I 
PRINCIPLES OF PRACTICAL PSYCHOTHERAPY 1 
Psychotherapy is a domain of the healing art which has developed and acquired a certain independence only within the last fifty years. Views in this field have changed and become differentiated in a great variety of ways, and the mass of experience accumulated has given rise to all sorts of different interpretations. The reason for this lies in the fact that psychotherapy is not the simple, straightforward method people at first believed it to be, but, as has gradually become clear, a kind of dialectical process, a dialogue or discussion between two persons. Dialectic was originally the art of conversation among the ancient philosophers, but very early became the term for the process of creating new syntheses. A person is a psychic system which, when it affects another person, enters into reciprocal reaction with another psychic system. This, perhaps the most modern, formulation of the psychotherapeutic relation between physician and patient is clearly very far removed from the original view that psychotherapy was a method which anybody could apply in stereotyped fashion in order to reach the desired result. It was not the needs of speculation which prompted this unsuspected and, I might well say, unwelcome widening of the horizon, but the hard facts of reality. In the first place, it was probably the fact that one had to admit the possibility of different interpretations of the observed material. Hence there grew up various schools with diametrically opposed views. I would remind you of the Liebeault-Bernheim French method of suggestion therapy, reeducation de la volonte; Babinski's "persuasion"; Dubois' "rational psychic orthopedics"; Freud's psychoanalysis, with its' emphasis on sexuality and the unconscious; 
1 [Delivered as a lecture to the _ Zurich Medical Society in 1935. Published as "Grundsatzliches zur praktischen Ps)'chotherapie," Zentralblatt fii-r PsychotheraPie, VIII (1935): 2, 66-82.-EDITORS.] 
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GENERAL PROBLEMS OF PSYCHOTHERAPY 
Adler's educational method, with its emphasis on power-drives and conscious fictions; Schultz's autogenic training-to name only the better known methods. Each of them rests on special psychological assumptions and produces special psychological results; comparison between them is difficult and often wellnigh impossible. Consequently it was quite natural that the champions of anyone point of view should, in order to simplify matters, treat the opinions of the others as erroneous. Objective appraisal of the facts shows, however, that each of these methods and theories is justified up to a point, since each can boast not only of certain successes but of psychological data that largely prove its particular assumption. Thus we are faced in psychotherapy with a situation comparable with that in modern physics where, for instance, there are two contradictory theories of light. And just as physics does not find this contradiction unbridgeable, so the existence of many possible standpoints in psychology should not give grounds for assuming that the contradictions are irreconcilable and the various views merely subjective and therefore incommensurable. Contradictions in a department of science merely indicate that its subject displays characteristics which at present can be grasped only by means of antinomies-witness the wave theory and the corpuscular theory of light. Now the psyche is infinitely more complicated than light; hence a great number of antinomies is required to describe the nature of the psyche satisfactorily. One of the fundamental antinomies is the statement that psyche depends on body and body depends on psyche. There are clear proofs for both sides of this antinomy, so that an objective judgment cannot give more weight to thesis or to antithesis. The existence of valid contradictions shows that the object of investigation presents the inquiring mind with exceptional difficulties, as a result of which only relatively valid statements can be made, at least for the time being. That is to say, the statement is valid only in so far as it indicates what kind of psychic system we are investigating. Hence we arrive at the dialectical formulation which tells us precisely that psychic influence is the reciprocal reaction of two psychic systems. Since the individuality of the psychic system is infinitely variable, there must be an infinite variety of relatively valid statements. But if individuality were absolute in its particularity, if one indi- 
4 

PRINCIPLES OF PRACTICAL PSYCHOTHERAPY 
vidual were totally different from every other individual, then psychology would be impossible as a science, for it would consist in an insoluble chaos of subjective opinions. Individuality, however, is only relative, the complement of human conformity or likeness; and therefore it is possible to make statements of general validity, i.e., scientific statements. These statements relate only to those parts of the psychic system which do in fact conform, i.e., are amenable to comparison and statistically measurable; they do not relate to that part of the system which is individual and unique. The second fundamental antinomy in psychology therefore runs: the individual signifies nothing in comparison with the universal, and the universal signifies nothing in comparison with the individual. There are, as we all know, no universal elephants, only individual elephants. But if a generality, a constant plurality, of elephants did not exist, a single individual elephant would be exceedingly improbable. 
	2 	These logical reflections may appear somewhat remote from 
our theme. But in so far as they are the outcome of previous psychological experience, they yield practical conclusions of no little importance. When, as a psychotherapist, I set myself up as a medical authority over my patient and on that account claim to know something about his individuality, or to be able to make valid statements about it, I am only demonstrating my lack of criticism, for I am in no position to judge the whole of the personality before me. I cannot say anything valid about him except in so far as he approximates to the "universal man." But since all life is to be found only in individual form, and I myself can assert of another individuality only what I find in my own, I am in constant danger either of doing violence to the other person or of succumbing to his influence. If I wish to treat another individual psychologically at all, I must for better or worse give up all pretensions to superior knowledge, all authority and desire to influence. I must perforce adopt a dialectical procedure consisting in a comparison of our mutual findings. But this becomes possible only if I give the other person a chance to play his hand to the full, unhampered by my assumptions. In this way his system is geared to mine and acts upon it; my reaction is the only thing with which I as an individual can legitimately confront my patient. 
5 

GENERAL PROBLEMS OF PSYCHOTHERAPY 
	3 	These considerations of principle produce in the psycho- 
therapist a very definite attitude which, in all cases of individual treatment, seems to me to be absolutely necessary because it alone is scientifically responsible. Any deviation from this attitude amounts to therapy by suggestion, the kind of therapy whose main principle is: "The individual signifies nothing in comparison with the universaL" Suggestion therapy includes all methods that arrogate to themselves, and apply, a knowledge or an interpretation of other individualities. Equally it includes all strictly technical methods, because these invariably assume that all individuals are alike. To the extent that the insignificance of the individual is a truth, suggestive methods, technical procedures, and theorems in any shape or form are entirely capable of success and guarantee results with the universal man -as for instance, Christian Science, mental healing, faith cures, remedial training, medical and religious techniques, and countless other isms. Even political movements can, not without justice, claim to be psychotherapy in the grand manner. The outbreak of war cured many a compulsion neurosis, and from time immemorial certain miraculous localities have caused neurotic states to disappear; similarly, popular movements both large and small can exert a curative influence on the individual. 
	4 	This fact finds the simplest and most nearly perfect expres- 
sion in the primitive idea of "mana." Mana is a universal medicinal or healing power which renders men, animals, and plants fruitful and endows chieftain and medicine-man with magical strength. Mana, as Lehmann has shown, is identified with anything "extraordinarily potent," or simply with anything impressive. On the primitive level anything impressive is therefore "medicine." Since it is notorious that a hundred intelligent heads massed together make one big fathead, virtues and endowments are essentially the hallmarks of the individual and not of the universal man. The masses always incline to herd psychology, hence they are easily stampeded; and to mob psychology, hence their witless brutality and hysterical emotionalism. The universal man has the characteristics of a savage and must therefore be treated with technical methods. It is in fact bad practice to treat collective man with anything other than "technically correct" methods, Le., those collectively recognized and believed to be effective. In this sense the old hypnotism or the 
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PRINCIPLES OF PRACTICAL PSYCHOTHERAPY 
still older animal magnetism achieved, in principle, just as much as a technically irreproachable modern analysis, or for that matter the amulets of the primitive medicine-man. It all depends on the method the therapist happens to believe in. His belief is what does the trick. If he really believes, then he will do his utmost for the sufferer with seriousness and perseverance, and this freely given effort and devotion will have a curative effect-up to the level of collective man's mentality. But the limits are fixed by the "individual-universal" antinomy. 
	5 	This antinomy constitutes a psychological as well as a philo- 
sophical criterion, since there are countless people who are not only collective in all essentials but are fired by a quite peculiar ambition to be nothing but collective. This accords with all the current trends in education which like to regard individuality and lawlessness as synonymous. On this plane anything individual is rated inferior and is repressed. In the corresponding neuroses individual contents and tendencies appear as psychological poisons. There is also, as we know, an overestimation of individuality based on the rule that "the universal signifies nothing in comparison with the individuaL" Thus, from the psychological (not the clinical) point of view, we can divide the psychoneuroses into two main groups: the one comprising collective people with underdeveloped individuality, the other individualists with atrophied collective adaptation. The therapeutic attitude differs accordingly, for it is abundantly clear that a neurotic individualist can only be cured by recognizing the collective man in himself-hence the need for collective adaptation. It is therefore right to bring him down to the level of collective truth. On the other hand, psychotherapists are familiar with the collectively adapted person who has everything and does everything that could reasonably be required as a guarantee of health, but yet is ill. It would be a bad mistake, which is nevertheless very often committed, to normalize such a person and try to bring him down to the collective level. In certain cases all possibility of individual development is thereby destroyed. 
	6 	Since individuality, as we stressed in our introductory argu- 
ment, is absolutely unique, unpredictable, and uninterpretable, in these cases the therapist must abandon all his preconcep- 
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10 
GENERAL PROBLEMS OF PSYCHOTHERAPY 
tions and techniques and confine himself to a purely dialectical procedure, adopting the attitude that shuns all methods. 
	7 	You will have noticed that I began by presenting the dialec- 
tical procedure as the latest phase of psychotherapeutic development. I must now correct myself and put this procedure in the right perspective: it is not so much an elaboration of previous theories and practices as a complete abandonment of them in favour of the most unbiased attitude possible. In other words, the therapist is no longer the agent of treatment but a fellow participant in a process of individual development. 
	8 	I would not like it to be supposed that these discoveries 
dropped straight into our laps. They too have their history. Although I was the first to demand that the analyst should himself be analysed, we are largely indebted to Freud for the invaluable discovery that analysts too have their complexes and consequently one or two blind spots which act as so many prejudices. The psychotherapist gained this insight in cases where it was no longer possible for him to interpret or to guide the patient from on high or ex cathedraJ regardless of his own personality, but was forced to admit that his personal idiosyncrasies or special attitude hindered the patient's recovery. When one possesses no very clear idea about something, because one is unwilling to admit it to oneself, one tries to hide it from the patient as well, obviously to his very great disadvantage. The demand that the analyst must be analysed culminates in the idea of a dialectical procedure, where the therapist enters into relationship with another psychic system both as questioner and answerer. No longer is he the superior wise man, judge, and counsellor; he is a fellow participant who finds himself involved in the dialectical process just as deeply as the so-called patient. 
	9 	The dialectical procedure has another source, too, and that 
is the multiPle significance of symbolic contents. Silberer distinguishes between the psychoanalytic and the anagogic interpretation, while I distinguish between the analytical-reductive and the synthetic-hermeneutic interpretation. I will explain what I mean by instancing the so-called infantile fixation on the parental imago, one of the richest sources of symbolic contents. The analytical-reductive view asserts that interest ("libido") streams back regressively to infantile reminiscences and 
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PRINCIPLES OF PRACTICAL PSYCHOTHERAPY 
there "fixates" -if indeed it has ever freed itself from them. The synthetic or anagogic view, on the contrary, asserts that certain parts of the personality which are capable of development ar~ in an infantile state, as though still in the womb. Both interpretations can be shown to be correct. We might almost say that they amount virtually to the same thing. But it makes an enormous difference in practice whether we interpret something regressively or progressively. It is no easy matter to decide aright in a given case. Generally we feel rather uncertain on this point. The discovery that there are essential contents of an indubitably equivocal nature has thrown suspicion on the airy application of theories and techniques, and thus helped to range the dialectical procedure alongside the subtler or cruder suggestion methods. 
The depth-dimension which Freud has added to the problems of psychotherapy must logically lead sooner or later to the conclusion that any final understanding between doctor and patient is bound to include the personality of the doctor. The old hypnotists and Bernheim with his suggestion therapy were well enough aware that the healing effect depended firstly on the "rapport"-in Freud's terminology, "transference"-and secondly on the persuasive and penetrative powers of the doctor's personality. In the doctor-patient relationship, as we have said, two psychic systems interact, and therefore any deeper insight into the psychotherapeutic process will infallibly reach the conclusion that in the last analysis, since individuality is a fact not to be ignored, the relationship must be dialectical. 
	11 	It is now perfectly clear that this realization involves a very 
considerable shift of standpoint compared with the older forms of psychotherapy. In order to avoid misunderstandings, let me say at once that this shift is certainly not meant to condemn the existing methods as incorrect, superfluous, or obsolete. The more deeply we penetrate the nature of the psyche, the more the conviction grows upon us that the diversity, the multidimensionality of human nature requires the greatest variety of standpoints and methods in order to satisfy the variety of psychic dispositions. It is therefore pointless to subject a simple soul who lacks nothing but a dose of common sense to a complicated analysis of his impulses, much less expose him to the bewildering subtleties of psychological dialectic. It is equally 
9 

