Glover - The Therapeutic Effect of Inexact Interpretation
Glover - The Therapeutic Effect of Inexact Interpretation
Glover - The Therapeutic Effect of Inexact Interpretation
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transference neurosis threatens to bring out deep anxiety or guilt together with their
covering layer of repressed hate. One is apt to forget, however, that the same
factors can operate in a more unobtrusive way and take effect at a much later date
in analysis. In this case the gradual disturbance of deep guilt is undoubtedly the
exciting cause of increased repression. According to this view cures effected in the
absence of knowledge of specific phantasy systems would be due to a general
redressing of the balance of conflict by true analytic means, bringing in its train
increased effectiveness of repression.
If we accept this view we can afford to neglect the practical significance of
inexact interpretations. It will be agreed of course that in the hypothetical case we
are considering, many of the interpretations would be inexact in that they did not
uncover the specific phantasy system, although they might have uncovered systems
of a related type with some symbolic content in common. Nevertheless, we are
scarcely justified in neglecting the theoretical significance of inexact
interpretations. After all, if we remember that neuroses are spontaneous attempts at
self-healing, it seems probable that the mental apparatus turns at any rate some
inexact interpretations to advantage, in the sense of substitution products. If we
study the element of displacement as illustrated in phobias and obsessions, we are
justified in describing the state of affairs by saying that the patient unconsciously
formulates and consciously lives up to an inexact interpretation of the source of
anxiety. It seems plausible, therefore, that another factor is operative in the cure of
cases where specific phantasy systems are unknown; viz. that the patient seizes
upon the inexact interpretation and converts it into a displacement-substitute. This
substitute is not by any means so glaringly inappropriate as the one he has chosen
himself during symptom formation and yet sufficiently remote from the real source
of anxiety to assist in fixing charges that have in any case been considerably
reduced by other and more accurate analytic work. It used to be said that inexact
interpretations do not matter very much, that if they do no good at any rate they do
no great damage, that they glide harmlessly off the patient's mind. In a narrow
symptomatic sense there is a good deal of truth in this, but in the broader analytic
sense it does not seem a justifiable assumption. It is probable that there is a type of
inexact interpretation which, depending on an optimum degree of psychic
remoteness from the true source of anxiety, may bring about improvement in the
symptomatic sense at the cost of refractoriness to deeper analysis. A glaringly
inaccurate interpretation
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treatment of narcissistic neuroses and less rapid (if ultimately more radical) results
in the transference neuroses. The deep examination of guilt layers might be
expected to postpone alleviation in cases where the maladaptation lay more
patently in the libidinal organization.1
One more comment on 'incomplete' interpretation. Apart from the degree of
thoroughness in uncovering phantasy, an interpretation is never complete until the
immediate defensive reactions following on the interpretation are subjected to
investigation. The same applies to an interpretation in terms of 'guilt' or 'anxiety':
the latter is incomplete until the phantasy system associated with the particular
affect is traced. The tracing process may lead one through a transference repetition
to the infantile nucleus or through the infantile nucleus to a transference repetition
(7).
Turning now to the non-analytical aspect of the problem, there are one or two
points worthy of consideration. The psycho-analyst has never called in question the
symptomatic alleviation that can be produced by suggestive methods either of the
simple transference type or of the pseudo-analytical type, i.e. suggestions based on
some degree of interpretative appreciation. He has of course queried the
permanence of results or speculated as to the price paid for them in general
happiness or adaptability or emotional freedom. But he could not very well
question the occurrence of such alleviations; in his own
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consultative practice the analyst has many occasions of observing the therapeutic
benefit derived from one or more interviews. Even in this brief space he is able to
observe the same factors at work which have been described above. Patients get
better after consultation either because they have relieved themselves of trigger
charges of anxiety and guilt, or because they have been frightened off
unconsciously by the possibility of being analysed or because in the course of
consultation the physician has made some fairly accurate explanations which are
nevertheless sufficiently inexact to meet the patient's need.
