Atlas›Domain I · Psychodynamic & depth psychology›Guide 002
Guide I-002

Janet's psychological analysis

Pierre Janet1889
A 22 · L 49 · M 2922 interventions in the Trinity explorer1 described for recognition only
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: Pierre Janet's "psychological analysis" and treatment as set out in L'automatisme psychologique (1889), Principles of Psychotherapy (1924, Eng. trans. 1925) and Psychological Healing (1925, the English translation of Les médications psychologiques, 1919; cited below as PH with its page numbers), organised into the three-stage reconstruction of van der Hart, Brown & van der Kolk (1989; cited as VBK89). Modern adaptations follow van der Hart, Steele, Boon & Brown (1993; VSBB93). Janet wrote no step-by-step manual. The phase structure is a later scholarly reconstruction, which VBK89 call a heuristic rather than a protocol. [source: VBK89; VSBB93]

Janet's "psychological analysis" (analyse psychologique) is a careful search for the dissociated, "subconscious fixed ideas" (idées fixes) behind a patient's symptoms. These are usually unassimilated traumatic memories. Treatment then follows a "mental economy": first restore the patient's psychological energy, then "liquidate" the fixed ideas, then rebuild the capacity for completed, adaptive action. [source: van der Kolk & van der Hart 1989; VBK89]

The core idea of change is this. A traumatic memory is a fixed, sensorimotor re-enactment that the person cannot "recite". Janet held that "memory is an action: essentially it is the action of telling a story" (PH p. 661, quoted in van der Kolk & van der Hart 1989). Change happens when that memory is turned into a personal narrative and "realized", i.e. owned and placed in the present life history. This frees energy that the person was spending on "everlasting recommencements" of an unfinished act (PH p. 663, quoted in van der Hart & Rydberg 2019), so that it can go into new, completed actions. [source: van der Kolk & van der Hart 1989; van der Hart & Rydberg 2019; VSBB93]

2. Framework

Janet's stages "constantly shift and return". They are not linear. Retrieving one memory can stabilise a patient, and personality functioning sometimes has to be restored before any memory work. Traumatic memories are layered, so new material can surface after the work seemed complete. [source: VBK89]

Stage 1: Stabilisation and symptom reduction

  • Goals: build rapport, raise the patient's "psychological income" (sleep, food, rest), cut "expenses" (crises, medical problems, draining relationships), simplify life and relieve acute symptoms. [source: VBK89; PH pp. 485, 587]
  • Format: frequent individual sessions. Janet used hospitalisation ("isolation") freely; today that means outpatient work plus environmental protection, with inpatient care kept for crisis. [source: VBK89] [synthesis for the modern format]
  • Move on when: sleep and basic functions are adequate, crises are reduced, rapport is stable, the patient can tolerate the therapist approaching trauma-related material without decompensating, and the patient consents. [synthesis, derived from VBK89 and VSBB93 readiness criteria]

Stage 2: Identification, exploration and modification of traumatic memories ("liquidation")

  • Goals: identify the fixed ideas, then transform them into narrative memory by neutralisation, decomposition, substitution or reframing. [source: VBK89; Principles pp. 38–41]
  • Format: in Janet's work, individual sessions over weeks to months, often with hypnosis. Irène needed months to build a verbal memory (PH p. 681). VSBB93 subdivide this stage into preparation, synthesis and realisation/integration. [source: VBK89; VSBB93]
  • Move on when: the patient can tell the event "without reexperiencing it" (VSBB93 p. 14), the symptom tied to the fixed idea has subsided, and recall no longer triggers sensorimotor intrusions. [source: VSBB93]

Stage 3: Relapse prevention, reintegration and rehabilitation

  • Goals: treat residual symptoms and personality deficits, and restore action, attention, work and relationships through education, excitation and moral guidance. [source: VBK89; PH Part IV]
  • Format: practice-based sessions, often daily drills between sessions (PH pp. 718–720, 731–732). Termination comes by spacing sessions out and fading the therapist's influence. [source: VBK89; PH]
  • End when: the patient acts independently, and relapse risk is managed. Janet saw a patient forgetting appointments ("ingratitude") as a sign of recovery (PH pp. 1198–1199). [source: VBK89]