12 
GENERAL PROBLEMS OF PSYCHOTHERAPY 
obvious that with complex and highly intelligent people we shall get nowhere by employing well-intentioned advice, suggestions, and other efforts to convert them to some kind of sys· tem. In such cases the best thing the doctor can do is lay aside his whole apparatus of methods and theories and trust to luck that his personality will be steadfast enough to act as a signpost for the patient. At the same time he must give serious consideration to the possibility that in intelligence, sensibility, range and depth the patient's personality is superior to his own. But in all circumstances the prime rule of dialectical procedure is that the individuality of the sufferer has the same value, the same right to exist, as that of the doctor, and consequently that every development in the patient is to be regarded as valid, unless of course it corrects itself of its own accord. Inasmuch as a man is merely collective, he can be changed by suggestion to the point of becoming-or seeming to become-different from what he was before. But inasmuch as he is an individual he can only become what he is and always was. To the extent that "cure" means turning a sick man into a healthy one, cure is change. Wherever this is possible, where it does not demand too great a sacrifice of personality, we should change the sick man therapeutically. But when a patient realizes that cure through change would mean too great a sacrifice, then the doctor can, indeed he should, give up any wish to change or cure. He must either refuse to treat the patient or risk the dialectical procedure. This is of more frequent occurrence than one might think. In my own practice I always have a fair number of highly cultivated and intelligent people of marked individuality who, on ethical grounds, would vehemently resist any serious attempt to change them. In all such cases the doctor must leave the individual way to healing open, and then the cure will bring about no alteration of personality but will be the process we call "individuation," in which the patient becomes what he really is. H the worst comes to the worst, he will even put up with his neurosis, once he has understood the meaning of his illness. More than one patient has admitted to me that he has learned to accept his neurotic symptoms with gratitude, because, like a barometer, they invariably told him when and where he was straying from his individual path, and also whether he had let important things remain unconscious. 
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PRINCIPLES OF PRACTICAL PSYCHOTHERAPY 
Although the new, highly differentiated methods allow us an unsuspected glimpse into the endless complications of psychic relationships and have gone a long way to putting them on a theoretical basis, they nevertheless confine themselves to the analytical-reductive standpoint, so that the possibilities of individual development are obscured by being reduced to some general principle, such as sexuality. This is the prime reason why the phenomenology of individuation is at present almost virgin territory. Hence in what follows I must enter into some detail, for I can only give you an idea of individuation by trying to indicate the workings of the unconscious as revealed in the observed material itself. For, in the process of individual development, it is above all the unconscious that is thrust into the forefront of our interest. The deeper reason for this may lie in the fact that the conscious attitude of the neurotic is unnaturally one-sided and must be balanced by complementary or compensatory contents deriving from the unconscious. The unconscious has a special significance in this case as a corrective to the onesidedness of the conscious mind; hence the need to observe the points of view and impulses produced in dreams, because these must take the place once occupied by collective controls, such as the conventional outlook, habit, prejudices of an intellectual or moral nature. The road the individual follows is defined by his knowledge of the laws that are peculiar to himself; otherwise he will get lost in the arbitrary opinions of the conscious mind and break away from the mother-earth of individual instinct. ' 
	13 	So far as our present knowledge extends, it would seem that 
the vital urge which expresses itself in the structure and individual form of the living organism produces in the unconscious a process, or is itself such a process, which on becoming partially conscious depicts itself as a fugue-like sequence of images. Persons with natural introspective ability are capable of perceiving fragments of this autonomous or self-activating sequence without too much difficulty, generally in the form of visual fantasies, although they often fall into the error of thinking that they have created these fantasies, whereas in reality the fantasies have merely occurred to them. Their spontaneous nature can no longer be denied, however, when, as often happens, some fantasy-fragment becomes an obsession, like a tune you cannot get 
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GENERAL PROBLEMS OF PSYCHOTHERAPY 
out of your head, or a phobia, or a "symbolic tic." Closer to the unconscious sequence of images are the dreams which, if examined over a long series, reveal the continuity of the unconscious pictorial flood with surprising clearness. The continuity is shown in the repetition of motifs. These may deal with people, animals, objects, or situations. Thus the continuity of the picture sequence finds expression in the recurrence of some such motif over a long series of dreams. 
	14 	In a dream series extending over a period of two months, one 
of my patients had the water-motif in twenty-six dreams. In the first dream it appeared as the surf pounding the beach, then in the second as a view of the glassy sea. In the third dream the dreamer was on the seashore watching the rain fall on the water. In the fourth there was an indirect allusion to a voyage, for he was journeying to a distant country. In the fifth he was travelling to America; in the sixth, water was poured into a basin; in the seventh he was gazing over a vast expanse of sea at dawn; in the eighth he was aboard ship. In the ninth he travelled to a far-off savage land. In the tenth he was again aboard ship. In the eleventh he went down a river. In the twelfth he walked beside a brook. In the thirteenth he was on a steamer. In the fourteenth he heard a voice calling, "This is the way to the sea, we must get to the sea!" In the fifteenth he was on a ship going to America. In the sixteenth, again on a ship. In the seventeenth he drove to the ship in an automobile. In the eighteenth he made astronomical calculations on a ship. In the nineteenth he went down the Rhine. In the twentieth he was on an island, and again in the twenty-first. In the twentysecond he navigated a river with his mother. In the twentythird he stood on the seashore. In the twenty-fourth he looked for sunken treasure. In the twenty-fifth his father was telling him about the land where the water comes from. And finally in the twenty-sixth he went down a small river that debouched into a larger one. 
	15 	This example illustrates the continuity of the unconscious 
theme and also shows how the motifs can be evaluated statistically. Through numerous comparisons one can find out to what the water-motif is really pointing, and the interpretation of motifs follows from a number of similar dream-series. Thus the sea always signifies a collecting-place where all psychic life 
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PRINCIPLES OF PRACTICAL PSYCHOTHERAPY originates, i.e., the collective unconscious. Water in motion means something like the stream of life or the energy-potential. The ideas underlying all the motifs are visual representations of an archetypal character, symbolic primordial images which have served to build up and differentiate the human mind. These primordial images are difficult to define; one might even call them hazy. Cramping intellectual formulae rob them of their natural amplitude. They are not scientific concepts which must necessarily be clear and unequivocal; they are universal perceptions of the primitive mind, and they never denote any particular content but are significant for their wealth of associations. Levy-Bruhl calls them "collective representations," and Hubert and Mauss call them a priori categories of the imagination. 
	16 	In a longer series of dreams the motifs frequently change 
places. Thus, after the last of the above dreams, the water-motif gradually retreated to make way for a new motif, the "unknown woman." In general, dreams about women refer to women whom the dreamer knows. But now and then there are dreams in which a female figure appears who cannot be shown to be an acquaintance and whom the dream itself distinctly characterizes as unknown. This motif has an interesting phenomenology which I should like to illustrate from a dream series extending over a period of three months. In this series the motif occurred no less than fifty-one times. At the outset it appeared as a throng of vague female forms, then it assumed the vague form of a woman sitting on a step. She then appeared veiled, and when she took off the veil her face shone like the sun. Then she was a naked figure standing on a globe, seen from behind. After that she dissolved once more into a throng of dancing nymphs, then into a bevy of syphilitic prostitutes. A little later the unknown appeared on a ball, and the dreamer gave her some money. Then she was a syphilitic again. From now on the unknown becomes associated with the so-called "dual motif," a frequent occurrence in dreams. In this series a savage woman, a Malay perhaps, is doubled. She has to be taken captive, but she is also the naked blonde who stood on the globe, or else a young girl with a red cap, a nursemaid, or an old woman. She is very dangerous, a member of a robberband and not quite human, something like an abstract idea. She 
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GENERAL PROBLEMS OF PSYCHOTHERAPY 
is a guide, who takes the dreamer up a high mountain. But she is also like a bird, perhaps a marabou or pelican. She is a mancatcher. Generally she is fair-haired, a hairdresser's daughter, but has a dark Indian sister. As a fair-haired guide she informs the dreamer that part of his sister's soul belongs to her. She writes him a love-letter, but is another man's wife. She neither speaks nor is spoken to. Now she has black hair, now white. She has peculiar fantasies, unknown to the dreamer. She may be his father's unknown wife, but is not his mother. She travels with him in an airplane, which crashes. She is a voice that changes into a woman. She tells him that she is a piece of broken pottery, meaning presumably that she is a part-soul. She has a brother who is prisoner in Moscow. As the dark figure she is a servant-girl, stupid, and she has to be watched. Often she appears doubled, as two women who go mountain-climbing with him. On one occasion the fair-haired guide comes to him in a vision. She brings him bread, is full of religious ideas, knows the way he should go, meets him in church, acts as his spiritual guide. She seems to pop out of a dark chest and can change herself from a dog into a woman. Once she appears as an ape. The dreamer draws her portrait in a dream, but what comes out on the paper is an abstract symbolic ideogram containing the trinity, another frequent motif. 
	17 	The unknown woman, therefore, has an exceedingly con- 
tradictory character and cannot be related to any normal woman. She represents some fabulous being, a kind of fairy; and indeed fairies have the most varied characters. There are wicked fairies and good fairies; they too can change themselves into animals, they can become invisible, they are of uncertain age, now young, now old, elfin in nature, with part-souls, alluring, dangerous, and possessed of superior knowledge. We shall hardly be wrong in assuming that this motif is identical with the parallel ideas to be found in mythology, where we come across this elfin creature in a variety of forms-nymph, oread, sylph, undine, nixie, hamadryad, succubus, lamia, vampire, witch, and what not. Indeed the whole world of myth and fable is an outgrowth of uncon.scious fantasy just like the dream. Frequently this motif replaces the water-motif. Just as water denotes the unconscious in general, so the figure of the unknown woman is a personification of the unconscious, which I have 
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PRINCIPLES OF PRACTICAL PSYCHOTHERAPY 
called the "anima." This figure only occurs in men, and 1 emerges clearly only when the unconscious starts to reveal problematical nature. In man the unconscious has femini features, in woman masculine; hence in man the personificati of the unconscious is a feminine creature of the type we have j; described. 
	18 	I cannot, within the compass of a lecture, describe all t 
motifs that crop up in the process of individuation-when, t] is to say, the material is no longer reduced to generalities: plicable only to the collective man. There are numerous mot and we meet them everywhere in mythology. Hence we ( only say that the psychic development of the individual p duces something that looks very like the archaic world of fab and that the individual path looks like a regression to man's p history, and that consequently it seems as if something very un ward were happening which the therapist ought to arrest. , can in fact observe similar things in psychotic illnesses, es] cially in the paranoid forms of schizophrenia, which oft swarm with mythological images. The fear instantly arises tl we are dealing with some misdevelopment leading to a wOl of chaotic or morbid fantasy. A development of this kind m be dangerous with a person whose social personality has r found its feet; moreover any psychotherapeutic interventi may occasionally run into a latent psychosis and bring it full flower. For this reason to dabble in psychotherapy is play with fire, against which amateurs should be stringeuI cautioned. It is particularly dangerous when the mythologi( layer of the psyche is uncovered, for these contents have a fee ful fascination for the patient-which explains the tremendo influence mythological ideas have had on mankind. 
	19 	Now, it would seem that the recuperative process mobilil 
these powers for its own ends. Mythological ideas with their ( traordinary symbolism evidently reach far into the hum psyche and touch the historical foundations where reason, wi and good intentions never penetrate; for these ideas are ba of the same depths and speak a language which strikes an a sweringchord in the inner man, although our reason may n understand it. Hence, the process that at first sight looks li an alarming regression is rather a reculer pour mieux sautt 
15 