Strictly speaking this observation is not an analytical one, but taken in
conjunction with the earlier discussion of the effect of inexact interpretation in
actual analysis, it seems to justify some reconsideration of current theory of
suggestion. One is tempted to short-circuit the process by stating outright that
whatever psychotherapeutic process is not purely analytical must, in the long run,
have something in common with the processes of symptom formation. Unless we
analyse the content of the mind and uncover the mental mechanisms dealing with
this content together with its appropriate affect, we automatically range ourselves
on the side of mental defence. When therefore an individual's mental defence
mechanisms have weakened and he goes to a non-analytical psychotherapeutist to
have his symptoms (i.e. subsidiary defences) treated, the physician is bound to
follow some procedure calculated to supplement the secondary defence (or
symptomatic) system. He must employ a tertiary defence system.
Theoretical considerations apart, it would seem reasonable to commence by
scrutinizing the actual technique employed in suggestion. This can be done most
conveniently by using a common standard of assessment, to wit, the amount of
psychological truth disclosed to the patient. Or, to reverse the standard, suggestive
procedure can be classified in accordance with the amount of deflection from
psychological truth, or by the means adopted to deflect attention.
Using these standards it would no doubt be possible to produce an elaborate
sub-division of methods, but there is no great advantage to be obtained by so
doing. It will be sufficient for our purpose to contrast a few types of suggestive
procedure, using analytical objectivity as the common measure. The most extreme
form of deviation from objectivity is not generally regarded as a suggestive method
at all. Yet there is no doubt that it belongs to suggestive procedure and produces
very definite results. It is the method of 'neglect' combined with 'counterstimulation' employed by the general practitioner or
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consultant (8). The psychological truth is not even brushed aside; it is completely
ignored. Nevertheless, stimulated no doubt by intuitive understanding of counterirritations and attractions, the practitioner recommends his patient to embark on
activities outside his customary routine. He advises a change of place (holiday) or
of bodily habit (recreation, sport, etc.) or of mental activity (light reading, musichall, etc.). The tendencies here are quite patent. The physician unwittingly tries to
reinforce the mechanism of repression (neglect) and quite definitely invokes a
system of counter-charge, or anticathexis. His advice to go for a holiday or play
golf or attend concerts is therefore an incitement to substitute (symptom) formation.
And on the whole it is a symptom of the obsessional type. The patient must do or
think something new (obsessional ceremonial or thought), or take up some counter
attraction (anticathexis, cancellation, undoing, expiation). This counter-charge
system no doubt contributes to the success of the general manoeuvre but the
repression element is important. The physician encourages the patient by
demonstrating his own capacity for repression. He says in effect, 'You see, I am
blind; I don't know what is the matter with you: go and be likewise'.
The next group, though officially recognized, does not differ very greatly from
the unofficial type. It includes the formal methods of suggestion or hypnotic
suggestion. Here again the tendency is in complete opposition to the analytical
truth; but the repression aspect is not so strongly represented. The suggestionist
admits that he knows something of his patient's condition but either commands or
begs the patient to neglect it (auxiliary to repression). The patient can and will get
better, is in fact better and so on. To make up for the inherent weakness of the
auxiliary system, the suggestionist goes through various procedures (suggestions or
recommendations) that are again of an obsessional type. Interest has to be
transferred to 'something else' more or less antithetical in nature to the pathogenic
interest; and of course in hypnotic procedure there are always remainders of
magical systems (gestures and phrases).
A third group is distinguished by the fact that a certain amount of use is made of
psychological truth or analytic understanding. Explanations varying in detail and
accuracy are put before the patient or expounded to him. This is followed by direct
or indirect suggestion. By exhortation or persuasion or implication the patient is
led to believe that he is now or ought now to be relieved of his symptoms.
