REVIEWS.

The Technique of Psycho-Analysis. By DAVID FORSYTH, M.D., D.Sc., F.R.C.P. London: Kegan, Paul, Ltd., 1922. Pp. 133. Price 58.

This excellently written small book comes as a refreshing surprise to anyone who has had to handle the type of manual on psycho-analysis which has become so common. The pernicious nonsense contained in some of them on the subject of technique is perhaps the most distressing thing about them; for theory or disbelief hurts no one, but the technique of any curative treatment is a serious matter. Dr Forsyth's small volume, however, is a great contrast to these and will consequently be of real value to the many who are seriously endeavouring to fit themselves to practise this method. Their number and the absence of any adequate means of instruction would alone deservedly ensure it great success; those who know little or nothing about the matter will find in it broad general outlines and many details that will no doubt set them on the right path. It must be said, however, that when they have won their own experience by other paths by being analysed, analysing others, and becoming imbued with the theory and principles laid down by the initiator of this workwe think they will regard some of the views it expresses with surprise.

There is one striking omission which gives a somewhat false perspective to the book as a whole, and this is the absence of any specific mention in it of the 'fundamental rule' of the method. It is in fact alluded to once incidentally, as the rule that "the patient is to speak everything that comes to his mind." But it is not honoured with a bare statement in plain terms on its own account. 'Free association' too is only mentioned in passing in connection with dreamanalysis, where "it is assumed that the reader is familiar with what is meant by it." He may be familiar with the meaning of the phrase; but it would be ascribing advanced experience to the beginner to assume that he is familiar with the importance of it in the work. In analytic treatment the rule is the one and only, but an absolutely necessary, prescription to be given to the patient. Upon the degree to which he adheres to it and upon nothing else depends the success of the treatment; the whole problem of resistance (and therefore, of analysis) is bound up with it. But from reading this book one would not imagine that this rule was anything of fundamental importance. This attitude of the author's is most plainly seen in regard to the opening of the treatment and is in the sharpest contrast with Freud's own view in this matter. In Freud's paper dealing with this1 we find an example of the kind of opening words the analyst should address to the patient before he begins to speak. They deal entirely with this rule and occupy a full page of a large book. A comparison of this with Dr Forsyth's suggestion for the same occasion will illustrate the point. We can only conclude that this is one of Freud's 'discoveries and theoretical conceptions' which have been found 'difficult of acceptance' by the author; it is perhaps the reason why he advises the beginner "to keep an open mind and test the validity of Freud's work." If, however, the beginner does indeed adhere to 'practical observations on patients,' as 1 Sammlung Kl. Schriften, IVte Folge, S. 428.

Dr Forsyth recommends, we believe that the result will only be an everdeepening realisation in him of the supreme importance of this rule; he will discover that it contains the essence and whole secret of analytic treatment and that all other prescriptions are merely accessory to it-indeed, it may be said that the depth of this appreciation is a mark distinguishing the expert from the inexpert analyst.

It is not surprising that we find a corresponding absence in the book of any mention of the 'rule for the analyst'-the counterpart to the rule for the patient. In a most important passage1 Freud expounds the way in which the analyst is to employ his instrument-his mind, memory and knowledge-in the work by making use of his own unconscious. But although nearly every other paragraph in this one essay is quoted by the author of this book, he has ignored this essential point which, as Freud says, represents the aim of all the minor prescriptions, gives the key to the analyst's attitude, and explains the necessity for his being himself free from inhibitions.

The absence of any reference to the underlying basis on which the technique is constructed affects the whole book and makes much that the author has to say appear didactic and not clearly worked out. This applies particularly to the section on the analyst, in which great insistence is laid on the important part played by the 'personality' of the analyst, though it is by no means clear what this means. We are told that "the analyst's first duty is to be passive,' that "it is for the analyst never to allow his feelings to be played on," that "his own feelings must not become involved," and that "the personality of the analyst is to be kept altogether apart from the treatment"; there even seems to be a contradiction here, for we read that "some personal traits are of help and others stand in the way," while the analyst must learn "how to employ his personality with each case that comes before him." We are told most explicitly too that no social relations between physician and patient are permissible during the treatment; but no reason is given for these injunctions. One passage plainly shows the want of clearness in the author's mind on this point; for he says "the fact that the analyst keeps his personality in the background is only likely to provoke the patient's curiosity...to lead him to seize upon every casual remark or action"...and "these side-winds...impede rather than expedite the analysis." There is no explanation of why the analyst must take up an attitude which has this effect. The fact is that it does not actually have this effect, if the function of the transference and resistances is properly understood.