GENERAL PROBLEMS OF· PSYCHOTHERAPY 
an amassing and integration of powers that will develop into a new order. 
	lto 	A neurosis at this level is an entirely spiritual form of suf- 
fering which cannot be tackled with ordinary rational methods. For this reason there are not a few psychotherapists who, when all else fails, have recourse to one of the established religions or creeds. I am far from wishing to ridicule these efforts. On the contrary, I must emphasize that they are based on an extremely sound instinct, for our religions contain the still living remains of a mythological age. Even a political creed may occasionally revert to mythology, as is proved very clearly by the swastika, the German Christians, and the German Faith Movement. Not only Christianity with its symbols of salvation, but all religions, including the primitive with their magical rituals, are forms of psychotherapy which treat and heal the suffering of the soul, and the suffering of the body caused by the soul. How much in modern medicine is still suggestion therapy is not for me to say. To put it mildly, consideration of the psychological factor in practical therapeutics is by no means a bad thing. The history of medicine is exceedingly revealing in this respect. 
	21 	Therefore, when certain doctors resort to the mythological 
ideas of some religion or other, they are doing something historically justified. But they can only do this with patients for whom the mythological remains are still alive. For these patients some kind of rational therapy is indicated until such time as mythological ideas become a necessity. In treating devout Catholics, I always refer them to the Church's confessional and its means of grace. It is more difficult in the case of Protestants, who must do without confession and absolution. The more modern type of Protestantism has, however, the safetyvalve of the Oxford Group movement, which prescribes lay confession as a substitute, and group experience instead of absolution. A number of my patients have joined this movement with my entire approval, just as others have become Catholics, or at least better Catholics than they were before. In all these cases I refrain from applying the dialectical procedure, since there is no point in promoting individual development beyond the needs of the patient. If he can find the meaning of his life and the cure for his disquiet and disunity within the framework of an existing credo-including a political credo-that should 
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PRINCIPLES OF PRACTICAL PSYCHOTHERAPY 
be enough for the doctor. After all, the doctor's main concern is the sick, not the cured. 
	22 	There are, however, very many patients who have either no 
religious convictions at all or highly unorthodox ones. Such persons are, on principle, not open to any conviction. All rational therapy leaves them stuck where they were, although on the face of it their illness is quite curable. In these circumstances nothing is left but the dialectical development of the mythological material which is alive in the sick man himself, regardless of history and tradition. It is here that we come across those mythological dreams whose characteristic sequence of images presents the doctor with an entirely new and unexpected task. He then needs the sort of knowledge for which his professional studies have not equipped him in the least. For the human psyche is neither a psychiatric nor a physiological problem; it is not a biological problem at all but-precisely-a psychological one. It is a field on its own with its own peculiar laws. Its nature cannot be deduced from the principles of other sciences without doing violence to the idiosyncrasy of the psyche. It cannot be identified with the brain, or the hormones, or any known instinct; for better or worse it must be accepted as a phenomenon unique in kind. The phenomenology of the psyche contains more than the measurable facts of the natural sciences: it embraces the problem of mind, the father of all science. The psychotherapist becomes acutely aware of this when he is driven to penetrate below the level of accepted opinion. It is often objected that people have practised psychotherapy before now and did not find it necessary to go into all these complications. I readily admit that Hippocrates, Galen, and Paracelsus were excellent doctors, but I do not believe that modern medicine should on that account give up serum therapy and radiology. It is no doubt difficult, particularly for the layman, to understand the complicated problems of psychotherapy; but if he will just consider for a moment why certain situations in life or certain experiences are pathogenic, he will discover that human opinion often plays a decisive part. Certain things accordingly seem dangerous, or impossible, or harmful, simply because there are opinions that cause them to appear in that light. For instance, many people regard wealth as the supreme happiness and poverty as man's greatest curse, al- 
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GENERAL PROBLEMS OF PSYCHOTHERAPY 
though in actual fact riches never brought supreme happiness to anybody, nor is poverty a reason for melancholia. But we have these opinions, and these opinions are rooted in certain mental preconceptions-in the Zeitgeist) or in certain religious or antireligious views. These last play an important part in moral conflicts. As soon as the analysis of a patient's psychic situation impinges on the area of his mental preconceptions, we have already entered the realm of general ideas. The fact that dozens of normal people never criticize their mental preconceptionsobviously not, since they are unconscious of them-does not prove that these preconceptions are valid for all men, or indeed unconscious for all men, any more than it proves that they may not become the source of the severest moral conflict. Quite the contrary: in our age of revolutionary change, inherited prejudices of a general nature on the one hand and spiritual and moral disorientation on the other are very often the deeperlying causes of far-reaching disturbances in psychic equilibrium. To these patients the doctor has absolutely nothing to offer but the possibility of individual development. And for their sake the specialist is compelled to extend his knowledge over the field of the humane sciences, if he is to do justice to the symbolism of psychic contents. 
	23 	I would make myself guilty of a sin of omission if I were 
to foster the impression that specialized therapy needed nothing but a wide knowledge. Quite as important is the moral differentiation of the doctor's personality. Surgery and obstetrics have long been aware that it is not enough simply to wash the patient-the doctor himself must have clean hands. A neurotic psychotherapist will invariably treat his own neurosis in the patient. A therapy independent of the doctor's personality is just conceivable in the sphere of rational techniques, but it is quite inconceivable in a dialectical procedure where the doctor must emerge from his anonymity and give an account of himself, just as he expects his patient to do. I do not know which is the more difficult: to accumulate a wide knowledge or to renounce one's professional authority and anonymity. At all events the latter necessity involves a moral strain that makes the profession of psychotherapist not exactly an enviable one. Among laymen one frequently meets with the prejudice that psychotherapy is the easiest thing in the world and consists in 
18 

PRINCIPLES OF PRACTICAL PSYCHOTHERAPY 
the art of putting something over on people or wheedlinl money out of them. But actually it is a tricky and not undanger ous calling. Just as all doctors are exposed to infections an( other occupational hazards, so the psychotherapist runs the ris] of psychic infections which are no less menacing. On the onl hand he is often in danger of getting entangled in the neurose of his patients; on the other hand if he tries too hard to guan against their influence, he robs himself of his therapeutic ef ficacy. Between this Scylla and this Charybdis lies the peril, bu also the healing power. 
	24 	Modern psychotherapy is built up of many layers, corre 
sponding to the diversities of the patients requiring treatment The simplest cases are those who just want sound commor sense and good advice. With luck they can be disposed of in : single consultation. This is certainly not to say that cases whicl look simple are always as simple as they look; one is apt t( make disagreeable discoveries. Then there are patients f01 whom a thorough confession or "abreaction" is enough. The se verer neuroses usually require a reductive analysis of thei' symptoms and states. And here one should not apply this or tha method indiscriminately but, according to the nature of the case, should conduct the analysis more along the lines of Freu( or more along those of Adler. St. Augustine distinguishes tW( cardinal sins: concupiscence and conceit (superbia). The firs corresponds to Freud's pleasure principle, the second to Adler' power-drive, the desire to be on top. There are in fact tW( categories of people with different needs. Those whose mair characteristic is infantile pleasure-seeking generally have the satisfaction of incompatible desires and instincts more at hear than the social role they could play, hence they are often well to-do or even successful people who have arrived socially. Bu those who want to be "on top" are mostly people who are eithel the under-dogs in reality or fancy that they are not playing the role that is properly due to them. Hence they often have diffi culty in adapting themselves socially and try to cover up thei1 inferiority with power fictions. One can of course explain al neuroses in Freudian or Adlerian terms, but in practice it i better to examine the case carefully beforehand. In the case of educated people the decision is not difficult: I advise then to read a bit of Freud and a bit of Adler. As a rule they soor 
	B 	19 

