In practically all her major works Horney describes in detail the behaviour and personality traits that develop in a neurosis. She explains how neurosis develops and why it is so destructive to the real self. Understanding of one's neurosis is a key development for anyone in the grips of a neurosis, but it is not a cure. She makes it clear, the cure is a process that has to be worked upon with real effort, but knowledge and understanding are the starting point (Horney 1950, 319).
Any knowledge of the neurotic trends and their implications gives a rough conception of what has to be worked through in analysis. It is also desirable, however, to know something about the sequence in which the work must be done. According to Horney (1942, 87), Freud had declared that a person will first present in the analysis the same front that he presents to the world in general, and that then his repressed strivings will gradually appear, in succession from the less repressed to the more repressed.
It may not matter how many divisions there are in an “ideal analysis”, but all in all there seems to be three steps within each division. They are: recognition of a neurotic trend; discovery of its causes, manifestations, and consequences; and discovery of its interrelations with other parts of the personality, especially with other neurotic trends. Working through these steps, making it possible to disentangle the many vicious circles, slowly makes the whole structure of the personality become more clear (Horney, l942, 88-89).With the above steps at the back of our minds, we are going to look at the therapeutic process as idealized in the theory of Horney. We shall talk about the goals of therapy; the relationship between the therapist and the client – to be included in that will also be the disposition expected in each of them.
1. Goals of Therapy
At the end of Our Inner Conflicts, Horney said that the goals of therapy are helping patients to assume responsibility for themselves and to achieve inner independence, spontaneity of feeling, and wholeheartedness. She cautioned, however, that neither the analyst nor the patient is likely wholly to attain these goals. If we are not clear about the meaning of ideals, we run the danger of replacing an old idealized image with a new one. We must be aware, too, that it does not lie within the power of the analyst to turn the patient into a flawless human being. He can only help him to become free to strive toward an approximation of these ideals (1945, 243).
We begin now with the object of therapy.
Psychoanalysis, as already discussed, has not only a clinical value as a therapy for neuroses but also a human value in its potentialities for helping people toward their best possible further development. According to Horney, Freud, from his earliest to his latest writings, was primarily interested in the removal of neurotic symptoms. Personality change was important only if it was a guarantee for a permanent cure of symptoms or in other words liberating a client from the symptoms (Horney l942, 21). Horney sees this as negative, because it is a gaining of “freedom from”, instead of gaining “freedom for”. The goal which she would suggest as positive would be “rendering a person free from inner bondages making him free for the development of his best potentialities”. She sees this shift in emphasis as sufficient to alter the matter of incentive entirely, in favour of the growth of the real self (ibid 21-22).
The goals or objectives can be pursued in other ways; peculiar to analysis is the attempt to reach these goals through human understanding, not only through sympathy, tolerance, and an intuitive grasp of interconnections, qualities that are indispensable in any kind of human understanding, but, more fundamentally, through an effort to obtain an accurate picture of the total personality. Horney (ibid) further says that this is undertaken by means of specific techniques for unearthing unconscious factors, for Freud has clearly shown that we cannot obtain such a picture without recognizing the role of unconscious forces which will see in one of the next sub-titles.
Horney (1939, 281), says that the objective in therapy is, after having recognized the neurotic trends, to discover in detail the functions they serve and the consequences they have on the patient’s personality and on his life. She would be interested in understanding what a particular trend accomplishes for the individual, and also what consequences the trend has on his character and life. This would be of key importance in helping the individual come to self-understanding.
She agrees with Freud that the tools with which the analyst operates during the psychotherapeutic procedure are free associations and interpretations, as a means of lifting unconscious processes into awareness; a detailed study of the relationships between patient and analyst, as a means of recognizing the nature of patient’s relationships to others (Horney 1939, 284).
The only differences she has with Freud regarding these aspects are two: the first one depends on the kind of interpretation given (i.e. to say that the character of interpretation given depends on the factors which one deems essential. The second one is that the factors which are less tangible and hence more difficult to formulate. They are implicit in the analyst’s way of handling the procedure: his activity or passivity, his attitude to the patient, his making or refraining from value judgements, the attitudes he encourages or discourages in the patient (ibid, 285).