Session count: none is given in the primary sources. Janet's documented cases range from a few weeks (Marie, with 5-month follow-up) to years (Irène; contact over 16 years, PH p. 1202). [source: VBK89] [uncertain: no standard dose exists]

3. Guiding principles

  • Mental economy (force and tension): judge how much energy the patient has (force) and how well they can organise it into action (tension). In practice, every intervention is checked for whether it raises income or cuts expenditure. [source: VBK89; Principles Part II; Heim/Bühler-cited 2011 review]
  • Increase income, reduce expenses, liquidate debts: in practice, the order of work is rest and nourishment, then removing drains, then resolving fixed ideas. [source: VBK89]
  • Stabilise before exploring: in practice, do not open traumatic memories in an exhausted or crisis-ridden patient. [source: van der Kolk & van der Hart 1989]
  • Trauma is a memory disorder that blocks action: in practice, target both the memory and the patient's capacity to act, not insight alone. [source: VBK89]
  • Look for the hidden fixed idea, but do not invent one: the physician must "guard against discovering such memories where they did not exist" (Principles p. 41). In practice, follow evidence in the patient's material and never suggest content. [source: Principles p. 41]
  • Treat the core fixed idea, not only secondary ones: in practice, if a symptom resolves and another appears, look for a deeper layer. [source: VSBB93 p. 11; VBK89]
  • Gradualness: start with the least threatening memories and the simplest actions. In practice, grade everything. [source: VBK89; PH pp. 715–718]
  • Authority with minimal control: the patient should accept guidance, but the therapist limits their dominance so the patient regains control of their life. In practice, be directive about method and leave the patient in charge of life decisions. [source: VBK89; traitement 1989 p. 5]
  • Rapport is both alliance and symptom: "somnambulistic passion" (intense attachment) is expected and usually transient. In practice, use the influence, but plan from the start to fade it. [source: VBK89; PH pp. 1154–1156]
  • Completed action restores tension: unfinished acts drain the patient, and completed acts raise integrative capacity. In practice, end tasks and sessions with something finished. [source: van der Hart & Rydberg 2019]
  • Keep the patient anchored in the present during memory work: in practice, the therapist's voice and orientation cues tie the patient to now. [source: VSBB93 p. 10]
  • Individualise: Janet tailored the order and methods to each patient. Ellenberger called his system "less a special therapy than a general economy of psychotherapy" (quoted in VBK89). In practice, pick tools by diagnosis of force and tension, not by a fixed sequence. [source: VBK89; traitement 1989]
  • Fade influence at the end: in practice, lengthen the intervals between sessions and welcome signs of independence. [source: VBK89]

4. Intervention inventory

Interventions are grouped by the stage where Janet mainly used them. All of them can recur in any stage. Some of Janet's somatic methods are not covered as interventions here: sedatives and stimulants, which he himself called a "necessary evil" (PH p. 1030), plus hydrotherapy and electrical stimulation. The house rules exclude drug dosing, and none of these is a psychotherapy technique. [source: VBK89]

4.1 Psychological analysis (assessment and history)

  • Purpose / when: at intake and whenever symptoms change. It maps the patient's force and tension, the symptoms, and possible fixed ideas behind them. [source: Principles p. 41; van der Kolk & van der Hart 1989]
  • Steps: (1) Take a detailed history of symptoms and when each began. (2) Ask the patient to describe memories from each period of life in turn (Principles p. 41). (3) Note gestures, reticence, gaps in time and amnesias as signs of a hidden memory (Principles p. 41). (4) Where useful and consented to, interview family members, as Janet did (van der Kolk & van der Hart 1989). (5) Rate energy (sleep, appetite, fatigue, crises) and capacity for organised action (ability to start and finish tasks, attention). (6) Form a hypothesis only, and do not share it as fact. [source: Principles p. 41; VBK89] [synthesis for steps 5–6]
  • Example language (illustrative): "Let's go through your life period by period. What do you remember from the years when you were about ten to fourteen?" / "You paused just then. Is there something there we should note, without going into it yet?"
  • Watch for / working: gaps or flat spots in the story that line up with when symptoms began, and re-enactments (posture, voice, sensations) that come up when certain topics are approached. It is working when a symptom map ties onset, triggers and possible fixed ideas together. Do not let a hypothesis turn into suggestion (Principles p. 41).

