Freudian psychoanalysis

1. Introduction

Version followed: Freud's papers on technique 1911–1915 (Standard Edition vol. 12: dream-interpretation 1911, dynamics of transference 1912, recommendations to physicians 1912, beginning the treatment 1913, remembering/repeating/working-through 1914, transference-love 1915), plus "Lines of Advance" (1919) and the 1937 papers "Analysis Terminable and Interminable" and "Constructions in Analysis"; with Ralph Greenson's The Technique and Practice of Psycho-Analysis, Vol. 1 (1967) as the classical ego-psychological operationalisation (working alliance; confrontation–clarification–interpretation–working through). Where Greenson extends or departs from Freud, this is flagged. Hypnosis, cathartic abreaction and the forehead "pressure technique" (Studies on Hysteria, 1895) are pre-analytic and not part of this version.

Classical psychoanalysis is a high-frequency (traditionally 4–6 sessions/week), open-ended treatment in which the patient lies on a couch and says whatever comes to mind (the fundamental rule) while the analyst listens with evenly suspended attention and interprets. Change is held to happen when unconscious conflicts, kept out of awareness by repression and the resistances that defend it, are re-lived in the relationship with the analyst (transference), recognised and interpreted there, and then repeatedly worked through until the ego can deal with the conflict consciously instead of through symptoms and repetition. Freud's descriptive aim is filling gaps in memory; his dynamic aim is overcoming the resistances due to repression [source: Freud 1914, SE 12:147–148]. The patient does not remember the repressed "but acts it out" in the treatment; the transference converts the ordinary neurosis into a "transference-neurosis", described as "an artificial illness which is at every point accessible to our intervention" [source: Freud 1914, SE 12:150, 154]. Greenson frames the work as producing material, analysing it, and sustaining a working alliance that lets the patient observe his own experiencing [source: Greenson 1967, ch. 1–3].

2. Framework

Freud explicitly declined to give a full schema; he likened analysis to chess, where only openings and end-games can be systematised [source: Freud 1913, SE 12:123]. The stages below combine Freud's opening and end-game advice with Greenson's description of the mid-phase. Session counts are approximate [uncertain: neither source specifies counts per phase].

Format (whole treatment). 45–50-minute sessions (Freud used a full hour; 50 minutes became standard later) [uncertain: Greenson-era convention, not Freud]. Freud saw patients daily except Sundays and public holidays; for mild cases or established treatments, three sessions a week sufficed [source: Freud 1913, SE 12:127]. Contemporary IPA standard for "psychoanalysis" is 3–5/week [uncertain: institute rules vary]. Couch, analyst seated behind and out of sight. Fixed fee, fixed leased hour, open-ended duration measured in years.

Phase 0 – Preliminary interviews / assessment (1–4 sessions, face-to-face).

Goals: diagnosis, suitability ("analysability"), discussion of practical arrangements, informed decision. Freud advised keeping preliminary talk short to avoid a pre-existing relationship complicating the transference [source: Freud 1913, SE 12:124–125].
Move on when: patient seems a suitable neurotic case, can commit time and money, and accepts the frame.

Phase 1 – Trial analysis / opening (first 1–2 weeks to several months).

Goals: test analysability on the couch; teach the fundamental rule; let a working rapport and transference form. Freud began every new case with a provisional "trial treatment of one to two weeks" conducted as real analysis [source: Freud 1913, SE 12:124, via nosubject summary].
Analyst activity: low; listens, intervenes mainly on resistances that block the flow (silence, "nothing comes to mind"); no deep content interpretation.
Move on when: the patient can associate, a positive (unobjectionable) transference is present, and material deepens. Freud: no deep communications until an effective transference/proper rapport has been established [source: Freud 1913, SE 12:139–140].

Phase 2 – Development and analysis of the transference neurosis (main body; typically years).

Goals: let the repressed be repeated in the transference; analyse resistances and transference reactions through confrontation, clarification, interpretation; reconstruct the infantile history.
Indicators of being in this phase: the analyst has become central in the patient's dreams and emotional life; symptoms and conflicts take transference meaning [source: Freud 1914, SE 12:154; Greenson 1967, §3.6].
Move on when: [synthesis based on Greenson and Freud 1937] core transference patterns have been repeatedly recognised and worked through; symptoms have diminished; the patient increasingly self-analyses; reconstructions have been confirmed by memories or indirect evidence.

Phase 3 – Working through (overlaps Phase 2). Repeated return to the same conflicts in new contexts until insight produces lasting change; Freud called this the part that most changes the patient and distinguishes analysis from suggestion [source: Freud 1914, SE 12:155–156].

Phase 4 – Termination (months).

