PSYCHE, 1968, Jg. 22, Ausgabe 5

lt is proposed that one of the specific features characterizing the analytic situation is the psychoanalytic dialogue. This is a form of communication based on empathy; both partners develop a feeling of intuitive understanding of each other. In practice the analyst will precede the patient by some steps owing to his professional knowledge of the unconscious process, so that he is able to understand, with a high degree of evidence, the events occurring in the session and after. In a preparatory phase the analyst tries to formulate, consciously or pre-consciously, the unconscious phantasy the patient has of the present situation. In the course of the dialogue, the patient learns »within this idiosyncratic world with its specific affective climate, step by step to transform insignificant perceptions into meaningful experiences«. This happens independent of the fact whether or not these experiences become fully conscious. It is for this reason that outsiders often believe the dialogue to be a harmless chatting only. The idea suggests itself that this kind of dialogue is a forerunner of the working alliance, a kind of transference prerequisite for the observing part of the patient's ego to fully grasp the implications of what he perceives (i. e. a widening of his ego-capacities). This transference relationship is accompanied by narcissistic feelings in that the sense of mutual uderstanding is satisfying. The inability of participating in a dialogue and of intensifying it to a working alliance may be connected with very early disturbances of the normal development of narcissism and also suggestive of a poor prognosis. The dialogue is exemplified by two. instances taken from a therapeutic session and from a session in group supervision (the »ghost-dialogue«) respectively. The principle as such is demonstrated with the help of a historical case (the analysis of »little Hans«).

A review of the existing studies on spontaneous recovery from neurotic diseases is given; a critical comparison of most of these papers, however, is impossible as the published data are insufficient. In a follow-up study 5 years and more after the initial examination, of 165 patients consulting the Psychosomatic Clinic of the Heidelberg University whose complaints had been diagnosed as neurotic disturbances but who had not received any kind of psychotherapy, 59 could be re-examined in personal interviews. 34 per cent of these patients had recovered; the state of 66 percent was unchanged. Some typical cases are presented in detail for illustration. The results are given in a detailed table. An analysis of the results shows that the rate of recoveries was higher than expected in the patients suffering from psychosomatic diseases and hysterias. Patients with a more recent symptomatology had better chances of recovering than those with old complaints. In the higher age groups the rate of recovery decreased. This rate was highest with people of the middle classes with a tendency to rise and with artisans in paid jobs and skilled workers. With childless couples, patients coming from broken homes and single children the rate was lower than expected. Eldest and youngest children seem to have a less favorable prognosis than those in the middle position of several siblings. Stays in hospitales and rest-cures seemed to have had little influence on the neurotic symptomatology. Most of the existing publications discussing the outcome of psychotherapeutic treatments give a rate of two thirds of recoveries; this is confronted by a rate of one third of spontaneously recovered patients, as shown in the present study. Although the number of patients who could be re-examined is small, the results obtained may indicate certain tendencies and alleys of approach by which to come to safer statements.

After a brief account of the functional and the genetic aspects of the super-ego as formulated by Freud and his followers, the super-ego as a stable structure is being discussed. An attempt is made to show the relations between the development of psychic structures, particularly the super-ego, and the drive-development. This is demonstrated mainly with regard to the development of the libido. However, the concept of aggression as contributing factor to the building-up of the super-ego is being considered, with special interest in the processes of sublimation and neutralisation.

In several of his papers Freud used the term »guessing« in describing his psychoanalytical task. It is attempted to show that the concept of guessing is useful for defining a specific element of psychoanalytic understanding. The ideational structure of guessing the secret is exemplified by some mythological riddles and by significant processes of interpretation in psychoanalytic treatments. Indeed, many interpretations could be viewed as successful solutions of riddles. The consequences implied in this theoretical model are then discussed.