Auxiliary suggestions of an antithetical type may or may not be added. Although
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varying in detail, all these procedures can be included under one heading, viz.:
pseudo-analytical suggestion. And as a matter of fact, although the view has
aroused much resentment, analysts have made so bold as to describe all pseudoFreudian analysis as essentially pseudo-analytic suggestion. The only difference
they can see is that no open suggestive recommendations are made in the second or
third stage of the procedure. As however the negative transference is not analysed
at all, and very little of the positive, a state of rapport exists which avoids the
necessity for open recommendation. Despite this, and presumably to make
assurance doubly sure, a good deal of oblique ethical or moral or rationalistic
influence is exerted.
There is one feature in common to all these methods; they are all backed by
strong transference authority, which means that by sharing the guilt with the
suggestionist and by borrowing strength from the suggestionist's super-ego, a new
substitution product is accepted by the patient's ego. The new 'therapeutic symptom
construction' has become, for the time, ego-syntonic.2
At this point the critic of psycho-analysis who for reasons of his own is anxious
to prove that psycho-analysis is itself only another form of suggestion, may argue
as follows: if in former times analysts did not completely uncover unconscious
content, then surely the analytic successes of earlier days must have been due in
part to an element of suggestion in the affective sense as distinct from the verbal
sense. It may be remembered that the old accusation levelled against psychoanalysis was that analytic interpretations were disguised suggestions of the 'verbal'
or ideoplastic order. At the risk of being tedious the following points must be made
clear. Analysis has always sought to resolve as completely as possible the
affective analytic bond, both positive and negative. It has always pushed its
interpretations to the existing maximum of objective understanding. It is certainly
possible that the factor of repression (always an unknown quantity) has dealt with
psychic constructions that were incompletely interpreted, but analysis has always
striven its utmost to loosen the bonds of repression. It is equally possible that when
interpretation has been incomplete some displacement systems are left to function
as substitutes or anticathexes; nevertheless analysis has always endeavoured to
head
2 I have omitted here any detailed description of the dynamic and topographic
changes involved in the processes of suggestion. These have been exhaustively
described by Ernest Jones in the papers already quoted.
3 In a personal communication Mrs. Riviere has emphasized the importance of
sadistic factors in any assessment of analytic or suggestive method.
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off all known protective displacements. In short, it has never sought to maintain a
transference as an ultimate therapeutic agent; it has never offered less than the
known psychological truth; it has never sided with the mechanisms of repression,
displacement or rationalisation. Having made its own position clear, psychoanalysis offers no counter-attack to the criticism. It offers instead a theory of
suggestion. It is prepared to agree that the criticism might be valid for bad analysis
or faulty analysis or pseudo-analysis. It adds, however, that bad analysis may
conceivably be good suggestion, although in certain instances it has some
misgivings even on this point. For example, it has always been poor analysis to stir
up repressed sadistic content and then, without analysing the guilt reactions fully,
to remove the props of displacement. And it has probably always been good
suggestion to offer new or reinforced displacement substitutes and to buttress what
tendencies to withdraw cathexis are capable of conscious support. It is
conceivably bad suggestion or more accurately bad pseudo-analytic suggestion to
disturb deep layers of guilt. Presumably a good deal of the success of ethical
suggestion and side-tracking is due not only to the fact that the patient's sadistic
reactions are given an extra coating of rationalization, but to the fact that the
sidetracking activities recommended act as obsessional 'cancellings' of
unconscious sadistic formations.3
In addition to these two factors of repression and substitution there is a third
fundamental factor to be considered. A great deal of information has now been
collected from various analytical sources to show that at bottom mental function is
and continues to be valued in terms of concrete experience. There has of course
always been some academic interest in the relation of perceptual to conceptual
systems, but the contributions of psycho-analysis to this subject have been so
detailed and original that it is for all practical purposes a psycho-analytical
preserve. For the unconscious a thought is a substance, a word is a deed, a deed is
a thought. The complicated variations which psycho-analysis has discovered
within this general system depend on the fact that in the upper layers of the
unconscious (if we may use this loose topographical term) the substance is
regarded as having different origin, properties and qualities. Put systematically;
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the nature of the substance depends upon the system of libidinal and aggressive
interest in vogue during the formation of the particular layer of psychic
organization.