GENERAL PROBLEMS OF PSYCHOTHERAPY 
find out which of the two suits them best .. So long as one is moving in the sphere of genuine neurosis one cannot dispense with the views of either Freud or Adler. 
	25 	But when the thing becomes monotonous and you begin 
to get repetitions, and your unbiased judgment tells you that a standstill has been reached, or when mythological or archetypal contents appear, then is the time to give up the analytical-reductive method and to treat the symbols anagogically or synthetically, which is equivalent to the dialectical procedure and the way of individuation. 
	26 	All methods of influence, including the analytical, require 
that the patient be seen as often as possible. I content myself with a maximum of four consultations a week. With the beginning of synthetic treatment it is of advantage to spread out the consultations. I then generally reduce them to one or two hours a week, for the patient must learn to go his own way. This consists in his trying to understand his dreams himself, so that the contents of the unconscious may be progressively articulated with the conscious mind; for the cause of neurosis is the discrepancy between the conscious attitude and the trend of the unconscious. This dissociation is bridged by the assimilation of unconscious contents. Hence the interval between consultations does not go unused. In this way one saves oneself and the patient a good deal of time, which is so much money to him; and at the same time he learns to stand on his own feet instead of clinging to the doctor. 
	27 	The work done by the patient through the progressive as- 
similation of unconscious contents leads ultimately to the integration of his personality and hence to the removal of the neurotic dissociation. To describe the details of this development would far exceed the limits of a lecture. I must therefore rest content with having given you at least a general survey of the principles of practical psychotherapy. 
20 

II 
WHAT IS PSYCHOTHERAPY? 1 
	28 	It is not so very long ago that fresh air, application of cc 
water, and "psychotherapy" were all recommended in the sal breath by well-meaning doctors in cases mysteriously comF cated by psychic symptoms. On closer examination "psyd therapy" meant a sort of robust, benevolently paternal advi which sought to persuade the patient, after the manner Dubois, that the symptom was "only psychic" and therefoT<: morbid fancy. 
	29 	It is not to be denied that advice may occasionally do SOl 
good, but advice is about as characteristic of modern psyd therapy as bandaging of modern surgery-that is to say, persor and authoritarian influence is an important factor in healir but not by any means the only one, and in no sense does it cc stitute the essence of psychotherapy. Whereas formerly it seem to be everybody's province, today psychotherapy has becom~ science and uses the scientific method. With our deepen understanding of the nature of neuroses and the psychic co plications of bodily ills, the nature of the treatment, too, 1 undergone considerable change and differentiation. The earl] suggestion theory, according to which symptoms had to suppressed by counteraction, was superseded by the psycl analytical viewpoint of Freud, who realized that the cause the illness was not removed with the suppression of the syn tom and that the symptom was far more a kind of signpost poil ing, directly or indirectly, to the cause. This novel attitud, which has been generally accepted for the last thirty years so-completely revolutionized therapy because, in contrad tion to· suggestion therapy, it required that the causes brought to consciousness. 
1 [Delivered as a lecture, "Was ist Psychotherapie?:' in May 1935, at a symposi Ol\ "Psychotherapy in Switlerland." Subsequently published in Schweiuris 4eT%te~itun~ fUT Stande.!TClgCTI, XVI: 26 (June, 193~), !I!15-39.-!'.l>1TOIlS.] 
U 

GENERAL PROBLEMS OF PSYCHOTHERAPY 
	3° 	Suggestion therapy (hypnosis, etc.) was not lightly aban- 
doned-it was abandoned only because its results were so unsatisfactory. It was fairly easy and practical to apply, and allowed skilled practitioners to treat a large number of patients at the same time, and this at least seemed to offer the hopeful beginnings of a lucrative method. Yet the actual cures were exceedingly sparse and so unstable that even the delightful possibility of simultaneous mass treatment could no longer save it. But for that, both the practitioner and the health insurance officer would have had every interest in retaining this method. It perished, however, of its own insufficiency. 
	31 	Freud's demand that the causes be made conscious has be- 
come the leitmotiv or basic postulate of all the more recent forms of psychotherapy. Psychopathological research during the last fifty years has proved beyond all possibility of doubt that the most important aetiological processes in neurosis are essentially unconscious; while practical experience has shown that the making conscious of aetiological facts or processes is a curative factor of far greater practical importance than suggestion. Accordingly in the course of the last twenty-five or thirty years there has occurred over the whole field of psychotherapy a swing away from direct suggestion in favour of all forms of therapy whose common standpoint is the raising to consciousness of the causes that make for illness. 
	32 	As already indicated, the change of treatment went hand 
in hand with a profounder and more highly differentiated theory of neurotic disturbance. So long as treatment Was restricted to suggestion, it could content itself with the merest skeleton of a theory. People thought it sufficient to regard neurotic symptoms as the "fancies" of an overwrought imagination, and from this view the therapy followed easily enough, the object of which was simply to suppress those products of imaginationthe "imaginary" symptoms. But what people thought they could nonchalantly write off as "imaginary" is only one manifestation of a morbid state that is positively protean in its symptomatology. No sooner is one symptom suppressed than another is there. The core of the disturbance had not been reached. 
	33 	Under the influence of Breuer and Freud the so-called 
"trauma" theory of neuroses held the field for a long time. Doctors tried to make the patient conscious of the original 22 

WHAT IS PSYCHOTHERAPYf 
traumatic elements with the aid of the "cathartic method." Bu even this comparatively simple method and its theory demandel an attitude of doctor to patient very different from the sugge: tion method, which could be practised by anyone with the ne< essary determination. The cathartic method required carefu individual scrutiny of the case in question and a patient attitud that searched for possible traumata. For only through the mm meticulous observation and examination of the material coull the traumatic elements be so constellated as to result in abrea< tion of the original affective situations from which the neurosi arose. Hence a lucrative group treatment became exceedingl difficult, if not impossible. Although the performance expectel of the doctor was qualitatively higher than in the case of sugge: tion, the theory was so elementary that there was always th possibility of a rather mechanical routine, for in principle ther was nothing to prevent the doctor from putting several patient at once into the relaxed condition in which the traumatic memc ries could be abreacted. 
	34 	As a result of this more exhaustive treatment of the indi 
vidual case it could no longer be disguised that the trauma theor was a hasty generalization. Growing experience made it clear t every conscientious investigator of neurotic symptoms that sp< cifically sexual traumata and other shocks may indeed accoun for some forms of neurosis, but not by any means for all. Freu himself soon stepped beyond the trauma theory and came ou with his theory of "repression." This theory is much mor complicated, and the tn;atment became differentiated accon ingly. It was realized that mere abreaction cannot possibly lea to the goal, since the majority of neuroses are not traumati at all. The theory of repression took far more account of th fact that typical neuroses are, properly speaking, development2 disturbances. Freud put it that the disturbance was due to th repression of infantile sexual impulses and tendencies whic were thereby made unconscious. The task of the theory was t track down these tendencies in the patient. But since by defin tion they are unconscious, their existence could only be prove hy a thorough examination of the pati~nt's anamnesis as we as his actual fantasies. 
	35 	In general the infantile impulses appear mainly in dream 
and that is why Freud now turned to a serious study of th 23 

GENERAL PROBLEMS OF PSYCHOTHERAPY 
dream. This was the decisive step that made modern psychotherapy a method of individual treatment. It is quite out of the question to apply psychoanalysis to several patients at once. It is anything but a mechanical routine. 
	36 	Now whether this form of treatment calls itself "individual 
psychology" with Adler or "psychoanalysis" with Freud and Stekel, the fact remains that modern psychotherapy of whatever kind, so far as it claims to be medically conscientious and sci· entifically reliable, can no longer be mass-produced but is obliged to give undivided and generous attention to the individual. The procedure is necessarily very detailed and lengthy. True, attempts are often made to shorten the length of treatment as much as possible, but one could hardly say that the results have been very encouraging. The point is that most neuroses are misdevelopments that have been built up over many years, and these cannot be remedied by a short and intensive process. Time is therefore an irreplaceable factor in healing. 
	37 	Neuroses are still-very unjustly-counted as mild illnesses, 
mainly because their nature is not tangible and of the body. People do not "die" of a neurosis-as if every bodily illness had a fatal outcome! But it is entirely forgotten that, unlike bodily illnesses, neuroses may be extremely deleterious in their psychic and social consequences, often worse than psychoses, which generally lead to the social isolation of the sufferer and thus render him innocuous. An anchylosed knee, an amputated foot, a long-drawn-out phthisis, are in every respect preferable to a severe neurosis. When the neurosis is regarded not merely from the clinical but from the psychological and social standpoint, one comes to the conclusion that it really is a severe illness, particularly in view of its effects on the patient's environment and way of life. The clinical standpoint by itself is not and cannot be fair to the nature of a neurosis, because a neurosis is more a psychosocial phenomenon than an illness in the strict sense. It forces us to extend the term "illness" beyond the idea of an individual body whose functions are disturbed, and to look upon the neurotic person asa sick system of social relationships. When one has corrected one's views in this way, one will no longer find it astonishing that a proper therapy of neuroses is an elaborate and complicated matter. 
24 

WHAT IS PSYCHOTHERAPY? 
	38 	Unfortunately, the medical faculties have bothered far too 
little with the fact that the number of neuroses (and above all the frequency of psychic complications in organic diseases) is very great and thus concerns the general practitioner in un· usually high degree, even though he may not realize it. Never· theless his studies give him no preparation whatever in thi~ most important respect; indeed, very often he never has a chance to find out anything about this subject, so vital in prac· tice. 
	39 	Although the beginnings of modern psychotherapy rest in 
the main on the services of Freud, we should be very wrong if we-as so often happens-identified psychological treatment with Freudian "psychoanalysis" pure and simple. This error is certainly fostered by Freud himself and his adherents, who, in most sectarian fashion, regard their sexual theory and their methodology as the sole means of grace. Adler's "individual psychology" is a contribution not to be underestimated, and represents a widening of the psychological horizon. There is much that is right and true in the theory and method of psy· choanalysis; nevertheless it restricts its truth essentially to the sexual frame of reference and is blind to everything that is not subordinate to it. Adler has proved that not a few neurose~ can be more successfully explained in quite another way. 
	40 	These newer developments of theory have as their thera· 
peutic aim not only the raising to consciousness of pathogenic contents and tendencies, but their reduction to original "simple" instincts, which is supposed to restore the patient to hi~ natural, unwarped state. Such an aim is no less praiseworth~ than it is logical and promising in practice. The wholesome re· sults are, when one considers the enormous difficulties in treat· ing the neuroses, most encouraging, if not so ideal that we need wish for nothing better. 
	41 	Reduction to instinct is itself a somewhat questionable 
matter, since man has always been at war with his instinctsthat is to say, they are in a state of perpetual strife; hence the danger arises that the reduction to instinct will only replace the original neurotic conflict by another. (To give but one example: Freud replaces the neurosis by the so-called "transference neurosis.") In order to avoid this danger, psychoanalysis tries to devalue the infantile desires through analytical insight, whereas 
25 

