Brit. J . Med. Psychol.
(1967), 40, 101
Printed in Great Britain
Rationality and irrationality in psychotherapy : some reflections
on psychoanalytic technique
BY HERBERT S. STREAN
In The History of the Psychoanalytic Move-
ment, written in 1914, Freud stated: It may
thus be said that the theory of psychoanalysis
is an attempt to account for two striking and
unexpected facts of observation which emerge
whenever an attempt is made to trace the
symptoms of a neurotic back to their sources
in his past life: the facts of transference and
of resistance. Any line of investigation which
recognizes these two facts and takes them as
the starting point of its work may call itself
psychoanalysis.
Despite the fact that virtually all psycho-
analysts have been unanimous in their belief
that Freuds observations of transference and
resistance are of the most profound made
about psychotherapy and frequently explain
many of the baffling phenomena in the treat-
ment situation, Freud never set out to give a
systematic account of resistance and trans-
ference, basic as these concepts are to the
whole theory and practice of psychoanalysis
(Fine, 1962).
As several investigators have noted, in all
of Freuds writings there is not a single paper
devoted exclusively to resistance in the ana-
lytic process (Burchard, 1958; Fine, 1962;
Lorand, 1953). From 1910 on, when he began
to have a number of followers and noticed
that some of them did not fully grasp what
he was teaching, Freud did begin to write a
series of papers on transference. However,
as Fine (1962) has noted, even these papers
are rather sketchy and scarcely satisfactory for
the purpose. His rather casual handling of the
topics of transference and resistance is in
sharp contrast to his meticulous discussion of
the unconscious in The Interpretation of
Dreams and of sexuality in The Three Essays.
* New York.
101
Although the development of Freuds ideas
about psychoanalytic technique is difficult to
trace because he wrote so little about it, the
material available bears review.
In the 1890s the cathartic method was
gradually replaced by psychoanalysis. After
a long discussion of the technique of psycho-
therapy in the Studies on hysteria Freud
wrote nothing at all on the subject until 1904.
In the paper of 1904 entitled Freuds
psychoanalyticprocedure ,liftingthe amnesias
of childhood became the major therapeutic
focus. Abreaction was relegated to the back-
ground and making the unconsciousconscious
became the therapeutic tool. In both the
Studieson hysteria and in Freuds psychoan-
alytic procedure one searches but in vain for a
systematic explanation of what in the process
of catharsis causes the therapeutic improve-
ment or why making the unconscious con-
scious through the removal of the amnesias
assists the patient to restore his ability to lead
an active life and recover his capacity for
enjoyment.
In a paper written in 1913, On beginning
the treatment , Freud himself discussed the
limitations inherent in hypnosis and particu-
larly those in lifting the amnesias. He con-
cluded that his failure to take into sufficient
account both transference and resistance
frequently caused incomplete therapeutic
success. He stated that abreaction, lifting the
amnesias, and making the unconscious, con-
scious in and of themselves, do not account
for very much.
When Freud reflected on why the expected
success was not forthcoming he began to
stress the transference more and more (Fine,
1962). In the Case of Dora he was quite
critical of himself for overlooking some of the
102 H. S. STREAN
patients transference manifestations which
led to an abrupt and premature termination
of the therapy. Although he stated with much
conviction a little later that finally every
conflict has to be fought out in the sphere of
the transference (Freud, 1912), he does not
enlighten us with any explanation as to why
this should be so. If Doras sexualized trans-
ference were interpreted to her and she be-
came aware of her erotic feelings towards her
analyst, why would the treatment have been
sustained? In The dynamics of transference,
written in 1912, Freud brilliantly expounds on
the nature of the transference, why it may be
positive, negative, or ambivalent and how it
is the strongest weapon of the resistance. He
then goes on to say that after it has been
overcome, the overcoming of other portions
of the neurotic complex raises few further
difficulties . But how interpretation of trans-
ference manifestations over and over again
succeeds in overcoming them and other
portions of the neurotic complex he does not
demonstrate.
