The Ethic of Honesty: The Fundamental Rule of Psychoanalysis (Book Review)

Author:  Thompson, M. Guy
Publisher: Eugene L. J. Cord, PhD
Reviewed By: Rodopi Press, 2003, Vol. 26 (2), pp. 61-63

Honesty: The All-Encompassing Premise of Psychoanalysis

Michael Guy Thompson has written a cogent, concise, and extremely relevant work about the role of honesty in the psychoanalytic enterprise. It ought to be must-reading for every psychoanalytic practitioner, new or seasoned, still in training or already practicing in the field. Thompson’s study is manageable to read and absorb since he has limited it to eight technical principles that were originally articulated by Freud and addresses how they need to be handled. Freud’s conception of honesty pervades his psychoanalytic method completely, and in doing so, it haunts every psychoanalytic encounter. Although writing about the eight technical principles, he has focused his attention on the fundamental role of honesty in psychoanalysis. This choice was both wise and inevitable, based on Freud’s philosophy of treatment.

Thompson lays out his main theme in the Preface: “The book you hold in your hands concerns the technical principles of psychoanalysis… the over-riding principles from which all the elements of psychoanalytic technique are derived” (p. xiii). The author then refers to the fundamental rule of psychoanalysis: “…. the pledge to be honest as articulated by Freud and, with modifications, remains so today.” This “fundamental rule” remains the basis for the book and the premise around which the material is organized.

Thompson goes on to say: “It is my thesis that the fundamental pivot around which the psychoanalytic experience revolves is the self-disclosure that each patient affects through the act of free association” (p. xvii). Thompson believes not only that free association is ubiquitous to the analytic experience but also that the understanding of what it entails hinges on a fundamental premise, mostly omitted from the psychoanalytic literature since Freud introduced it, namely, “the (explicit or implicit) promise to conceal nothing from one’s analyst, i.e., the pledge to be honest or candid.”

The practice of psychoanalysis is an inherently dangerous proposition…. Freud took pains to harness the potential for inflicting harm on one’s patients by formalizing a set of constraints that were conceived as rules, or recommendations, to follow…. These technical recommendations were paradoxically intended to restrain psychoanalysts from the temptation of doing too much (therapeutic ambition) for their patients, while protecting themselves (the rule of abstinence) and their patients (the rule of neutrality) from the risks unavoidably courted in this enigmatic treatment methodology” (p. xviii) “Freud’s technical recommendations are nothing less than ethical precepts, because their purpose was to formulate a working terminology with which the analyst’s experience could be articulated and communicated to colleagues. Thus, the Hippocratic counsel, ‘do no harm,’ remains the paramount consideration, not the utilitarian goal of success by any measure. (p. xviii-xix)

Thompson states, in referencing the role of phenomenology in psychoanalytic inquiry,

[I]nstead of applying a theory that presumes to account for what is happening ‘in’ the patient one is analyzing, the phenomenologist goes directly to the person himself, by examining his experience of his relationship with this person. This is not a matter of speculation but rather of determining the ground of experience at the moment it is transformed through the interhuman bond shared with others. (p. xvi)

By way of helping to clarify his own understanding of phenomenology, Thompson states that:

Phenomenology shares with psychoanalysis the view that explanation is inadequate to the task of understanding what is given to experience and shares with psychoanalytic treatment the task of determining the nature of suffering itself. In other words, instead of posing the scientific question of what CAUSES one to be this way or that, the phenomenologist asks, “What does it MEAN that I experience the world this way or that?” Once the meaning-question is substituted for that of causation one enters the realm of phenomenology, because in raising this question one accepts the inherent mystery of existence…This feature of phenomenology (that the object of experience can never be decisively separated from the subject who experiences it) is both intentional and intersubjective, because my experience of the other is always unremittingly MINE, with all its attendant ambiguity and luggage. (pp. xvi + xvii)