During the primacy of oral interest and aggression, all the world's a breast and
all that's in it good or bad milk. During the predominance of excretory interest and
anal mental organization, all the world's a belly. During infantile genital phases,
the world at one time is a genital cloaca, at another a phallus. The overlappings
and interdependence of these main systems give rise to the multiplicity and variety
of phantasy formations. One element is however common to all phases, and
therefore is represented in all variations of phantasy. This is the element of
aggression direct or inverted. So all the substances in the world are benign or
malignant, creative or destructive, good or bad.
Psycho-analysts have shown over and over again that, given the slightest
relaxation of mental vigilance, the mind is openly spoken of as a bodily organ. The
mind is the mouth; talk is urine or flatus, an idea is fertile and procreative. Our
patients are 'big with thought' and tell us so when off guard. This has been
demonstrated with considerable detail in the analysis of transference phantasies.
An interpretation is welcomed or resented (feared) as a phallus. Analysts are
reproached for speaking and for keeping silent. Their comments are hailed as
sadistic attacks; their silences as periods of relentless deprivation. In short,
analysis is unconsciously regarded as the old situation of the infant in or versus the
world. An interpretation is a substance, good or bad milk, good or bad fces or
urine (or baby, or phallus). It is the supreme parent's substance, friendly or hostile;
or it is the infant's substance, returning in a friendly or malignant form, after a
friendly or hostile sojourn in the world.
As I have pointed out elsewhere (9) this innate tendency of the mind is a
perpetual stumbling block to objectivity not only on the patient's part but on the
part of the analyst. It must be constantly measured and allowed for in all stages of
analysis. This measurement and uncovering is the essence of transference
interpretation. In both transference and projection forms it plays a large part in the
fear of analysis which is universally observed. Only the other day a patient with
intuitive understanding of symbolism, but without any direct or indirect orientation
in analytic procedure expressed the following views during the first stage of
analysis: words are really urine and the stream of urine is an attacking instrument:
associations may be either unfriendly or friendly urine: interpretation is generally
friendly urine,
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except on days when erotic and sadistic phantasies are important: when the
associations are bad the urine is bad; when the interpretation is bad the analyst is
putting bad urine into the patient: the patient must get it out or as the case may be
the analyst must take it out. Prognostically speaking the situation in this case was
not very good, but the material was entirely spontaneous.
As has been remarked this innate tendency of the mind is a perpetual stumbling
block to analysis. But what is a stumbling block to analysis may be a keystone to
suggestion. At any rate part of a key structure. From the earliest times some
appreciation of the significance of 'substance' has crept into theories of suggestion;
it is to be seen in the old belief in a 'magnetic fluid' and in the quite modern
'implantation' theories of Bernheim and others (ideoplasty). And it seems plausible
that these, in their time apparently scientific explanations, are remote derivatives
from a more primitive 'concrete' ideology such as is to be studied in the animistic
systems of primitives, the delusional systems of paranoiacs and (given analytical
investigation) the transference systems of neurotics. Janet, it will be remembered,
regarded the 'somnambulistic passion' or craving as comparable with the craving
of drug addicts; and Ernest Jones (3) has pointed out the relation of this to psychoanalytic ideas concerning the significance of alcohol (Abraham). Discredited or
inadequate theories of suggestion thus come into their own in an unexpected
fashion. They give us one more hint of the nature of hypnotic and suggestive
rapport. And they give us some hint of the therapeutic limits of pseudo-analytic
suggestion. The essential substance, symbolized by words or other medium of
communication, must be a friendly curative substance. It must be capable of filling
a dangerous space in the patient's body-mind, it must be able to expel gently the
dangerous substances in the patient's body-mind, or at the least it must be able to
neutralize them. In the process of neutralizing guilt, it must not awaken anxiety. The
hysteric, for example, must not be made psychically pregnant in the course of
psychic laparotomy. So the pseudo-analytical suggestionist does well to alleviate
anxieties before administering his suggestive opiate for guilt. And he should steer
clear of analysing sadism. The general practitioner sets him a good example in his
unofficial and unwitting system of suggestion (8). As we have seen the latter not
only weighs in on the side of repression and inculcates policies of obsessional
anticathexis, but he caters for the patient's fundamental core of paranoia. He doesn't
know what is wrong with his patient's mind but
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he knows, or thinks he knows, what is wrong with his patient's intestinal system.
