had led to illness, and the promise that another will pave the way to health; secondly, the powerful change of all conditions since the time of that first rejection. At that time the ego had been weak, infantile and may have had reason to denounce the claims of the libido as if they were dangerous. Today it is strong, experienced and is supported by the assistance of the physician. And so we may expect to guide the revived conflict to a better issue than a suppression, and in hysteria, fear and compulsion neuroses, as I have said before, success justifies our claims.
There are other forms of illness, however, in which our therapeutic procedure never is successful, even though the causal conditions are similar. Though this may be characterized topically in a different way, in them there was also an original conflict between the ego and libido, which led to suppression. Here, too, it is possible to discover the occasions when suppressions occurred in the life of the patient. We employ the same procedure, are prepared to furnish the same promises, give the same kind of help. We again present to the patient the connections we expect him to discover, and we have in our favor the same interval in time between the treatment and these suppressions favoring a solution of the conflict; yet in spite of these conditions, we are not able to overcome the resistance, or to remove the suppression. These patients, suffering from paranoia, melancholia, and dementia praecox, remain untouched on the whole, and proof against psychoanalytic therapy. What is the reason for this? It is not lack of intelligence; we require, of course, a certain amount of intellectual ability in our patients; but those suffering from paranoia, for instance, who effect such subtle combinations of facts, certainly are not in want of it. Nor can we say that other motive forces are lacking. Patients suffering from melancholia, in contrast to those afflicted with paranoia, are profoundly conscious of being ill, of suffering greatly, but they are not more accessible. Here we are confronted with a fact we do not understand, which bids us doubt if we have really understood all the conditions of success in other neuroses.
In the further consideration of our dealings with hysterical and compulsion neurotics we soon meet with a second fact, for which we were not at all prepared. After a while we notice that these patients behave toward us in a very peculiar way. We thought that we had accounted for all the motive forces that could come into play, that we had rationalized the relation between the patient and ourselves until it could be as readily surveyed as an example in arithmetic, and yet some force begins to make itself felt that we had not considered in our calculations. This unexpected something is highly variable. I shall first describe those of its manifestations which occur frequently and are easy to understand.
We see our patient, who should be occupying himself only with finding a way out of his painful conflicts, become especially interested in the person of the physician. Everything connected with this person is more important to him than his own affairs and diverts him from his illness. Dealings with him are very pleasant for the time being. He is especially cordial, seeks to show his gratitude wherever he can, and manifests refinements and merits of character that we hardly had expected to find. The physician forms a very favorable opinion of the patient and praises the happy chance that permitted him to render assistance to so admirable a personality. If the physician has the opportunity of speaking to the relatives of the patient he hears with pleasure that this esteem is returned. At home the patient never tires of praising the physician, of prizing advantages which he constantly discovers. “He adores you, he trusts you blindly, everything you say is a revelation to him,” the relatives say. Here and there one of the chorus observes more keenly and remarks, “It is a positive bore to hear him talk, he speaks only of you; you are his only subject of conversation.”
Let us hope that the physician is modest enough to ascribe the patient’s estimation of his personality to the encouragement that has been offered him and to the widening of his intellectual horizon through the astounding and liberating revelations which the cure entails. Under these conditions analysis progressed splendidly. The patient understands every suggestion, he concentrates on the problems that the treatment requires him to solve, reminiscences and ideas flood his mind. The physician is surprised by the certainty and depth of these interpretations and notices with satisfaction how willingly the sick man receives the new psychological facts which are so hotly contested by the healthy persons in the world outside. An objective improvement in the condition of the patient, universally admitted, goes hand in hand with this harmonious relation of the physician to the patient under analysis.
But we cannot always expect to have fair weather. There comes a day when the storm breaks. Difficulties turn up in the treatment. The patient asserts that he can think of nothing more. We are under the impression that he is no longer interested in the work, that he lightly passes over the injunction that, heedless of any critical impulse, he must say everything that comes to his mind. He behaves as though he were not under treatment, as though he had closed no agreement with the physician; he is clearly obsessed by something he does not wish to divulge. This is a situation which endangers the success of the treatment. We are distinctly confronted with a tremendous resistance. What can have happened?
Provided we are able once more to clarify the situation, we recognize the cause of the disturbance to have been intense affectionate emotions, which the patient has transferred to the physician. This is certainly not justified either by the behavior of the physician or by the relations the treatment has created. The way in which this affection is manifested and the goals it strives for will depend on the personal affiliations of the two parties involved. When we have here a young girl and a man who is still young we receive the impression of normal love. We find it quite natural that a girl should fall in love with a man with whom she is alone a great deal, with whom she discusses intimate matters, who appears to her in the advantageous light of a beneficent adviser. In this we probably overlook the fact that in a neurotic girl we should rather presuppose a derangement in her capacity to love. The more the personal relations of physician and patient diverge from this hypothetical case, the more are we puzzled to find the same emotional relation over and over again. We can understand that a young woman, unhappy in her marriage, develops a serious passion for her physician, who is still free; that she is ready to seek divorce in order to belong to him, or even does not hesitate to enter into a secret love affair, in case the conventional obstacles loom too large. Similar things are known to occur outside of psychoanalysis. Under these circumstances, however, we are surprised to hear women and girls make remarks that reveal a certain attitude toward the problems of the cure. They always knew that love alone could cure them, and from the very beginning of their treatment they anticipated that this relationship would yield them what life had denied. This hope alone has spurred them on to exert themselves during the treatments, to overcome all the difficulties in communicating their disclosures. We add on our own account —“and to understand so easily everything that is generally most difficult to believe.” But we are amazed by such a confession; it upsets our calculations completely. Can it be that we have omitted the most important factor from our hypothesis?
And really, the more experience we gain, the less we can deny this correction, which shames our knowledge. The first few times we could still believe that the analytic cure had met with an accidental interruption, not inherent to its purpose. But when this affectionate relation between physician and patient occurs regularly in every new case, under the most unfavorable conditions and even under grotesque circumstances; when it occurs in the case of the elderly woman, and is directed toward the grey-beard, or to one in whom, according to our judgment, no seductive attractions exist, we must abandon the idea of an accidental interruption, and realize that we are dealing with a phenomenon which is closely interwoven with the nature of the illness.
The new fact which we recognize unwillingly is termed transference. We mean a transference of emotions to the person of the physician, because we do not believe that the situation of the cure justifies the genesis of such feelings. We rather surmise that this readiness toward emotion originated elsewhere, that it was prepared within the patient, and that the opportunity given by analytic treatment caused it to be transferred to the person of the physician. Transference may occur as a stormy demand for love or in a more moderate form; in place of the desire to be his mistress, the young girl may wish to be adopted as the favored daughter of the old man, the libidinous desire may be toned down to a proposal of inseparable