[P]sychoanalysis is already phenomenological in its latency because it has always favored interpretation over explanation, and because it relies on the EXPERIENCE OF THE PATIENT to guide the treatment, not what the psychoanalyst claims to know. Yet despite the phenomenological nature of psychoanalytic inquiry, there has always been a tendency among analysts – beginning with Freud – to extrapolate theories from experience (or from the theoretical constructs of others) that presume to explain what they are unable to see with their eyes. Whereas the phenomenologist resists engaging in speculation as a matter of course, psychoanalysts appear to thrive on it, in effect wanting it both ways: to offer, in one breath, interpretations that endeavor to deepen the patient’s experience, while in the next offering explanations for what is presumed to have ‘caused’ the patient to be such and such a way in the first place. In contrast, the phenomenologist admits from the beginning of his inquiries that he does not know where he is going and does not pretend to. Hence the phenomenologist’s perspective is skeptical instead of theoretical, because it is rooted in a philosophy of perpetual inquiry that is surprisingly compatible with Freud’s technical principles. Indeed, Freud’s principles of technique make little sense outside of a phenomenological context. (p. xvii)

In America psychoanalysis has rarely been concerned, as it is in Europe, with the problem of human existence—la condition humain—that speaks to the enduring fact of our suffering and the elusive promise of deliverance. Instead, its goal has become one of relieving that old saw, mental illness, diagnosable, to be sure, whose anticipated cure holds the hope that one eventually will recover, if you are lucky… Europe, the birthplace of existentialist philosophy, phenomenology, scepticism, and the avante garde, remains an existential culture to this day…. There, Freud is still perceived, a hundred years hence, as a radical, the first in a long line of subversives including Ferenczi, Reich, Groddeck, Klein, Fromm-Reichmann, Laing, Lacan, and others, who collectively cut against the grain of America’s penchant for the pragmatic. Yet, all of them, no matter how original, old-fashioned, or contemporary their views appear to us today…. shared with him [Freud] a view of human nature that is unremittingly disturbing. Like Freud, they believe you must swallow the poison and pay the price if you seriously expect to change. (p. xix-xx)

It was Freud who introduced the principles of morality, character, ethics, into the fabric of psychoanalysis and inaugurated in its wake a novel conception of honesty, becoming the greatest moral essayist since Montaigne (Harold Bloom). Psychoanalysis has always been and is even today about truth, about disclosing what we dare about ourselves to an other. In fact, it is concerned with no other question (Sterba). It is only concerned with the truth (even the law) of the jungle, and of the price we invariably pay when we suppress it. This is why psychoanalysis was always supposed to be radical from the start, because it championed the act of lifting the veil and giving voice to what lurks beneath our protestations to the contrary…. All that we have to go on, as a beacon in the darkness ahead, are what we had in our discipline’s infancy: a set of FIRST PRINCIPLES that, if sufficiently elastic, guide us in that necessarily isolated, unremittingly lonely universe of the treatment situation…. the essential, albeit unpopular, features of psychoanalysis are in danger of being forgotten, overlooked, and suppressed by successive generations of analysts who, ironically, have the most invested in its survival. The common wisdom characterizes Freud as the instigator of what is erroneously depicted as classical technique, whose contribution bears little, if any, relation to the so-called orthodox psychoanalytic perspective. (pp. xx-xxi)

The fundamental rule is fundamental for a reason, because the outcome of every treatment experience relies on the patient’s capacity to sit in judgment by another, at a considerable degree of risk, with no guarantee of the outcome. (p. xxii)

Thompson approach is to take

[E]ach of the technical principles on which psychoanalytic technique is rooted and explores them from a phenomenological perspective, which is to say, the manner in which they are encountered in the treatment…..Throughout this study, he endeavors to ask, WHAT is the fundamental rule of psychoanalysis? of free association? of neutrality? of abstinence? of transference? of countertransference? of therapeutic ambition? of working through?” He has “…. chosen these eight conceptual designations as representing the eight technical principles upon which psychoanalytic treatment is founded. (p. xxii)

For example,

[W]hereas many analysts insist that interpretation is the principal tool of every psychoanalytic encounter, Thompson has assigned it a more measured, though nonetheless essential, role. His chapters on free association, neutrality, transference, therapeutic ambition, and working through illustrate his view that interpretation sometimes interferes with and, at other times, furthers the psychoanalytic enterprise. And this enterprise has no other purpose than to return the analytic patient to the ground of his or her originary experience. (pp. xxii-xxiii)

