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Discovering Transference

The Letter, Issue 38, Autumn 2006, Pages 91 - 104


Barry O'Donnell

Today we are marking the one hundred and fiftieth anniversary of the birth of Sigmund Freud. Why? Because he founded a new clinical practice, named psychoanalysis. His radical step, which he himself described, retrospectively, as arising from "an insight such as... falls to one's lot but once in a lifetime", involved taking up a new clinical position in the treatment of his patients.[1] So radical was his step that one has to ask how a young medical doctor in the 1880's and 1890's found himself able to make it. What distinctions did Freud have to make to realise an innovative clinical position which could respond to his fundamental redefinition of hysteria? Central to his founding of a new clinical practice was his recognition of the phenomena of transference. In my paper I would like to present to you some details and some remarks on what I gather to be a key moment in his taking this step, namely his case history, Fragment of an analysis of a case of hysteria, otherwise known as the 'Dora' case.[2]

Before looking at this case history it is useful to consider a little bit of history. Freud's birth in 1856, even with the error in the date recorded by the Registrar, is easier to pinpoint than a moment when he recognised the transference and decided to respond to it in a new way. The dominant theories of hysteria in the 1880' s were those of Jean Martin Charcot, Hippolyte Bernheim and Paul Briquet. Charcot had proposed a theory of hysteria as hereditary and due to mental degeneracy. This renowned French physician was less interested in treating or curing hysteria than in reproducing it by means of hypnosis for scientific study, which is an interesting approach to take. Although highly regarded by Freud, Charcot did not consider hysteria from a psychological point of view at all. Bernheim, for his part, was occupied more with treatment, which he based on suggestion facilitated by hypnosis and the trappings of charismatic healing. Paul Briquet wrote Traite de l'Hysterie in 1859 having carried out 'a comprehensive clinical and epidemiological study of 430 patients with hysteria' Briquet situated hysteria in the brain and therefore marks the beginning of the approach to hysteria as a neurological phenomenon. The young doctor Freud found himself amid these different theories and practices in the 1880's and engaged enthusiastically in their implementation. Along with his colleagues he had at his disposal a heterogeneous collection of forms of therapeutic intervention - hypnosis, pressure technique, electrotherapy, suggestion, medication.

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