Am J Psychiatry 155:2, February 1998

Regular Articles

DAVID J. LYNN
METHODS OF SIGMUND
AND GEORGE
FREUD
E. VAILLANT

Anonymity, Neutrality, and Confidentiality in the Actual Methods

of Sigmund Freud: A Review of 43 Cases, 1907–1939

David J. Lynn, M.D., and George E. Vaillant, M.D.

Objective: The aim of this historical study was to examine the methods actually used by
Sigmund Freud in his practice of psychoanalysis in his mature years (1907–1939) and to assess
the relationship between these methods and Freud’s published recommendations concerning
anonymity, neutrality, and confidentiality. Method: The authors used both published and
unpublished sources, including reports or autobiographies by analysands, letters by analy-
sands, interviews of analysands, letters by Freud, published works by Freud, and clinical re-
cords of subsequent treatment. Results: Information concerning Freud’s actual methods was
found in 43 cases, including 10 clinical psychoanalyses, 19 didactic analyses, and 14 with
combined clinical and didactic purposes. These 43 cases probably encompassed a majority of
Freud’s psychoanalytic hours during these years. Deviations from Freud’s recommendations
were found to the following extent: for anonymity, 43 cases (100%); for neutrality, 37 cases
(86%); for confidentiality, 23 cases (53%). In addition, there were significant extra-analytic
relations between Freud and 31 of these analysands (72%). Conclusions: These results show
a substantial disparity between Freud’s recommendations and his actual methods. Freud’s
prescribed method, as defined by his recommendations, was not tested or used in his practice.
Freud’s actual method was never explicitly described in his writings and cannot be replicated.
(Am J Psychiatry 1998; 155:163–171)

T he quantity of information available to scholars

concerning how Sigmund Freud actually con-
ducted his psychoanalyses has been steadily growing
his relations with them. A large number of Freud’s let-
ters became available for review at the Library of Con-
gress in the 1980s, but the relative illegibility of his
for several decades, but the location and compilation of gothic script and the suppression of some important
these data have not been simple tasks. Since Freud did passages remained as obstacles. These obstacles have
not allow others to observe his clinical work, reliable been partly overcome in the past 4 years by the publi-
information about his actual practices can come only cation of his complete correspondence with Ernest
from Freud or his analysands. Freud’s published work Jones (2) and much of his correspondence with Sandor
includes his notes in the famous case of the Rat Man (1, Ferenczi (3, 4).
pp. 259–318), but otherwise the standard edition of Data from analysands are found in much more scat-
Freud’s works contains little material describing how tered and diverse places. Published accounts, including
Freud actually treated analysands or how he conducted book-length memoirs, autobiographies, and shorter re-
ports from more than 20 analysands, appeared by the
end of the 1980s. Unpublished accounts, reports and
Received Feb. 20, 1996; revisions received Dec. 2, 1996, and June transcripts of interviews of analysands, and letters writ-
5 and Aug. 5, 1997; accepted Aug. 7, 1997. From the Division of
Psychiatry, Brigham and Women’s Hospital, Boston, and the Psychia-
ten by analysands have gradually emerged. However,
try Residency Program, St. Francis Medical Center. Address reprint no index or bibliography of these materials has ever
requests to Dr. Lynn, Psychiatry Residency Program, St. Francis been available.
Medical Center, 400 45th St., Pittsburgh, PA 15201; djlynn@pitt.edu Past attempts to review Freud’s methods have been
(e-mail). limited by the sources that were used. One of Freud’s
The authors thank Gerd Teschke, M.D., for assistance in transla-
tion, Terry Alan Bragg, M.A., M.L.S., for location of primary sources, biographers, Gay (5), noted several cases in which
and Jonathan O. Cole, M.D., and Jonathan F. Borus, M.D., for advice Freud’s actual methods differed from his recommenda-
and encouragement. tions: the preexisting friendships in the cases of Max