Again, although a passive attitude is laid down as correct early in the book there is much in it which controverts the statement. Numerous passages are written on the assumption that the analyst can actively control the course of the treatment. For instance, we are told that the beginner cannot "go very deep" into his cases and that he should "carry on superficially with two or three cases," while "working hard" at another. We think that any beginner proceeding on such an assumption will not merely learn very little, but will have a great deal to unlearn if he should ever hope to go deep into a case. We are expressly told that an analysis can be conducted "by short cuts and abridgements" (although this is advised against except after long experience); also that "deeper analysis is work for more experienced hands." A treatment conducted by short cuts' is not analysis: it implies an active management

1 Idem, S. 405.

of its course which is fundamentally incompatible with it. As a practical experiment it may be advisable on occasion to combine two kinds of technique, but it should have been made clear that any such treatment is working by a mechanism which is the opposite of analysis, however much use may be made of analytic knowledge. As regards the advice to beginners not to go in for 'deeper analysis,' how is it possible for the analyst to ordain whether the analysis will be deep or shallow, whether the patient will reproduce his infantile attitudes or not? This of course depends entirely on what is in the patient's mind and is completely independent of the analyst's will. Nor do we understand how an analyst can work hard' at or 'practice and experiment' on a case. He may not know what the associations mean, and if so, he can only wait until the meaning becomes clear to him later; and he may make mistakes and learn from them. These are passive attitudes- -a phrase which, incidentally, means 'passive to the analysis,' which is something much deeper and subtler than 'passive to the patient.'

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In regard to the transference, too, there appears to be some confusion of ideas. The transference has two functions, or rather, it is (1) a phenomenon, which (2) has a function in the treatment. In so far as it is a phenomenon, i.e. the re-animation of the infantile conflicts and fixations in regard to the analyst, the author comprehends it completely and gives it its full due. The phenomenon, however, is not the same thing as its function; but he says, once these emotions appear in the transference they are thereby permanently severed from their out-of-date attachments, which then lose their emotional value"; he even describes the 'working off' or 'abreaction' of energy as in itself affecting the cure. We should have expected that by this time the word 'abreaction' would have led an analyst to suspect that he had not 'gone very deep.' If this were the function of the transference how would analysis differ from any other treatment in which transference to the physician manifests itself? This confusion between the phenomenon and the function is exactly what Freud has dissipated in evolving the analytic method out of the old 'abreaction method.' His essay on the struggle which goes on during analysis between the recollection and repetition of infantile conflicts illustrates this differentiation very clearly. The 'repetition' serves no purpose; when the author says that the patient is to be given 'every encouragement' in 'working off' the accumulated nervous energy we can only point out that this is not analysis. Again, he says that an analysis is an emotional experience and not a scientific enquiry; whereas, on the contrary, the patient wants to make it an emotional experience, while the analyst must perpetually remind him that it is a scientific enquiry.

The author has not ignored the real function of the transference, i.e. the additional incentive to overcome his resistances which the patient derives from it; but its importance appears to be under-estimated, and we surmise that this is not unconnected with the great insistence elsewhere laid on the necessity for the analyst to keep himself apart from the treatment.' The true reason why this attitude should be adopted is that the patient's feelings may reflect as little as possible of anything real; nothing is done to stimulate them, so that they develop as a 'pure culture,' showing in isolation the original form and subsequent development of his love-impulses. This attitude does indeed 'provoke resistances,' as the author truly says, because the transference is always first employed by the patient as a resistance; it has none the less a successful result; an unconscious impulse has been provoked to display itself

in a pure and quite individual form. We may here point out that the author has misread Freud's passage about the analyst communicating to the patient something of his own life. Freud says that, although it would seem natural to do so, it has the effect of encouraging the patient in his tendency to turn the analysis on to the physician. The same objection applies to the author's statement that, when a patient expresses his "inability to continue without an explicit assurance of the sympathy and esteem of the physician, this difficulty should never be allowed to remain." To give such an assurance is to vacate the position of analyst, whose judgments are necessary, but whose feelings and opinions are always irrelevant.