Goals: analyse reactions to ending (often a return of symptoms and transference intensification); consolidate self-analytic capacity.
Criteria (Freud 1937): the patient no longer suffers from symptoms and has overcome anxieties and inhibitions; enough repressed material made conscious and resistance overcome that repetition of the pathological processes is not to be feared [source: Freud 1937a, SE 23:219, paraphrased]. Freud stressed analysis is in principle interminable and recommended the analyst be re-analysed periodically [source: Freud 1937a, SE 23:249].
Date-setting: an end-date is set jointly, usually 3–12 months ahead [synthesis; Freud gives no standard interval].

3. Guiding principles

Fundamental rule – the patient says everything that comes to mind without selection, including the embarrassing, trivial and seemingly irrelevant. Practical: you teach it once clearly, then analyse deviations rather than re-preach it [source: Freud 1913, SE 12:134–135; Freud 1912b].
Evenly suspended attention – the analyst gives equal weight to everything heard, without directing attention or selecting. Practical: don't hunt for content you expect; let your own associations surface [source: Freud 1912b, SE 12:111–112].
Analyst's unconscious as receiver – the analyst turns his unconscious towards the patient's like a telephone receiver to the transmitter. Practical: notice images, words and feelings that arise in you as data [source: Freud 1912b, SE 12:115–116].
No note-taking during sessions beyond dates and dreams/key sentences; notes distract attention [source: Freud 1912b, SE 12:113].
Surgeon-like emotional reserve – put aside personal feelings and therapeutic ambition. Practical: tolerate slowness; don't push for cure [source: Freud 1912b, SE 12:115].
Opacity / mirror – the analyst shows the patient only what the patient shows him; no self-disclosure of personal life. Practical: answer personal questions by exploring them first [source: Freud 1912b, SE 12:118].
No educative ambition – don't mould the patient to your ideals; work with his own capacities [source: Freud 1912b, SE 12:119].
Abstinence – the treatment is carried out in privation: the analyst does not gratify transference wishes (love, reassurance, advice) so that the need remains as a motive force for work [source: Freud 1915, SE 12:165; Freud 1919, SE 17:162–163].
Neutrality – equidistance from id, ego and superego; no siding in the patient's conflicts. [uncertain: term coined by Anna Freud 1936/Strachey's translation of Freud's Indifferenz; implicit in Freud 1915].
Surface to depth – start from what is on the surface of the patient's mind now [source: Freud 1914, SE 12:147; Greenson 1967, §2.6].
Resistance before content; ego before id – analyse how and why the patient avoids before what is avoided [source: Greenson 1967, §2.6].
Timing: interpret only when the patient is close – communicate repressed content only when the patient has nearly reached it himself and rapport exists; intellectual knowledge alone does not cure [source: Freud 1913, SE 12:140–142].
Transference is both the strongest resistance and the main vehicle – positive (affectionate, unobjectionable) transference is the carrier of success; negative and erotic transference must be analysed [source: Freud 1912a, SE 12:105–106].
Repetition replaces remembering – treat the illness as a present-day force; trace current enactments back [source: Freud 1914, SE 12:151].
Working through takes time – naming a resistance does not end it; wait [source: Freud 1914, SE 12:155].
Postpone major life decisions during treatment [source: Freud 1914, SE 12:153].
Working alliance – keep the patient's observing, reasonable ego allied with you against the resistances; this requires the analyst's humanness and consistency [source: Greenson 1967, §3.5; Greenson 1965]. [uncertain: Greenson's emphasis goes beyond Freud's "unobjectionable positive transference"].
Analyst's own analysis and self-analysis – the analyst must undergo analysis and monitor countertransference [source: Freud 1912b, SE 12:116–117; Freud 1910; Freud 1937a, SE 23:248–249].
Strict frame – leased hour, fee paid regardless of attendance, consistent schedule [source: Freud 1913, SE 12:126–127].

4. Complete intervention inventory

Ordered roughly as they arise in treatment. Greenson's core sequence for any piece of material is: confrontation → clarification → interpretation → working through [source: Greenson 1967, §1.3]. All therapist wording is (illustrative) unless quoted and cited.

4.1 Preliminary interviews and assessment of analysability

Purpose / when: Before starting; to decide whether analysis (vs. psychotherapy) is indicated and to agree terms. Freud excluded psychoses and severe cases from the classical method and warned that long preliminary talks or prior acquaintance complicate the transference [source: Freud 1913, SE 12:124–126; Freud 1905 "On Psychotherapy"].
Steps: (1) 1–3 face-to-face meetings. (2) Take history and current complaint; listen to how the patient tells it as much as content. (3) Assess: capacity to tolerate frustration and regression, to observe oneself, to form a relationship, motivation, ego strength [source: Greenson 1967, §3.9 on analysability; criteria list here is a summary, uncertain detail]. (4) Explain that analysis is long and its duration can't be predicted; Freud gave an honest answer to "how long?" by saying it takes long periods of time [source: Freud 1913, SE 12:128–129]. (5) Agree frequency, fee, hours, policy on missed sessions. (6) Propose a trial period.
Language (illustrative): "I can't tell you how long it will take; analyses usually run in years rather than months. What I can propose is that we start, and after a few weeks we'll both know more about whether this method suits you."
Watch for / working signs: Pressure to start with a "plan" or guaranteed outcome; idealisation; a third party pushing the patient into treatment (poor sign, Freud 1913). Working: patient accepts uncertainty and practical terms without major bargaining.