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METHODS OF SIGMUND FREUD

Eitingon and Sandor Ferenczi; Freud’s expressiveness what these authors believed was Freud’s principal
and warmth in the cases of the Rat Man, the Wolf Man, task—to make the unconscious conscious.
and Jeanne Lampl-de Groot; and the entire analysis of In his 1991 review of Freud’s technical papers, Ell-
Freud’s daughter Anna. Gay acknowledged “Freud’s man (21) noted that many reports from Freud’s analy-
sovereign readiness to disregard his own rules” (5, p. sands had reached publication. Without listing or re-
292) but noted, “It was the rules that Freud laid down viewing these, Ellman simply stated that “Freud was a
for his craft, far more than his license in interpreting highly variable analyst who frequently disregarded (or
them for himself, that would make the difference for violated) his own suggestions” and “when one looks at
psychoanalysis” (5, p. 292). Jones reported that Freud Freud’s behavior with patients, it is difficult to reconcile
had difficulty in keeping confidences, but he did not some of his conduct with his written work.”
specify whether the confidences in question had been The authors of four papers published in the last 5 years
given by analysands (6, p. 409). Roazen’s work (7, 8) is each used emerging historical sources to explore Freud’s
based on his interviews of as many as 25 Freud analy- conduct of a single psychoanalytic case. One of us de-
sands; it contains much material pertaining to a number scribed Freud’s psychoanalyses of “A.B.,” a young psy-
of cases but no attempt at a systematic compilation. chotic man (22), and Albert Hirst (23), noting deviations
Ruitenbeek (9) concluded that Freud had related to his from anonymity and neutrality in each case. Warner (24)
analysands in unorthodox ways, but he did not clearly drew on correspondence and other archival material in
document his sources. Using case material from the stand- his examination of the case of Horace Frink. Finally, Kris
ard edition and limited additional sources (10, 11), Glenn (25) used the published Freud-Jones correspondence as
(12) noted that “Freud at times behaved contrary to the the historical source for a description and discussion of
principles that he laid down, even after espousing them.” Freud’s psychoanalysis of Joan Riviere. Without review-
Published reports of attempts to gather historical ing any other cases, Kris noted that Freud’s conduct in
data from a series of Freud cases and bring these data the case was very different from his published recom-
to bear on technical questions have been few in number. mendations. Kris viewed Freud’s failure to acknowl-
Lipton (13–16) contributed a series of papers in which edge this disparity as in part “the result of a divided al-
he considered technical implications of Freud’s actual legiance between his sense of what was needed by his
methods. In a 1977 paper largely devoted to the Rat patients and his determination to promote and preserve
Man case (14), Lipton did include a list of seven addi- the scientific standing of psychoanalysis” (25, p. 662).
tional analysands (Joseph Wortis, Hilda Doolittle, Sigmund Freud’s technical recommendations and
Smiley Blanton, Joan Riviere, Roy Grinker, Raymond theoretical contributions have retained an important in-
de Saussure, and Alix Strachey), citing their published fluence in American psychiatry. They are given substan-
descriptions, but only to “demonstrate the cordial rela- tial emphasis in discussions of psychotherapy in both of
tionships which Freud established with his patients.” the most prominent American textbooks of general
Lipton (15) reached the conclusion that Freud “regu- psychiatry (26–29). As recently as 1993, Freud’s 1915
larly established and maintained a personal relation- technical paper “Observations on Transference-Love”
ship with the patient which he took for granted and was reprinted in its entirety in the American Psychiatric
excluded from technique.” Momigliano (17) made use Press’s Journal of Psychotherapy Practice and Research,
of published reports from as many as 14 people who with Glen Gabbard’s prefatory statement that it “still
had undergone brief didactic analyses with Freud be- reigns as the state-of-the-art treatise on its subject” (30).
tween 1920 and 1938. She noted that Freud seemed not To the extent that psychiatrists use or rely on Freud’s
to have observed his recommendations in his daily contributions, they will benefit from an understanding
work, and she raised the question, “Was Freud a Freu- of the relationship between these contributions and
dian?” but she explicitly declined to answer it. Mahony Freud’s actual clinical activities and experiences. To
(18) briefly described two cases (Elma Palos and Hor- what extent were his technical recommendations
ace Frink), raising the question of whether they should rooted in actual practice? Because Freud did not engage
be used in the teaching of psychoanalysis. Gabbard (19) in any extensive direct observation of the psychoana-
included eight Freud cases (Elma Palos, Sandor Fer- lytic work of others, it was only in his own psychoanalytic
enczi, Loe Kann, Horace Frink, Marie Bonaparte, Alix practice that he could make observations and conduct
Strachey, James Strachey, and Anna Freud) in a discus- trials and evaluations of his technical recommenda-
sion of boundary violations in the early history of psy- tions. Therefore, a systematic historical review of the
choanalysis; he summarized, “Freud and his early dis- methods he actually used in his psychoanalytic practice
ciples indulged in a good deal of trial and error as they is currently highly relevant to American psychiatry.
evolved psychoanalytic technique” (p. 1115). Lohser From published and unpublished sources we gath-
and Newton (20) reviewed five cases (Abram Kardiner, ered extensive information on Sigmund Freud’s practice
Hilda Doolittle, Joseph Wortis, John Dorsey, and of psychoanalysis in his mature years. For the period
Smiley Blanton) in an attempt to reconstruct how Freud 1907–1939 we found data on 43 of his analytic cases.
actually practiced. They concluded that Freud’s actual There is much more information for some of these cases
methods had been inadequately studied and widely mis- than for others, but in each case some sense of the na-
understood and that Freud had used departures from ture of Freud’s management of his relationship with his
neutrality and opacity to good effect in accomplishing analysand emerges. At their best, these sources provide