4.2 Rest

  • Purpose / when: Stage 1 and relapses, for exhausted patients. It raises psychological "income". [source: VBK89; Principles Part I ch. IV]
  • Steps: (1) Identify where energy is lost (overwork, insomnia, crises). (2) Prescribe concrete rest periods and protected sleep. (3) Keep some mental influence going: Janet criticised rest given "without mental influence" (Principles p. 58), so keep sessions and a structured daily plan alongside the rest. (4) Review weekly and taper as energy returns. [source: VBK89; Principles p. 58] [synthesis for steps 1, 2 and 4]
  • Example language (illustrative): "For the next two weeks, your main job is to recover energy. We'll plan your rest the way we'd plan medication."
  • Watch for / working: sleep and appetite improve, and there are fewer crises. If rest slides into withdrawal or rumination, move on to graded activity (4.15, 4.17).

4.3 Isolation (protective removal from draining surroundings)

  • Purpose / when: when family or social pressures keep the patient in crisis. Janet often used hospitalisation for this (PH p. 485), and also to change family dynamics (PH p. 587). He found that younger patients with recent trauma benefited most. [source: VBK89]
  • Steps (modern adaptation): (1) Identify the specific relationships or settings that drain the patient or trigger crises. (2) Agree on temporary protective limits, such as fewer visits, a respite stay, or time off work. (3) Use inpatient care only for safety or crisis. (4) Plan re-entry and work with the family where possible. [synthesis; the historical method was hospital isolation]
  • Example language (illustrative): "It seems your crises come most often after Sunday visits. Could we try a month with shorter, planned contact and see what changes?"
  • Watch for / working: fewer crises and more energy in sessions. Watch for isolation becoming abandonment or reinforcing avoidance.

4.4 Simplification of life

  • Purpose / when: early Stage 1, when the patient cannot manage everyday decisions. Early on, the therapist takes over most decisions and environmental changes. [source: VBK89]
  • Steps: (1) List current demands. (2) Drop, delegate or postpone everything non-essential. (3) Set a simple fixed daily routine. Janet notes that routine saves energy (PH pp. 731–732). (4) Hand decisions back step by step as the patient's capacity grows. [source: VBK89; PH pp. 731–732] [synthesis for steps 1, 2 and 4]
  • Example language (illustrative): "For now, let's decide together which three things you'll keep doing this week. Everything else waits."
  • Watch for / working: less agitation and fewer unfinished tasks. Watch for dependence (see principle "Authority with minimal control").

4.5 Stimulation and re-education of basic functions

  • Purpose / when: Stage 1, when eating, sleeping or basic social contact have broken down. [source: VBK89; PH pp. 715, 723–725]
  • Steps: (1) Pick one function. (2) Set a graded regimen, for example a graded diet after initial rest in anorexia (PH p. 715), or sleep trained through posture and repeated words (PH pp. 723–725). (3) Practise daily. (4) Vary or stop any exercise that causes agitation or fatigue (VBK89). [source: VBK89; PH]
  • Example language (illustrative): "This week we'll only work on breakfast, at the same time each day, a small fixed amount. We'll adjust if it makes you more tense."
  • Watch for / working: the function becomes steadier. Agitation or fatigue mean the step was too large.

4.6 Hypnosis for symptom relief and relaxation (professional-training level only)

  • Purpose / when: Stage 1. Janet used it for relaxation, insomnia, conversion symptoms and amnesia, and in life-threatening conditions (PH p. 457). He sometimes used extended trance without specific suggestions. [source: VBK89]
  • Steps (outline only): use only with formal clinical hypnosis training. In outline: build rapport, explain hypnosis and get consent, induce, give suggestions aimed at the symptom or at rest, re-alert fully, and debrief. Keep trauma-related suggestions out of Stage 1: Janet found that patients often accepted symptom suggestions but refused trauma-related ones (traitement 1989 p. 2). [source: VBK89; traitement 1989; VSBB93 p. 7]
  • Example language: not provided. Induction scripts are outside the scope of this guide.
  • Watch for / working: sleep or the target symptom improves. Watch for trance being used to avoid painful issues (VSBB93 p. 7), and for intense attachment (4.19).