GENERAL PROBLEMS OF PSYCHOTHERAPY 
individual psychology tries to replace them by collectivizing the individual on the basis of the herd instinct. Freud represents the scientific rationalism of the nineteenth century, Adler the socio-political trends of the twentieth. 
	42 	Against these views, which clearly rest on time-bound as- 
sumptions, I have stressed the need for more extensive individualization of the method of treatment and for an irrationalization of its aims-especially the latter, which would ensure the greatest possible freedom from prejudice. In dealing with psychological developments, the doctor should, as a matter of principle, let nature rule and himself do his utmost to avoid influencing the patient in the direction of his own philosophical, social, and political bent. Even if all citizens are equal before the law, they are very unequal as individuals, and therefor~each can find happiness only in his own way. This is not to preach "individualism," but only the necessary pre-condition for responsible action: namely that a man should know himself and his own peculiarities and/have the courage to stand by them. Only when a man lives in his own way is he responsible and capable of action-otherwise he is just a hanger-on or follower-on with no proper personality. 
	43 	I mention these far-reaching problems of modern psycho- 
therapy not, indeed, to give an elaborate account of them but simply to show.the reader the sort of problems which the practitioner comes up against when his avowed aim is to guide the neurotic misdevelopment back to its natural course. Cons id et a man who is largely unconscious of his own psychology: in order to educate him to the point where he can consciously take the right road for him and at the same time clearly recognize his own social responsibilities, a detailed and lengthy procedure is needed. If Freud, by his observation of dreams-which are so very important therapeutically~has already done much to complicate the method, it is rendered even more exacting, rather than simplified, by further individualization, which logically sets greater store by the patient's individual material. But to the extent that his particular personality is thereby brought into play, his collaboration can be enlisted all the more. The psychoanalyst thinks he must see his patient for an hour a day for months on end; I manage in difficult cases with three or four sittings a week. As a rule I content myself with two, and 
26 

WHAT IS PSYCHOTHERAPY? 
once the patient has got going, he is reduced to one. In the interim he has to work at himself, but under my control. I provide him with the necessary psychological knowledge to free himself from my medical authority as speedily as possible. In addition, I break off the treatment every ten weeks or so, in order to throw him back on his normal milieu. In this way he is not alienated from his world-for he really suffers from his tendency to live at another's expense. In such a procedure time can take effect as a healing factor, without the patient's having to pay for th~ doctor's time. With proper direction most people become capable after a while of making their contribution-however modest at first-to the common work. In my experience the absolute period of cure is not shortened by too many sittings. It lasts a fair time in all cases requiring thorough treatment. Consequently, in the case of the patient with small means, if the sittings are spaced out and the intervals filled in with the patient's own work, the treatment becomes financially more endurable than when undertaken daily in the hope of (problematical) suggestive effects. 
	44 	In all clear cases of neurosis a certain re-education and 
regeneration of personality are essential, for we are dealing with a misdevelopment that generally goes far back into the individual's childhood. Accordingly the modern method must also take account of the philosophical and pedagogical views of the humane sciences, for which reason a purely medical educa· tion is proving increasingly inadequate. Such an activity should in all cases presuppose a thorough knowledge of psychiatry. But for adequate treatment of dreams a plentiful admixture of symbolical knowledge is needed, which can only be acquired by a study of primitive psychology, comparative mythology, and religion. 
	45 	Much to the astonishment of the psychotherapist, the ob- 
ject of his labours has not grown simpler with deepened knowledge and experience, but has visibly increased in scope and complexity; and in the clouds of the future the lineaments of a new practical psychology have already begun to take shape, which .will embrace the insights of the doctor as well as of the educator and all those whose concern is the human soul. Till then, psychotherapy will assuredly remain the business of the doctor, and it is to be hoped that the medical faculties 
	B* 	27 

GENERAL PROBLEMS OF PSYCHOTHERAPY 
will not long continue to turn a deaf ear to this plea addressed to the doctor by the sick. The educated public knows of the existence of psychotherapy, and the intelligent doctor knows, from his own practice, the great importance of psychological influence. Hence in Switzerland there is already a fine body of doctors who stand up for the rights of psychotherapy and practise it with self~sacrificing devotion, despite the fact that their work is often made bitter for them by ridicule, misinterpretation, and criticism, as inept as it is malevolent. 
28 

III 
SOME ASPECTS OF MODERN PSYCHOTHERAPY 1 
	46 	Modern psychotherapy finds itself in rather an awkward 
position at a public-health congress. It can boast of no international agreements, nor can it provide the legislator or the minister of public hygiene with suitable or workable advice. It must assume the somewhat humble role of personal charity work versus the big organizations and institutions of public welfare, and this despite the fact that neuroses are alarmingly common and occupy no small place among the host of evils that assail the health of civilized nations. 
	47 	Psychotherapy and modern psychology are as yet individual 
experiments with little or no general applicability. They rest upon the initiative of individual doctors, who are not supported even by the universities. Nevertheless the problems of modern psychology have aroused a widespread interest out of all proportion to the exceedingly restricted official sympathy. 
	48 	I must confess that I myself did not find it at all easy to 
bow my head to Freud's innovations. I was a young doctor then, busying myself with experimental psychopathology and mainly interested in the disturbances of mental reactions to be observed in the so-called association experiments. Only a few of Freud's works had then been published. But I could not help seeing that my conclusions undoubtedly tended to confirm the facts indicated by Freud, namely the facts of repression, substitution, and "symbolization." Nor could I honestly deny the very real importance of sexuality in the aetiology and indeed in the actual structure of neuroses. 
	49 	Medi~al psychology is still pioneer work, but it looks as if 
the medical profession were beginning to see a psychic side 1 [Written in English. Read at the Congress of the Society of Public Health, Zurich, in 1929. First published in Journal of State Medicine (London), XXXVIII: 6 Oune, 1930), 34S-M.-EDITORS.] 
:tg 

GENERAL PROBLEMS OF PSYCHOTHERA?Y 
to many things which have hitherto been considered from the physiological side only, not to mention the neuroses, whose psychic nature is no longer seriously contested. Medical psychology seems, therefore, to be coming into its own. But where, we may ask, can the medical student learn it? It is important for the doctor to know something about the psychology of his patients, and about the psychology of nervous, mental, and physical diseases. Quite a lot is known about these things among specialists, though the universities do not encourage such studies. I can understand their attitude. If I were responsible for a university department, I should certainly feel rather hesitant about teaching medical psychology. 
	5° 	In the first place, there is no denying the fact that Freud's 
theories have come up against certain rooted prejudices. It was to no purpose that he modified the worst aspects of his theories in later years. In the public eye he is branded by his first statements. They are one-sided and exaggerated; moreover they are backed by a philosophy that is falling more and more out of favour with the public: a thoroughly materialistic point of view which has been generally abandoned since the turn of the century. Freud's exclusive standpoint not only offends too many ideals but also misinterprets the natural facts of the human psyche. It is certain that human nature has its dark side, but the layman as well as the reasonable scientist is quite convinced that it also has its good and positive side, which is just as real. Common sense does not tolerate the Freudian tendency to derive everything from sexuality and other moral incompatibilities. Such a view is too destructive. 
	51 	The extraordinary importance which Freud attaches to the 
unconscious meets with scant approval, although it is an interesting point with a certain validity. But one should not stress it too much, otherwise one robs the conscious mind of its practical significance and eventually arrives at a completely mechanistic view of things. This goes against our instincts, which have made the conscious mind the arbiter mundi. It is nevertheless true that the conscious mind has been overvalued by the rationalists. Hence it was a healthy sign to give the unconscious its due share of value. But this should not exceed the value accorded to consciousness. 
30 

SOME ASPECTS OF MODERN PSYCHOTHERAPY 
	52 	A further reason for hesitation is the absence of a real me 
cal psychology, though there may be a psychology for doct< Psychology is not for professionals only, nor is it peculiar certain diseases. It is something broadly human, with prol sional and pathological variations. Nor, again, is it merely stinctual or biological. If it were, it could very well be jus chapter in a text-book of biology. It has an immensely i portant social and cultural aspect without which we could I imagine a human psyche at all. It is therefore quite impossi to speak of a general or normal psychology as the mere expI sion of a clash between instinct and moral law, or other ino veniences of that kind. Since the beginning of history man] been the maker of his own laws; and even if, as Freud see to think, they were the invention of our malevolent forefathc it is odd how the rest of humanity has conformed to them a given them silent assent. 
	53 	Even Freud, who tried to restrict what he called psycl 
analysis to the medical sphere (with occasional, somewhat appropriate excursions into other spheres), even he was fon to discuss fundamental principles that go far beyond pur medical considerations. The most cursory professional tn ment of an intelligent patient is bound to lead to basic issI; because a neurosis or any other mental conflict depends mt more on the personal attitude of the patient than on his fantile history. No matter what the influences are that disturl his youth, he still has to put up with them and he does so means of a certain attitude. The attitude is all-importa Freud emphasizes the aetiology of the case, and assumes t] once the causes are brought into consciousness the neurosis" be cured. But mere consciousness of the causes does not hl any more than detailed knowledge of the causes of war he to raise the value of the French franc. The task of psycl therapy is to correct the conscious attitude and not to go ch ing after infantile memories. Naturally you cannot do the c without· paying attention to the other, but the main emph;: should be upon the attitude of the patient. There are extrem practical reasons for this, because there is scarcely a neuro who does not love to dwell upon the evils of the past and wallow in self-commiserating memories. Very often his neurc 
31 

GENERAL PROBLEMS OF PSYCHOTHERAPY 
consists precisely in his hanging back and constantly excusing himself on account of the past. 
	54 	As you know, I am critical of Freud in this particular 
respect, but my criticism would not go so far as to deny the extraordinary power of the retrospective tendency. On the contrary, I consider it to be of the greatest importance, so important that I would not call any treatment thorough that did not take it into account. Freud in his analysis follows this regressive tendency to the end and thus arrives at the findings you all know. These findings are only apparent facts; in the main they are interpretations. He has a special method of interpreting psychic material, and it is partly because the material has a sexual aspect and partly because he interprets it in a special way that he arrives at his typical conclusions. Take for instance his treatment of dreams. He believes that the dream is a fa~ade. He says you can turn it inside out, that this or that factor is eliminated by a censor, and so forth. 
	55 	I hold that interpretation is the crux of the whole matter. 
One can just as well assume that the dream is not a fa~ade, that there is no censor, and that the unconscious appears in dreams in the naivest and most genuine way. The dream is as genuine as the albumen in urine, and this is anything but a fa~ade. If you take the dream like this, you naturally come to very different conclusions. And the same thing happens with the patient's regressive tendency. I have suggested that it is not just a relapse into infantilism, but a genuine attempt to get at something necessary. There is, to be sure, no lack of infantile perversions. But are we so certain that what appears to be, and is interpreted as, an incestuous craving is really only that? When we try, conscientiously and without theoretical bias, to find out what the patient is really seeking in his father or mother, we certainly do not, as a rule, find incest, but rather a genuine horror of it. 'Ve find that he is seeking something entirely different, something that Freud only appreciates negatively: the universal feeling of childhood innocence, the sense of security, of protection, of reciprocated love, of trust, of faith-a thing that has many names. 
	56 	Is this goal of the regressive tendency entirely without jus- 
tification? Or is it not rather the very thing the patient urgently needs in order to build up his conscious attitude? 
32 