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 DAVID J. LYNN AND GEORGE E. VAILLANT

many particulars—Freud’s various expressions toward published sources in these cases included reports or
analysands, his responses to them, his activities and de- autobiographies by analysands in 23 cases, letters writ-
cisions that affected them. They have the qualities of ten by analysands in 16 cases, interviews of analysands
historical materials—vivid detail here and there, frus- in 19 cases, letters written by Freud in 25 cases, Freud’s
trating gaps elsewhere. published works in 10 cases, and clinical records from
What emerges can be seen as a survey of Freud’s clini- subsequent treatment in two cases. In 19 cases, indirect
cal and experimental activity during his mature years. sources contributed additional information. (A fully
In this paper we review Freud’s published recommen- referenced draft of this paper, including 353 references,
dations as they pertain to anonymity, neutrality, and is available from NAPS, c/o Microfiche Publications,
confidentiality. Next, we systematically describe Freud’s P.O. Box 3513, Grand Central Station, New York, NY
actual practices in 43 cases and provide accounts of five 10163-3513.) The information in most cases was de-
illustrative cases. Finally, we discuss the implications of rived from multiple sources. In this series we have in-
our findings. cluded only the cases for which information was avail-
able either directly from Freud or from the analysand.
The timing of these cases is displayed in figure 1. This
FREUD’S RECOMMENDATIONS graphic display indicates the extent of our sampling of
Freud’s work. Especially when seen in terms of what is
Freud published comprehensive recommendations known of Freud’s caseload (2–4; 6; 7; 40; 41, pp. 272,
regarding how psychoanalysts should conduct them- 275, 278; 42), this collection of cases is extensive. It prob-
selves in their relationships with analysands. Three of ably encompasses a majority of Freud’s analytic hours in
the most basic issues addressed by Freud’s recommen- these years, but not necessarily a majority of Freud’s cases.
dations concern anonymity, neutrality, and confidenti- The basic characteristics of these analyses are as fol-
ality. Pulver (31) reviewed each of these three topics. lows. Of the total of 43 analysands, 27 were male and
First, with regard to anonymity, Freud recommended 16 were female. Ten of these psychoanalyses were clini-
that the analyst not reveal his own emotional reactions cal, 19 were didactic, and 14 were both. German was
or discuss his own experiences (32, pp. 117–118; 33, p. the language used in 24 of these cases, English (or prob-
125; 34, pp. 225, 227; 35, p. 175). Freud viewed any ably English) was used in 14, and the remaining five
previous acquaintance with the patient or relation with cases involved mixed use of the two languages. The me-
the patient or the patient’s family as a serious disadvan- dian duration was 26 months, 18 months for men and
tage (33, p. 125; 36, p. 461). 38 months for women. The ages of the analysands at
Second, with regard to neutrality, Freud recom- the initial hour ranged from 22 to 49 years, and the
mended that the analyst not give the patient directions median was 33.
concerning choices in the patient’s life nor assume the
role of teacher or mentor (32, pp. 118–120; 37, p. 433;
38, p. 164; 39, p. 232; 35, p. 175). Finally, Freud rec- FINDINGS
ommended that the analyst preserve the patient’s con-
fidentiality (33, pp. 136–137; 36, p. 460; 35, p. 173). There is little question that Freud considered each of
These recommendations are familiar to experienced these cases to be a valid attempt at psychoanalysis. He
clinicians. They are fundamental to Freud’s technical always used the term “psychoanalysis” whenever he re-
contributions. None of them was ever retracted or sub- ferred to any of them. He used eight of them as exam-
stantially modified in any of Freud’s writings. ples in his published writings. He approved all of the
As Freud acknowledged in 1928 (6, p. 241), “The trainees in the group to practice psychoanalysis, and his
‘Recommendations on Technique’ I wrote long ago were clinical activities in these years (except for the 1-hour
essentially of a negative nature. I considered the most im- afternoon consultations that he offered in the Vienna
portant thing was to emphasize what one should not do, medical tradition) were composed exclusively of psy-
and to point out the temptations in directions contrary to choanalyses (43, p. 260).
analysis.” His recommendations concerning the three is- Nevertheless, in all 43 cases Freud deviated from
sues of anonymity, neutrality, and confidentiality were strict anonymity and expressed his own feelings, atti-
both negative and relatively simple. Deviations from such tudes, and experiences. Freud’s expressions included his
simple, negative recommendations can be rather readily feelings toward the analysands, his worries about issues
identified in historical sources. Systematic historical study in his own life and family, and his attitudes, tastes, and
of deviations from (or adherence to) more complex, posi- prejudices. Likewise, in 31 (72%) of the cases, Freud’s
tive recommendations would be vastly more difficult. participation in extra-analytic relations with analy-
sands and/or his selection of analysands who already
had important connections to himself or his family
SOURCES AND CHARACTERISTICS OF CASES helped to eliminate anonymity. These various expres-
sions and relations obviated the anonymity and opacity
There are 43 cases in the period 1907–1939 for which prescribed in Freud’s published works and gave each
we were able to find some information on Freud’s ac- analysand a rich view of the real Freud.
tual conduct of the psychoanalysis. Published and un- Freud’s directives to his analysands also implicitly