4.7 Uncovering through hypnosis or induced somnambulism (professional-training level only)

  • Purpose / when: Stage 2, when the analysis (4.1) points to a fixed idea the patient cannot reach awake. Janet found such memories surfaced in somnambulism (Principles pp. 38–39). Patients remembered best when returned to a state like the original one (van der Kolk & van der Hart 1989). [source: Principles; VBK89]
  • Steps (outline only): use only with formal training and only after Stage 1 readiness. In outline: agree on the aim and limits beforehand, induce, invite whatever memory is linked to the symptom without suggesting content, keep the patient oriented to the therapist, close, re-alert, then review the material awake. Treat what emerges as material to work with, not as verified fact (Principles p. 41). Janet's own inductions sometimes took weeks or months to work (VBK89). [source: VBK89; Principles p. 41] [synthesis for the in-session safeguards]
  • Example language: not provided (training-level only).
  • Watch for / working: symptom-relevant material comes up with appropriate affect and the patient can later tolerate it awake. Watch for crises being triggered (as with Irène) and for suggestibility contaminating content.

4.8 Automatic writing

  • Purpose / when: Stage 2, for highly dissociative patients whose split-off material or parts can "write" what the patient cannot say. In the case of Lucie, automatic writing under hypnosis revealed an alter, "Adrienne", who described a frightening event from age 7. [source: VBK89; Principles p. 41; L'automatisme psychologique 1889]
  • Steps (modern, cautious adaptation): (1) Use only in a stable, consenting patient, with dissociation-specific training. (2) Frame it as a way of letting another part of the self communicate, at the patient's pace. (3) Give paper and pen, and invite writing without censoring, either in session or (with care) in a structured diary. (4) Read it together afterwards, awake. (5) Close and contain. [synthesis; Janet's historical use was under hypnosis or distraction] [uncertain]
  • Example language (illustrative): "Some people find that their hand can say things their voice can't yet. If you'd like, write whatever comes, and we'll read it together afterwards."
  • Watch for / working: linked material appears that makes sense of a symptom. Watch for flooding, switching, and treating the writing as literal truth.

4.9 "Dream aloud" and observation of dreams

  • Purpose / when: Stage 2, to bring traumatic dream content to awareness. With the patient Co, a "dream aloud" suggestion recovered dreams about a friend's funeral. Janet used dreams to observe repeating automatic processes, not to interpret symbols. [source: VBK89; 2011 review]
  • Steps (modern adaptation): (1) Ask for a dream log. (2) Look for repeating sensory scenes, not symbols. (3) Link repeats to symptoms and to the life history. Hypnotic "dream aloud" is training-level only. [synthesis for the dream log]
  • Example language (illustrative): "Write down any dream that repeats, just what you saw, heard and felt. We're looking for scenes that keep returning, not hidden meanings."
  • Watch for / working: recurrent scenes can be matched to a dated event. Changes in dream content track progress (for example, with the patient Zy, Janet transformed and then removed the dream content; VBK89).

4.10 Suggestion by distraction

  • Purpose / when: Stage 2, for very resistant patients. While the patient's attention is taken up elsewhere, the dissociated part is addressed so the material can come out. [source: VBK89; L'automatisme psychologique 1889]
  • Steps: historical only. Primary procedural detail is not drawn on here, and it is not recommended without specialist training in dissociation. [uncertain]
  • Example language: not provided.
  • Watch for: high risk of suggestion and of confusing the patient's sense of agency. [synthesis]