For Horney, the principal object of therapy is to help patients relinquish their defenses, accept themselves as they are, and replace their search for glory with a striving for self-realization. Insight is useful in leading patients to see that their defenses are self-defeating and cannot possibly work, but they must experience as well as understand the destructiveness of their solutions if they are to have a strong enough motivation to change.
2. Therapist - Client Relationship
For Horney, the therapist is not to be a remote authority figure but a real person with strengths and weaknesses, just like the patient. In her lecture on The Analyst’s Personal Equation, she warned “the fear that neurotic remnants may be exposed will make some analysts unduly cautious, thereby depriving the patient of the opportunity to experience his analyst as a human being with both shortcomings and assets” (Horney 1999, 193).
Although she continued to employ her theoretical framework, she taught that intellectual insight is only one aspect of understanding, and not the most significant. Indeed, she feared that theory might obstruct an awareness of the patient’s individuality, “that a detached, purely intellectual attitude would lead not to understanding but to a mechanical classification of the patient’s personality according to our pre-existing ideas” (ibid, 199).
Horney rejected the then-prevailing authoritarian model of the therapist-patient relationship and proposed a democratic one instead. “Therapists do not occupy a morally or psychologically superior position and should be humble about their ability to understand the patient. It will help them to attain a democratic spirit if they remember that, however experienced they are, they are dealing with a particular patient and their knowledge of this patient is limited” (ibid, 208). “They should regard all interpretations as more or less tentative and should be truthful about the degree of certainty they feel” (ibid, 206). “Their truthfulness has two advantages: their groping will stimulate the patient to be active, to wonder, to search, and it will have more meaning for the patient when they feel confident” (ibid, 206–207).
This brings us to Horney’s model of the therapist-patient relationship, which she saw as mutual, cooperative, and democratic. Her model is not one in which therapists and patients analyse each other but rather one in which therapists continually analyse themselves while helping their patients toward self-understanding and growth. Their self-analysis benefits their patients as well as themselves, since it helps mitigate counter-transferential problems and deepens their emotional understanding.
3. Role and Characteristics of the Therapist
Theory should not be used to pigeonhole the patient, nor should the patient be used to confirm the preconceived ideas of the analyst. Horney taught that therapists should attend to the patient not only with reason and knowledge but also with intuition and emotion. “Understanding is a process of moving toward another person’s position while still maintaining our own, and therapists do this very largely through their emotions, which enable them to feel their way into the patient’s situation” (ibid, 199).
Horney characterized the therapeutic attitude as one of undivided or wholehearted attention in which therapists let all their faculties operate while nearly forgetting about themselves (ibid, 188). “They must not relinquish themselves, however, for if they lose their own stand altogether, they will not have understanding but blind surrender” (ibid, 199). “If they can lay themselves open without losing themselves, they can listen wholeheartedly while simultaneously becoming aware of their own reactions to the patient and his problems” (ibid, 201). Horney urged therapists not to overestimate their own mental health, but to have a proper humility. They should constantly analyse themselves, paying attention to their feelings and trying to determine how reliable they are as guides to understanding the patient.
Horney also frequently emphasized that analysis is a cooperative undertaking saying that therapists can help their patients formulate and clarify the data, but the patients must supply it by revealing themselves. Perhaps the most important ways in which they can do this is through free association and the sharing of their dreams—things on which Horney placed more emphasis in her lectures than she did in her books. Self-revelation is difficult and must be facilitated by the therapists’ having a genuine respect for their patients, a sincere desire for their well-being, and a wholehearted interest in everything they think and feel. This will create a sense of trust that will make it easier for patients to tell everything that comes to them without selecting (ibid, 202).
At the same time she said that supporting the patient during the disillusioning phase of therapy is very important. Her opinion was that patients need support in dealing with discouragement, anxiety, and the realization of painful truths about themselves. “The therapist assists them in overcoming fear or hopelessness, giving them a sense that their problems can be resolved. Patients will feel profoundly threatened when, bereft of glory, they realize they are not as saintly, as loving, as powerful, as independent as they had believed” (Horney, 1942, 145).