Am J Psychiatry 155:2, February 1998 165

METHODS OF SIGMUND FREUD

FIGURE 1. Timing of 43 Psychoanalyses Conducted by Freud FIVE ILLUSTRATIVE CASES

Albert Hirst

Albert Hirst (case 3) en-

tered analysis with Freud in
the autumn of 1909 at the
age of 22. His unpublished
autobiography and transcripts
of his interviews with K.R.
Eissler are the principal sources
in his case (23). He wanted
help with increasing symp-
toms of depression and long-
standing sexual difficulties.
He had been treated by Freud
for 2 weeks in the spring of
1903 after a suicide gesture.
He had known Freud and
Freud’s family from the be-
ginning of his life. Hirst’s
mother, Käthe Eckstein, was
the elder sister of Freud’s
analysand Emma Eckstein.
The Eckstein and Freud fam-
ilies often took vacations to-
gether (44). His elder sister,
Ada, had also made a brief at-
tempt at analysis with Freud.
Hirst’s difficulties were
characterized by a lack of self-
confidence. Although he was
a
Exact timing is uncertain. b
Analysis was probably interrupted.
a gifted Gymnasium student
and achieved high grades, he
typically experienced terror
communicated his feelings. As will be illustrated in the in anticipation of examinations, to the point of vomit-
cases described, Freud breached his repeated recommen- ing and total insomnia. He consistently procrastinated in
dation against directiveness by the analyst in 37 (86%) response to any duty or task. He was unable to apply
of these cases. Freud’s directiveness spanned this entire himself as a university student, and he withdrew after a
period and was as much a feature of his work in one time year. His sexual difficulties included a general feeling of
as in another. incompetence and feelings of guilt and shame about his
Freud communicated with others about analysands masturbation. Most important to him was his inability
in 23 (53%) of these cases. These communications were to ejaculate inside a woman. He was chronically preoc-
to people known to the analysand and included Freud’s cupied with unrequited love for a young woman he
identification of the analysand. This group of 23 does had met in Gymnasium, and her explicit and humiliating
not include Freud’s published cases of unidentified rejection precipitated his crisis. As his mood deteriorated,
analysands, such as the Rat Man, the Wolf Man, and he blamed himself for all his difficulties. He saw
A.B. (22), nor does it include Freud’s communications himself as selfish, incompetent, and completely inferior
with referring practitioners or consultants. We tabu- to his family. He doubted the sincerity and validity of all
lated deviations from expected confidentiality only in of his thoughts and feelings. He felt totally isolated.
cases where we found clear evidence. This is the most Freud reassured Hirst about the inevitability and
unambiguously documented finding in our study; most harmlessness of his masturbation. He often encouraged
of these breaches of confidentiality can be read in Hirst and expressed appreciation for Hirst’s intelli-
Freud’s own handwriting. A listing of these 23 cases gence, his talent in poetry, and his business skills. Freud
with the respective recipients of information is con- told Hirst that Hirst’s feelings were sincere and real. He
tained in table 1. These communications occurred in praised Hirst’s own interpretations of dreams and his
cases throughout the years 1907–1939. An interesting discussions of various novels.
additional finding is that no fewer than 20 (47%) of the Freud freely discussed his own feelings, experiences,
43 analysands in our series received information from and opinions. He told Hirst that he had been annoyed by
Freud about other analysands. the absence of public toilets in New York City and that