SOME ASPECTS OF MODERN PSYCHOTHERAPY 
	57 	I believe that incest and the other perverted sexual aspects 
are, in most cases, no more than by-products, and that the essential contents of the regressive tendency are really those which I have just mentioned. I have no objection to a patient's going back to that kind of childhood, nor do I mind his indulging in such memories. 
	58 	I am not blind to the fact that the patient must sink or 
swim, and that he may possibly go under as the result of infantile indulgence; but I call him back to these valuable memories with conscious intent. I appeal to his sense of values deliberately, because I have to make the man well and therefore I must use all available means to achieve the therapeutic aim. 
	59 	The regressive tendency only means that the patient is seek- 
ing himself in his childhood memories, sometimes for better, sometimes for worse. His development was one-sided; it left important items of character and personality behind, and thus it ended in failure. That is why he has to go back. In Psychological Types, I tried to establish the general lines along which these one-sided developments move. There are two main attitudes which differ fundamentally, namely introversion and extraversion. Both are perfectly good ways of living, so long as they co-operate reasonably well. It is only a dominating onesidedness that leads to disaster. Within this very general framework there are more subtle distinctions based upon whatever function is preferred by the individual. Thus sOIllebody with a good brain will develop a powerful intellect at the expense of his feelings. Or again, the facts perceived by the realist will obliterate the beautiful visions of the intuitive. All such people will look back to childhood when they come to the end of their particular tether, or they will hanker for some state when they were still in touch with the lost world, or their dreams will reproduce enchanting memories of a past that has sunk into oblivion. 
	60 	By adopting a more idealistic philosophy, one can interpret 
things differently and produce a perfectly decent and respectable psychology which is just as true, relatively speaking, as the sordid underside. I do not see why one should not interpret the facts in a decent and positive way when one can easily afford to do so. For many people this is much better and more encouraging than to reduce everything to primitive constitu- 
33 

GENERAL PROBLEMS OF PSYCHOTHERAPY 
ents with nasty names. But here too we must not be one-sided, because certain patients are all the better for being told some drastic but cleansing truth. 
	61 	Freud's original idea of the unconscious was that it was a 
sort of receptacle or storehouse for repressed material, infantile wishes, and the like. But the unconscious is far more than that: it is the basis and precondition of all consciousness. It represents the unconscious functioning of the psyche in general. It is psychic life before, during, and after consciousness. And inasmuch as the newborn child is presented with a ready-made, highly developed brain which owes its differentiation to the accretions of untold centuries of ancestral life, the unconscious psyche must consist of inherited instincts, functions, and forms that are peculiar to the ancestral psyche. This collective heritage is by no means made up of inherited ideas, but rather of the possibilities of such ideas-in other words, of a priori categories of possible functioning. Such an inheritance could be called instinct, using the word in its original sense. But it is not quite so simple. On the contrary, it is a most intricate web of what I have called archetypal conditions. This implies the probability that a man will behave much as his ancestors behaved, right back to Methuselah. Thus the unconscious is seen as the collective predisposition to extreme conservatism, a guarantee, almost, that nothing new will ever happen. 
	62 	If this statement were unreservedly true, there would be 
none of that creative fantasy which is responsible for radical changes and innovations. Therefore our statement must be in part erroneous, since creative fantasy exists and is not simply the prerogative of the unconscious psyche. Generally speaking, it is an intrusion from the realm of the unconscious, a sort of lucky hunch, different in kind from the slow reasoning of the conscious mind. Thus the unconscious is seen as a creative factor, even as a bold innovator, and yet it is at the same time the stronghold of ancestral conservatism. A paradox, I admit, but it cannot be helped. It is no more paradoxical than man himself and that cannot be helped either. 
	63 	There are sound philosophical reasons why our arguments 
ihould end in paradox and why a paradoxical statement is the better witness to truth than a one-sided, so-called "positive" 34 

SOME ASPECTS OF MODERN PSYCHOTHERAPY 
statement. But this is not the place to embark on a lengtl logical discourse. 
	64 	Now if you will bear in mind what we have just said abOl 
the significance of the unconscious, and if you will recall our di cussion of the regressive tendency, you will discover a further an cogent reason why the patient should have such a tendenc and why he is quite justified in having it. To be retrospecti~ and introspective is a pathological mistake only when it stO] short at futilities like incest and other squalid fantasies, or ; feelings of inferiority. Retrospection and introspection shou] be carried much further, because then the patient will not on discover the true reason for his childhood longings, but, goir beyond himself into the sphere of the collective psyche, he wi enter first into the treasure-house of collective ideas and the into creativity. In this way he will discover his identity with tl whole of humanity, as it ever was, is, and ever shall be. He wi add to his modest personal possessions which have proved then selves insufficient. Such acquisitions will strengthen his att tude, and this is the very reason why collective ideas have a ways been so important. 
	65 	It looks as if Freud had got stuck in his own pessimisn 
clinging as he does to his thoroughly negative and person; conception of the unconscious. You get nowhere if you assurr that the vital basis of man is nothing but a very personal an therefore very private afJaire scandaleuse. This is utterly hop less, and true only to the extent that a Strindberg drama is tru But pierce the veil of that sickly illusion, and you step out ( your narrow, stuffy personal corner into the wide realm of t1 collective psyche, into the healthy and natural matrix of tl human mind, into the very soul of humanity. That is the tn: foundation on which we can build a new and more workab: attitude. 
35 

IV 
THE AIMS OF PSYCHOTHERAPY 1 
	66 	It is generally agreed today that neuroses are functional 
psychic disturbances and are therefore to be cured preferably by psychological treatment. But when we come to the question of the structure of the neuroses and the principles of therapy, all agreement ends, and we have to acknowledge that we have as yet no fully satisfactory conception of the nature of the neuroses or of the principles of treatment. While it is true that two currents or schools of thought have gained a special hearing, they by no means exhaust the number of divergent opinions that actually exist. There are also numerous non-partisans who, amid the general conflict of opinion, have their own special views. If, therefore, we wanted to paint a comprehensive picture of this diversity, we should have to mix upon our palette all the hues and shadings of the rainbow. I would gladly paint such a picture if it lay within my power, for I have always felt the need for a conspectus of the many viewpoints. I have never succeeded in the long run in not giving divergent opinions their due. Such opinions could never arise, much less secure a following, if they did not correspond to some special disposition, some special character, some fundamental psychological fact that is more or less universal. Were we to exclude one such opinion as simply wrong and worthless, we should be rejecting this particular disposition or this particular fact as a misinterpretation-in other words, we should be doing violence to our own empirical material. The wide approval which greeted Freud's explanation of neurosis in terms of sexual causation and his view that the happenings in the psyche turn essentially upon infantile pleasure and its satisfaction should be instruc- 
1 [ ·Delivered as a lecture, "Ziele der Psychotherapie," on April 12, 1929, at the 4th General Medical Congress for Psychotherapy, Bad Nauheim, and published in the Bericht of the Congress, 1929; republished in Seelenprobleme der Gegenwart (Zurich, 1931), pp. 87-114. Previously trans. by C. F. Baynes and W. S. Dell in Modern Man in Search of a Soul (London and New York, 1953).-EDrroRS.] 
,36 

THE AIMS OF PSYCHOTHERAPY 
tive to the psychologist. It shows him that this manner of thinking and feeling coincides with a fairly widespread trend or spiritual current which, independently of Freud's theory, has made itself felt in other places, in other circumstances, in other minds, and in other forms. I should call it a manifestation of the collective psyche. Let me remind you here of the works of Havelock Ellis and August Forel and the contributors to A nthropoPhyteia; 2 then of the changed attitude to sex in AngloSaxon countries during the post-Victorian period, and the broad discussion of sexual matters in literature, which had already started with the French realists. Freud is one of the exponents of a contemporary psychological fact which has a special history of its own; but for obvious reasons we cannot go into that here. 
	67 	The acclaim which Adler, like Freud, has met with on both 
sides of the Atlantic points similarly to the undeniable fact that, for a great many people, the need for self-assertion arising from a sense of inferiority is a plausible basis of explanation. Nor can it be disputed that this view accounts for psychic actualities which are not given their due in the Freudian system. I need hardly mention in detail the collective psychological forces and social factors that favour the Adlerian view and make it their theoretical exponent. These matters are sufficiently obvious. 
	68 	It would be an unpardonable error to overlook the element 
of truth in both the Freudian and the Adlerian viewpoints, but it would be no less unpardonable to take either of them. as the sole truth. Both truths correspond to psychic realities. There are in fact some cases which by and large can best be described and eXplained by the one theory, and some by the other. 
	69 	I can accuse neither of these two investigators of any funda- 
mental error; on the contrary, I endeavour to apply both hypotheses as far as possible because I fully recognize their relative rightness. It would certainly never have occurred to me to depart from Freud's path had I not stumbled upon facts which forced me into modifications. And the same is true of my relation to the Adlerian viewpoint. 
	70 	After what has been said it seems hardly necessary to add 
that I hold the truth of my own deviationist views to be equally relative, and feel myself so very much the mere exponent of another disposition that I could almost say with Coleridge: "I 2 [Published at Leipzig, 1904-15.-EDrroRS.] 
37 

GENERAL PROBLEMS OF PSYCHOTHERAPY 
believe in the one and only saving Church, of which at present I am the only member." 3 
	71 	It is in applied psychology, if anywhere, that we must be 
modest today and bear with an apparent plurality of contradictory opinions; for we are still far from having anything like a thorough knowledge of the human psyche, that most challenging field of scientific inquiry. At present we have merely more or less plausible opinions that cannot be squared with one another. 
	72 	If, therefore, I undertake to say something about my views 
I hope I shall not be misunderstood. I am not advertising a novel truth, still less am I announcing a final gospel. I can only speak of attempts to throw light on psychic facts that are obscure to me, or of efforts to overcome therapeutic difficulties. 
	73 	And it is just with this last point that I should like to begin, 
for here lies the most pressing need for modifications. As is well known, one can get along for quite a time with an inadequate theory, but not with inadequate therapeutic methods. In my psychotherapeutic practice of nearly thirty years I have met with a fair number of failures which made a far deeper impression on me than my successes. Anybody can have successes in psychotherapy, starting with the primitive medicine-man and faith-healer. The psychotherapist learns little or nothing from his successes, for they chiefly confirm him in his mistakes. But failures are priceless experiences because they not only open the way to a better truth but force us to modify our views and methods. 
	74 	I certainly recognize how much my work has been furthered 
first by Freud and then by Adler, and in practice I try to acknowledge this debt by making use of their views, whenever possible, in the treatment of my patients. Nevertheless I must insist that I have experienced failures which, I felt, might have been avoided had I considered the facts that subsequently forced me to modify their views. 
	75 	To describe all the situations I came up against is almost 
impossible, so I must content myself with singling out a few typical cases. It was with older patients that I had the greatest difficulties, that is, with persons over forty. In handling younger 
3 [·The attribution to Coleridge is incorrect, according to Coleridgean scholars who were consulted.-EDlToRS.] 
38 

