2) Freud emphasizes the 'constitutional factors' of mental life, i.e., the influences of biology and physiology over the mental.
3) Freud outlines three factors which are decisive for the success of the therapeutic enterprise.
Strachey points out that the differences expressed here regarding the alteration of the ego appears in the scepticism that Freud expresses in regard to the prophylactic power of psychoanalysis. That is, Freud doubts that it will prevent the return of a neurosis that has already been treated. This scepticism is due to the fact that it requires dealing with conflicts that are not current and therefore it is impossible to treat the patient effectively. (214)
Freud also speaks about the problems of making such conflicts 'current', i.e., reanimating them. Freud then indicates that since 'current' conflicts can't be separated from the 'latent' ones, the prophylactic success of psychoanalysis is determined by quantitative considerations. That is, psychoanalysis results in a relative increase in the strength of the ego and a concurrent relative decrease in the strength of the instincts. (See: An Outline of Psychoanalysis (23:Chapter VIII; 179).)
Freud comments on this 'black-mail" device as an effective measure to end analysis that provided one recognizes the right time for employing this method, still it cannot guarantee completely accomplishing the task.
For Freud, the termination of analysis occurs when:
According to Freud, in Ferenczi's case the were two issues which got in the way of full recovery: 1) there was never a purely positive transference between patient and analyst. Hence the illness may return, i.e. if there is a negative transference that wasn't deal with, it is because it was not visible. (222) 2) a patient may become ill once more from the same source as was the origin of the first illness, i.e., it may appear as a different manifestation of the same repressed impulses which the analyst only incompletely resolved. (Freud points to hysterical women as a second example.)
223) Freud goes on to note, however, that the two examples chosen belong to the early history of psychoanalytical work. He continues to justify these examples by noting that it is obvious that the more recent the example of a successful analysis, the less utilizable it is for this discussion since there is no meas of predicting it's ultimate outcome.
Freud turns to the opposition between the primary and secondary processes to further elucidate the argument. He notes that the project of 'taming' the instincts must account for the relative strength of any particular instinct. It is necessary to assume that what analysis achieves for neurotics is nothing other that what ordinary people bring about themselves without help. The difference is, however, that for the normal person any solution of an instinctual conflict only holds good in a particular relation to the strength of the instinct and to the strength of the ego. (226) If the ego becomes weaker all instincts become stronger. The proof is dreaming at night.
Freud notes that the strength of instincts is equally unambiguous, i.e., they are reinforced twice - at puberty and at menopause. Therefore, Freud is not surprised that one becomes neurotic during these periods. He also notes that the same things which reinforce these instincts at such times may irregularly be active during another period of one's life. They are usually brought about through 'accidental means.'
227) Freud goes on to note a possible objection to his argument thus far. The objection might follow as such: Freud's argument is all deduced from process which occur simultaneously between the ego and the instincts, and presupposes that therapy does not accomplish anything which doesn't't occur under favorable, normal conditions. His answer to this supposed objection surrounds the issue of repression (see: Repression (14:148).) He notes that various forms of repression are built upon childhood repressions and analysis allows for the 'unbinding' of such repressed material. The task of psychoanalysis is to revise and demolish repressions; normal life cannot do away with infantile repressions.
228) Freud goes on to state:
"it would mean that analysis sometimes succeeds in eliminating the influence of an increase in instincts, but not invariably, or that the effect of analysis is limited to increasing the power of resistance of the inhibitions, so that they are equal to much greater demands than before the analysis, if no analysis had taken place." In such situations, there are nearly always some 'residual phenomena'. For instance, the erotogenic phases appear gradually but also along side of fixations, inhibitions, and the like. For Freud this suggests a certain degree of inherent primitivism in each of us, he writes: "what has once come to life clings tenaciously to its existence. One feels inclined to doubt sometimes whether the dragons of primeval days are really extinct."