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he generally disapproved of the United TABLE 1. Freud’s Dissemination of Information About His Analysands
States, but he also related the American Starting Recipient Role(s)
success story of his Czech former cook. Case Numbera and Name Date of of Information From of Recipient in
Freud took pains to describe to Hirst his of Analysand Analysis Freud Analysand’s Life
role in the discovery of cocaine as a local 1) Max Eitingon 1907 Karl Jung Colleague, rival
anesthetic and discussed his views on 6) Elma Palos 1912 Sandor Ferenczi Analyst, fiancé,
sexual morality and marriage at length. mother’s lover,
Freud pointedly encouraged Hirst in future stepfather
the pursuit of sexual experiences with 7) Loe Kann 1912 Ernest Jones Common-law hus-
band, exhusband
women. Eventually, Hirst did succeed 8) Sandor Ferenczi 1914 Smiley Blanton Colleague
at intercourse. Freud expressed profuse 9) Anton von Freund 1918 Ernest Jones Colleague
pleasure and prescribed a vaginal sup- Karl Abraham Colleague
pository as a contraceptive. Later, Hirst 11) Anna Freud 1918 Abram Kardiner Colleague
Joan Riviere Colleague
told Freud about a young woman who Eduardo Weiss Colleague
was encouraging him but was not at- 15) James Strachey 1920 Ernest Jones Boss
tractive to him. When Freud insisted 17) Horace Frink 1921 Ernest Jones Colleague, rival
that Hirst proceed, Hirst found himself Clarence Oberndorf Colleague, rival
once more unable to ejaculate. Abram Kardiner Colleague, friend
18) Roger Money-Kyrle 1921 Ernest Jones Colleague, boss
Freud was directive with Hirst on sev- 19) Clarence Oberndorf 1921 Abram Kardiner Colleague
eral additional issues. He favored a busi- 20) Albert Polon 1921 Edith Jackson Colleague
ness career for Hirst, as opposed to poli- 21) Abram Kardiner 1921 Horace Frink Colleague, mentor
tics, the law, or writing. He discouraged 23) Joan Riviere 1922 Ernest Jones Former analyst,
boss, rival
Hirst’s immigration to the United States 25) Ruth Mack Brunswick 1922 Jeanne Lampl- Colleague
and proposed South America instead. de Groot
From Freud, Hirst learned about his Ernst Freud Friend
sister Ada’s abortive psychoanalysis. Anna Freud Friend
Freud gave an appraisal of Ada as less 26) Mark Brunswick 1924 Ruth Mack Brunswick Fiancée, wife
27) Otto Rank 1924 Karl Abraham Colleague, rival
gifted than Hirst. About Hirst’s aunt, Max Eitingon Colleague, rival
Emma Eckstein, another analysand, Ernest Jones Colleague, rival
Freud was even more informative. When Joan Riviere Colleague
Emma relapsed during Hirst’s analysis, Marie Bonaparte Colleague
Sandor Ferenczi Colleague, friend
she viewed her new symptoms as or- Joseph Wortis Colleague
ganic; Freud told Hirst that her symp- Arnold Zweig Acquaintance?
toms were neurotic. Freud even told 30) Marie Bonaparte 1925 Roger Money-Kyrle Colleague
Hirst that Freud’s decision to terminate Arnold Zweig Acquaintance?
his involvement in Emma’s treatment 32) David Brunswick 1927 Mark Brunswick Brother
Ruth Mack Brunswick Sister-in-law
was an angry response to her consulta- 33) Dorothy Burlingham 1927 Edith Jackson Collaborator
tion with another physician. Max Eitingon Colleague
Ludwig Binswanger Acquaintance?
Elma Palos 35) Eva Rosenfeld 1929 Anna Freud Collaborator, friend
36) Edith Jackson 1930 Martin Freud Close friend
37) Irmarita Putnam 1931 Ives Hendrick Colleague
Elma Palos (case 6) began psycho- 40) Joseph Wortis 1934 Hilda Doolittle Fellow analysand
analysis with Freud in January 1912 at aFrom a series of 43.
the age of 24. She was referred to Freud
by Sandor Ferenczi, and the correspon-
dence between the two men provides information on of an illness.” Ferenczi had been continuing his psycho-
her treatment (3, 4). Ferenczi had begun an analysis of analysis of Elma through all of these events, without
Elma in July 1911. At that point Ferenczi, aged 38, was objections from Freud, but he now implored Freud to
in the midst of a long affair with her mother, Gizella, take over Elma’s analysis immediately. He had already
48, whom he had previously analyzed and introduced arranged all the particulars with Elma and Gizella, in-
to Freud. Freud had ventured a diagnosis of dementia cluding the fee.
praecox for Elma as early as February 1911, although Freud did agree, after remarking, “In this humor, a
the extent of his examination of Elma at that time is woman can hardly be woo’d!” Note that this remark,
unclear. Elma’s initial difficulties seem to have involved like all previous references to Elma and her treatment
depression, possibly precipitated by difficulties with in Freud’s letters to Ferenczi, addressed Ferenczi’s inter-
suitors, one of whom killed himself in October 1911. ests, not Elma’s. After beginning Elma’s analysis, Freud
By November 14, Ferenczi was writing to Freud about began to report to Ferenczi on his findings, including
his wishes to marry Elma instead of Gizella. By Jan. 1, his formulation of Elma’s feelings for Ferenczi and his
1912, Ferenczi had begun to recognize that “the issue conclusions about her suitability as a wife. Ferenczi
here should be one not of marriage but of the treatment made clear to Freud that he had not decided what to do