Still, when the therapy is going on, constant encouragement helps a lot because the patients need someone who does not lose faith in them, even though their own faith is gone. “In the course of analysis, patients must confront not only their loss of glory but also their unsavoury characteristics, which are the product of their neurosis. They tend to react with unconstructive self-hate, rather than with the self-acceptance that will enable them to grow. The analyst perceives that they are striving and struggling human beings and still likes and respects them as a result”. This encouragement counteracts patients’ self-hate and helps them to like and respect themselves (ibid, 145).
The art of the therapist consists also in helping to mobilize because as patients become less defensive in the course of therapy, their constructive forces grow stronger, and the central inner conflict emerges. The therapist work lies not only in helping patients to perceive, experience, and work through their neurotic solutions but also in helping them to mobilize their constructive forces and supporting them in their struggle to find and actualise their real selves (ibid, 146).
Therapists must be understanding people, knowing that there is a constant battle in patients between their desire to change and their fear of letting go of the strategies that have enabled them to survive in what they feel to be a dangerous, frustrating, unsympathetic world. They are motivated to change by both a desire to relieve their suffering and the constructive forces that are still alive within them, but they can relinquish their defenses only when they feel safe enough to do so (ibid, 149).
Horney continues further to say that another role of the therapist’s role is to assuage their (patient’s) anxiety, to reinforce their healthy drives, and to encourage them to continue in their struggle to change. “As the central inner conflict rages, patients will oscillate between health and neurosis, but therapists must not become bewildered by these swings. If they have a clear vision based on their own constructiveness and are unambiguous allies of the endangered self, they will be able to support their patients at this most trying time” (Horney 1999, 256).
Finally, according to Horney (1939, 285) Freud’s suggestion on how the analyst is to behave was that he (analyst) should play a comparatively passive role, saying that Freud’s advice is that the analyst should listen to the patient’s associations with “evenly hovering attention”, avoiding deliberate attentiveness to certain details and avoiding conscious exertion. Horney does not entirely agree with this but on the contrary, her view is that the analyst should deliberately conduct the analysis (ibid, 286), and should exercise a more deliberate influence not only on the direction of the patient’s associations but also on those psychic forces which may help him eventually overcome his neurosis (ibid, 287).
In my opinion, the above paragraph contains not only the role of the therapist towards the patient, but it shows the two differences between Freud and Horney regarding the how the tools may be used. The difference is that for Freud, the analyst should be not be seen to play any role at all, or appear to be suggestive in a way that may influence the associations that a patient makes. On the other hand Horney thinks that the analyst should be active, suggestive in a way to influence the client and may even prod the patient to give associations.
4. Role of the ClientEvery analyst knows that an analysis proceeds more quickly and efficiently the more the patient co-operates (Horney 1999, 196). When speaking of co-operation Horney did not intend to mean the patient's polite and obliging acceptance of whatever the analyst suggests. Nor was she referring primarily to the patient's conscious willingness to give information about himself; most patients who go to analysis of their own accord sooner or later recognize and accept the necessity of expressing themselves with utmost sincerity (ibid). Horney was rather referring to a kind of self-expression which is as little as the patient's conscious command as it is at the composer's command to express his feelings in music. If factors within himself bar him from expression, the composer is flatly unable to work; in other words he is unproductive (ibid 197).
1.3. Techniques of a therapeutic processTalking about the techniques of a therapeutic process, we may as well have to remember what Horney indicated as the goal of in psychoanalysis that is, to render a person free from inner bondage making him free for development, and possibly arrive at the real self (1942, 22).
In other words she was suggesting William James's concept of real self as distinguished from material and social self. This relates to what one really feels, wants, believes, and also decides. She refers to it as the most alive centre of psychic life. It is this psychic centre to which the appeal is made in analytical work (ibid, 290).
In neurosis the scope of the real self and aliveness are decreased. This is because the development of the self and its components, genuine self regard, native dignity, initiative, and the capacity to take responsibility for one’s life have been battered (ibid 291).
To reach this goal, she idealized a therapeutic process which we are going to see below. Though we are going to demonstrate it, it’s wise to take note of what Horney said: that no amount of description, regardless of how carefully it is presented, can convey fully an adequate impression of exactly what is involved in the process of reaching an understanding of oneself (ibid, 194). She however, wanted to demonstrate that something can be done using the techniques or tools mentioned below.