Freud notes that there are two ways of making such dormant conflicts active:
The first method does not require technical purposes. It also is not necessarily sufficient, i.e., not all conflicts can come out. Furthermore, the attempt to artificially bring out such conflicts may have a damaging effect on the patient. That is, the patient's affectionate attitude is the strongest motive of the patient's share in the work of analysis.
This means that only the latter technique is left to analysts. That is, the arousal of the patient's expectations that other instinctual conflicts may possible appear. Still, this method is problematic insofar as the expected result may not occur - that the analyst may only increase the patient's awareness but nothing is stopped. Hence, concludes Freud, theoretical enlightenment of such possible conflicts does nothing more than inform the patient about their possibility.
Alterations of the ego appear as either: 1) congenital or 2) acquired (the second is said to be easier to treat - via the mechanisms of defense which are set up during the ego's development). (237) Freud goes on to note that since the ego cannot flee from instinctual danger, the defense mechanisms are condemned to falsify one's internal perception and only provide an imperfect and distorted picture of one's id.
238) The energy use for maintaining the defenses is a heavy burden in the psychic economy. And, the adult ego continues to defend itself against dangers which no longer exist in reality. For Freud, the defenses constitute one-half of the analysis and the id's hidden secretes the other half. The crux is that the defenses contribute to resistances against recovery. It follows, therefore, that the ego treats recovery as a new danger.
Freud notes that the defenses are easier to identify than is the hidden material of the id. It is often the case that during analysis the ego withdraws from the 'analyst's pact' and therefore ceases to support the analyst's efforts at uncovering the id. The ego even goes so far as to oppose this project. (239) The process is described as a situation in which the patient feels a fresh activation of the defenses and a negative transference, when under the influence of the unpleasure caused by analysis. Consequently, the defenses and the negative transference may gain the upper hand and completely annul the analytic situation. Freud outlines this argument in the following comment: "Thus we see there is a resistance against the uncovering of resistances, and the defense mechanisms really do deserve the name which we gave them originally, before they had been more closely examined." (240) Thus, he concludes, it is easy to understand that the outcome of analysis depends essentially on the strength and on the depth of the roots of these resistances which bring about the alteration of the ego.
There is a second type of resistance that needs consideration. This is the type which shows the "adhesiveness of the libido." In such cases, the process proceeds much slower - apparently because they cannot 'make up their minds' to detach libidinal cathexes from one object and displace them elsewhere. (241) The opposite types are also found but unfortunately in the results of analysis they often turn out to be impermanent.
242) Freud then considers resistances coming from the id. That is all psychical relationships are unchangeable, rigid, and fixed.
243) Freud notes that it is not possible to elucidate the processes involved in the concurrent or mutually opposing action of the two primal instincts working together to keep the illness in place. (244) Freud uses bisexuals as his example of these conditions: the two sexual trends are not clashing at all. This leads one to the understanding that the tendency to conflict is something special which is newly added to the situation, irrespective of the quantity of libido.
245) Freud refers to Empedocles of Acragas' Girgenti (495 BC) as well as William Capelle's Die Vorsokratinen (Leipzig, 1935) also suggests the dichotomy between erotic (love) and aggressive (strife) instincts.
247) Analysts must be aware of their errors and mistakes and learn to get over the weak points of their personalities (Ferenczi is the continued example) in order to be more successful with their patients. (248) The analyst must achieve some level of mental correctness and normality as well as be able to work in complete honesty.
249) But it seems that a number of analysts lean to make use of defense mechanisms which allow them to divert the implications and demands of analysis form themselves so that they themselves remain as they are and are able to withdrawal from the critical and corrective influences of analysis. Every analyst should periodically (every five years) submit to further analysis. Freud justifies this by pointing out that all the work with repressed instinctual forces can't help but stir them up again which the analysts must often suppress anew. "The would mean, then, that not only the therapeutic analysis of patient's but his own analysis would changed from a terminable to an interminable task."
Freud goes on to note that generally it is the attitude deemed 'proper' to the opposite sex which is repressed. But this does not mean that the repressed is necessarily sexualized. Rather it based in biological grounds rather than psychical ones.
The essay goes on to discuss Ferenczi further.