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What is the Talking Cure?

Published on by Andrew Marshall1 Comment

Introduction

The Talking Cure and chimney sweeping were terms Bertha Pappenheim, known in case studies by the alias Anna O., used for the verbal therapy given to her by Josef Breuer. They were first published in Studies on Hysteria (1895).

As Ernest Jones put it, “On one occasion she related the details of the first appearance of a particular symptom and, to Breuer’s great astonishment, this resulted in its complete disappearance,” or in Lacan‘s words, “the more Anna provided signifiers, the more she chattered on, the better it went”.

Refer to Neutrality.

Development

Invention of the Term

Breuer found that Pappenheim’s symptoms – headaches, excitement, curious vision disturbances, partial paralyses, and loss of sensation, which had no organic origin and are now called somatoform disorders – improved once the subject expressed her repressed trauma and related emotions, a process later called catharsis. Peter Gay considered that, “Breuer rightly claimed a quarter of a century later that his treatment of Bertha Pappenheim contained ‘the germ cell of the whole of psychoanalysis’.”

Sigmund Freud later adopted the term talking cure to describe the fundamental work of psychoanalysis. He himself referenced Breuer and Anna O. in his Lectures on Psychoanalysis at Clark University, Worcester, MA, in September 1909: “The patient herself, who, strange to say, could at this time only speak and understand English, christened this novel kind of treatment the ‘talking cure’ or used to refer to it jokingly as ‘chimney-sweeping’.”

Locus Classicus

There are currently three English translations of Studies on Hysteria, the first by A. A. Brill (1937), the second by James Strachey (1955), included in the Standard Edition, and the third by Nicola Luckhurst (2004). The following samples come from Breuer’s case study on “Anna O…” where the concept of talking cure appears for the first time and illustrate how the translations differ:

EditionOutline
1937In the country, where I could not see the patient daily, the situation developed in the following manner: I came in the evening when I knew that she was in a state of hypnosis, and I took away from her the whole supply of fantasms which she had collected since my last visit. In order to obtain good results this had to be accomplished very thoroughly. Following this, she was quite tranquil and the next day she was very pleasant, docile, industrious and cheerful. The following day she was always more moody, peevish, and unpleasant; all of which became more marked on the third day. In this state of mind it was not always easy even in hypnosis to induce her to express herself, for which procedure she invented the good and serious name of “talking-cure,” and humorously referred to it as “chimney-sweeping.” She knew that after expressing herself, she would lose all her peevishness and “energy,” yet whenever (after a long pause) she was in an angry mood she refused to talk, so that I had to extort it from her through urging and begging, as well as through some tricks, such as reciting to her a stereotyped introductory formula of her stories. But she never spoke until after she had carefully touched my hands and had become convinced of my identity. During the nights when rest could not be obtained through expression, one had to make use of chloral. I tried this a number of times before, but I had to give her 5 grams per dose, and sleep was preceded by a sort of intoxication, which lasted an hour. In my presence she was cheerful, but when I was away, there appeared a most uncomfortable, anxious state of excitement (incidentally, the deep intoxication just mentioned made no change in the contractures). I could have omitted the narcotic because the talking, if it did not bring sleep, at least produced calm. In the country, however, the nights were so intolerable between the hypnotic alleviations, that we had to resort to chloral. Gradually, however, she did not need so much of it.
1955While she was in the country, when I was unable to pay her daily visits, the situation developed as follows. I used to visit her in the evening, when I knew I should find her in her hypnosis, and I then relieved her of the whole stock of imaginative products which she had accumulated since my last visit. It was essential that this should be effected completely if good results were to follow. When this was done she became perfectly calm, and next day she would be agreeable, easy to manage, industrious and even cheerful; but on the second day she would be increasingly moody, contrary and unpleasant, and this would become still more marked on the third day. When she was like this it was not always easy to get her to talk, even in her hypnosis. She aptly described this procedure, speaking seriously, as a ‘talking cure’, while she referred to it jokingly as ‘chimney-sweeping’.[1] She knew that after she had given utterance to her hallucinations she would lose all her obstinacy and what she described as her ‘energy’; and when, after some comparatively long interval, she was in a bad temper, she would refuse to talk, and I was obliged to overcome her unwillingness by urging and pleading and using devices such as repeating a formula with which she was in the habit of introducing her stories. But she would never begin to talk until she had satisfied herself of my identity by carefully feeling my hands. On those nights on which she had not been calmed by verbal utterance it was necessary to fall back upon chloral. I had tried it on a few earlier occasions, but I was obliged to give her 5 grammes, and sleep was preceded by a state of intoxication which lasted for some hours. When I was present this state was euphoric, but in my absence it was highly disagreeable and characterized by anxiety as well as excitement. (It may be remarked incidentally that this severe state of intoxication made no difference to her contractures.) I had been able to avoid the use of narcotics, since the verbal utterance of her hallucinations calmed her even though it might not induce sleep; but when she was in the country the nights on which she had not obtained hypnotic relief were so unbearable that in spite of everything it was necessary to have recourse to chloral. But it became possible gradually to reduce the dose.
—————————
[1] These two phrases are in English in the original.
2004While the patient was in the country, where I was unable to visit her every day, the situation developed as follows. I came in the evening, when I knew that she would be in her hypnosis, and removed the entire stock of phantasms that she had amassed since my last visit. For this to be successful, there could be no omissions. Then she would become quite calm and on the following day was agreeable, obedient, industrious, and even in good spirits. But on the second day she was increasingly moody, contrary and disagreeable, and this worsened on the third. Once she was in this temper it was not always easy, even in her hypnosis, to get her to talk things through, a procedure for which she had found two names in English, the apt and serious ‘talking cure’ and the humorous ‘chimney-sweeping’. She knew that having spoken out she would lose all her contrariness and ‘energy’. If, after a comparatively long break, she was already in a bad mood, she would refuse to talk, and I had to wrest it from her, with demands, pleas and a few tricks such as reciting one of the phrases with which she would typically begin her stories. But she would never speak until she had made sure of my identity by carefully feeling my hands. During those nights when talking things through had not calmed her, it was necessary to resort to chloral. I had tried this on a few previous occasions, but found it necessary to give her 5 grams, and sleep was then preceded by a state of intoxication lasting several hours. Whenever I was present, this state was bright and cheerful, but, in my absence, it took the form of an anxious and extremely unpleasant excitement. (The contracture was completely unaffected by this state of severe intoxication.) I had been able to avoid the narcotic, because the talking through at the very least calmed her down, even if it did not also allow her to sleep. But while she was living in the country the nights between those in which she was relieved by hypnosis were so unbearable that it was necessary to resort to chloral; gradually, however, she needed to take less of it.

Current Sstatus

Mental health professionals now use the term talking cure more widely to mean any of a variety of talking therapies. Some consider that after a century of employment the talking cure has finally led to the writing cure.

The Talking Cure: The science behind psychotherapy is also the name of a book published by Holt and authored by Susan C. Vaughan MD in 1997. It explores the way in which psychotherapy reshapes the through incorporating neuroscience research with psychotherapy research and research on development. It contains clinical vignettes of the “talking cure” in action from real psychotherapies.

Celebrity Endorsement

The actress Diane Keaton attributes her recovery from bulimia to the talking cure: “All those disjointed words and half-sentences, all those complaining, awkward phrases…made the difference. It was the talking cure; the talking cure that gave me a way out of addiction; the damn talking cure.”

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Talking_cure >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Neutrality (in Psychoanalysis)?

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Introduction

Neutrality is an essential part of the analyst’s attitude during treatment,  developed as part of the non-directive, evenly suspended listening which Freud used to complement the patient’s free association in the talking cure.

Refer to Psychoanalysis.

Early Development

In the Little Hans case study of 1909, Freud criticised the boy’s father (the prime ‘analyst’): “He asks too much and investigates in accord with his own presuppositions instead of letting the little boy express himself”.  In 1912 he laid down the mirror rule, that the analyst should not reciprocate the patient’s confidences, but only reflect back what they themselves contained.  In 1915 he introduced the term neutrality, warning especially against too great eagerness to cure; and in 1919 he wrote against offering guidance or counselling – synthesis as opposed to analysis – as to what form the patient’s cure should take.