Freud further pointed out (1914) that
resistance and transference manifestations do
not disappear soon after they come on the
scene. It is only by persistent and repeated
analysis of them that the patient gradually
comes to see the true nature of his neurosis
and to overcome it. The questions, What
transpires in the working through process,
in the persistent analysis of transference and
resistance, that the patient gradually comes
to see the true nature of his neurosis and
overcomes it? and What is it about working
through which effects the greatest changes in
the patient? are not fully elucidated.
It appears that most of Freuds statements
on technique were of a pessimistic nature. In
the Ego and the Id (1923) he speaks of the
negative therapeutic reaction or untreatable
case: in the Origins of Psychoanalysis he
emphasized that psychoanalysis would make
its greatest contributions as a method of
research and as a general theory of psychology,
not as a method of therapy, which he felt, for
many reasons, would have a limited useful-
ness (McLaughlin, 1963). He wrote at
length on why the narcissistic disorders could
not be treated by the psychoanalytic method
(Freud, 1914) and in Analysis terminable and
interminable (1937) he expounded on why
penis envy in women and passivity in men
impeded the successful termination of many
analyses.
Just as Freud never wroteafull-length paper
on resistance, subsequent writers, in spite of
their voluminous contributions, have not
tackled the problem systematically either
(Fine, 1962). Reichs resistance analysis is
an approach to one kind of resistance (Reich,
1945). Critical of Freuds passive technique
and his limiting of interpretations to the
content of the patients verbal productions,
the main feature of Reichs technique was to
point out to the patient certain features of his
behaviour, particularly behaviour in the
analytic situation. He recommended that the
analyst take an active role and directly con-
front the patient, instead of waiting for the
patient to bring material to him. But how or
why this process effectively removes the
patients resistance, Reich does not elucidate.
Why, for example, does a confrontation by the
analyst of the patients resistive behaviour
dissolve the resistance?
Those writers who have attempted to
elaborate on Freuds classical techniques such
as Fenichel (1941), Glover (1958), Lorand
(1953), and Menninger (1958) have all stressed
that in the process of therapy part of the ego
turns out to be sick and part healthy; the
therapist makes a pact, as it were, with the
healthy part of the patients ego and analyst
and patient proceed together against the sick.
Yet, anyone who has ever undertaken the task
of helping another human being by means of
psychotherapy is immediately aware of the
fact that purely rational procedures do not get
one very far. There is, instead, the develop-
ment of an intense emotional relationship
with the therapist, the transference, and a
strong fight on the part of the patient against
the possibility of improvement, the resistance.
Under the impact of irrational urges the
 Rationality and irrationality in psychotherapy
patient comes into psychoanalytic treatment
and poses the same kind of resistance to the
uncovering of his wishes and defences that he
opposes in real life despite his ego strength
and health. Consequently, therapy which
attempts to proceed in a completely rational
manner must necessarily fail because it does
not take into consideration the nature of the
illness (Fine, 1962).
If we concur with the notion that the patient
is governed by irrational urges, has strong
resistance to renouncing infantile wishes and
neurotic defences, is not particularly inter-
ested in replacingid with ego, living according
to the reality principle instead of the pleasure
principle nor trading in neurotic suffering for
common misery (Freud, 1895), why does he
form a therapeutic alliance with his analyst
and work towards cure? It is the thesis of this
paper that the patient makes changes for the
same irrational reasons that constitute his
illness and that his positive or negative
responses to analytic interpretations have
little to do with their exactness but are gov-
erned much more by his neurotic fantasies,
primary process thinking, super-ego admoni-
tions, and his defensive adaptation. An inter-
pretation is in reality a suggestion by the
analyst, and a patients positive or negative
suggestibility will mainly determine his
emotional acceptance of it. If the patients
separation anxiety, fear of loss of the thera-
pists love and approval or castration anxiety
is at stake, he will, in all probability, accept
the interpretation regardless of its content.