4.2 Trial analysis

Purpose / when: First 1–2 weeks of real analytic work to test suitability; Freud said it spares the patient the disappointment of an attempted cure that fails [source: Freud 1913, SE 12:124].
Steps: (1) Tell the patient this is provisional. (2) Run it as analysis proper: couch, fundamental rule, minimal intervention. (3) Observe: can the patient associate? Are there psychotic features? Does a rapport form? (4) At the end, decide jointly to continue or refer.
Language (illustrative): "For the next couple of weeks let's work in the way we'll continue, and treat it as a trial for both of us."
Watch for: Disorganisation on the couch, severe regression, inability to say anything even with help → consider face-to-face psychotherapy.

4.3 Setting and maintaining the frame (time, fee, frequency)

Purpose / when: At the outset and whenever tested. Freud leased each patient a fixed hour; the patient is responsible for it even if he doesn't use it [source: Freud 1913, SE 12:126–127]. He advised open, matter-of-fact discussion of money and against free treatment, which he found increased resistance [source: Freud 1913, SE 12:131–133].
Steps: (1) State hour(s), fee, billing interval, holiday arrangements. (2) State missed-session policy (charged unless otherwise agreed). (3) Hold to it; when the patient challenges it, explore meaning before any change. (4) Changes to the frame are your decision, made deliberately and later analysed.
Language (illustrative): "The hours are reserved for you, so sessions you miss are charged." / later: "You were angry about paying for Tuesday. What comes to mind about that?"
Watch for: Lateness, missed sessions, payment delays, requests to change times → treat as material (resistance or transference), not only logistics.

4.4 Introducing the couch

Purpose / when: From the trial analysis onward. Freud's reasons: he disliked being stared at 8+ hours a day, and his facial expression shouldn't give the patient material or influence associations; it isolates the transference [source: Freud 1913, SE 12:133–134]. Recumbency also favours regression and reduces visual cues [source: Greenson 1967, §4.2].
Steps: (1) Explain briefly and invite the patient to lie down; sit behind, out of sight. (2) Don't argue at length if anxious; acknowledge and explore. (3) Note the patient's reactions to lying down (fears of passivity, sexual meanings, loss of control) as early material.
Language (illustrative): "From now on I'd like you to lie on the couch. I'll sit behind you. It usually makes it easier to let thoughts come without watching my reactions."
Watch for: Patient twisting round, sitting up, refusing to lie down; these are resistances or anxiety signals to explore, not override.

4.5 Instructing the fundamental rule (free association)

Purpose / when: In the first couch session; the patient's side of the method [source: Freud 1913, SE 12:134–135; Freud 1900].
Steps: (1) Explain that ordinary conversation selects; here the patient should report everything that comes to mind. (2) Name the specific objections he'll feel: unimportant, irrelevant, nonsensical, embarrassing, rude to me. (3) Ask him not to yield to these objections; precisely what he wants to leave out is often most important. (4) Freud used the image of a railway passenger describing the changing view from the window to a person inside [source: Freud 1913, SE 12:135]. (5) Ask him to be honest and never leave anything out because it's unpleasant to say. (6) Leave the starting point to the patient [source: Freud 1913, SE 12:134].
Language (illustrative): "Please try to say whatever comes to mind, as it comes, even if it seems trivial, unrelated, embarrassing or rude toward me. If you notice yourself deciding to leave something out, that's exactly the thing to mention. Imagine you were describing to someone beside you the scenery passing a train window."
Watch for / working: Over time, increased spontaneity, emergence of affect, unexpected links, dreams. Note: free association is an ideal; deviations are expected and are the material of resistance analysis [source: Greenson 1967, §4.2]. Avoid presenting it as a moral demand; Busch (1995) recommends framing associations as data both parties listen to [source: Busch 1995].

4.6 Analytic listening (evenly suspended attention)

Purpose / when: Every session; the analyst's counterpart to free association [source: Freud 1912b, SE 12:111–112].
Steps: (1) Don't concentrate on anything in particular; don't select or try to remember. (2) Let your own associations and feelings arise and note them. (3) Track sequence (what follows what), repetitions, omissions, shifts in affect, slips, transference allusions. (4) Only after this receptive phase shift into active reflection and formulation [source: Greenson 1967, §1.3 on oscillation between empathic and cognitive listening].
Language: none (internal).
Watch for: Your own selection (theory-driven hearing), sleepiness, boredom, urge to intervene: these are countertransference data.