4.11 Neutralisation: graded recounting into narrative memory ("liquidation")

  • Purpose / when: the central Stage 2 method. The patient re-experiences and puts the trauma into words step by step, beginning with the least threatening memories, until a verbal, assimilated memory replaces the re-enactment. It suits well-prepared patients only. [source: VBK89; traitement 1989 pp. 3–4]
  • Steps: (1) Confirm Stage 1 readiness and get consent. (2) Rank the memories from least to most threatening and start low. (3) Ask the patient to tell the event as a story in the first person: what happened first, then next, then how it ended. (4) Keep them in the present with your voice (VSBB93 p. 10). (5) Slow down or pause when arousal gets too high, and do not push catharsis, because uncontrolled abreaction leads to hyperarousal (VSBB93 p. 6). (6) Repeat across sessions until the account is coherent, includes the ending ("it is over"), and is told with affect that fits but does not flood. In Irène's case this took months, "after much labor" (PH p. 681). (7) Link the story to the patient's present life (see realisation, 4.13). [source: VBK89; VSBB93; PH p. 681] [synthesis for steps 2, 3 and 6]
  • Example language (illustrative): "Tell it to me as a story, starting a little before it began, and we'll stop wherever you need. You're here with me now, telling it." / "And what happened after that? How did it end?"
  • Watch for / working: the patient tells the event "without reexperiencing it" (VSBB93 p. 14), and the symptom tied to it fades. Warning signs: more intrusions, crises or resistance. Janet himself noted these risks (VBK89). If they appear, go back to Stage 1 tools.

4.12 Guided synthesis (modern adaptation, not Janet's own technique)

  • Purpose / when: a structured, hypnosis-assisted Stage 2 procedure developed by van der Hart et al. for patients with dissociative identity disorder (then called MPD). It brings the dissociated parts of one traumatic memory together. It is included here because it is the main modern descendant of liquidation. [source: VSBB93]
  • Steps (outline, training-level only): (1) Preparation: safety, mapping which parts were involved, correcting distorted beliefs, explaining the plan repeatedly, and getting the patient's conscious decision (VSBB93 pp. 6–9). (2) In hypnosis, parts that are not involved withdraw to a protected place. (3) The event is divided into about 10 segments and counted through from onset to aftermath. (4) No more than three rounds per session, with rest in between. (5) Fractionate if needed, so the patient experiences only part of the intensity. (6) Close with suggestions of accomplishment, then reorient fully. (7) Plan aftercare: getting home, a check-in call at a set time, and a session available at short notice (VSBB93 pp. 12–14). [source: VSBB93]
  • Example language: not provided (training-level only).
  • Watch for / working: contradictory versions or reactivation afterwards mean the synthesis is incomplete (VSBB93 p. 11). Unsynthesised remnants can trigger suicidality (p. 13), so monitor closely.

4.13 Realisation: personification and presentification

  • Purpose / when: late Stage 2 into Stage 3. The aim is for the patient to own the event as "mine" (personification) and to place it in a past that is over, in relation to the present and the future (presentification). This includes grief. [source: VSBB93; van der Hart & Rydberg 2019, drawing on Janet 1935]
  • Steps: (1) Once the narrative holds, invite first-person ownership statements. (2) Contrast then and now explicitly. (3) Make room for grief and mourning, which VSBB93 call a "crucial transition" (p. 15). (4) Explore what the event means now and what follows for present choices. (5) Listen to the full story again whenever needed, as testimony (VSBB93 p. 19). [source: VSBB93] [synthesis for steps 1 and 2]
  • Example language (illustrative): "Say it as yours: 'This happened to me, when I was nine.' And now, where are you, and how old are you?"
  • Watch for / working: the patient speaks of the event in the past tense, grieves rather than re-enacts, and makes forward-looking decisions. Being stuck in grief or numb acceptance means realisation is incomplete [synthesis].

4.14 Decomposition of the fixed idea

  • Purpose / when: Stage 2, when the fixed idea is too strong to approach whole. Janet broke it into its elements and altered them one at a time rather than attacking the whole (Janet 1894a p. 128, as cited in the 2011 review). [source: 2011 Psychotherapy review] [uncertain: the primary text, Histoire d'une idée fixe / Névroses et idées fixes]
  • Steps (reconstructed): (1) Elicit the fixed image or scene in detail. (2) List its components (sights, sounds, body sensations, words). (3) Work on one component at a time, through narration, neutralisation or substitution. (4) Check how intense the whole scene is after each change. [synthesis]
  • Example language (illustrative): "Let's not take on the whole scene. Which single part of it is the most vivid: a sound, an image, a feeling in your body?"
  • Watch for / working: overall distress drops as elements change. If the scene re-forms intact, return to the core fixed idea (VSBB93 p. 11).

