This is the 2007 version. Click here for the 2017 chapter 13 table of contents.

Freud's Early Therapy Experiences

Freud initially did not want to try Breuer's talking cure on his own patients. For one thing, he knew that Bertha Pappenheim had not been cured. Freud's wife ran into Bertha five years after Breuer stopped treating her, and Bertha said she was still having hallucinations at night plus other serious symptoms. Breuer himself said he wondered if she might be better off dead.

How did Freud know the "talking cure" had not produced a lasting cure? How was Bertha honored later in life?

Over the long run, Bertha Pappenheim improved, and she went on to lead a productive life. She started the first orphanage for Jewish girls in Germany. In fact, her image appeared on a German postage stamp honoring her for this achievement, years before anybody realized she was the patient called "Anna O." However, when Freud first heard about the case, the talking cure appeared to have failed, and Bertha herself (in later life) offered scathing opinions about psychoanalysis, Freud's technique, which she regarded as ineffective.

Freud kept using the methods he had been taught in medical school. These included massage, sedative drugs, rest, and a technique called electrotherapy, in which mild electric current was applied to the body. As Freud gained experience, he increasingly suspected that none of his techniques had a genuine healing effect. What really helped his patients when they appeared to improve, he suspected, was the suggestion that they were going to get well. Today we would call this a placebo effect or suggestion. It is a powerful effect—basically the same thing as hypnosis—but Freud wanted a technique that could do more than suggestion by itself.

In 1889, growing increasingly impatient with the therapy methods he was already using, Freud decided to try Breuer's talking cure. He tried to hypnotize his patients and lead them back in their memories to see if some traumatic incident might underlie the symptoms of hysteria. Following Breuer's model, Freud encouraged his patients to relive the traumatic incident with a great flood of emotion. Sure enough, he was able to rid his patients of hysterical symptoms, using this technique.

What is abreaction? Catharsis?

Freud called the act of emotional recollection abreaction. The ancient Greeks called it catharsis. Catharsis means a cleansing in Greek. It occurs when people pour out their emotions, then feel better afterward. Catharsis is implied by the expression "a good cry." Aristotle used the concept to explain why theater audiences enjoyed tragedies and sad music. He said they identified with the tragedies shown onstage, sympathized with the emotions, and experienced the same cleansing effect from expressing their emotions.

How did Freud know about catharsis? What was the "new wrinkle" in Freud's cathartic method?

Catharsis was a popular concept in Vienna during Freud's time, assuming "the proportions of a craze" (Sulloway, 1978). Freud's wife had an uncle who wrote about catharsis, and his work inspired over 140 German-language publications on catharsis. This was all before Freud began using his "cathartic method." But the systematic search for early memories related to present-day symptoms, in order produce catharsis and eliminate the symptoms, was a new wrinkle in Freud's therapy.

Freud hypothesized that "psychic energy" was tied up in keeping down or repressing traumatic memories. Freud viewed catharsis as a way of releasing that energy so the patient could regain normal strength and energy.

Freud found that he had difficulty hypnotizing some patients, but soon Freud was getting good results without hypnosis. He had patients relax in a dimly-lit room, facing away from him to avoid distraction. He assured patients they could remember long-lost traumatic episodes of their lives. If they said they could not, he urged them to try harder, to look for little scraps or pieces of memory and use these to retrieve larger and larger segments. Given plenty of time and encouragement, Freud found, people could remember events that explained their hysterical symptoms.

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