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E. James Lieberman

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Psychotherapy: How it Evolved after Freud
By E. James Lieberman   

Last edited: Thursday, July 17, 2003
Posted: Thursday, July 17, 2003

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How Sigmund Freud's contributions have changed over time, with specific regard for modifications credited to his "foster son," Otto Rank.

Otto Rank's influence on psychotherapy after FreudThe Evolution of
Psychotherapy Since Freud
by E. James Lieberman, M.D.
In 1906, Sigmund Freud (1856-1939), neurologist and first psychoanalyst, hired
a young locksmith, Otto Rank (1884-1939), as secretary of the Wednesday
Psychological Society--the future Vienna Psychoanalytic Society. Freud, then
50, became a second father to the brilliant, self-taught, working-class youth
of who was alienated from his own father, Simon Rosenfeld, an artisan jeweler
hot-tempered and given to alcoholic excess.
It was probably Alfred Adler, having read an essay by Rank on the psychology
of the artist, who recommended the youth to Freud. Adler, Rank's family
physician and a member of Freud's inner circle, recognized the value of Rank's
essay, which used the new psychoanalytic theory to create a "sexual psychology
of the artist."
Much impressed, Freud hired Rank and sent him back to complete the Gymnasium
so he could go on to University. Thus began a 20-year professional and
personal relationship between the two men, closer than those between Freud and
his sons or Rank and his father. With Freud's help Rank finished his education
in six years, becoming the first "lay" or nonmedical analyst. When he obtained
his Ph.D. at the University of Vienna in 1912, Rank already occupied an
important role at Freud's side as specialist in history, philosophy, art and
mythology. Evidence of the esteem in which he was held appears in editions 4
to7 of Die Traumdeutung, Freud's masterwork, where Rank's name appears on the
title page as contributor of two chapters in addition to his work as editor
and bibliographer.
The year 1913 stands out in the history of psychoanalysis. After the
departures of Alfred Adler and Carl Jung over theoretical differences, a
Committee, "The Ring," was founded to guide and control the evolution of the
new science. Besides Freud himself the members were: Ernest Jones (1879-1958),
British biographer of Freud and longtime president of the International
Psychoanalytic Association (IPA); Karl Abraham (1877-1925), head of the Berlin
Institute for psychoanalytic training; Sandor Ferenczi (1873-1933), the
affable, creative intimate of Freud and Rank, from Budapest; Otto Rank, the
only one in Vienna with Freud; and, in Berlin, Max Eitingon and lawyer Hanns
Sachs (besides Rank the only nonphysician).
The World War blocked communication among the Committee, but the members began
to meet and correspond beginning in 1918. The northern axis of the group,
London and Berlin, tended to be conservative. Jones and Abraham interpreted
psychoanalytic theory narrowly, at times opposing Freud himself, who was
flexible and able to change his views. Supporting certain changes, Rank and
Ferenczi, the southern axis, elaborated an "active therapy": it made the
analyst less isolated--more a partner in exploration than a surgical
authority, masked and removed. Besides listening and interpreting, the
therapist would guide, support and challenge the patient. Thus began
relationship or interpersonal therapy as we know it today.
Freud heartily endorsed the innovation, proposing a prize for the best paper
on active therapy in the next IPA Congress (1922). During the next two years
disputes raged among the "brethren" under Freud, as the northern and southern
contingents strove for Freud's approval and ultimately, his mantle. Jones and
Abraham saw a departure from the rigorous science begun by Freud, who in 1912
had written that the ideal analyst would conduct himself as a surgeon, with
objective expertise, emotional detachment and authority.
Even Freud did not conduct himself so. In both speaking and writing, he
balanced scientific authority with human warmth, charm, humility. These
qualities evidently resonated more in Ferenczi and Rank than in Jones and
Abraham. Over the years observers have remarked that Freud was less orthodox
than his most fervent disciples--beginning, I suggest, with the latter two.