4.15 Substitution

  • Purpose / when: Stage 2, when recounting fails or is not tolerated. It replaces traumatic imagery with neutral or positive imagery, or changes how the event is interpreted or felt. Examples: Marie (a suggestion that the old woman had only tripped; a "very nice child who was not sick") and Cam (images of her children's deaths replaced with blossoming flowers). Janet mostly used hypnosis for this. [source: VBK89; van der Kolk & van der Hart 1989 citing Janet 1889 p. 440]
  • Steps (modern, cautious adaptation): (1) Use it only after the actual memory has been acknowledged. Modern authors insist substitution must sit alongside keeping the real memory, to avoid denial (VSBB93 pp. 15–16). (2) Elicit the intrusive image. (3) Invite the patient to create an alternative image: a symbolic ending, protection, or a changed scene, as imagery rather than a revised fact. (4) Rehearse it. (5) Check that the patient still knows what really happened. [synthesis, modelled on VSBB93] Hypnotic substitution is training-level only.
  • Example language (illustrative): "We both know what really happened. Now, when that image comes, what would you want to see instead, as a picture that helps you put it down?"
  • Watch for / working: less intrusion and a narrative that stays intact. Avoid it in highly suggestible patients, where it "can also lead to confusion" (VSBB93), and with abuse survivors who were never believed, who may hear it as denial (Kluft, cited in VBK89).

4.16 Reframing (replacing the "patient myth" with a "therapeutic myth")

  • Purpose / when: Stage 2 or 3, especially with psychasthenic (obsessional, perfectionistic, self-blaming) patients. Janet worked on their verbal narrative, reassured them, restored morale, and helped them see their conduct as pathological rather than immoral (the case of Nicole). [source: VBK89; traitement 1989 p. 4]
  • Steps: (1) Draw out the patient's own account of the event and of their guilt. (2) Identify its moral verdict. (3) Offer an alternative, more acceptable account grounded in the facts, for example that their conduct reflected an illness or an overwhelmed state, not wickedness. (4) Restore morale. (5) Revisit until the new account holds. [source: VBK89] [synthesis for steps 2 and 5]
  • Example language (illustrative): "You've been judging what you did as a crime. Looking at the state you were in, it reads more like someone overwhelmed and unwell. Which is closer to the truth?"
  • Watch for / working: less self-reproach, and obsessive review of the event fades. Watch for empty reassurance that the patient rejects.

4.17 Education (re-education by supervised repetition)

  • Purpose / when: Stage 3, and Stage 1 for basic functions. It restores lost functions and builds new habits. Janet defined education as "the production and repetition of a new action" (PH p. 786), carried out in front of a competent witness who supervises and corrects it until it becomes automatic. For obsessions he used methods resembling thought-stopping and response prevention (VBK89, citing Janet 1903). [source: PH ch. XII; VBK89]
  • Steps: (1) Choose one target action. (2) Break it into basic parts, e.g. practising lying, then sitting, then standing (PH pp. 715–716). (3) The therapist models the action, the patient copies and describes it (PH p. 712), and the therapist checks useless movements early and encourages useful ones (PH pp. 784–785). (4) Lengthen in small steps, e.g. holding still a few seconds longer each time (PH pp. 717–718). (5) Practise daily at a fixed hour (PH pp. 731–732) and keep going after the symptom has gone (PH pp. 718–720). (6) Withdraw supervision step by step. [source: PH]
  • Example language (illustrative): "Let's do it together once, slowly. Now you do it and tell me what you notice. Tomorrow at ten, the same thing, five seconds longer."
  • Watch for / working: the action takes less effort over time, and Janet notes it is "performed with increasing ease" (PH p. 786). Watch for exhaustion: Janet cites Foy's concern that intense effort can exhaust patients already prone to it (PH p. 721).