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METHODS OF SIGMUND FREUD

about the marriage and that he would “make every- participation in Loe’s medical treatment. Jones believed
thing dependent on the results of the analysis.” Ferenczi that a diagnosis of pyelonephritis had been established
felt “totally dominated by the reports that you give me previously in London, and Loe concurred that her ab-
about Elma,” and he tried to describe all of his feelings dominal pains were basically organic. Freud favored a
to Freud, even his unsatisfying renewal of his sexual diagnosis of hysteria even after medical consultation in
relationship with Gizella at this time. Vienna yielded a contrary opinion. He had heated dis-
Freud acknowledged that for Ferenczi a decision agreements with Loe about this issue, to the point that
would be possible only after the end of Elma’s treat- in the fifth month of the analysis she felt “forced, bul-
ment and that at some point Freud would be “able to lied, and teased” by Freud. He conducted a urinalysis
pass judgment” on Elma. For her part, Elma wanted to and arranged radiological and, finally, surgical evalu-
know from Ferenczi exactly what Freud was writing ation, which confirmed Jones’s, and Loe’s, view.
about her. As of Jan. 20, 1912, Ferenczi was writing, in Throughout this analysis, Freud provided Jones with
response to Freud’s reports, that he was ready to give details of Loe’s progress and, especially, her feelings
up the idea of marrying Elma, but he frequently vacil- about Jones. Jones and Freud had hoped that her sexual
lated thereafter. He and Freud arranged to meet secretly responsiveness would improve as a result of the analy-
and discuss Elma. In March, Freud began to report sis. In January 1913, Freud advised both Loe and Jones
progress in Elma’s analysis. He suggested to Ferenczi to refrain from sexual relations. Shortly thereafter Loe
that it be terminated at Easter. The two men agreed on discovered that Jones had been unfaithful, and she
this timing and began to plan a holiday together in Dal- ended their long affair. Despite this change, Freud con-
matia. Elma wanted to have the treatment continue tinued to keep Jones informed of Loe’s feelings toward
longer, but Freud and Ferenczi prevailed. him, her dating activity, and Jones’s chances for a rec-
In November 1912, Ferenczi had given up the idea of onciliation. Freud predicted a reconciliation, but it never
marrying Elma, and the two men began to consider occurred.
how to marry her off. In June 1914, Loe married a young American man in
Ferenczi married Gizella in 1919, but in a 1922 letter Budapest; Freud, Rank, and Ferenczi were present as
to his friend George Groddeck (45) he regretted his de- official witnesses. She terminated her analysis shortly
cision not to marry Elma and blamed Freud for it. In thereafter. She had been able to reduce, but not elimi-
1932 he wrote in his clinical diary that he was struck nate, her use of morphine.
by “the ease with which Freud sacrifices the interests of
women” (46). It is clear from the correspondence that Anna Freud
Freud used Elma’s analysis to serve the interests of his
friend Ferenczi and the psychoanalytic movement and Anna Freud (case 11), Freud’s youngest child, entered
that he never objected to Ferenczi’s similar behavior. analysis with him in 1918 at the age of 23. Little is
known about this analysis except what Young-Bruehl
Loe Kann (47) drew from Anna’s correspondence and a few other
sources. Until an interruption in 1922, Anna had 6
Loe Kann (case 7), the common-law wife of Ernest hours each week at 10:00 p.m. Another period of analy-
Jones, began her analysis with Freud in June 1912. An sis began in 1924. Although other sources describe a
account of her analysis emerges from the Freud-Jones complete cessation of the analysis after 1925, it is clear
correspondence (2). Loe was of Jewish ancestry and from her letters to Eva Rosenfeld that Anna was still in
was born Louise Dorothea Kann in the Netherlands, analysis with her father as of September 1929 (48). In
but her precise age is not clear. (Jones himself was 33 his September 1927 letter to Joan Riviere, Freud used
at this time.) She had been suffering from abdominal the present tense in describing himself as Anna’s “con-
pain and associated addiction to morphine (then legally trol analyst” (41, p. 267). Until 1970 the identity of
available) and depression. She had moved from London Anna’s analyst was not generally known. When, as an
to Toronto with Jones in 1908, and she became more adult, Peter Heller, a former analysand of Anna and a
and more isolated and unhappy there. son-in-law of Dorothy Burlingham (another analysand
At the psychoanalytic congress in Weimar in Septem- of Sigmund Freud), asked Anna in Dorothy’s presence
ber 1911, in her absence Jones requested that Freud take who her analyst was, she exchanged knowing glances
her into analysis. Freud agreed. Later he linked his will- with Dorothy but remained silent (P. Heller, personal
ingness to his “deep personal interest” in Jones, as one of communication, April 6, 1991).
the “men who give me so much assistance and friend- During the first period of his analysis of his daughter,
ship.” In analysis, Freud found Loe very appealing. He Freud was also analyzing Abram Kardiner. In one of
wrote to Ferenczi that she was “extremely intelligent,” “a Kardiner’s hours Freud raised the subject of Anna and
jewel,” and finally, “Loe has become extraordinarily her unmarried status, asking Kardiner for his theories.
dear to me, and I have produced with her a very warm Kardiner had heard rumors that Anna was in analysis
feeling” (3). By December 1912 he had brought Loe to with her father, but he did not ask Freud about this.
meet his family in their apartment (3). Loe and Anna Kardiner believed that most of Freud’s male followers
Freud began a long friendship at this time (47). had offered to become his son-in-law (49).
An interesting feature of this analysis was Freud’s Anna never married, and she remained tied to her fa-