Thompson begins his book by saying that “…. it has been my observation that theories have never played a significant role in the formulation of what analysts actually do” (p. xiii). But it isn’t long before Thompson uncovers a problem which, presumably, he fails to recognize as one, namely, that “Freud’s conception of free association wouldn’t make much sense unless one appreciates the degree to which we ordinarily conceal most of what spontaneously comes to mind in the course of conversation.” This implies what is typical, average, and usual. But then he says, in the very next paragraph, that free association is not an artificial process but rather a form of verbal meditation that nevertheless requires considerable discipline to perform

Thompson goes on to say,

To free associate in the manner that Freud intended is simply an admonition to be candid during the therapy session. It entails nothing more complicated than the willingness to speak spontaneously and unreservedly, as one sometimes does when not the least self-conscious about what is being disclosed to another person. “Nothing more complicated,” sounds very much like a bit of denial of the difficulty of achieving this goal, as witnessed by how few people actually achieve it. Obviously, Freud’s conception of free association wouldn’t make much sense unless one appreciates the degree to which we ordinarily conceal most of what spontaneously comes to mind in the course of conversation. Seen from this angle, the fundamental rule—wherein I consent to reveal the thoughts that occur to me—is a precondition for grasping the nature of free association as it was originally conceived. (p. 3)

“Free association is not an artificial process but rather a form of verbal meditation that nevertheless requires considerable discipline to perform.” On the contrary, free association appears very much to be an artificial process, and in particular, one which we shy away from in order to protect our self-esteem.

Moreover, it entails speaking unreservedly while remaining attentive to what is being disclosed, something we don’t ordinarily do. Most of us either speak impulsively without awareness of what we say or think through everything we are about to disclose before speaking. Once patients realize the frequency with which they customarily resist disclosing things about themselves, they come to appreciate why complying with this rule plays such an integral role in the treatment experience. Hence, a patient’s capacity to free associate hinges on his willingness to comply with this rule. (p. 3)

“But Freud didn’t realize then that only someone who is uncommonly honest would be willing to spontaneously disclose the contents of her mind [as Dora did]” (p. 9). This statement by Thompson implies that spontaneous self-disclosure is not natural but rather is artificial, and thus requires effort to achieve.

Thompson goes on to cast doubt on two authors, S. Lipton and R.R. Greenson, when he says that “Both Lipton’s and Greenson’s characterization of free association overlook the ethical component of the fundamental rule stated earlier, the pledge to be honest with one’s analyst.” I doubt this conjecture of Thompson’s seriously. Both Lipton and Greenson probably presume that honesty goes without saying, a rather dubious assumption to be sure.

By 1913 Freud concluded that the need to fathom the ultimate cause of one’s suffering—as though knowing why one is neurotic has mutative value—is antithetical to the spirit of submitting to free association. though Freud didn’t know it, this is an inherently phenomenological manner of thinking, not a rationalistic (i.e., scientific) one. (pp. 32-33).

In effect, this becomes Freud’s unwitting espousal of a phenomenological manner of thinking as the crux of psychoanalysis!

Later in the book, Thompson states that “…. the delay of gratification is essential to this perspective and…. without it the treatment experience would be diluted, if not entirely ineffectual” (p. 61). In effect, Thompson seems to be saying that abstinence preserves the pain of suffering till treatment is over. Thompson goes on to say that

[P]sychoanalytic treatment was never intended to provide satisfaction in the conventional sense but to enhance the patient’s capacity for bearing hardship…. If the patient hopes to genuinely benefit from what the treatment has to offer, says Freud, then the patient, “has to learn from [the analyst] to overcome the pleasure principle, [and] to give up a satisfaction which lies to hand but is socially not acceptable, in favor of a more distant one, [but] which is perhaps altogether uncertain. (p. 66)

The Ethic of Honesty is an excellent book. It begins with an observation that psychoanalysis’s fundamental rule is NOT free association but the patient’s agreement to be honest with himself and with the analyst. The rule of free association derives from this, but it is NOT the fundamental rule itself. Most of the main thesis is handled in the first chapter, and the remaining seven chapters serve as elaboration of the main thesis and how it leads to the other “rules” of psychoanalysis.

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