In a case published in one of her books (1942) we can see an excellent example of the use and the application of these tools by Horney.
We are going to use some excerpts of this case as an example of analysis which she refers to as self-analysis, a terminology which will be used for “analysis” in this part of this chapter for a reason to be indicated at the end of this sub-title.
The case deals with a woman's morbid dependency on a man, a problem which for many reasons Horney says is frequent in our civilization (ibid, 195). She adds that the situation described would be interesting enough if it were regarded merely as a common feminine problem, but its importance extends beyond the feminine sphere. An involuntary and in a deeper sense unwarranted dependency upon another person is a problem known to nearly everyone. She said that most of the people deal with one or another aspect of it at one or another period of our lives (ibid).
We have said that the term self-analysis will be hereby used to stand for analysis though the two give different connotations. In my opinion, I think Horney uses it (self-analysis) to also mean analysis because in both of them, and at least in as far as her book (1942) is concerned the therapist is involved whether in the case of analysis or self-analysis. In other words, self-analysis doesn’t exclude the therapist, but he is present and has a role to play – like trying to mobilize the patient to do some things such as free associations or even work with resistances. The slight difference we can see between analysis and self-analysis, is where the patient in self-analysis can take his or her own notes as will be seen in the next sub-title.
I hope this explanation will serve to clarify as well as to justify the use of the term “self-analysis” whereas for all practical purposes we should just use “analysis”.
5. Free Association and interpretation
One of the techniques in self-analysis is free association. Horney suggests that it differs from the method in analysis in that the patients take mental notes of their associations and they can then write them down. Writing down, or noting key words, means they can be gone over easily afterward and missed connections may be seen, or old connections may be seen in a different light at a later time. One may also realize little headway has been made when reviewing previous notes (Horney l942, l86-189).
The case of Clare's self-analysis in Horney’s book shows “resistance” to her associations and where she “transfers” it.
Horney says that Clare had a memory of a scene in a novel which came to her when she was thinking about her own anger with her boyfriend. Clare made a correct interpretation but not deep enough regarding the connection between her anger and the cause. Horney goes on to say that she had resistance to the import of her associations because she was not ready to understand. It took a whole night to penetrate her awareness, and even then, it first concealed its true meaning by transferring itself to the author. (ibid l95-l96)
Clare continues to have dreams and try to analyse them but Horney says she still doesn't go far enough. However, she seems to have been left with emotions which she could not intellectually analyse away. These lingered on and were instrumental in her pursuing the path of analysis she subsequently embarked upon (ibid, l98)
“Resistance” once again enters her analysis. Her boyfriend let her down by not turning up and in a memory Clare recalled an incident with her mother and a present her mother offered her but Clare turned it down even though she desperately wanted it using the excuse that her mother could not afford it. Clare felt relief at this connection, temporarily. Horney says the problem was not Clare's timidity in stating what she wanted but her need to hold on to the relationship to avoid becoming the object of even a vague resentment. Again it appears that in “transferring” her emotions to a pseudo solution Clare succeeded, temporarily, in circumventing the crucial problem. This problem was a pattern which meant she clung to difficult relationships by taking the blame when she was distressed and she avoided any bad feelings about herself (ibid, l99-20l).
Horney continues to talk about how Clare continued her analysis using memories, dreams, associations and note taking. She made connections and they would fade and come back and she made deeper connections (ibid, 220-228). Over and over she came close to the real answers and began to realize that resistance against facing her findings was the real stumbling block (ibid, 235-240). Some months later Clare returned to analysis with Horney and continued working on issues which Horney says she could have resolved on her own with time (ibid, 246).
Horney says repeatedly that the process of free association, of frank and unreserved self-expression, is the starting point and continuous basis of all analytic work (ibid, 247-248. It becomes more difficult and more important when working alone to express exactly what one is feeling, not what one thinks is supposed to feel. She refers to Freud, indirectly by saying, in psychological matters we cannot hang anybody whom we have not first caught we must first recognize the full intensity of our feelings before we can work on their origins (ibid, 250). The last thing she says regarding free association is that reason has no place in this process because it will hamper spontaneity. It comes later with conscious efforts to make sense of it all (ibid, 252).