Freud’s guidelines, especially with regard to the bracketing of ethical judgements, and personal disclosures, rapidly became accepted in the psychoanalytic mainstream,  as did the need to respect the patient’s speech and not impose preconceptions on it.

Transference

The principle of neutrality took on especial force as regards manifestations of transference, particularly given the strength of the emotions aroused thereby. Neutrality meant resisting the natural impulse to reciprocate affects, so as to remain in a position to analyse the transference, not respond to it.

Deviations and Criticisms

Freud’s analytic practice was noticeably less austere than the principles of neutrality he laid down: he would argue with, praise, and lend money to patients, and even records feeding the Rat Man on one occasion. However the first theoretical challenge to Freud’s concept came from Sándor Ferenczi, who saw the analyst’s attitude of non-disclosure in particular as part of the problem not the solution. Others would subsequently expand on Ferenczi’s points, Nina Coltart for example suspecting the “austere and benevolently neutral manner which we hold as our working ideal” and stressing that “we can do no harm to a patient by showing authentic affect”.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Neutrality_(psychoanalysis) >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

On This Day … 29 November [2022]

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People (Births)

  • 1825 – Jean-Martin Charcot, French neurologist and psychologist (d. 1893).
  • 1945 – Csaba Pléh, Hungarian psychologist and linguist.

Jean-Martin Charcot

Jean-Martin Charcot (29 November 1825 to 16 August 1893) was a French neurologist and professor of anatomical pathology. He worked on hypnosis and hysteria, in particular with his hysteria patient Louise Augustine Gleizes. Charcot is known as “the founder of modern neurology”, and his name has been associated with at least 15 medical eponyms, including various conditions sometimes referred to as Charcot diseases.

Charcot has been referred to as “the father of French neurology and one of the world’s pioneers of neurology”. His work greatly influenced the developing fields of neurology and psychology; modern psychiatry owes much to the work of Charcot and his direct followers. He was the “foremost neurologist of late nineteenth-century France” and has been called “the Napoleon of the neuroses”.

Csaba Pleh

Csaba Pléh (born 29 November 1945) is a Hungarian psychologist and linguist, professor at the Department of Cognitive Science, Budapest University of Technology and Economics.

He graduated from the Eötvös Loránd University where he earned his degrees in psychology (1969) and linguistics (1973). In 1970 he received his PhD in psychology. He became Candidate of Psychological Science in 1984 and Doctor of Psychological Science in 1997. He obtained his habilitation in 1998. He became a corresponding member of the Hungarian Academy of Sciences is 1998, a full member in 2004.

On This Day … 26 November [2022]

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People (Births)

  • 1936 – Margaret Boden, English computer scientist and psychologist.

People (Deaths)

  • 1987 – J.P. Guilford, American psychologist and academic (b. 1897).

Margaret Boden

Margaret Ann Boden OBE FBA (born 26 November 1936) is a Research Professor of Cognitive Science in the Department of Informatics at the University of Sussex, where her work embraces the fields of artificial intelligence, psychology, philosophy, and cognitive and computer science.

J.P. Guildford

Joy Paul Guilford (07 March 1897 to 26 November 1987) was an American psychologist best remembered for his psychometric study of human intelligence, including the distinction between convergent and divergent production.

Developing the views of L.L. Thurstone, Guilford rejected Charles Spearman’s view that intelligence could be characterized in a single numerical parameter. He proposed that three dimensions were necessary for accurate description: operations, content, and products. A Review of General Psychology survey, published in 2002, ranked Guilford as the 27th most cited psychologist of the 20th century.

On This Day … 25 November [2022]

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People (Births)

  • 1938 – Erol Güngör, Turkish sociologist and psychologist (d. 1983).

Erol Gungor

Erol Güngör (25 November 1938 to 24 April 1983) was a Turkish sociologist, psychologist, and writer.