4.7 Analyst's silence

Purpose / when: Default stance; lets material unfold and transference develop. Interventions are fewer in the opening and when associations flow productively [source: Freud 1913, SE 12:139–140; Greenson 1967, §4.2].
Steps: (1) Stay silent while associations are productive. (2) Break silence when a resistance blocks the work, when the patient is near a significant insight, or when distress is too great to be useful.
Watch for: Silence experienced as rejection or punishment; prolonged mutual silences; patient's regression into disorganisation. Silence is not withholding contact; it must be accompanied by attentive presence [source: Greenson 1967].

4.8 Questions and prompts

Purpose / when: To keep associations going or obtain missing detail; to move from vague to specific [source: Greenson 1967, §1.3, as part of clarification].
Steps: (1) Use open, short prompts. (2) Ask about details the patient glosses over, about feelings, about what came to mind just before. (3) Avoid interrogation or leading questions.
Language (illustrative): "What comes to mind about that?" / "You stopped there. What were you thinking?" / "Say more about the moment you felt that."
Watch for: Patient becoming dependent on questions to speak; then shift to analysing the need to be led.

4.9 Confrontation

Purpose / when: First step of analysing any phenomenon: make it evident to the patient's conscious ego [source: Greenson 1967, §1.3].
Steps: (1) Ensure the phenomenon is visible enough that the patient will recognise it. (2) Point it out neutrally, without explaining it. (3) Wait for the patient's reaction.
Language (illustrative): "You're avoiding something." / "Each time you talk about your father your voice becomes flat." / "You laughed as you described the accident."
Watch for: Patient denying it (wait for more evidence; don't argue); patient becoming curious (working).

4.10 Clarification

Purpose / when: After confrontation; to bring the phenomenon into sharp focus by isolating details and the pattern [source: Greenson 1967, §1.3]. Often merges with confrontation.
Steps: (1) Dig out the significant details and separate them from extraneous material. (2) Identify the pattern: when it occurs, what precedes it, what it protects against. (3) Invite the patient's observing ego to join.
Language (illustrative): "So it happens when you start feeling close to someone, including here. It seems to come right after you mention something you want."
Watch for: The patient adding further examples himself = alliance working.

4.11 Interpretation

Purpose / when: The ultimate and decisive instrument: making an unconscious phenomenon conscious by stating its unconscious meaning, source, history, cause or mode of operation [source: Greenson 1967, §1.3]. Use only when the patient is near the material himself and a rapport exists [source: Freud 1913, SE 12:140–142].
Steps: (1) Check readiness: material has been confronted and clarified, the patient is approaching it, affect is present but not overwhelming. (2) Interpret defence/resistance before the warded-off content (ego before id). (3) Interpret what is on the surface and closest to the patient's experience first; deepen gradually. (4) Phrase tentatively, concretely, in the patient's words; short. (5) Link present (incl. transference) → past where possible. (6) Wait and observe the response.
Language (illustrative): "I think you go quiet with me because if you told me how angry you are, you'd fear I'd withdraw the way your mother did when you protested."
Watch for / working: Confirmation is shown less by "yes" than by new memories, dreams, associations that elaborate the interpretation, affect, or a change in behaviour. Freud: neither the patient's "yes" nor "no" is decisive; look at indirect confirmation [source: Freud 1937b, SE 23:262–263]. A flat intellectual agreement or a slick "aha" without affect indicates the interpretation hasn't landed.

4.12 Analysis of resistance (procedure)

Purpose / when: Whenever the flow of associations or the work is impeded; Freud's third-phase technique uses interpretation mainly to recognise resistances and make them conscious [source: Freud 1914, SE 12:147].
Steps (Greenson's sequence): (1) Recognise the resistance: silence, "nothing comes to mind", avoidance of topics, absence or inappropriateness of affect, rigid routines (e.g., always starting with dreams), lateness/missed sessions, trivial or intellectualised talk, posture, "I've got nothing to say" [source: Greenson 1967, §2.2; list paraphrased, uncertain completeness]. (2) Demonstrate it to the patient (confrontation). (3) Clarify: what is being resisted? (the painful affect), why? (the fear behind it), how? (the mode of defence). (4) Interpret the motive and the history of this way of defending. (5) Work through.
Language (illustrative): "You seem to be steering away from what you mentioned at the start. What makes it hard to stay with it?" / "Perhaps talking about the weekend feels safer than about what happened on Thursday."
Watch for: Interpreting content when resistance is active (wasted or used intellectually); accusing tone; repeated naming without waiting. Freud: naming a resistance doesn't stop it; let the patient become familiar with it [source: Freud 1914, SE 12:155].