If, on the other hand, he is dominated by
competition, envy, spite, revenge or nega-
tivism, the correctness or incorrectness,
exactness or inexactness of the interpretation
will in little way prevent the patient from
rejecting it.
The patient frequently ascribes to the
analyst the role of his own super-ego; if
listening to his super-ego and accepting its
criticism holds out the promise of a better life
and does not threaten the status quo too much,
the patient will accept the analysts remarks
as valid. Changes on the part of the patient
103
evolve through the same processes that
children modify their behaviour, If the child
believes that the parent will offer a love
premium for his behaviour, he will renounce
a gratification, modify an attitude, or assume
increased responsibility. Likewise, if the
patient does not fantasy the future gratifica-
tion of an id wish in the transference or in the
outside world, the promise of a forgivenessby
the analyst-super-ego, or an enhancement of
self-esteem or self-betterment, he has limited
use for the analysts statement. Every analytic
utterance has symbolic meaning within the
transference relationship and its rationality is
of minor significance when compared to the
promise or lack of promise it holds for the
patient.
Let us examine a fragment of a case
example by Wolberg (1954) which most
students of psychotherapy would agree is an
adequate description of a frequent therapeutic
happenstance in a Freudian psychoanalysis.
A patient with a phobia of being subject to
imminent, but indefinable injury develops an
aversion and dread of the analyst, and ex-
presses it in fear of being mutilated by the
analyst. At the same time, incestuous wishes
for the mother appear in dreams. Analysis of
the relationship with the analyst (transfer-
ence) reveals an identification of the analyst
with the patients father. It becomes apparent
that the patient secretly feared injury by the
father for his forbidden wish to possess the
mother and his phobia was an expression of
this fear of mutilation, which had been dis-
associated from awareness by repression. To
quote Wolberg, The bringing of the patients
attention to the source of his fear, and his
realization of its irrational nature, resulted in
an amelioration or cure of his neurosis.
The question, obviously, is why is a cure
affected by bringing the patients attention to
the sources of his fear and what motivates the
patient to realize its irrational nature? As
Freud (1912) advised us, the oedipal battle
would have to be fought out in the trans-
ference. It is the contention of this paper that
if the patient renounced this oedipal wish,
104 H. S . STREAN
he did so out of fear of the analysts castration
and disapproval.
The interpretations the analyst offered
would have been experienced unconsciously
as a command to give up his oedipal wishes
and the modified behaviour was a homo-
sexual submission to the father-analyst.
Otherwise, why should the patient merely
give up his incestuous wishes? He renounces
them, we believe, for the same reason that
any oedipal boy does-a wish for his fathers
love and a fear of his fathers castration.
Little Hans psychotherapy may be viewed
in similar terms. The modified behaviour and
attitude that resulted are essentially no
different from the resultant interaction, con-
scious or unconscious, that transpires be-
tween many parents and their children. The
discussions were formalized by calling them
psychotherapeutic sessions, yet the type of
interaction and discussion that transpired
between Little Hans and his father is what
takes place in most psychotherapy. The child-
patient meets the parent or superego in the
form of an analyst. The two parties interact
and the child-patients improvement or lack
of improvement rests, to a large extent, on
what his parent-analyst knows about child-
rearing. If the parent-analyst is too indulgent
and gratifying, he provides the patient with
the possibility that, Alas, I think Ive found
the omnipotent parent. I feel comforted,
warm and secure. I wont dissent too much
because his love is everything and I must keep
him. If the analyst is too frustrating and not
sufficiently gratifying, the patient, most likely,
will frequently dissent, express aggression
sometimes, may try using his own resources
occasionally, but may also leave treatment
because he feels that there may be no promise
of a better tomorrow. In other words, we see
the good analyst as a good parent always aware
of his child-patients maturational needs
(Spotnitz, Nagelberg & Feldman, 1956). He
administers appropriate doses of frustration
and gratification depending on where his
child is, developmentally. He attempts to
assess at all times how he is being experienced
by his child-patient and how any given inter-
vention will be received in terms of the trans-
ference relationship.