Other points which suggest a lack of reliance on the function of the transference are the over-estimation of intelligence in patients-frequently a cause of great opposition to adherence to the rule, since this requires that all the critical objections of reason shall be ignored; the under-estimation of professional authority, which is the same here as in any other work-it is merely used in a different way; and the emphasis laid on the difficulties presented by 'negative' and 'narcissistic' types. Apart from their appearance in psychotics, these characteristics are secondary and nearly always analysable; nothing is more likely to bring them to the surface, however, than any failure in the analyst to trust the power of the unconscious impulses and to make use of them. Incidentally, it may be said that the word 'narcissistic' is used much too loosely by analysts. It is rarely understood, for a great deal of work on the subject remains to be done; at present it is used as a handy label to apply to failures. The obsessional neurosis too is far from being as peculiarly inaccessible to analysis as the author suggests; on the contrary, through psychoanalytic research it has become more comprehensible than hysteria. Resistances seem altogether to be regarded too much as 'impediments'; the author's dissatisfaction when they arise is expressed quite explicitly. He gives numerous instances of the ways in which they are roused-by curiosity, jealousy, dislike of paying fees, even by the surging into consciousness of the erotic transference and he frequently refers to them as causing regrettable loss of time. Yet the part played by these emotions in the patient's mental life is exactly what he needs to learn. How can he recognise something which never appears? As Freud says, we are dissatisfied only if we cannot succeed in bringing the resistances to the surface. Any anxiety to hasten the patient's recovery often makes the resistances insurmountable; he can then make use of them to gratify the transferred unconscious wish to disappoint the parents a reproduction instead of a recollection.

There is one peculiarity in the book which needs mention. It seems connected with the assumption that the analyst can control the course of the analysis, and it is in striking, though significant, contrast to the repudiation of professional authority. It consists in implications that the analyst requires to exercise some aggressivity at times-in references to 'hurting the patient' and to the use of force,' to explanations being given 'with a steel fist,' or with 'violence short and sharp,' and to cases needing to be ended, if necessary, with some violence.' Apart from what is known as 'active technique'-i.e. prescriptions affecting the patient's life outside the treatment, designed to cut off substitutive gratifications of libido and intensify the conflict for purposes of analysis when active measures are necessary, all that is required is the kind and quiet firmness of the best professional traditions.

One essential pre-requisite for the analyst is patience. The passivity of his

task is explained by the fact that, as Freud says, he merely sets in motion a process which then continues according to its own laws. Active intervention in the process can only spoil its progress and can never hasten it. Anxiety for the patient's recovery is a medical attitude, not a scientific one, and it vitiates analytic work; recovery is a secondary, accessory result of the scientific work to be done. The attitude of investigation alone gives the key to all the injunctions laid down for the analyst and makes it possible for him to adhere to them. When he possesses it, it follows that his own feelings do not become involved; no question of impatience or of hurting his patients will arise. A profound acceptance of determinism will alone ensure him the indifference, the patience, and the kindness necessary for the work.

JOAN RIVIERE.

"A Study of Psychological Types." By BEATRICE HINKLE, M.D. Psychoanalytic Review, April, 1922.

The Psychoanalytic Review for April contains a long and important article on Psychological Types, by Dr Beatrice Hinkle, a well-known American analyst of many years' standing. She states that very early in her psychoanalytical practice she noted that patients showed such marked differences in their reactions to their life problems, that they appeared to fall into completely different categories. At this time she came in contact with Jung's first brief contribution on the subject1 which at once shed light on her own observations, and proved a stimulus to further work. Using Jung's introverted and extraverted types as a starting-point she soon came to realise, as he also did, that many sub-types were included in the original definitions. When, after many years' independent work, these two observers met again in Europe, both had formulated very definitely several different types. Jung's important work Psychologische Typen was published in Zürich in 1921, and Dr Hinkle's contribution now appears in print for the first time.

Dr Jung describes eight types, according to the predominant function used for adaptation, each type having an introverted or extraverted mechanism. He further delineates them from the standpoint of the conscious and unconscious. Dr Hinkle describes six types and covers the same ground. She calls them Simple introverts and extraverts; Objective introverts and extraverts, and Subjective introverts and extraverts. Jung's intuitive type is not regarded as a type in itself, because intuitive characteristics belong equally to introverts and extraverts, relating in the one chiefly to thought and the unconscious and in the other mainly to feeling and external life. The special intuitive mechanisms are most characteristically seen in the two subjective types.

The "simple" introvert and extravert types are described first in this monograph. We are already familiar with them from Jung's earliest description. The simple types react in an almost prescribed way, according to the main direction of their libido currents. The extravert turns most readily to the external world, and has a definite tendency to lose his individuality in it. He has a feeling relation with the object, so that he is able to handle it directly; whereas the simple introvert reaches it only secondarily, apprehending it first by his thought, and hence his reaction is delayed and uncertain, 1 See Collected Papers on Analytical Psychology, Chapter XI.