An amusing comment on this phenomenon comes from the pioneer analyst Abraham
Kardiner, who was in Vienna with mainly American and British
analysts-in-training in the early 1920s. He reported that there was tension
between the two groups, the former mostly Jewish, the latter not (Ernest Jones
was the only non-Jew on the Committee). One day the British invited the
Americans to tea to discuss the different experiences of the two nationalities
in working with Freud. The British analysands were perplexed in finding Freud
almost totally silent. They had heard that he talked quite freely with at
least some of the Americans. Was it true ?
Yes. Often Freud would discuss books, theoretical points, even art and
politics in the analytic hours.
Apparently the British, not to feel chagrined, concluded that Freud conducted
a more serious analysis with them than with their casual, rather motley
American counterparts. Kardiner, an immigrant from Europe, heard complaints
over the years about long, silent, ineffectual analyses by members of the
British school, where "the analyst says nothing except 'good morning' and
'good day.
He added, significantly, that Freud had not conversed with one New Yorker in
the Vienna group who was held in lower esteem. Evidently Freud, despite his
remark about the surgical attitude, did not hide behind the blank screen of
analytic expressionlessness. Those who pleased Freud made him more active. The
phenomenon of forthcoming responsiveness is now being taken more seriously by
the analytic profession, e.g., in discussions of mirroring, and in renewed
interest in the Ferenczi-Rank monograph of 1924, The Development of
Psychoanalysis.
The Committee was shaken badly when, at age 67, Freud was afflicted with
cancer of the palate. The next year, 1924, fraternal rivalry intensified for
heir-apparent. Freud never attended another IPA Congress because of
embarrassment or discomfort in speaking and eating due to a prosthesis. But he
lived another 16 years, to age 83, enduring repeated operations. He continued
to analyze and write, even radically changing his theory about anxiety
(Inhibition, Symptom and Anxiety 1926), partly in rebuttal to Rank's Trauma of
Birth (1924).
The leadership of the IPA was not elected by the membership, but chosen by the
Committee from within. Freud never took the presidency, but approved the
decision. Jones, on account of his power in the expanding English-speaking
movement, presided for many years; Ferenczi, because of problems in Hungary,
stepped down after brief tenure; Abraham died in 1925, and Rank never served,
breaking with the movement in 1926. Freud, always afraid that psychoanalysis
would be identified as a Jewish science, acceded to Jones although he did not
trust the man. Jones and Rank despised each other cordially, and Jones merely
gave lip-service to Freud's support of lay analysis. Sachs, Reik, Anna Freud,
Melanie Klein, Beata Rank and others--but especially Otto Rank--proved that
medical training was not needed to be a good practitioner, theorist or teacher
of psychoanalysis.
Ferenczi also fought in the losing battle to keep the IPA open to nonmedical
professionals. The active, interpersonal, time-limited therapy which he
initially championed with Rank came in response to the Freudian furor after
World War I. Physicians and others were lining up to be trained in the new
profession, patients were lining up to be treated, writers and critics were
taking a new approach to literature, sex was discussed in a new way, and no
field was immune to psychoanalytic interpretation. Freud's Introductory
Lectures (1917) had been translated into at least seven languages.
According to Ferenczi and Rank, the practice of psychoanalysis had stagnated
due to overly strict devotion to theory, and clinical results were too often
unsatisfactory. Freud wanted to work out a general psychology more than a
method of treatment and he did not presume much about the therapeutic effect
of his discoveries. A pessimist, he said that successful psychoanalysis could
only transform neurotic misery into ordinary unhappiness. Nevertheless the
idea of real help became popular; Ferenczi and Rank firmly held this view and
tried to understand and teach its basis.
They criticized the practice of the time for its 1) emphasis on the past; 2)
need to uncover--in order to interpret--a basic oedipal complex in every
analysand; 3) excessive use of the concept "transference, which concerns the
appearance in the analytic situation of a constellation of emotions in the
patient toward the therapist, representing unconscious emotions attached to
important (parental) figures from the past. Theoretically the process of
analysis postulates an inevitable transference neurosis which can be analyzed
through profound knowledge of the history, fantasies, dreams and free
associations of the patient. But according to the new critique, too many
practitioners strove to follow an exact--but nonexistent--Freudian formula.
Like Freud, they valued research above helping; at times they imposed
inappropriate interpretations about a hidden oedipal complex, and analyzed any
resistance until the patient yielded to the truth.