'tHE AIMS OF PSYCHOTHERAPY 
people I generally get along with the familiar viewpoints of Freud and Adler, for these tend to bring the patient to a certain level of adaptation and normality. Both views are eminently applicable to the young, apparently without leaving any disturbing after-effects. In my experience this is not so often the case with older people. It seems to me that the basic facts of the psyche undergo a very marked alteration in the course of life, so much so that we could almost speak of a psychology of life's morning and a psychology of its afternoon. As a rule, the life of a young person is characterized by a general expansion and a striving towards concrete ends; and his neurosis seems mainly to rest on his hesitation or shrinking back from this necessity. But the life of an older person is characterized by a contraction of forces, by the affirmation of what has been achieved, and by the curtailment of further growth. His neurosis comes mainly from his clinging to a youthful attitude which is now out of season. Just as the young neurotic is afraid of life, so the older one shrinks back from death. What was a normal goal for the young man becomes a neurotic hindrance to the old-just as, through his hesitation to face the world, the young neurotic's originally normal dependence on his parents grows into an incest-relationship that is inimical to life. It is natural that neurosis, resistance, repression, transference, "guiding fictions," and so forth should have one ~meaning in the young person and quite another in the old, despite apparent similarities. The aims of therapy should undoubtedly be modified to meet this fact. Hence the age of the patient seems to me a most important indicium. 
	76 	But there are various indicia also within the youthful phase 
of life. Thus, in my estimation, it is a technical blunder to apply the Freudian viewpoint to a patient with the Adlerian type of psychology, that is, an unsuccessful person with an infantile need to assert himself. Conversely, it would be a gross misunderstanding to force the Adlerian viewpoint on a successful man with a pronounced pleasure-principle psychology. When in a quandary the resistances of the patient may be valuable signposts. I am inclined to take deep-seated resistances seriously at first, paradoxical as this may sound, for I am convinced that the doctor does not necessarily know better than the patient's own psychic constitution, of which the patient himself may be 
39 

GENERAL PROBLEMS OF PSYCHOTHERAPY 
quite unconscious. This modesty on the part of the doctor is altogether becoming in view of the fact that there is not only no generally valid psychology today but rather an untold variety of temperaments and of more or less mdividual psyches that refuse to fit into any scheme. 
	77 	You know that in this matter of temperament I postulate 
two different basic attitudes in accordance with the typical differences already suspected by many students of human nature-namely, the extraverted and the introverted attitudes. These attitudes, too, I take to be important indicia, and likewise the predominance of one particular psychic function over the others.4. 
	78 	The extraordinary diversity of individual life necessitates 
constant modifications of theory which are often applied quite unconsciously by the doctor himself, although in principle they may not accord at all with his theoretical creed. 
	79 	While we are on this question of temperament I should not 
omit to mention that there are some people whose attitude is essentially spiritual and others whose attitude is essentially materialistic. It must not be imagined that such an attitude is acquired accidentally or springs from mere misunderstanding. Very often they are ingrained passions which no criticism and no persuasion can stamp out; there are even cases where an apparently outspoken materialism has its source in a denial of religious temperament. Cases of the reverse type are more easily credited today, although they are not more frequent than the others. This too is an indicium which in my opinion ought not to be overlooked. 
	80 	When we use the word indicium it might appear to mean, 
as is usual in medical parlance, that this or that treatment is indicated. Perhaps this should be the case, but psychotherapy has at present reached no such degree of certainty-for which reason our indicia are unfortunately not much more than warnings against one-sidedness. 
	81 	The human psyche is a thing of enormous ambiguity. In 
every single case we have to ask ourselves whether an attitude or a so-called habitus is authentic, or whether it may not be just a compensation for its opposite. I must confess that I have so often been deceived in this matter that in any concrete case 4. [Viz., thinking, feeling, sensation, and intuition.-EDlToRS.] 
40 

THE AIMS OF PSYCHOTHERAPY 
I am at pains to avoid all theoretical presuppositions about the structure of the neurosis and about what the patient can and ought to do. As far as possible I let pure experience decide the therapeutic aims. This may perhaps seem strange, because it is commonly supposed that the therapist has an aim. But in psychotherapy it seems to me positively advisable for the doctor not to have too fixed an aim. He can hardly know better than the nature and will to live of the patient. The great decisions in human life usually have far more to do with the instincts and other mysterious unconscious factors than with conscious will and well-meaning reasonableness. The shoe that fits one person pinches another; there is no universal recipe for living. Each of us carries his own life-form within him-an irrational form which no other can outbid. 
	82 	All this naturally does not prevent us from doing our ut- 
most to make the patient normal and reasonable. If the therapeutic results are satisfactory, we can probably let it go at that. If not, then for better or worse the therapist must be guided by the patient's own irrationalities. Here we must follow nature as a guide, and what the doctor then does is less a question of treatment than of developing the creative possibilities latent in the patient himself. 
	83 	What I have to say begins where the treatment leaves off 
and this development sets in. Thus my contribution to psychotherapy confines itself to those cases where rational treatment does not yield satisfactory results. The clinical material at my disposal is of a peculiar composition: new cases are decidedly in the minority. Most of them already have some form of psychotherapeutic treatment behind them, with partial or negative results. About a third of my cases are not suffering from any clinically definable neurosis, but from the senselessness and aimlessness of their lives. I should not object if this were called the general neurosis of our age. Fully two thirds of my patients are in the second half of life. 
	84 	This peculiar material sets up a special resistance to ra- 
tional methods of treatment, probably because most of my patients are socially well-adapted individuals, often of outstanding ability, to whom normalization means nothing. As for so-called normal people, there I really am in a fix, for I have no readymade philosophy of life to hand out to them. In the majority 
41 

GENERAL PROBLEMS OF PSYCHOTHERAPY 
of my cases the resources of the conscio~s mind are exhausted (or, in ordinary English, they are "stuck"). It is chiefly this fact that forces me to look for hidden possibilities. For I do not know what to say to the patient when he asks me, "What do you advise? What shall I do?" I don't know either. I only know one thing: when my conscious mind no longer sees any possible road ahead and consequently gets stuck, my unconscious psyche will react to the unbearable standstill. 
	85 	This "getting stuck" is a psychic occurrence so often re- 
peated during the course of human history that it has become the theme of many myths and fairytales. We are told of the Open sesame! to the locked door, or of some helpful animal who finds the hidden way. In other words, getting stuck is a typical event which, in the course of time, has evoked typical reactions and compensations. 'Ve may therefore expect with some probability that something similar will appear in the reactions of the unconscious, as, for example, in dreams. 
	86 	In such cases. then, my attention is directed more particu- 
larly to dreams. This is not because I am tied to the notion that dreams must always be called to the rescue, or because I possess a mysterious dream-theory/which tells me how everything must shape itself; but quite simply from perplexity. I do not know where else to go for help, and so I try to find it in dreams. These at least present us with images pointing to something or other, and that is better than nothing. I have no theory about dreams, I do not know how dreams arise. And I am not at all sure that my way of handling dreams even deserves the name of a "method." I share all your prejudices against dream-interpretation as the quintessence of uncertainty and arbitrariness. On the other hand, I know that if we meditate on a dream sufficiently long and thoroughly, if we carry it around with us and turn it over and over, something almost always comes of it. This something is not of course a scientific result to be boasted about or rationalized; but it is an important practical hint which shows the patient what the unconscious is aiming at. Indeed, it ought not to matter to me whether the result of my musings on the dream is scientifically verifiable or tenable, otherwise I am pursuing an ulterior-and therefore autoerotic-aim. I must content myself wholly with the fact that the result means something to the patient and sets his life in 
42 

THE AIMS OF PSYCHOTHERAPY 
motion again. I may allow myself only one criterion for the result of my labours: Does it work? As for my scientific hobbymy desire to know why it works-this I must reserve for my spare time. 
	87 	Infinitely varied are the contents of the initial dreams, that 
is, the dreams that come at the outset of the treatment. In many cases they point directly to the past and recall things lost and forgotten. For very often the standstill and disorientation arise when life has become one-sided, and this may, in psychological terms, cause a sudden loss of libido. All our previous activities become uninteresting, even senseless, and our aims suddenly no longer worth striving for. What in one person is merely a passing mood may in another become a chronic condition. In these cases it often happens that other possibilities for developing the personality lie buried somewhere or other in the past, unknown to anybody, not even to the patient. But the dream may reveal the clue. 
	88 	In other cases the dream points to present facts, for exam- 
ple marriage or social position, which the conscious mind has never accepted as sources of problems or conflicts. 
	89 	Both possibilities come within the sphere of the rational, and 
I daresay I would have no difficulty in making such initial dreams seem plausible. The real difficulty begins when the dreams do not point to anything tangible, and this they do often enough, especially when they hold anticipations of the future. I do not mean that such dreams are necessarily prophetic, merely that they feel the way, they "reconnoitre." These dreams contain inklings of possibilities and for that reason can never be made plausible to an outsider. Sometimes they are not plausible even to me, and then I usually say to the patient, "I don't believe it, but follow up the clue." As I have said, the sole criterion is the stimulating effect, but it is by no means necessary for me to understand why such an effect takes place. 
	go 	This is particularly true of dreams that contain something 
like an "unconscious metaphysics," by which I mean mythological analogies that are sometimes incredibly strange and baffling .. 
	91 	Now, you will certainly protest: How on earth can I know 
that the dreams contain anything like an unconscious metaphysics? And here I· must confess that I do not really know. I 
43 

