Principles of Intensive Psychotherapy by Fromm-Reichmann Frieda

Author:Fromm-Reichmann, Frieda [Fromm-Reichmann, Frieda]
Language: eng
Format: epub
Publisher: Read Books Ltd.
Published: 2013-04-16T00:00:00+00:00

e) “ACTING OUT”

One more among the psychotherapeutically important phenomena which may be used by patients in the pursuit of transference reactions as well as of resistance and other security operations are processes of “acting out” instead of verbalizing interpersonal experiences. More specifically, “acting-out processes” are the actions and activities in which patients engage—during the psychotherapeutic interview and outside it—as an expression of, or a reflection upon, their relations with and their attitude toward the therapist and the psychotherapeutic process and, through this medium, as an expression of their interpersonal problems at large. The investigation and interpretation of these reflected actions and activities inside and outside the therapeutic interview have to be kept in the focus of interpretive attention for the entire duration of the psychotherapeutic process.

In addition to these “acting-out” processes in the strict sense of the word, the activities and the behavior of most patients who are under psychoanalytic treatment also show some general reflections of their interpersonal experiences in the treatment situation. Although most of the time the latter are too vague, diffuse, or tenuous to make their therapeutic use rewarding, it is always worth while to have them in mind while listening to and evaluating the patients’ presentation of data of their current life. The patients’ presentation of intercurrent events and the events themselves if co-determined by the patients’ attitudes may be inadvertently influenced by the way in which they experience and evaluate the personality of their doctor and the mutual aspects of the doctor-patient relationship.

Acting out, of course, is not encouraged by the psychiatrist, who is mainly interested in the investigation of verbalized material. But it happens, irrespective of all the discouragement which it may be given. The observations, investigations, and interpretations of the patients’ acting-out processes can frequently be used as a means ot resolving his resistance and its retarding consequences. They may also be used as a contribution toward discovering and making the patient gain understanding of his interpersonal problems, as in the following example.

A lonely woman patient became engaged to an unsuitable partner each time that the psychiatrist, the only person with whom she had meaningful interpersonal contact, took a vacation. Previous to her acting out her loneliness in this way, the patient had not been able to accept as a problem the fact of her being lonely, nor could her interest be sufficiently aroused that she would enter into a scrutiny of the cause of her aloneness and her loneliness. The whole experience was too much under censorship because of the attitude of this culture toward it. A girl is not supposed to be or to feel lonely or alone. She is supposed to be popular. If one is lonely, one is a failure. It is one’s own fault.

The patient finally faced her loneliness after a third meaningless engagement during the vacation of the psychiatrist. The realization of the symptomatological meaning of the acting-out engagements as devices to counteract her loneliness was, of course, of the greatest therapeutic significance. Only after the

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