Dr. Clara Thompson, an American psychiatrist whose own analyst was Ferenczi
and who analyzed Harry Stack Sullivan, once wrote vividly about the new
attitude. She disliked the tendency to analyze everything in relation to
parents and the past because, as Rank taught, this diverts attention from the
actual relationship.
Rank was the first to point out that in doing this the patient was led away
from the living present, at the area of real feeling. As he put it, it is
always easier to talk about the past because it is not present. He and
Ferenczi stressed, for the first time, that not every attitude toward the
analyst is transferred from the past, that there is some reaction to the
analyst in his own right, and that it is actually anxiety-relieving and,
therefore, stops the progress of analysis, to point out to the patient, You do
not really feel this way about me but about your father, etc. Thus, if the
patient finally gets the courage to tell the analyst he looks like a pig, the
whole issue may be conveniently buried by referring it to the past, saying,
That must be what you thought of your father. Two things may happen as a
result--the analyst does not have to face the fact that he does look like a
pig and the patient feels "I got safely out of that one," but he does not feel
more secure thereby because he knows he really meant the analyst and not his
father. From that day on he is likely to assume that the analysts' feelings
have to be protected. Realizing this, Rank and Ferenczi discovered the
importance of the picture of the analyst in his own right--thus transference
became more precisely defined as only the irrational attitudes felt and
expressed toward the analyst.
Soon Jones and Abraham attacked Ferenczi and Rank. Besides that book, Rank
added fuel to the fire with his birth trauma theory, which established the
nurturing (pre-oedipal) mother-child relationship as primary in psychological
development. At first enthusiastic, Freud gradually aligned himself with the
northern axis against the innovators.
In 1924, at age 40, Rank sailed to New York for the summer to analyze and
teach. Received warmly as Freud's emissary and then in his own right, his
accolades included honorary membership in the American Psychoanalytic
Association. Increasingly bitter about the attacks and Freud's withdrawal of
support, Rank finally emigrated to Paris in 1926, visiting the United States
almost every year until his permanent move there in 1934. He died a month
after Freud in 1939, at 55.
Among those who knew Rank and acknowledge his influence are Frederick Allen,
pioneer child psychiatrist; Carl Rogers and Jessie Taft, psychologists; and
Virginia Robinson, social worker--the last two associated with the
Pennsylvania School of Social Work. Many others hid their indebtedness to
Rank, since acknowledging him could only hurt them when Freudian
psychoanalysis dominated American psychiatry, psychology and social work. In
the 20s Rank was one of the most sought after analysts. After 1930, his former
analysands were required to undergo reanalysis with a certified Freudian to
qualify for IPA membership.
Ferenczi died in 1933, having broken first with Rank and then, in the end,
with Freud and the movement. Jones, who completed his massive Freud biography
just before his death in 1958, attributed the defections of Rank and Ferenczi
to mental illness. This calumny continues to crop up in histories of
psychoanalysis, but gradually the writings of these creative pioneers are
coming back into the mainstream with the help of interpreters like Leo Stone,
John Gedo and Esther Menaker.
Sigmund Freud attempted to secure a scientific basis for knowledge of the
psyche belonging previously to poets and philosophers. Regardless of the
validity of his theory, he invented a new form of human interaction, the
analytic situation. His followers used and modified this invention to its
present status, chiefly in psychotherapy, 100 years after the beginning.
With a schematic representation of contrasting emphases, we can look at
differences in viewpoint, ideology and practice which characterize the
Freudian and divergent--Rankian--psychodynamic systems which now include the
interpersonal, existential, client-centered, time-limited and humanistic.
1. Freudian/classical: Science--objective, general
Rankian/modern: Art--subjective, unique
Freud admired artists but considered himself a scientist who worked to
validate objectively the intuitions of poets and philosophers. He tried to
avoid the appearance of speculative thinking, even denying the influence of
Nietzsche. Otto Rank willingly embraced philosophical and artistic sources,
and once offered this paradoxical principle: For each patient I need a
different theory."