4.18 Gymnastics of attention

  • Purpose / when: Stage 3, for scattered or weakened attention and low mental tension. [source: Principles p. 69; PH pp. 731–732 (case of Justine)]
  • Steps: (1) Set a short, fixed daily period of focused mental work (e.g. reading and summarising, calculation, or a precise description of an object). (2) Same hour every day. (3) Increase length or difficulty gradually. (4) Gently overcome the patient's reluctance to make the effort. [source: Principles p. 69; PH pp. 731–732] [synthesis for the example tasks]
  • Example language (illustrative): "Ten minutes at nine each morning: read one page and write three sentences about it. Bring them next time."
  • Watch for / working: longer sustained focus and less mental fog. Stop or scale down if it brings agitation or fatigue.

4.19 Aesthesiogeny (retraining bodily sensation)

  • Purpose / when: for anaesthesias and loss of body awareness in dissociative and conversion presentations. Janet observed passing states of full health with "no more anesthesia and no more amnesia" (Principles p. 35) and tried to make them last. [source: PH ch. XIII p. 788; Principles pp. 35–36; VBK89]
  • Steps (modern adaptation): (1) Map the areas of reduced sensation. (2) Guide the patient's attention to sensory stimulation of that area: touch, temperature, movement. (3) Ask them to describe what they feel in detail. (4) Repeat daily. [synthesis] [uncertain: the full text of PH ch. XIII; Janet's historical methods included metallotherapy and magnetisers' techniques, which are not recommended]
  • Example language (illustrative): "Put your palm on the table. Describe its temperature and texture, as precisely as you can."
  • Watch for / working: sensation returns and the patient feels more present. Body focus can trigger trauma memories, so pace it.

4.20 Excitation through graduated, completed actions

  • Purpose / when: Stage 3, to raise psychological tension, build mastery and reverse helplessness. Janet used awareness exercises (PH p. 972), graduated performance of neglected activities (PH p. 967), and channelling of agitation into creative work. Completed acts bring mastery and relief, and modern authors call these "acts of triumph" (van der Hart & Rydberg 2019, citing Ogden). [source: VBK89; PH ch. XIV; van der Hart & Rydberg 2019] [uncertain: the body of PH ch. XIV]
  • Steps: (1) List the actions the patient has neglected or left unfinished. (2) Choose one that is slightly hard but achievable. (3) The therapist models it, the patient practises until it comes naturally, then does it alone (PH p. 741). (4) Make sure it is finished. (5) Name and savour the completion. (6) Step up the difficulty. (7) Lend courage from the relationship: van der Hart & Rydberg describe patients borrowing courage from the therapist (citing PH p. 737). [source: VBK89; van der Hart & Rydberg 2019] [synthesis for steps 1, 2 and 5]
  • Example language (illustrative): "You've been meaning to call the bank for months. Let's write the first sentence now. Make the call before Thursday and tell me how it went." / "You finished it. Notice what that feels like."
  • Watch for / working: rising energy, initiative and mood. Several unfinished attempts in a row mean the step is too large, so scale it down.

4.21 Moral guidance and management of rapport ("somnambulistic influence")

  • Purpose / when: throughout, and actively managed in Stage 3. This is sustained personal guidance in a consistent relationship (Principles pp. 73–76; PH ch. XVI). It uses the patient's attachment and also manages it. [source: Principles; PH ch. XVI; VBK89]
  • Steps: (1) Keep continuity: one therapist and regular contact. (2) Give clear direction on method. (3) Expect strong attachment and treat it as transient (PH pp. 1154–1156). (4) Keep handing control back to the patient (VBK89). (5) Watch whether progress holds only while influence is high: dependence brings only temporary gains (traitement 1989 p. 5). [source: VBK89; traitement 1989]
  • Example language (illustrative): "I'll guide how we work. How you live is your decision. I'll keep handing more of it back to you."
  • Watch for / working: gains hold between sessions and between gaps. Warning signs are crises when sessions are spaced out, or gains that last only right after sessions.