4.13 Analysis of transference

Purpose / when: Central technique of the middle phase. Transference repeats infantile prototypes with the analyst; it is the strongest resistance and also the means of cure [source: Freud 1912a, SE 12:99–108; Freud 1914, SE 12:151]. Freud distinguished positive (affectionate, "unobjectionable") transference, which supports the work and is left uninterpreted while it does, from negative and erotic transference, which become resistances and must be analysed [source: Freud 1912a, SE 12:105]. Greenson distinguishes transference reactions from the working alliance and from the "real relationship" [source: Greenson 1967, ch. 3].
Steps: (1) Let the transference develop; don't contaminate it with self-disclosure or gratification. (2) Recognise it: feelings, wishes, fantasies or behaviour toward the analyst that are inappropriate, intense, ambivalent, capricious or tenacious relative to the present situation [source: Greenson 1967, §3.2, paraphrased]. (3) Wait until it is a resistance or until it is clearly visible and near consciousness. (4) Confront: show the patient the reaction toward you. (5) Clarify: details, fantasies, triggers (e.g., before weekends, after a fee change). (6) Interpret: its origin in past relationships and what it defends against. (7) Work through repeated appearances.
Language (illustrative): "You seem sure I'm bored with you today. What makes you sure?" / "Your feeling that I'll criticise you resembles how you described waiting for your father's verdict on your school reports."
Watch for / working: Allusions to the analyst disguised in stories about others (doctors, teachers, bosses), dreams with the analyst or the setting; reactions at separations. Working: patient can experience and observe the feeling simultaneously; it loses intensity once traced.

4.14 Handling transference-love (erotic transference)

Purpose / when: When the patient declares love or sexual longing for the analyst, often at a moment when painful material is near [source: Freud 1915, SE 12:157–171].
Steps: (1) Do not gratify it and do not suppress it or demand the patient renounce it; either ends the analysis [source: Freud 1915, SE 12:164–166]. (2) Treat it as something unreal, a situation to be gone through and traced back to its unconscious origins [source: Freud 1915, SE 12:166, paraphrased]. (3) Hold the love firmly but without responding; explore its details and conditions. (4) Show how it serves resistance (interrupts work, tests the analyst) and reproduces infantile prototypes. (5) Monitor your countertransference and seek consultation.
Language (illustrative): "These feelings are real to you and important for us to understand, not to act on. Let's look at what they're made of and when they came up – right after you began talking about your sister."
Watch for: Demands to prove care; threats to leave; seductive acting out. Any analyst boundary violation is documented as gravely harmful [source: Freud 1915; general professional ethics] – no steps beyond: never gratify; consult.

4.15 Analysis of negative transference

Purpose / when: Hostility, distrust, contempt toward the analyst; Freud lists it with erotic transference as resistance [source: Freud 1912a, SE 12:105–106]; Freud later regretted not analysing latent negative transference sufficiently [source: Freud 1937a, SE 23:221–222, uncertain page].
Steps: (1) Notice subtle signs (forgetting interpretations, sarcasm, "politeness", missed sessions). (2) Name it without defensiveness. (3) Invite elaboration; tolerate being the target. (4) Interpret its function and origins.
Language (illustrative): "I think you're quite angry with me today and also trying hard not to show it."
Watch for: Analyst's urge to justify or placate (countertransference); patient escalating to quitting – address directly in session.

4.16 Dream interpretation in analysis

Purpose / when: Dreams are a privileged route to unconscious wishes; Freud's 1911 paper gives the in-treatment rules [source: Freud 1911, SE 12:91–96; method from Freud 1900, SE 4–5].
Steps: (1) Let the patient report the dream in his own time; don't ask him to write it down on waking (it doesn't help and serves resistance) [source: Freud 1911, SE 12:95–96]. (2) Note the manner of telling (omissions, corrections, doubts). (3) Ask for associations to individual elements, starting from wherever the patient picks, or the most vivid/odd element. (4) Note the day residue. (5) Interpret as much as can be reached in that session; don't force a complete interpretation – later material often clarifies it [source: Freud 1911, SE 12:92–94]. (6) Don't let dream interpretation become an end in itself overriding the current surface of the session. (7) Look for transference references.
Language (illustrative): "Take the staircase in the dream – what comes to mind?" / "What happened yesterday that might connect?"
Watch for: Patient flooding sessions with dreams (resistance via compliance); dreams "to order" fitting your theories; dreams about the analyst (transference indicator).

4.17 Using parapraxes, symptomatic acts and details of behaviour

Purpose / when: Slips of the tongue, forgetting, mislaying, symptomatic acts in session (fiddling, posture), are surface evidence of unconscious intention [source: Freud 1901, SE 6; Greenson 1967, §2.2].
Steps: (1) Notice; let the patient notice first if possible. (2) Confront gently. (3) Ask for associations. (4) Interpret when the meaning becomes evident from associations, not from symbol dictionaries.
Language (illustrative): "You said 'my mother' just then instead of 'my wife'."
Watch for: Over-reading trivia (patient becomes self-conscious or compliant).

4.18 Handling acting out and repetition outside the session

Purpose / when: When the patient repeats rather than remembers, in or outside treatment [source: Freud 1914, SE 12:150–154].
Steps: (1) Recognise the repetition as a mode of remembering. (2) Ask the patient (ideally at the outset) not to take irreversible life decisions (profession, marriage partner) during treatment [source: Freud 1914, SE 12:153]. (3) Leave freedom in minor matters. (4) Bring the enactment into the transference and the session: name the action, connect it to the material it replaces. (5) Use the transference as a "playground" where the compulsion can expand under control [source: Freud 1914, SE 12:154].
Language (illustrative): "You decided to quit your job the day after we talked about your anger with me. I wonder if leaving there is a way of not leaving here."
Watch for: Dangerous acting out (self-harm, ruinous decisions) → prioritise safety; see section 5.