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 DAVID J. LYNN AND GEORGE E. VAILLANT

ther for the rest of his life as a companion, typist, col- lytic meeting. They became such close friends during
laborator, and nurse. Despite her lack of a university her analysis that Martin’s wife was convinced that they
education, she was accepted as a psychoanalyst and at- were having an affair (54). Martin did write many let-
tained prominence. What is remarkable about her ters to her, reporting at one point that his wife was
analysis is its very existence. At its inception Freud was nearly insane and that living with her was impossible
62 years old. He considered this analysis to be valid (53). At times Freud provided his son with information
enough for crucial use in two theoretical papers, “A about Edith Jackson and her intentions concerning him.
Child Is Being Beaten” in 1919 (50) and “Some Psychi- In a 1936 letter to her (55), Freud described the diffi-
cal Consequences of the Anatomical Distinction Be- culties that another analysand, Albert Polon, had en-
tween the Sexes” in 1925 (51). In 1935 he described it countered in a relationship with a young woman during
as a success in a letter to Eduardo Weiss (52). his analysis with Freud.
Despite her wish for an intimate relationship with a
Edith Banfield Jackson man, Edith Jackson never married. Although Freud
thought he had helped her, she was uncertain about this
Edith Jackson (case 36) began her analysis with (8). She did return to her career in psychiatry in the
Freud in January of 1930, at age 35. Her letters, espe- United States, and after 10 lackluster years, in 1946 she
cially to her sister Helen Jackson, are the principal began to perform remarkably well (56).
source in her case (53), together with a 1966 interview
by Roazen (8). She had been thoroughly trained as a
pediatrician in the United States. She hoped for both CONCLUSIONS
clinical and didactic results, having suffered from lone-
liness and an inability to establish an intimate relation- The limitations of this study must be kept firmly in
ship. She found Freud extremely charming. Sometimes mind. Any conclusions concerning the effectiveness of
he would gently strike the couch with his hand. He the methods Freud actually used in these cases would
discussed many things with her—his 1909 trip to the require much more detailed and comprehensive bio-
United States, Adler, Jung, Rank, Marianne Kris, and graphical study of these analysands. Any conclusions
the opera Don Giovanni (at times he would hum a few concerning Freud’s reasons or motives for acting as he
bars). Freud’s dog was present in the consulting room, did are beyond the scope of this study; this question
and when this chow had puppies, Freud gave one to would require much more detailed biographical study
Edith Jackson. of Freud. Finally, any conclusions concerning the effec-
In one of the first few sessions, Freud presented a tiveness of Freud’s recommended technique of psycho-
dream that Dorothy Burlingham, another analysand, analysis are obviously beyond the scope of this study.
had described to him, asking for her help in interpreting Throughout the period of this study, 1907 to 1939,
it. Later, at his direction, she began translating some of Freud consistently deviated from his published recom-
his writings, and he would use her analytic hours to mendations on psychoanalytic technique. Indeed, his
review her translations. At one point Freud told her that actual method could be seen as a quite different pro-
he wished she would improve as quickly in the analysis cess, characterized by expressiveness and a tendency to
as she had as a translator. At times she had as many as be forcefully directive. It might be tempting to see his
eight analytic hours with Freud each week, at a fee of recommended technique as superior to his actual
$25 per session. She chose to begin her analysis in bro- method. Such a view would be rather more moralistic