After spending a period in the Faculty of Law, Güngör graduated from the Faculty of Literature and Social Sciences of Istanbul University in 1961. He received his Ph.D. in 1965 with a thesis titled “Kelâmî (Verbal) Yapılarda Estetik Organizasyon”. Kenneth Hammond invited him to visit the University of Colorado. He became an associate professor with his thesis titled “Şahıslar arası Ihtilafların Çözümünde Lisanın Rolü” in 1970. He became an academic in the Faculty of Literature and Social Sciences of Istanbul University in 1975. He eventually became the president of Selçuk University in 1982.

He mostly studied culture, personality, customs, people and religion. He focused on the identity and cultural problems which Turkish people have faced in the last 150 years.

What is the Trauma Model of Mental Disorders?

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Introduction

The trauma model of mental disorders, or trauma model of psychopathology, emphasises the effects of physical, sexual and psychological trauma as key causal factors in the development of psychiatric disorders, including depression and anxiety as well as psychosis, whether the trauma is experienced in childhood or adulthood. It conceptualises people as having understandable reactions to traumatic events rather than suffering from mental illness.

Trauma models emphasise that traumatic experiences are more common and more significant in terms of aetiology than has often been thought in people diagnosed with mental disorders. Such models have their roots in some psychoanalytic approaches, notably Sigmund Freud’s early ideas on childhood sexual abuse and hysteria, Pierre Janet’s work on dissociation, and John Bowlby’s attachment theory. There is significant research supporting the linkage between early experiences of chronic maltreatment and severe neglect and later psychological problems.

In the 1960s trauma models became associated with humanist and anti-psychiatry approaches, particularly in regard to understanding schizophrenia and the role of the family. Personality disorders have also been a focus, particularly borderline personality disorder, with the role of dissociation and ‘freezing responses’ (more extreme reactions than fight-flight when someone is terrified and traumatised) thought to have a significant role in the aetiology of psychological disturbance. Extreme versions of trauma models have implicated the foetal environment and the trauma of being born, but these are not well-supported in the academic literature and have been associated with recovered memory controversies.

People are traumatised by a wide range of people, not just family members. For example, male victims of sexual abuse report being abused in institutional settings (boarding schools, care homes, sports clubs).

Trauma models thus highlight stressful and traumatic factors in early attachment relations and in the development of mature interpersonal relationships. They are often presented as a counterpoint to psychiatric orthodoxy and inform criticisms of mental health research and practice in that it has become too focused on genetics, neurochemistry and medication.

Refer to Models of Mental Health and The Mental Health Continuum.

Brief History

From the 1940s to the 1970s prominent mental health professionals proposed trauma models as a means of understanding schizophrenia, including Harry Stack Sullivan, Frieda Fromm-Reichmann, Theodore Lidz, Gregory Bateson, Silvano Arieti and R.D. Laing. Based on their clinical work they theorised that schizophrenia appears to be induced by children’s experiences in profoundly disturbed families and reflect victims attempts to cope with such families and live in societies that are inherently damaging to people’s psychological well-being. In the 1950s Sullivan’s theory that schizophrenia is related to interpersonal relationships was widely accepted in the United States. Silvano Arieti’s book Interpretation of Schizophrenia won the American National Book Award in the field of science in 1975. The book advances a psychological model for understanding all the regressive types of the disorder.

Some of the psychogenic models proposed by these early researchers, such as the “schizophrenogenic mother”, came under sustained criticism, from feminists who saw them as ‘mother-blaming’ and from a psychiatric profession that increasingly moved towards biological determinism. From the 1960s pharmacological treatments became the increasing focus of psychiatry, and by the 1980s the theory that the family dynamics could be implicated in the aetiology of schizophrenia became viewed as unacceptable by many mental health professionals in America and Europe. Before his death in 2001, at 90, Theodore Lidz, one of the main proponents of the “schizophrenogenic” parents theory, expressed regret that current research in biological psychiatry was “barking up the wrong tree”. Like Lidz, Laing maintained until his death that the cause of both schizoid personality disorder and schizophrenia was influenced by family relationships. Some more recent research has provided support for this; for instance, child abuse has been shown to have a causal role in depression, PTSD, eating disorders, substance abuse and dissociative disorders, and research reveals that the more severe the abuse the higher the probability that psychiatric symptoms will develop in adult life.