2. F: Analysis, exploration
R: Therapy, helping
Freud borrowed the word analysis (Greek: "separation") from the vocabulary of
chemistry. Therapy, on the other hand, derives from the Greek and Latin with
meanings of serving, care and healing. Otto Rank, after leaving Freud, used
the word "psychotherapy" to describe his work, even alluding to himself as a
philosopher of helping. Other pioneers who found a similar path from analysis
to helping include Franz Alexander, Karen Horney, Erich Fromm, Frieda
Fromm-Reichmann, Harry Stack Sullivan, Sandor Rado, Michael Balint, Erik
Erikson and John Bowlby.
3. F: The past, memories, childhood
R: The present, here-and-now
Clara Thompson's statement illustrates this point.
4. F: The unconscious, repression, suppression by the ego
R: The conscious, expression of the ego
If Freud devoted the analytic hour to free that of which one is not aware,
Rank used the occasion to confront that which the patient knows but fails to
express in words or action.
5. F: Wish, instinct
R: Will, creativity
In psychoanalysis, conscious will has virtually no place; Freud dismissed the
will as found in 19th-century psychology. Rank put it back as a central
factor, the essence of human identity. Will expresses both ego and instinctual
energy. His approach was called "will therapy. This signifies not willfulness
but the ability to combine strong goal-directedness with self-discipline and
free, spontaneous improvisation.
6. F: Understanding, intellect
R: Experience, emotion
Rank believed that the neurotic suffers precisely because of too much
self-analysis, while lacking the courage, on account of guilt and life-fear,
to engage in appropriate experience and action. If for Freud (as with
Socrates) the unexamined life is not worth living, then with Rank we can say
that the uncreative life is not worth living, and the unlived life is not
worth examining.
7. F: Transference, interpretation
R: Actual relationship, intimacy
Rankian actuality and existentialism de-emphasizes childhood projection, the
kernel of the transference neurosis. Instead, Rank postulates real
relationship as the core of therapy, one which (somewhat paradoxically) has a
professional kind of intimacy and openness, in contrast with Freud's method in
which the analyst keeps removed and unknown.
8. F: Biology
R: Psychology
Freud used the Oedipus myth as a deterministic model of human family dynamics.
He argued that every boy unconsciously wishes to kill his father and marry his
mother. But Oedipus, an adoptee, loved his psychological parents; of course,
he did not know his biological ones because they abandoned him as an infant.
Oedipus pursued literal truth over the edge, into tragedy. Knowing who he is"
biologically, historically, overcame prudent warnings and Jocasta's petition
that he abandon the quest and pursue life. Emotional truth is often not
congruent with the factual kind; having relations can mean being related
biologically or being intimate. With Jocasta, Rank favored psychological over
biological relationship, and he gave philosophical primacy to self-creation
over predetermination.
9. F: Death fear
R: Life fear
According to Freud, the patricidal son controls himself for fear of paternal
punishment, castration-fear, which symbolizes death. In contrast, Rank sees
the problem as one of individuation after involuntary birth. Can we, starting
as unwilling newborn creatures, attain a stage in which we embrace our lives,
affirming creative will and human responsibility without paralyzing guilt and
fear? If so, this signifies a psychological rebirth, the transformation of
creature to creator.
10. F: Normality
R: Individuality
According to Rank, the challenge to us in the post-Freudian world is to create
an individual personality. In this respect, one who positively engages his/her
own will becomes a successful artist, not by painting or composing, but by
living according to one's own genius, spirit and limitations. Life is a loan,
death the repayment. The creative type invests or spends it; the neurotic,
also strong-willed but paralyzed by fear, is a failed artist who
(neurotically) tries to deny death: "It can't be all over, I haven't begun to
live yet..."
This schematization oversimplifies categories, but may be useful in viewing
the forest. It should be clear that Rank, if not the originating source of
everything attributed to him, is a major forerunner--largely
unacknowledged--of what is now accepted psychotherapeutic theory and practice.



Psychiatric Times, XIV:4, April 1997, used by permission. Auf
Deutsch:"Trennung und Selbsterschaffung: Leben und Werk von Otto Rank",
Psychoanalyse im Widerspruch, 5:56-64, December 1994.
En Esperanto"La Evoluo de Psikoterapio depost Sigmund Freud"


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