, Scientific Method and Philosophy. New York: New York University Press.
Kubie, Lawrence S. (1960): Psychoanalysis and scientific method. Journal of Nervous and Mental disease, 131:495-512
Lindner, Robert (1944): Rebell Without a Cause. New York: Grune & Stratton.
Scharff, Jill Savege & Scharff, David (1994): Object Relation Therapy of Physical and Sexual Trauma. Northwale, N.J.:Aronson.
Scharnberg, Max (1996): Textual Analysis: A Scientific Approach for Assessing Cases of Sexual Abuse. I: The Theoretical Framework, the Psychology of Lying, and Cases of Older Children. Uppsala: Uppsala Studies in Education no. 64, kap. 57-68.
Scharnberg, Max (2007): Tales from the Vienna Woods. Internet: International Network of Freud Critics.
Strupp, H. H. & Hadley, S. W. & Gomes-Schwartz, B. (eds.) (1977): Psychotherapy – for Better or Worse. The Problem of Negative Effects. New York: Jason Aronson.
Tallis, Raymond (1997): The Shrink from Hell. [Review of Elizabeth Roudinesco: Jacques Lacan & Co.: A History of Psychoanalysis in France, 1925-1985. This is the English translation of La Bataille de cent ans: histoire de la psychanalyse en France, vol. 2] The Times Higher Education Supplement, 20, 31 October 1997, p. 20. reprinted in Internet: International Network of Freud Critics; also in The Raymond Tallis Reader. (Ed. Michael Grant, Palgrave, 2000 (pp. 284-288).
Wilcocks, Robert (2000): Mousetraps and the Moon. The Strange Ride of Sigmund Freud and the Early Years of Psychoanalysis. Lanham: Lexington.