Freuds Thoughts on Doctor-Patient Relationship - Speech or Presentation Example

SIGMUND FREUD Psychology is one of the newer sciences. While human beings have always been interested in the motivations and identities of individuals and how both are expressed, it is only relatively recently that scientists and theorists have begun to explore these questions in an interesting way. In the course of this speech I will discuss one of psychology’s foundational theorists, Sigmund Freud and what he thought about the human condition, and what he contributed to the body of knowledge that tells us most about ourselves. Specifically, I want to talk about a problem that sometimes arises from treating patients, one that Freud called countertransference. It is very important of psychologists to understand and account for this phenomenon in their practice. Although not all of Freuds theories are in vogue anymore this one may have a special place. It goes to the root of the doctor-patient relationship. To begin with, there is a very famous man upon whom much of contemporary psychology rests. He is the main foundational theorist without question—even if some of his ideas today seem somewhat controversial and difficult to agree with. The great Austrian psychologist Sigmund Freud was very influential. He was born in 1856 and lived a long life, mostly in Vienna. Back then psychology was a very new science and he did a lot to shape it. He had several children who followed in his footsteps. Sadly, he had to lead the last days of his life in London after being chased out of Austria by the Nazis. Freud came from the psychoanalytical school (which he founded). He worked hard to deconstruct what up until that point had been considered the unitary personality or identity of individuals. Freud’s emphasis on subjectivity, the unconscious, and perspective powerfully effected artists and writers of the period. Theorists in the psychoanalytic school frequently believed that people had a fractured identity, creating a multiplicity of perspectives and views on the world, none of which was especially better than the other. In a way this is a legacy of Freud’s ideas about subjectivity. One of his important ideas involving treating patients was called countertransference. The notion of the word ‘Countertransference’ was first mentioned by Freud (1856 -1939) as an opposition to ‘Transference’, when he discovered that patients in psychoanalysis would begin to treat him as if he were a significant figure from their childhood. This caused a serious problem in his treatment of them. To introduce ‘Transference’, we might say that it is highly significant to an effective therapeutic relationship. People need to understand one another, they need to know that there is empathy as the basis of all such professional relationships. The therapeutic relation has many facets, which are all important for its effectiveness in therapy and one aspect to this relationship is that clients may unconsciously react to the therapist from patterns established earlier in their life. This is exactly the label given to transference. It is a common phenomenon that we seem to react to precipitating events in our life through the template of previous relationships and experiences. In 1910, Sigmund Freud wrote: ‘We have become aware of the ‘counter-transference’, which arises in [the analyst] as a result of the patient’s influence on his unconscious feelings, and we are almost inclined to insist that he shall recognize this counter-transference in himself and overcome it.’1 An example of countertransference is when a doctor begins to identify with a patient and empathize too much with a patients feelings and sickness. Freud was at the time formulating warnings to himself and other therapists. He was very concerned about this—which he saw at the time as a problem. The goal was to keep the professional at a neutral and objective distance from the subject. This made the treatment of the patient a lot easier. Unconscious or erotic longings or even basic misdirected feelings would throw off therapy and cause serious problems. Freud suggested that analysts had to be extremely vigilant about their personal feelings and that these personal feelings should play no role in the therapy. He famously wrote in 1915: I cannot advise my colleagues too urgently to model themselves during psychoanalytic treatment on the surgeon, who puts aside all his feelings, even his human sympathy, and concentrates his mental forces on the single aim of performing the operation as skilfully as possible . . . A surgeon of earlier times took as his motto the words: ‘Je le pensai, Dieu le guerit.’ (‘I dressed his wounds, God cured him.’) The analyst should be content with something similar.2 It is strange to think that much of Freud’s thinking on the issue of countertransference may have come from his own feelings towards the relationship developing between his disciple C.G. Jung and Sabrina Spielrein. This was a relationship that caused a lot of problems. Whatever the origin, this interpretation and this warning proved hugely influential to other therapists, when they would be treating their patients. It became diffuse in professional cultures—the watchwords for doctors and psychiatrists were always “emotional restraint,” “appropriate distance,” and the like. Freud’s view of the dangers of too close an emotional relationship with patients has been passed down to generations of practitioners. While this may be appropriate in some cases, Freud’s influence can not today be seen to be as especially useful. When it comes to palliative care and our contemporary understanding of terminal illnesses it has been increasingly important to focus on the emotional, empathetic relationship between practitioner and patient. It can have a very positive influence. It could be said that countertransference is now in vogue. When treating patients it is important to have a good bedside manner and for the patient to fill as though their doctor actually cares about them. Indeed, it can be argued that the traditional view of countertransference has no real place in the contemporary hospice. The drastic redefinitions of death that have occurred over the last century require a profoundly empathetic approach: one that embraces countertransference and directs it to good aims. Indeed, the history of countertransference over the course of the last one hundred plus years involves a greater recognition of its importance to palliative care. Far from being something to be “shirked away” from, counter-transference is something that should be harnessed and used to help ease the final days and months in the lives of terminal patients. This is a lesson that has grown out of Freuds teachings. The truth is that practitioners cannot and should not hide from their humanity. There is plenty of evidence to show that efforts to subvert or repress human feelings will not make for good care. This is important to recognize especially when we look at the major changes that have occurred in our scientific and cultural interpretations of death—for there is virtually no event in human professional life that will elicit so strong an emotional reaction as death. And the changes wrought in our understanding of death have made new demands on professionals. It can therefore be argued that end of life care is one of the best sites upon which to examine countertransference. The history of psychology is the history of building upon psychological theories. Each had a role to play in the way contemporary psychology views itself. Some theories grew out of reactions towards theories that founders felt were illegitimate or incorrect. Others appear almost spontaneously on the scene. What is true of all of them is that they contributed, in some way, to our understanding of the human mind. Freuds theories were especially influential. However, today more people look at how he came up with terms and ideas that how he actually applied them. Today, Freuds theory of countertransference is considered to be a positive idea not a negative one. It can help us treat patients with the care and respect they deserve. This is important for us to consider. Whether people one hundred years from now will agree with us remains an open question. Works consulted Berger, Arthur, ed. Perspectives on Death and Dying. Philadelphia: Charles Press, 1989. Brenner (2006), "Psychoanalysis: Mind and Meaning", Psychoanalytic Quarterly Press (New York) Bugental, J.F.T (1964). "The Third Force in Psychology". Journal of Humanistic Psychology 4 (1): 19–25. Fodor, Jerry A. (1983). Modularity of Mind: An Essay on Faculty Psychology. Cambridge, Mass.: MIT Press. Freud S (1895), Project for a Scientific Psychology, I (2nd ed.), Hogarth Press, 1955 Read More