And he uses cathartic drugs or gentle laxatives to drive out the poison, following
them up with friendly tonics and invigorating hmatinics. In this way he deals with
the paranoidal and dangerous omnipotence systems of his patient, without bringing
the mind into the matter at all. The suggestionist who openly endeavours to deal
with mind through mind should remember that in the last resort he must base his
suggestive interferences on a system of 'friendly paranoia'. Here again the
difference between suggestion and true analysis becomes apparent. Analysis must
at all times uncover this deepest mental system: the suggestionist with an eye on his
patient's anxiety reactions must invariably exploit it.
Conclusion.There are many other factors in the operation of suggestion,
concerning which analysis has had or will have much to say. But for the present
purpose it is unnecessary to go into greater detail. Examination of the effect of
inexact interpretation in analysis focusses our attention on the possibility that what
is for us an incomplete interpretation is for the patient a suitable displacement. By
virtue of the fact that the analyst has given the interpretation, it can operate as an
ego-syntonic displacement system (substitution-product, symptom). Applying this
to the study of methods of suggestion, we see that suggestion technique varies in
accordance with the emphasis placed on various defensive mechanisms. All
methods depend on the mechanism of repression, but as regards auxiliaries to
repression there are quite definite variations in method. In general, non-analytical
types of suggestion, by virtue of their complete opposition to the psychological
truth and the stress they put on modifications of conduct and thought, might be
regarded as 'obsessional systems of suggestion'. Pseudo-analytical types, although
nearer the truth, are yet sufficiently remote to operate by focussing energy on a
displacement, and in this respect might be called 'hysterical suggestions of a
phobiac order'. But the most original and in a sense daring technician, who seldom
gets credit for being an expert in suggestion, is the general practitioner or
consultant. Intuitively he attempts to deal at once with the patient's superficial
anxiety layers and his deepest guilt layers. He is unwittingly a pure 'hysterical
suggestionist' in the sense that he plumps for repression and tacitly offers his own
repressions (ignorance) as a model; but by his use of drugs he shows intuitive
appreciation of the deeper cores of guilt which, under other circumstances, give
rise to paranoia. And he plays the rle of the 'friendly persecutor'. He is
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REFERENCES
Freud Group Psychology and the Analysis of the Ego Hogarth Press 1922 []
Ferenczi 'Introjection and Transference' Contributions to Psycho-analysis 1916
Ernest Jones 'The Action of Suggestion in Psychotherapy'; 'The Nature of Autosuggestion' Papers on Psycho-analysis Baillire, Tindall & Cox 1923 340-381,
382-403
Abraham 'Psycho-analytical Notes on Cou's Method of Self-mastery' Int. J.
Psychoanal. 1926 vii 190-213 []
Rad 'The Economic Principle in Psycho-Analytic Technique' Int. J. Psychoanal.
1925 vi 35-44 []
'The Significance of Precipitating Factors in Neurotic Disorder' A Symposium held
by the British Psycho-Analytical Society May 6, 1931
Glover 'The Technique of Psycho-Analysis' (JOURNAL SUPPLEMENT, No. 3)
1928 []
Glover 'The Psychology of the Psychotherapist' British Journal of Medical
Psychology 1929 ix 1-16 []
Glover 'Introduction to the Study of Psycho-analytical Theory' Int. J. Psychoanal.
1930 xi 471-484 []
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Copyright 2016, Psychoanalytic Electronic Publishing. All Rights Reserved. This download is only for the personal use of UniParisDiderot.