ken German, which Freud found intolerable; he soon than scientific. Freud’s use of self-disclosures and di-
chose to have her proceed in English. He forbade her to rectives may more closely resemble the techniques that
have sexual relations while in analysis. current psychotherapy research has demonstrated to
Gradually Edith Jackson was drawn into Freud’s cir- be most effective than does his recommended technique
cle. She met his wife and sister-in-law. She had social (57, 58).
contact with most of Freud’s other analysands of this Concerning Freud’s recommendation that the analyst
period: Smiley Blanton, Dorothy Burlingham, Marie remain anonymous (a blank screen, as it were), his self-
Bonaparte, Irma Putnam, Ruth Mack Brunswick and revelations in 100% of these cases and his participation
her husband Mark, Anna Freud, and Eva Rosenfeld. in extra-analytic relations in 72% raise important ques-
She followed Freud, at his invitation, to continue her tions. These deviations had implications for the devel-
analysis in Berlin and at Grundlsee. She donated $5,000 opment of each analysand’s emotional experience of
per year to establish a nursery school in collaboration Freud and feelings toward him—the transference.
with Anna Freud and Dorothy Burlingham. Freud’s recommendations to maintain an uncontami-
Early in the analysis Edith Jackson was stunned when nated transference through anonymity have by no
Freud brought up her mother’s suicide; he had learned means been unanimously endorsed by subsequent con-
about it not from her but from a source whom Freud tributors. (The literature on this issue is simply too vast
refused to name. She began an exploration of this issue to review here.) The feasibility and effectiveness of the
that included a review of her mother’s diary, obtained anonymous approach Freud recommended deserve to
from her sister. be scientifically tested. One point clearly established by
In 1931 she met Freud’s eldest son, Martin, at an ana- our study is that Freud’s psychoanalytic work was not

Am J Psychiatry 155:2, February 1998 169

METHODS OF SIGMUND FREUD

such a test. Instead, Freud’s personal expressiveness 5. Gay P: Freud: A Life for Our Time. New York, WW Norton,
1988, pp 267, 292, 295, 303–304, 439–443, 464
and extra-analytic involvements invite consideration of 6. Jones E: The Life and Work of Sigmund Freud, vol 2. New York,
each of these 43 analyses as a unique emotional and Basic Books, 1955
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Perhaps each outcome should be attributed more to 1976
8. Roazen P: How Freud Worked. Northvale, NJ, Jason Aronson,
these interactions and their qualities—warmth, sup- 1995
port, acceptance, trust (or conversely, coldness, rejec- 9. Ruitenbeek HM: The professor, in Freud as We Knew Him. Ed-
tion, etc.)—than to insights achieved through an inter- ited by Ruitenbeek HM. Detroit, Wayne State University Press,
pretive exploration of the transference. 1973, pp 17–21
10. Gardiner M: The Wolf Man by the Wolf Man. New York, Basic
Freud’s deviations from neutrality in 86% of these Books, 1971
cases likewise require attention. Obviously, because of 11. Doolittle H: Tribute to Freud. New York, Pantheon Books, 1956
Freud’s stature and authority in these years, his direc- 12. Glenn J: Notes on psychoanalytic concepts and style in Freud’s
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Glenn J. New York, Jason Aronson, 1980, p 15
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to others about his analysands do raise both ethical and ticing Psychoanalyst. Edited by Wolman BB. New York, Basic
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technical issues. Crucial to consideration of the ethical 14. Lipton SD: The advantages of Freud’s technique as shown in his
issues is the question of the consent of the analysand. analysis of the Rat Man. Int J Psychoanal 1977; 58:255–273
For most of these cases, this is unknown. Analysands 15. Lipton SD: An addendum to “The advantages of Freud’s tech-
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