Freuds statement in his Outline of Psycho-
analysis that the analyst has to play many
roles towards the analys and is an expression
of practical variations based upon the patients
narcissism. Freud states in this treatise that
the analyst will be a teacher, parental figure,
he will instruct, give guidance, impose rules
of conduct, he will praise and condemn. Is it
not possible that this mandate can pertain to
all patients and all analysts? The patient is
constantly casting the analyst into many
different roles during the course of an analysis
and the analyst shifts from one role to another
depending on what he wants to suggest or
influence at a specific time (Coleman &
B. Nelson, 1957; M. Nelson, 1962).
The patient, unable or unwilling to function
solely on his own resources, seeks assistance
from somebody who will help him out of his
dilemmas. At the initial consultation, the
prospective analysand is invited to describe
symptoms, difficulties in interpersonal rela-
tionships, and salient aspects of the story of
his life. This, to many patients, often means in
the unconscious, Ill tell him what he wants
and hell mend the situation. Even when the
patient is asked to take the couch and is
commanded to say everything that he thinks,
feels, or remembers and is responded to with
silence after he does so, he often thinks un-
consciously, Ill just have to work harder,
my magic helper will eventually come across.
To many patients, the recitation of free
associations to a passive listener may mean :
That lovely object provides me with so much
narcissistic satisfaction. He observes my
products and does not admonish me or
criticize me. Ill go on talking for quite a
while longer. Eventually the analysts silence
may be experienced as a deprivation and a
frustration and the patient might respond with
anger. Depending on the story of his life, he
will complain about the lack of certain
gratifications in the transference relationship.
The analyst then interprets the patients
 Rationality and irrationality in psychotherapy
wishes in terms of his transference, needs, his
current life situation, and his past. Let us say
the patients wish can be seen as a desire for
oral merger, a symbiosis, to which the analyst
offers a correct interpretation based on
dynamic, structural, genetic and economic
considerations. In a neutral manner, the
analyst says, Your wish to be with me
constantly is similar to your wish to be with
your wife constantly. When you are not
gratified, you respond in the same angry
manner as you did when your mother was
unavailable. The patient responds affirma-
tively. He recalls several examples of temper
tantrums at the ages of three and four when
his mother was unavailable to him. He adds
that when his wife went to the bridge party
last night, he really did have murderous
thoughts towards her, developed a headache
and couldnt sleep. He confirms the correct-
ness of the analysts interpretation by telling
him that when he was in the waiting room
this morning, he felt an irrational feeling that
the analyst would not appear for the session.
Yes, you are right, the patient concludes,
I want a mother all the time and I get angry
when I dont have her. I really give my wife
too hard a time. The patient then resolves to
be less demanding of his wife and keeps this
promise for some time. He may even bring in
a dream the following session in which his
wife departs from the home for the evening
and he cheerfully bids her farewell. This series
of events is frequently witnessed in many
psychoanalytic hours. Why does the patient
accept the interpretation, recall events to
substantiate it, give ample evidence that he is
behaving similarly in the present, resolve
to change his behaviour, and in fact,
does?
In this hypothetical example which Kris
would have probably called, The Good Hour
the patient unconsciously experiences a com-
mand from the pre-oedipal love object, the
analyst. You are a little baby with your wife,
with me and in general. Stop it or Ill take
away my love. In order to maintain the pre-
oedipal object and his love, the patient takes
105
the analysts neutral statement as a command
and performs similarly to an obedient child.
Through an identification with how the
patient experiences the analyst, he conforms
to what is in reality not a neutral statement
but a parental or super-ego dictate.
Much therapeutic gain transpires within
this type of transference relationship. Based
on the primitive and irrational id wish of oral
merger with the analyst, the very wish the
analyst may wish to weaken by his interpreta-
tion, the patient improves. However, most
analysts would regard an analysis incomplete
unless the transference were as well analysed
as possible. Therapeutic gain in the service of
pre-oedipal fantasies may be acceptable but
insufficient. The analyst, therefore, might then
point out to the patient that the latter accepts
interpretations and modifies his behaviour
because he wants to please a parental figure.