4.19 Constructions / reconstruction

Purpose / when: Mid-to-late phase; presenting the patient with a piece of his forgotten early history pieced together from fragments of memories, associations, dreams and transference repetitions [source: Freud 1937b, SE 23:257–269].
Steps: (1) Gather converging evidence over time. (2) Offer the construction tentatively as a hypothesis. (3) Don't regard "yes" or "no" as decisive; evaluate by indirect responses (new memories, associations with similar content, "I never thought of that") [source: Freud 1937b, SE 23:262–263]. (4) Revise or drop if no confirmation; a wrong construction does little harm if abandoned [source: Freud 1937b, SE 23:261]. (5) Even without recovered memory, a firm conviction of its truth can have the same therapeutic effect [source: Freud 1937b, SE 23:265–266].
Language (illustrative): "Putting together what you've said: perhaps when your brother was born you were around three and felt you'd been replaced, and you decided then never to need anyone too much."
Watch for: Suggestibility; constructions of abuse or trauma imposed by the analyst. [synthesis: the late-20th-century recovered-memory controversy documented harm from suggestive reconstruction; keep constructions about meaning/feeling patterns, flag uncertainty, never press for "memories".]

4.20 Working through

Purpose / when: After an insight; repeated, extended exploration of the same resistance/conflict in new contexts until change becomes durable [source: Freud 1914, SE 12:155–156; Greenson 1967, §1.3].
Steps: (1) Expect recurrence; don't treat it as failure. (2) Each time it reappears, re-confront, re-clarify, broaden the interpretation (other relationships, other ages, the transference). (3) Track affect: intellectual repetition is not working through. (4) Be patient – Freud called it a trial of patience for the analyst [source: Freud 1914, SE 12:155].
Language (illustrative): "Here it is again – the same retreat we saw with your boss, now with your partner and last week with me."
Watch for / working: The patient recognises the pattern earlier, unaided; new behaviour outside; decreasing intensity.

4.21 Countertransference monitoring and self-analysis

Purpose / when: Continuous. Freud required the analyst to recognise and overcome his countertransference and to undergo analysis [source: Freud 1910, SE 11:144–145; Freud 1912b, SE 12:116; Freud 1937a, SE 23:248–249]. [uncertain: the later use of countertransference as information (Heimann 1950) goes beyond the classical version; Greenson treats it mainly as interference to be analysed.]
Steps: (1) After sessions note strong feelings, urges, blind spots, boredom, enactments (extended time, reduced fee). (2) Self-analyse: whom does this patient represent for me? (3) Consult/supervise or return to personal analysis when stuck. (4) Don't disclose countertransference to the patient in the classical version.
Watch for: Repeated urge to reassure, advise, rescue, punish, or to gratify; any wish to change the frame for one patient.

4.22 Fostering the working alliance

Purpose / when: From the start, throughout. Greenson: the alliance between the analyst's analysing ego and the patient's reasonable, observing ego is the basis for all resistance work [source: Greenson 1967, §3.5; Greenson 1965]. Freud's parallel: interest and sympathetic understanding to establish rapport [source: Freud 1913, SE 12:139–140].
Steps: (1) Be consistent, punctual, attentive. (2) Explain the method when asked; invite the patient to look "with you" at his experiences. (3) Use "we" for the work. (4) Show humane concern (e.g., real loss, illness) without abandoning abstinence on transference wishes. (5) Interpret resistances to the alliance itself.
Language (illustrative): "Let's look together at what just happened here."
Watch for: Pseudo-alliance (compliance); alliance used to avoid transference ("we're just colleagues").

4.23 Handling requests, questions and demands (abstinence in practice)

Purpose / when: When the patient asks personal questions, for advice, reassurance, extra time or contact [source: Freud 1915, SE 12:165; Freud 1919, SE 17:162–164; Greenson 1967].
Steps: (1) Distinguish real/practical questions (holiday dates – answer) from transference questions. (2) Before answering or declining, explore: what prompted it, what answer is hoped/feared. (3) Decline gratification tactfully, explain the reason once if needed. (4) Interpret the frustration it creates.
Language (illustrative): "I'll answer if it still seems useful, but first, what are you imagining about me?" / "I know you'd like me to tell you what to do. If I did, we'd lose sight of why it's so hard for you to decide."
Watch for: Rigid refusals felt as cruelty (Greenson criticises coldness) → balance with warmth.