Judith Herman’s book Trauma and Recovery has heavily influenced therapeutic approaches. Recovery entails three phases which are best worked through sequentially: First ‘establishing safety’; secondly ‘a process of remembrance and mourning for what was lost’; thirdly ‘reconnecting with community and more broadly, society’.

Critiques

Critics of the model, such as August Piper, argue that the logic that childhood trauma causes insanity has a serious flaw: If the claim was true, the abuse of millions of children over the years should have caused higher prevalence rates of mental disorders than the literature reveals. Other critics, particularly proponents of behaviour family therapy, have seen trauma models as parent blaming, and have emphasised the fact that families are usually the main, and often only, source of support for people diagnosed with severe mental illness. Lucy Johnstone has pointed out that some critics advocate family interventions for adult psychiatric patients whilst at the same time maintaining that childhood experiences are not causal as regards mental illness – as if family members can only have a helpful or damaging impact on their adult children.

In response to Piper’s assertion, it has been noted that Arieti stated in Interpretation of Schizophrenia that a trauma is more significant when committed by people to whom young human beings are emotionally bonded, and abuse is often interwoven with other forms of neglect and confusing behaviours from care-givers:

First of all we have to repeat here what we already mentioned…, that conditions of obvious external danger, as in the case of wars, disasters, or other adversities that affect the collectivity, do not produce the type of anxiety that hurts the inner self and do not themselves favor schizophrenia. Even extreme poverty, physical illness, or personal tragedies do not necessarily lead to schizophrenia unless they have psychological ramifications that hurt the sense of self. Even homes broken by death, divorce or desertion may be less destructive than homes where both parents are alive, live together, and always undermine the child’s conception of himself.

Recent Approaches

A 2005 meta-analysis of schizophrenia revealed that the prevalence of physical and sexual abuse in the histories of people diagnosed with psychotic disorders is very high and has been understudied. This literature review revealed prevalence rates of childhood sexual abuse in studies of people diagnosed with schizophrenia ranging from 45% to 65%. An analysis of the American National Comorbidity Study revealed that people who have endured three kinds of abuse (e.g. sexual, physical, bullying) are at an 18-fold higher risk of psychosis, whereas those experiencing five types are 193 times more likely to become psychotic. A 2012 review article supported the hypothesis that current or recent trauma may affect an individual’s assessment of the more distant past, changing the experience of the past and resulting in dissociative states. Several reviews of risk factors for common mental disorders have emphasised trauma. Such research has rejuvenated interest in this field, both from clinicians, researchers and service user organisations such as the Hearing Voices movement.

Psychiatrist Colin Ross calls his model the “trauma model of mental disorders” and emphasises that, unlike biological models, this addresses the literature on comorbidity of trauma with mental disorders. Ross describes the theoretical basis of his trauma model as common sense:

“The problem faced by many patients is that they did not grow up in a reasonably healthy, normal family. They grew up in an inconsistent, abusive and traumatic family. The very people to whom the child had to attach for survival were also abuse perpetrators and hurt him or her badly…. The basic conflict, the deepest pain, and the deepest source of symptoms, is the fact that mom and dad’s behavior hurts, did not fit together, and did not make sense.”

In terms of psychoses, most researchers and clinicians believe that genetics remains a causative risk factor but “genes alone do not cause the illness”. Modern views of genetics see genes more like dimmer switches, with environmental factors switching the genes on; the more severe the environmental stress, the more effect genes have.

In the field of criminology, Lonnie Athens developed a theory of how a process of brutalization by parents or peers that usually occurs in childhood results in violent crimes in adulthood. Richard Rhodes’s Why They Kill describes Athens’s observations about domestic and societal violence in the criminals’ backgrounds. Both Athens and Rhodes reject the genetic inheritance theories.