GENERAL PROBLEMS OF PSYCHOTHERAPY 
know far too little about dreams for that. I see only the effect on the patient, of which I would like to give you a little exam· pIe. 
	9~ 	In a long initial dream of one of my "normal" patients, the 
illness of his sister's child played an important part. She was a little girl of two. 
	93 	Some time before, this sister had in fact lost a boy through 
illness, but otherwise none of her children was ill. The occurrence of the sick child in the dream at first proved bafHing to the dreamer, probably because it failed to fit the facts. Since there was no direct and intimate connection between the dreamer and his sister, he could feel in this image little that was personal to him. Then he suddenly remembered that two years earlier he had taken up the study of occultism, in the course of which he also discovered psychology. So the child evidently represented his interest in the psyche-an idea I should never have arrived at of my own accord. Seen purely theoretically, this dream image can mean anything or nothing. For that matter, does a thing or a fact ever mean anything in itself? The only certainty is that it is always man who interprets, who assigns meaning. And that is the gist of the matter for psychology. It impressed the dreamer as a novel and interesting idea that the study of occultism might have something sickly about it. Somehow the thought struck home. And this is the decisive point: the interpretation works, however we may elect to account for its working. For the dreamer the thought was an implied criticism, and through it a certain change of attitude was brought about. By such slight changes, which one could never think up rationally, things are set in motion and the dead point is overcome, at least in principle. 
	94 	From this example I could say figuratively that the dream 
meant that there was something sickly about the dreamer's occult studies, and in this sense-since the dream brought him to such an idea-I can also speak of "unconscious metaphysics." 
	95 	But I go still further: Not only do I give the patient an 
opportunity to find associations to his dreams, I give myself the same opportunity. Further, I present him with my ideas and opinions. If, in so doing, I open the door to "suggestion," I see no occasion for regret; for it is well known that we are susceptible only to those suggestions with which we are already se- 
44 

THE AIMS OF PSYCHOTHERAPY 
credy in accord. No harm is done if now and then one goes astray in this riddle-reading: sooner or later the psyche will reject the mistake, much as the organism rejects a foreign body. I do not need to prove that my interpretation of the dream is right (a pretty hopeless undertaking anyway), but must simply try to discover, with the patient, what acts for him-I am almost tempted to say, what is actual. 
	Q6 	For this reason it is particularly important for me to know 
as much as possible about primitive psychology, mythology, archaeology, and comparative religion, because these fields offer me invaluable analogies with which I can enrich the associations of my patients. Together, we can then find meaning in apparent irrelevancies and thus vastly increase the effectiveness of the dream. For the layman who has done his utmost in the personal and rational sphere of life and yet has found no meaning and no satisfaction there, it is enormously important to be able to enter a sphere of irrational experience. In this way, too, the habitual and the commonplace come to wear an altered countenance, and can even acquire a new glamour. For it all depends on how we look at things! and not on how they are in themselves. The least of things with a meaning is always worth more in life than the greatest of things without it. 
	97 	I do not think I underestimate the risk of this undertak- 
ing. It is as if one began to build a bridge out into space. Indeed, the ironist might even allege-and has often done 50that in following this procedure both doctor and patient are indulging in mere fantasy-spinning. 
	98 	This objection is no counter-argument, but is very much to 
u1.e point. I even make an effort to second the patient in his fantasies. Truth to tell, I have no small opinion of fantasy. To me, it is the maternally creative side of the masculine mind. When all is said and done, we can never rise above fantasy. It is true that there are unprofitable, futile, morbid, and unsatisfying fantasies whose sterile nature is immediately recognized by every person endowed with common sense; but the faulty performance proves nothing against the normal performance. All, the works of man have their origin in creative imagination. What right, then, have we to disparage fantasy? In the normal course of things, fantasy does not easily go astray; it is too deep for that, and too closely bound up with the tap-root 
45 

101 
GENERAL PROBLEMS OF PSYCHOTHERAPY 
of human and animal instinct. It has a surprising way of always coming out right in the end. The creative activity of imagination frees man from his bondage to the "nothing but" 5 and raises him to the status of one who plays. As Schiller says, man is completely human only when he is at play. 
	99 	My aim is to bring about a psychic state in which my pa- 
tient begins to experiment with his own nature-a state of fluidity, change, and growth where nothing is eternally fixed and hopelessly petrified. I can here of course adumbrate only the principles of my technique. Those of you who happen to be acquainted with my works can easily imagine the necessary parallels. I would only like to emphasize that you should not think of my procedure as entirely without aim or limit. In handling a dream or fantasy I make it a rule never to go be· yond the meaning which is effective for the patient; I merely try to make him as fully conscious of this meaning as possible, so that he shall also become aware of its supra-personal connections. For, when something happens to a man and he supposes it to be personal only to himself, whereas in reality it is a quite universal experience, then his attitude is obviously wrong, that is, too personal, and it tends to exclude him from human society. By the same token we need to have not only a personal, contemporary consciousness, but also a supra-personal consciousness with a sense of historical continuity. However abstract this may sound, practical experience shows that many neuroses are caused primarily by the fact that people blind themselves to their own religious promptings because of a childish passion for rational enlightenment. It is high time the psychologist of today recognized that we are no longer dealing with dogmas and creeds but with the religious attitude per se) whose importance as a psychic function can hardly be overrated. And it is precisely for the religious function that the sense of historical continuity is indispensable. 
	100 	Coming back to the question of my technique, I ask my- 
self how far I am indebted to Freud for its existence. At all 
5 [ .The term "nothing but" (nichts als) denotes the common habit of explaining something unknown by reducing it to something apparently known and thereby devaluing it. For instance, when a certain illness is said to be "nothing but psychic," it is explained as imaginary and is thus devalued. The expression is borrowed from James, The Varieties of Religious Experience, p. 12.-EDlTORS,] 
46 

THE AIMS OF PSYCHOTHERAPY 
events I learned it from Freud's method of free association, and 
I regard it as a direct extension of that. 
So long as I help the patient to discover the effective elements in his dreams, and so long as I try to get him to see the general meaning of his symbols, he is still, psychologically speaking, in a state of childhood. For the time being he is dependent on his dreams and is always asking himself whether the next dream will give him new light or not. Moreover, he is dependent on my having ideas about his dreams and on my ability to increase his insight through my knowledge. Thus he is still in an undesirably passive condition where everything is rather uncertain and questionable; neither he nor I know the journey's end. Often it is not much more than a groping about in Egyptian darkness. In this condition we must not expect any very startling results-the' uncertainty is too great for that. Besides which there is always the risk that what we have woven by day the night will unravel. The danger is that nothing permanent is achieved, that nothing remains fixed. It not infrequently happens in these situations that the patient has a particularly vivid or curious dream, and says to me, "Do you know, if only I were a painter I would make a picture of it." Or the dreams are about photographs, paintings, drawings, or illuminated manuscripts, or even about the films. 
	102 	I have turned these hints to practical account, urging my 
patients at such times to paint in reality what they have seen in dream or fantasy. As a rule I am met with the objection, "But I am not a painter!" To this I usually reply that neither are modern painters, and that consequently modern painting is free for all, and that anyhow it is not a question of beauty but only of the trouble one takes with the picture. How true this is I saw recently in the case of a talented professional portraitist; she had to begin my way of painting all over again with pitiably childish efforts, literally as if she had never held a brush in her hand. To paint what we see before us is a different art from painting what we see within. 
	10!! 	Many of my more advanced patients, then, begin to paint. 
I can well understand that everyone will be profoundly impressed with the utter futility of this sort of dilettantism. Do not forget, however, that we are speaking not of people who still have to prove their social usefulness, but of those who can no 
47 

GENERAL PROBLEMS OF PSYCHC11 tfERAPY 
longer see any sense in being socially useful and who have come upon the cteeper and more dangerous question of the meaning of their own individual lives. To be a particle in the mass has meaning and charm only for the man who has not yet reached that stage, but none for the man who is sick to death of being a particle. The import'lnce of what life means to the individual may be denied by those who are socially below the general level of adaptation, and is inv"l.riably denied by the educator whose ambition it is to breed mass-men. But those who belong to neither category will sooner or later come up against this painful question. 
	104 	Although my patients occasionally produce artistically 
beautiful things that might wry well be shown in modern "art" exhibitions, I nevertheless treat them as completely worthless when judged by the canons of Teal art. As a matter of fact, it is essential that they should be considered worthless, otherwise my patients might imagine themselves to be artists, and the whole point of the exercise would be missed. It is not a question of art at all-or rather, it should not be a question of artbut of something more and other than mere art, namely the living effect upon the patient himself. The meaning of individual life, whose importance from the social standpoint is negligible, stands here at its highest, and for its sake the patient struggles to give form, however crude and childish, to the inexpressible. 
	105 	But why do I encourage patients, when they arrive at a 
certain stage in their development, to express themselves by means of brush, pencil, or pen at all? 
	106 	Here again my prime purpose is to produce an effect. In 
the state of psychological childhood described above, the patient remains passive; but now he begins to play an active part. To start off with, he puts down on paper what he has passively seen, thereby turning it into a deliberate act. He not only talks about it, he is actually doing something about it. Psychologically speaking, it makes a vast difference whether a man has an interesting conversation with his doctor two or three times a week, the results of which are left hanging in mid air, or whether he has to struggle for hours with refractory brush and colours, only to produce in the end something which, taken at its face value, is perfectly senseless. If it were really ~ij.seless to 
is 

THE AIMS OF PSYCHOTHERAPY 
him, the effort to paint it would be so repugnant that he could scarcely be brought to perform this exercise a second time. But because his fantasy does not strike him as entirely senseless, his busying himself with it only increases its effect upon him. Moreover, the concrete shaping of the image enforces a continuous study of it in all its parts, so that it can develop its effects to the full. This invests the bare fantasy with an element of reality, which lends it greater weight and greater driving power. And these rough-and-ready pictures do indeed produce effects which, I must admit, are rather difficult to describe. For instance, a patient needs only to have seen once or twice how much he is freed from a wretched state of mind by working at a symbolical picture, and he will always turn to this means of release whenever things go badly with him. In this way something of inestimable importance is won-the beginning of independence, a step towards psychological maturity. The patient can make himself creatively independent through this method, if I may call it such. He is no longer dependent on his dreams or on his doctor's knowledge; instead, by painting himself he gives shape to himself. For what he paints are active fantasies-that which is active within him. And that which is active within is himself, but no longer in the guise of his previous error, when he mistook the personal ego for the self; it is himself in a new and hitherto alien sense, for his ego now appears as the object of that which works within him. In countless pictures he strives to catch this interior ag~nt, only to discover in the end that it is eternally unknown and alien, the hidden foundation of psychic life. 
	1°7 	It is impossible for me to describe the extent to which 
this discovery changes the patient's standpoint and values, and how it shifts the centre of gravity of his personality. It is as though the earth had suddenly discovered that the sun was the centre of the planetary orbits and of its own earthly orbit as well. 
	108 	But have we not always known this to be so? I myself be- 
lieve that we have always known it. But I may know something with my head which the other man in me is far from knowing, for indeed and in truth I live as though I did not know it. Most of my patients knew the deeper truth, but did not live it. And why did they not live it? Because of that bias which makes us 
49