It is quite conceivable that the patient will
battle this problem out with himself and in the
analysis, but if he becomes more independent
of the analyst and seeks overtly to be less
passive and submissive and more assertive,
he again has done it out of compliance with a
fantasy. If I become assertive, independent
and dont look for symbiotic oral mergers,
my analyst will approve, tell me Im success-
fully analysed and be a proud parental figure.
The analyst then becomes part of the perma-
nent ego ideal and a permanent unconscious
identification with the analyst has been
partially substituted for the one with the
primary object, the parent.
Many interpretations are experienced, as
we have suggested, as deprivations. Tarachow
(1963) is of the opinion that all interpretations
are experienced as such. While we cannot
concur with Tarachow completely as we are
aware of the fact that the mere utterance of
words by the analyst, regardless of content,
can be experienced by the analysand as a
gratification, many analytic interventions are
experienced as commands to cease and
desist! This then can lead to a negative or
ambivalent transference and should be ana-
lysed. What is involved in the process of
106 H. S. STREAN
analysing of a negative transference that helps
the patient resolve and overcome it?
The overcoming of a negative transference
is often equated in the patients mind with
giving the analyst a love premium. The greatest
love premium an analyst can be given, in
many patients minds at least, is terminating
a successful analysis. In the unconscious of
the patient, it is often equivalent to forgiving
the parent for not being a good parent,
usually the most tenacious resistance to be
observed in analytic therapy. It is our conten-
tion that a negative transference or a resist-
ance born out of negativism is given up when
it serves the patient limited, if no pleasurable,
gratification in the transference relationship,
Recently Eissler, in a paper on The psycho-
analytic concept of cure (1963), reported a
case of a woman suffering from erythophobia,
sexual frigidity, diffuse anxiety and other
conflicts. During three years of intensive
analytic treatment the patient did not overtly
respond to any of the analysts interventions.
She left treatment apparently unmoved; all of
her conflicts remained. At a follow-up study
several years later, the patient, to the analysts
surprise, reported marked improvement in
virtually every area that was troublesome when
she left treatment. Eissler offers several
hypotheses to account for this including the
principle, I would rather act sanely than face
the truth about myself. Yet, Eissler gave to
the patient, in the form of many id interpreta-
tions, a great deal of truth about herself for
three years. Is it not possible that an alterna-
tive explanation was that the patient did not
want to give the analyst the satisfaction of
curing her. If we assume that she was being
a negativistic patient, then would she remain
intractable through the final hour, as indeed
she did? Only upon achieving distance from
the analyst, having defeated his attempt to
cure her, and only by first gratifying her
negativism was she then enabled to overcome
her pathological conflict.
In his 1912 paper, The future prospects of
psychoanalytic therapy, Freud thought that
if the meaning of symptoms came to be
generally known, the neurotic might feel
inhibited about showing them, just as ladies
would no longer say at a garden party that
they were going to pick flowers once it was
generally known that it was a subterfuge to
hide the necessity of going to the bathroom.
The implication of this remark is that patients
are frequently disinterested in learning or
accepting the real truth about themselves.
Resistances against the emotional truth are
constantly raised. Freud pointed out that the
analysis of these resistances constitutes the
heart of analytic therapy which is fought out
in the transference. In every individual case of
analysis, the analyst is viewed as an amalga-
mation of authorities, each interpretation is
viewed by the patient as a direct or indirect
command, approval, criticism or threat. In
the Outline of Psychoanalysis, Freud implied
that depending upon the factor that decides
influence at the moment, the sensitive analyst
will meet the patients ever evolving and ever
modifying therapeutic needs by appropriate
adaptive changes in his own therapeutic
behaviour .
ACKNOWLEDGEMENT
The writer would like to thank Dr Oscar
Sternbach for several of the ideas expressed in this
paper.
 Rationality and irrationality in psychotherapy
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