Criminologists Jonathan Pincus and Dorothy Otnow Lewis believe that although it is the interaction of childhood abuse and neurological disturbances that explains murder, virtually all of the 150 murderers they studied over a 25-year period had suffered severe abuse as children. Pincus believes that the only feasible remedy for crime would be the prevention of child abuse.

The logical conclusion of the trauma model is that the task for clinicians is not to treat biological disorders but to help people manage and modify their learned, and often embedded, responses to traumas they have experienced. As such, services need to be reconstituted to focus on this aim.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Trauma_model_of_mental_disorders >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

On This Day … 24 November [2022]

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People (Births)

  • 1932 – Claudio Naranjo, Chilean psychiatrist (d. 2019).
  • 1954 – Margaret Wetherell, English psychologist and academic.

Claudio Naranjo

Claudio Benjamín Naranjo Cohen (24 November 1932 to 12 July 2019) was a Chilean-born psychiatrist of Arabic/Moorish, Spanish and Jewish descent who is considered a pioneer in integrating psychotherapy and the spiritual traditions. He was one of the three successors named by Fritz Perls (founder of Gestalt Therapy), a principal developer of Enneagram of Personality theories and a founder of the Seekers After Truth Institute. He was also an elder statesman of the US and global human potential movement and the spiritual renaissance of the late 20th century. He was the author of various books.

Margaret Wetherell

Margaret Wetherell (born 24 November 1954), is a prominent academic in the area of discourse analysis.

Wetherell worked for 23 years at the Open University, UK from which she retired as Emeritus Professor in 2011. She then took up a part-time post of Professor in Psychology at the University of Auckland, New Zealand.

What is the World Council for Psyhcotherapy?

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Introduction

The World Council for Psychotherapy is a non-governmental organisation (NGO) with consultative status at the Economic and Social Council of the United Nations.

It was founded in 1995, has its headquarters in Vienna, and holds a World Congress every three years with more than a thousand participants.

Objectives

The main objectives of the association are the promotion of psychotherapy on all continents (based on the principles in the Strasbourg Declaration on Psychotherapy in 1990), to improve the conditions of patients, to cooperate with national and international organisations to improve crisis management and peacekeeping, and to unify world training standards. Members are both psychotherapists and organisations. President of the WCP is Alfred Pritz.

The World Certificate for Psychotherapy (WCPC) is only awarded on the basis of recognised psychotherapy training and aims to encourage mobility within the profession. Each year, together with the city of Vienna, the Council awards the International Sigmund Freud Award for Psychotherapy.

World Congress for Psychotherapy

  • 1996 Vienna.
  • 1999 Vienna.
  • 2002 Vienna.
  • 2005 Buenos Aires.
  • 2008 Beijing.
  • 2011 Sydney.
  • 2014 Durban.
  • 2017 Paris.
  • 2020 Moscow.
  • 2022 Moscow.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/World_Council_for_Psychotherapy >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

On This Day … 22 November [2022]

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People (Births)

  • 1927 – Robert E. Valett, American psychologist, teacher, and author (d. 2008).

Robert E. Valett

Robert E. Valett (22 November 1927 to 14 November 2008) was an American psychology professor who wrote more than 20 books primarily focused on educational psychology. He earned the distinguished psychologist award from the San Joaquin Psychological Association and was a president of the California Association of School Psychologists.

On This Day … 20 November [2022]

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People (Births)

  • 1916 – Charles E. Osgood, American psychologist (d. 1991).
  • 1920 – Douglas Dick, American actor and psychologist (d. 2015).

Charles E. Osgood

Charles Egerton Osgood (20 November 1916 to 15 September 1991) was an American psychologist and professor at the University of Illinois.

He was known for his research on behaviourism versus cognitivism, semantics (he introduced the term “semantic differential), cross-culturalism, psycholinguistic theory, and peace studies. He is credited with helping in the early development of psycholinguistics. Charles Osgood was recognised distinguished and highly honoured psychologist throughout his career.

Douglas Dick

Douglas Harvey Dick (20 November 1920 to 19 December 2015) was an American actor and occasional screenwriter. His most famous role came in the 1948 film Rope. In 1971, Dick left the entertainment industry to work as a psychologist.