Another technique of self analysis is the interpretation. This should be guided by the person's interest, what catches their attention. This will hopefully mean that intuitively something is chosen which falls in line with emotional chords and the possibility of understanding at that time (ibid 253-256). Interpretations need to remain on a tentative nature to allow exploration wherever the path may lead. It is also important not to let insights remain scattered but to look for the structure they reveal. How things influence each other is an important concept psychologically, as well as in all other areas of life (ibid, 258-262). It is the interest and incentive and the spirit with which self-analysis is undertaken, not the rules which are decisive (ibid 266).
6. Working with resistances
Transference in self-analysis is a way of dealing with “resistances”, as Karen Horney referred to it. Resistances are seen as forces opposing change, or liberation, and when the neurotic structure is challenged they block progress in any way possible. Horney says Freud used the term “resistances” to denote everything that hampered work from within. They are the sum of forces seeking to preserve the status quo and to improve the functioning of the neurosis. They maintain those aspects of the neurosis that have present subjective value (Horney l942, 268).
Horney does not say “transference”, but says there is resistance in all relationships. The same responses and feelings are produced by the analyst but since analysis is an explicit attack on the neurotic structure, the challenge it presents is greater. She says she does not agree with those who say that resistances cannot be tackled alone but need expert help. She also does not agree with Freud's view of the prominent role of a destructive instinct in human nature which leaves little space for constructive forces which might strive for growth. Her argument is that the outcome of any type of analysis depends on the strength of the resisting forces and the strength of the self to deal with them (ibid 268-269).
Recognizing resistances and defenses which work toward maintaining the status quo means some understanding of their sources and how they show themselves. It is the person's secret claims on life, their illusions about themselves which have subjective value and are safety zones which defy change (ibid, 271).
Horney says that in analysis the resistances arise usually as a result of something specific which has occurred in the analysis and defenses immediately come to the client's rescue. If touched upon, in any part of life, these repressed factors will produce the resistance and defenses which accompany it. In analysis the analyst may provoke resistance by interpretation or getting near a sensitive area. In self-analysis daily life may have greater power to produce blockage because the person's emotions are not concentrated, even temporarily, on the analyst (ibid 272-273). In other words it is to say that there are many distractions in an individual’s daily life such that to have a proper concentration which is not interrupted by anything is a bit difficult.
Horney says that in professional analysis resistances may be grouped under three main headings. The first type is an open fight with what is suggested or felt to be going on. The second type can be concentrated on the analyst and is seen as defensive emotional reactions. The third Horney refers to as defensive inhibitions or tactics of evasion (ibid 275).
In self-analysis resistance may be seen in several ways. One would be toward starting the analytical work itself and an inhibition continuing it, and evasion of issues in innumerable ways. The value of the free associations may be impaired, as well as blockage of any understanding of them. Resistance may invalidate the significance of the findings. There will be emotional reactions to material which comes up. Feelings of guilt or apprehension, or irritation at oneself will occur. These may also cause the person to minimize or avoid the problem for the time being (ibid, 276-279).
As we draw to the end of this point on resistances, we may need to say something on how they (resistances) are recognized and coped with. With persistence and time many will be seen and the emotions may then be able to be faced as well. Horney further says that noticing emotions, how the person is feeling will help them see something is wrong. Whenever a blockage is noticed she says that the person should drop other analytical pursuits and concentrate on the resistance because you can't get past it (ibid, 279-281).
She suggests free associating to the resistance, after looking back over recent notes to see if some issue has been touched upon which may have triggered the blockage to further understanding. These resistances are organic developments which developed as a result of threatening forces during a lifetime. They should be approached with respect, not with hostility. With this approach they may be understood, even in self-analysis. If they are stronger than one's constructive will, expert help may then be needed (ibid, 282-285).
In conclusion to this chapter, once again from reading her books, we might gain an impression of Horney as a therapist who relied heavily on rigorous analysis of her patients in terms of an elaborate taxonomy of defenses. A different picture emerges from the lectures (1987, 1999) she gave in her courses on analytic technique, which were published posthumously.