4.22 Termination by fading influence

  • Purpose / when: end of Stage 3. [source: VBK89; traitement 1989 p. 5]
  • Steps: (1) Gradually lengthen the intervals between sessions. (2) Cut back directiveness. (3) Read missed or forgotten appointments, "ingratitude" in Janet's term, as a possible sign of recovery, not an insult (PH pp. 1198–1199). (4) Keep a door open for relapse. Janet kept in contact with Irène for 16 years (PH p. 1202). [source: VBK89] [synthesis for step 4]
  • Example language (illustrative): "Let's move to every three weeks. If you find yourself forgetting we have a session, that may be a good sign."
  • Watch for / working: stability holds across longer gaps, and the patient makes plans that don't involve the therapist.

5. Handling problems

  • "Phobia of memory" (avoidance of the traumatic material): Janet's term for the anxiety that blocks recounting (PH p. 661). VSBB93 call it "a flight from the act of realization". Response: go back to Stage 1, approach the least threatening memory first (4.11), or use decomposition (4.14). Don't force it. [source: van der Kolk & van der Hart 1989; VSBB93]
  • Resistance to hypnosis or to suggestions about the trauma: Janet put this down to unresolved fixed ideas. Induction could take weeks or months (VBK89). Response: keep hypnosis for symptom relief, work on the alliance, and ask whether the memory work is premature. [source: VBK89; traitement 1989]
  • Overwhelm or abreaction during memory work: uncontrolled catharsis brings hyperarousal and possible decompensation (VSBB93 p. 6). Response: slow down, fractionate, use the therapist's voice to anchor the present, contain unfinished material, and finish with orientation. If synthesis is premature, contain rather than push (VSBB93 p. 7). [source: VSBB93]
  • Reactivation between sessions: response: identify and neutralise triggers, stress the safety of the present, consider a co-therapist, and use crisis support or hospitalisation if needed (VSBB93 p. 7). Use aftercare calls (VSBB93 pp. 13–14). [source: VSBB93]
  • Layered memories and symptom substitution: response: when one symptom clears and another appears, look for a deeper or earlier fixed idea and treat the core, not only the secondary ones (VSBB93 p. 11; Marie had two traumas, VBK89). [source: VSBB93; VBK89]
  • Dissociative parts objecting to memory work: response: negotiate with them rather than override them, to avoid internal punishment for disclosure (VSBB93 p. 9). [source: VSBB93]
  • Over-attachment ("somnambulistic passion") and dependence: response: name it as expected and transient, keep firm boundaries, hand control back, and fade influence (4.21, 4.22). [source: VBK89; PH pp. 1154–1156]
  • Risk of creating false memories through suggestion: Janet himself warned about this (Principles p. 41). Response: never offer content, keep hypotheses private, treat recovered material as clinical data rather than verified fact, and get informed consent about memory malleability before any trance work. [source: Principles p. 41] [synthesis for the consent step]
  • Substitution felt as denial: response: confirm the real memory before any substitution, and avoid it with patients who were never believed (Kluft, cited in VBK89). [source: VBK89; VSBB93]
  • Exhaustion or agitation from exercises (non-adherence to education and excitation): response: vary the exercise or stop it if it produces agitation or fatigue (VBK89). Cut the step size, and fix a time of day to lower the effort of starting. [source: VBK89; PH p. 721] [synthesis for the fixed time]
  • Stuck client (no change despite stabilisation): response: re-run the psychological analysis (4.1) and re-estimate force versus tension. Too little force calls for rest and economy; too little tension calls for education and excitation. Check for a drain you have missed: a relationship, an illness, or an undisclosed fixed idea. [synthesis, built on Janet's force/tension distinction as cited in the 2011 review and VBK89]
  • Therapeutic rupture (patient feels controlled or criticised): Janet's balance of authority with minimal control applies. Response: acknowledge it, return decision-making to the patient, and go back to a collaborative plan. Janet's sources don't describe rupture repair as such. [synthesis]
  • Suicidality during Stage 2: unsynthesised remnants can trigger serious suicidality (VSBB93 p. 13). Response: pause memory work, do a safety assessment, increase contact, and consider inpatient care. [source: VSBB93] [synthesis for the specific steps]
  • Applying Janet's hospital-based methods in outpatient practice: response: replace isolation with protective limits agreed with the patient, and replace sedatives and stimulants with medical referral. [synthesis]

Sources

← Previous · I-001Breuer's cathartic method and abreactionNext · I-004 →Freudian psychoanalysis