4.24 Active technique in phobias (Freud 1919)

Purpose / when: Freud said the analyst sometimes must be active: with severe agoraphobia, the patient must be induced to go out and struggle with the anxiety before the material becomes accessible [source: Freud 1919, SE 17:165–166].
Steps: (1) After analysis has stalled on a phobia, ask the patient to expose himself to the feared situation. (2) Analyse the material and anxiety that then emerge.
Language (illustrative): "I think we'll make more progress if you try going out alone this week and tell me what comes up."
Watch for: [uncertain: Freud describes this briefly; Ferenczi's broader "active technique" is a separate development, not part of this version.]

4.25 Termination

Purpose / when: Once the criteria in section 2 are approximately met [source: Freud 1937a, SE 23:219].
Steps: (1) Raise or respond to the idea; explore meaning first (flight? accomplishment?). (2) Agree an end-date well in advance. (3) Expect revival of symptoms and old transference; analyse them, don't extend automatically. (4) Review the work and the patient's capacity for self-analysis. (5) Leave the door open for return.
Language (illustrative): "Setting the date seems to have brought back the old fear of being dropped. Let's look at it while we still have time."
Watch for: Analyst-imposed time limits: Freud used one with the Wolf Man and judged it effective only if timed right and irreversible once set; he warned it can leave material buried [source: Freud 1937a, SE 23:217–219]. Use rarely, if at all.

5. Handling problems

5.1 Silence and "nothing comes to mind"

Freud read initial silence as a repetition and resistance, not absence of thoughts; there are always thoughts the patient is withholding, often about the analyst or the room [source: Freud 1913, SE 12:137–138; Freud 1914, SE 12:150].
Response: wait a reasonable time; then confront gently, ask what it is like to be silent and what the patient imagines you're thinking; explore thoughts about the analyst, the room, or what he decided not to say.
Language (illustrative): "You may feel nothing comes, but perhaps something did and seemed not worth saying. What was the last thing that crossed your mind?"
If chronic: analyse the function (control, spite, shame, fear of judgment) and its history. [synthesis: with very anxious or inexperienced patients, a brief face-to-face phase or more active prompting may be needed before returning to classical stance.]

5.2 Stuck analysis / stalemate

Signs: repetitive sessions without affect; patient says the same; analyst bored or sleepy; intellectual "insight" without change.
Responses: (1) Consider unrecognised transference resistance, especially latent negative transference [source: Freud 1937a; Greenson 1967]. (2) Consider secondary gain or unconscious need for punishment/negative therapeutic reaction (patient worsens after progress because improvement provokes guilt) [source: Freud 1923, SE 19:49–50]. (3) Examine countertransference collusion (both avoid a topic). (4) Remember working through takes time; don't confuse this with stalemate [source: Freud 1914]. (5) Seek consultation. [synthesis: if after consultation a long stalemate persists, consider frequency change, a different analyst, or a different modality, discussed openly with the patient.]

5.3 Intellectualisation / compliance

Patient produces theory, "good" associations, accepts interpretations readily without change. Freud warned intellectual knowledge does not alter the repression [source: Freud 1913, SE 12:141–142].
Response: confront the absence of affect and the pleasure-in-agreeing as resistance; interpret the wish to please you; reduce your own interpretive output; avoid lending books or theory [source: Freud 1913 advised against patients reading analytic literature, uncertain page].

5.4 Overwhelm, excessive regression, flooding

Couch and frequency foster regression; in fragile patients this can become disorganising.
Response [synthesis, extending Greenson's emphasis on the observing ego]: increase activity and structure; address the here-and-now and the alliance; temporarily sit up face-to-face; reduce depth of interpretation; interpret defence before content; ensure safety (risk assessment, outside supports). If psychotic features emerge, revisit suitability – Freud did not consider psychoses accessible to the method [source: Freud 1913, SE 12:124].
Language (illustrative): "This is a lot right now. Let's slow down and look at what's happening between us here."

5.5 Non-adherence to the frame (lateness, missed sessions, non-payment)

Treat as communication first: what is being avoided or expressed? [source: Freud 1913; Greenson 1967, §2.2].
Keep the policy consistent (charge for missed hours) and analyse the reactions; Freud found that relaxing the fee/time rules increased missed sessions and resistance [source: Freud 1913, SE 12:127, 131–132].
[synthesis: if non-payment accumulates, discuss directly and early; unresolved debt is a frame breach that corrupts the transference. Agree a plan or pause.]

5.6 Acting out and threats to the treatment

Ask early for postponement of major life decisions [source: Freud 1914, SE 12:153]. Interpret enactments as remembering in action.
Freud acknowledged some patients break off by an action before analysis can help [source: Freud 1914, SE 12:153–154].
[synthesis: where acting out endangers life or health (suicidality, substance relapse, violence), safety overrides neutrality: assess risk explicitly, involve medical care, and document. This is not addressed in Freud's papers.]

5.7 Erotic transference turning into demands

See 4.14. Neither gratify nor demand suppression; interpret its resistance function; if the patient cannot accept analysis of it, Freud considered referral as a last resort [source: Freud 1915, SE 12:166–167, paraphrased].
Response: consult early; never meet outside the frame.