The conflict between healthy and neurotic forces may never be finally resolved, but there may be a decisive shift in the balance of power. Therapy can be terminated when the balance has shifted decisively to the side of the strivings for growth and patients are ready to deal with their problems themselves through continuing self-analysis (Horney 1939, 303-305).
Horney also believed in the inherent constructive forces, something that made her much more optimistic than Freud about the possibilities of psychotherapy. She thought that Freud did not have any clear vision of constructive forces in man and had to deny their authentic character (Horney 1950, 378). For Freud, creativity and love were sublimated forms of libidinal drives, and a striving for self-fulfilment could only be regarded as an expression of narcissistic libido (ibid).
Finally it's important to note that Horney continually stressed that self-awareness was part of becoming a better, stronger, richer human being. This is evident from practically all her books which seem to have a common running theme, namely the capacity of an individual to effect change in his or her life, which is to realize oneself.
Even thus saith Hermes: Through long years I have not ceased to experiment, neither have I have spared any labour of mind And this science and art I have obtained by the sole inspiration of the living God, who judged fit to open them to me His servant, who has given to rational creatures the power of thinking and judging aright, forsaking none, or giving to any occasion to despair. For myself, I had never discovered this matter to anyone had it not been from fear of the day of judgment, and the perdition of my soul if I concealed it. It is a debt which I’m desirous to discharge to the Faithful as the Father of the Faithful did liberally bestow it upon me.Understand ye, then, Oh Sons of Wisdom, that the knowledge of the four elements. All the ancient philosophers were not corporally or imprudently sought after, which are through patience to be discovered, according to their causes and their occult operation.But, their operation is occult, since nothing is done except the matter be decompounded, and because it is not perfected unless the colours be thoroughly passed and accomplished. Know then, that the division that was made upon the water by the ancient philosophers separates it into four substances; one into two, and three into one; the third part of which is colour, as it were-a coagulated moisture; but the second and third waters are the Weights of the Wise.Know ye then, O Sons of Science, there are seven bodies, of which gold is the first, the most perfect, the king of them, and their head, which neither the earth can corrupt nor fire devastate, nor the water change, for its complexion is equalised, and its nature regulated with respect to heat, cold, and moisture; nor is there anything in it which is superfluous, therefore the philosophers do buoy up and magnify themselves init saying that this gold, in relation of other bodies. is, as the sun amongst the stars, more splendid in Light; and as, by the power of God, every vegetable and all the fruits of the earth are perfected, so gold by the same power sustains all.For as dough without a ferment cannot be fermented so when thou sublimest the body and purifiest it, separating the uncleanness from it, thou wilt then conjoin and mix them together, and put in the ferment confecting the earth and water. Then will the Ixir ferment even as dough doth ferment. Think of this, and see how the ferment in this case doth change the former natures to another thing. Observe, also, that there is no ferment otherwise than from the dough itself. Observe, moreover, that the ferment whitens the confection and hinders it from turning, and holds the tincture lest it should fly, and rejoice the bodies, and makes them intimately to join and to enter one into another, and this is the key of the philosophers and the end of their work: and by this science, bodies are meliorated, and the operation of them, God assisting, is consummate. But, through negligence and a false opinion of the matter, the operation may be perverted, as a mass of leaven growing corrupt, or milk turned with rennet for cheese, and musk among aromatics. The sure colour of the golden matter for the red, and the nature thereof, is not sweetness; therefore we make of them Sericum - ie Ixir; and of them we make the enamel of which we have already without and with the king's seal we have tinged the clay, and in that have set the colour of heaven, which augments the sight of them that see.The Stone, therefore is the most precious gold without spots, evenly tempered, which neither fire nor air, nor water, nor earth is able to corrupt for it is the Universal Ferment rectifying all things in a medium composition, whose complexion is yellow and a true citrine colour. The gold of the wise, boiled and well digested with a fiery water, makes Ixir; for the gold of the wise is more heavy than lead, which in a temperate composition is a ferment Ixir, and contrariwise, in our intemperate composition, is the confusion of the whole. For the work begins from the vegetable, next from the animal, as in a hen's egg, in which is the greatest help, and our earth is gold, of all which we make Sericum, which is the ferment Ixir.
