Article
The Final Goal of Psycho-Analytic Treatment
Das Endziel der psychoanalytischen Behandlung
Michael Balint read this paper at the International Psychoanalytical Congress at Lucerne in August 1934, and it appeared the following year. He asks whether clinical experience alone, rather than a philosophical, moral or biological ideal of health, can define the point towards which an analysis naturally tends. He starts from re-analyses and difficult cases, which show the obstacles to cure more plainly than smooth ones, and from an observation: in deep analyses the final months bring almost no new unconscious material, yet that is when patients actually get well. Judged against this, the 'classical', structural definitions, all of them Freud's (making the unconscious conscious, lifting the infantile amnesia, overcoming the resistances), are neither necessary nor sufficient. The 'romantic', affective ones are too general or too narrow: abreaction of strangulated affects, the full reliving of the Oedipal relation (Ferenczi and Rank), abreaction of the birth trauma (Rank), the working-off of the repetition factor (Vilma Kovács), and orgastic potency (Reich). Balint develops the 'new beginning' he had described at Wiesbaden in 1932. Near the end of treatment, patients revive long-abandoned infantile wishes and seek to have them gratified. At first they do so timidly, then with an addictive passion. If this is mishandled, it turns into insatiable demands and an inflated narcissism. If patient and analyst persevere, it gives way to a realistic object relation. Because these wishes are always directed at an object, Balint turns to Ferenczi's theory of the erotic sense of reality. He argues that every drive is object-bound from the first and has a passive aim, to be loved and satisfied, which lasts throughout life. Autoerotism and narcissism, like active object love, are detours that frustration imposes. The anal-sadistic and phallic phases are artefacts of uncomprehending upbringing, not normal stages. Neurosis therefore always has a real cause in the environment. Balint presses this point against the stress on structure and constitution in the analysis of his day, taking Melanie Klein's The Psycho-Analysis of Children as his example. The final goal of treatment, then, is that the patient dare to begin loving anew. What must begin again is object love itself, not particular partial drives, and the analyst helps by noticing and protecting these tentative beginnings. Balint admits that patients who can only demand to be loved remain beyond his technique. He closes with the motto 'less sadism and more love'.
Main ideas
- Psychoanalytic treatment is a natural developmental process in the patient, so its end point should be read from clinical experience rather than derived from a philosophical, religious, moral or biological norm of health. Analyses that stall and are resumed years later, like the Wolf Man's, best reveal what blocks a cure.
- In sufficiently deep analyses the final phase brings almost no new unconscious material, yet it is then that patients recover. In Balint's opening case, roughly 500 hours that followed an earlier four-year analysis cured the man although nothing new was uncovered. The clinical facts behind the concept of working through have been left out of every proposed definition of the goal of analysis.
- Freud's structural, or 'classical', formulas (making the unconscious conscious, lifting the infantile amnesia, overcoming the resistances) are neither necessary nor sufficient. Cures occur without new material, while analysed people still dream, still meet resistance and still recover unsuspected memories years later.
- The 'romantic', affective formulas that descend from the cathartic method miss the mark. Abreaction of strangulated affects and Vilma Kovács's working-off of the repetition factor are too general. Ferenczi and Rank's full reproduction of the Oedipal relation is too narrow. Rank's abreaction of the birth trauma has already been criticised enough. Reich's orgastic potency fails as a criterion because markedly neurotic people may possess it.
- In the end phase patients make a 'new beginning'. They voice long-forgotten infantile instinctual wishes and demand that their environment gratify them, at first faintly and with reluctance or anxiety, later openly and with pleasure. Without exception, these newly begun activities are directed at an object.
- A shy first attempt at a new beginning is regularly followed by a passionate, addiction-like phase in which patients may feel 'over-healthy' and want to stop. Mishandled, this phase escalates into demands no real object can satisfy and ends in an inflated narcissism. If patient and analyst persevere, it subsides into an object relation adapted to reality.
- Following Ferenczi's account of the development of the erotic sense of reality in his genital theory, Balint holds that all drives, including those called autoerotic, are object-bound from the start. Their aim is passive, to be gratified and loved, and it is kept for life. Autoerotism and narcissism are one detour forced by frustration. Active object love, which gratifies the partner in order to be loved in return, is another.
- The anal-sadistic and phallic phases are not normal stages of development but artefacts: they are signs of a development bent by consistently inappropriate influences, above all uncomprehending upbringing. There is no repression without reality and object relations, so the real frustration at the root of every neurosis should not be eclipsed by the constitutional factor.
- Analysis of the time leans too heavily on structure and constitution. In Melanie Klein's The Psycho-Analysis of Children the index lacks entries such as 'love' or 'parental sadism'. Balint suggests that the split good and bad mother imagos may answer to capricious, unpredictable parents rather than to inborn sadism, in the spirit of Ferenczi's 'confusion of tongues between adults and the child'.
- The final goal of analysis is the patient's resolve to begin loving anew: what must be begun again is object love itself, not particular partial drives, which is why questions about how many new beginnings are needed, and in which drives, cannot be answered. The analyst helps through understanding interpretation and, above all, by noticing the timid first attempts and not scaring them away, meeting their passive aims tactfully until they find their way to active love.
- Less damaged patients recover gradually, without a distinct end phase. A few who cannot stop demanding compensation from the world, and who can only be loved, not love, could not be cured with Balint's technique. He still refuses to surrender to constitutional explanations, recalling Ferenczi's maxim that a way must be found to help any patient who is willing to go on. His motto: less sadism and more love.
What it shows
- 1935
Michael Balint introduced New beginning
In his Lucerne congress paper of 1934, printed in 1935, Balint names the new beginning: towards the end of deep analyses patients again seek simple, pleasurable gratifications, all of them aimed at an object, and he counts this as an essential mechanism of cure.
Gallery
Cover of Michael Balint's Die Urformen der Liebe und die Technik der Psychoanalyse (dtv/Klett-Cotta, dialog und praxis paperback), the German collection that reprints "Das Endziel der psychoanalytischen Behandlung"
External links
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