5.8 Hostile transference / threats to quit (ruptures)

Freud: negative transference unchecked leads to breaking off [source: Freud 1912a, SE 12:107].
Response: name it in session promptly; don't defend or apologise prematurely; invite full expression; acknowledge any real error the analyst made (Greenson stresses admitting real mistakes as part of the real relationship and alliance) [source: Greenson 1967, ch. 3]; then explore what the error evoked transferentially.
Language (illustrative): "You're right that I was late, and I'm sorry. I also think it touched something bigger – the feeling you're never quite a priority for anyone."
[synthesis: "rupture-repair" terminology comes from later alliance research (Safran & Muran), not this version; the classical analogue is analysing the alliance and transference resistance.]

5.9 Negative therapeutic reaction

Patient gets worse after a good session or interpretation because improvement mobilises unconscious guilt/need for punishment [source: Freud 1923, SE 19:49–50].
Response: recognise the pattern; interpret slowly, starting with the observable sequence (better → worse); explore guilt about success, rivalry, envy of the analyst. [uncertain: Freud thought it very hard to influence.]

5.10 Symptom aggravation early in treatment

Freud expected some patients to get worse or develop new symptoms as conflicts are activated, and to use this against the treatment [source: Freud 1914, SE 12:152].
Response: explain that intensification is often temporary and part of the work; analyse the resistance use ("see what happens if I give in"). [synthesis: rule out medical/psychiatric deterioration needing separate care.]

5.11 Questions about duration, demands for results, third-party pressure

Answer honestly that analysis is long and unpredictable [source: Freud 1913, SE 12:128–130]; explore the demand's meaning. [synthesis: when insurers or institutions set limits, discuss openly; consider whether psychoanalytic psychotherapy is the more honest offer.]

5.12 Couch difficulties

Patient refuses or cannot tolerate lying down (claustrophobia, trauma history, fear of passivity).
Response: explore meanings; don't force. [synthesis: in trauma histories, consider a gradual transition or face-to-face work; the couch is a means, not the method, and later analysts treat it as non-essential (nosubject summary).]

5.13 Analyst-side problems

Therapeutic or educative ambition, need to be liked, boredom, rescue fantasies: Freud's remedy is the analyst's own analysis, periodic re-analysis (about every five years) and self-scrutiny [source: Freud 1912b; Freud 1937a, SE 23:249].
[synthesis: keep regular supervision/consultation, especially in the first analytic cases; most institutes require supervised control cases.]

5.14 Problems not addressed by the primary sources [synthesis throughout]

Online/telephone analysis: keep fixed times, private room, patient lying down if possible with camera off; analyse reactions to the medium.
Medication and psychiatric co-care: coordinate with prescribers; analyse the meanings of medication without opposing indicated treatment.
Crisis between sessions: set clear limits on contact at the outset; provide emergency pathway; analyse use of contact.
Cultural and socio-economic difference: distinguish realistic perceptions of the analyst from transference; don't interpret real social experiences as purely intrapsychic.
Ethical/legal: confidentiality limits, mandatory reporting and consent override classical opacity when relevant; explain these at the start.

Sources

Sources:

Books and papers cited (Standard Edition = SE; page numbers for papers not directly opened are from standard citation and are [uncertain] where not confirmed):

Freud, S. (1900). The Interpretation of Dreams. SE 4–5.
Freud, S. (1901). The Psychopathology of Everyday Life. SE 6.
Freud, S. (1910). The future prospects of psycho-analytic therapy. SE 11.
Freud, S. (1911). The handling of dream-interpretation in psycho-analysis. SE 12.
Freud, S. (1912a). The dynamics of transference. SE 12.
Freud, S. (1912b). Recommendations to physicians practising psycho-analysis. SE 12.
Freud, S. (1913). On beginning the treatment. SE 12.
Freud, S. (1914). Remembering, repeating and working-through. SE 12.
Freud, S. (1915). Observations on transference-love. SE 12.
Freud, S. (1919). Lines of advance in psycho-analytic therapy. SE 17.
Freud, S. (1923). The Ego and the Id. SE 19.
Freud, S. (1937a). Analysis terminable and interminable. SE 23.
Freud, S. (1937b). Constructions in analysis. SE 23.
Greenson, R. R. (1965). The working alliance and the transference neurosis. Psychoanalytic Quarterly, 34.
Greenson, R. R. (1967). The Technique and Practice of Psycho-Analysis, Vol. 1. International Universities Press.
Busch, F. (1995). Beginning a psychoanalytic treatment: establishing an analytic frame. JAPA, 43.

Note on verification: the full texts of Freud 1912–1913, 1915, 1919, 1937 and Greenson 1967 are not drawn on here. Content attributed to them is from standard knowledge of these texts and secondary summaries opened above; page numbers for them are [uncertain]. Only Freud 1914 was read in full.

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