Horney & Humanistic Psychoanalysis
The Process of Psychotherapy
Horney said that her desire to reevaluate psychoanalytic theory had its origin in "a dissatisfaction with therapeutic results" (Horney, 1939, p. 7). In New Ways in Psychoanalysis (1939) she redefined transference, countertransference, and the goals of therapy, and in Self-Analysis (1942) she developed an account of the analytic process in accordance with her new paradigm. She refined her ideas about therapy in subsequent writings and lectures (1950, 1987, 1991, 1999), but her focus on the present rather than the past, structure rather than genesis, remained the same.
According to Freud, analysis fosters regressive reactions, leading the patient to transfer onto the analyst feelings that derive from childhood. Horney's view of transference was that patients behave toward analysts in accordance with their character structure. The analyst can therefore use the transference to understand the patient's defenses and inner conflicts. Like transference, countertransference is a manifestation not of infantile reactions but of character structure--in this case that of the analyst. Analysts must understand their own defenses lest they be blind to or indulgent of similar defenses in their patients.
Horney focused on recognizing patients' defenses and discovering their functions and consequences. The purpose of therapy is not to help people gain mastery over their instincts but to lessen their anxiety to such an extent that they can dispense with their neurotic solutions. The ultimate goal of therapy is "to restore the individual to himself, to help him regain his spontaneity and find his center of gravity in himself" (Horney, 1939, p. 11).
From reading her books, we might gain an impression of Horney as a very cerebral 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 she gave in her courses on analytic technique (1987, 1999). 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 preexisting ideas" (Horney, 1999, p. 199). Theory should not be used to pigeon-hole 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 (1999, p. 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 (1999, p. 188). They must not relinquish themselves, however, for if they lose their "own stand altogether, [they] will not have understanding but blind surrender" (1999, p. 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" (1999, p. 201). Horney urged therapists not to overestimate their own mental health, to have a proper humility. They should constantly analyze themselves, paying attention to their feelings and trying to determine how reliable they are as guides to understanding the patient.
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 analyze each other but rather one in which therapists continually analyze themselves while helping their patients toward self-understanding and growth. Their self-analysis benefits their patients as well as themselves, since it helps mitigate countertransferential problems and deepens their emotional understanding. 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 that "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" (1999, p. 193).
Horney frequently emphasized that analysis is a cooperative undertaking. 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 therapist's 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.
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" (1999, p. 208). They should regard all interpretations as "more or less tentative" and should "be truthful about the degree of certainty" they feel (1999, p. 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 (1999, pp. 206-7).
For Horney, the 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.
During the disillusioning phase of therapy, 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, p. 145). At this point, they 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 unsavory 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 being[s]" and "still likes and respects" them as a result (1942, p. 145). This encouragement counteracts patients' self-hate and helps them to like and respect themselves.
As patients become less defensive in the course of therapy, their constructive forces grow stronger, and the central inner conflict emerges. The art of the therapist 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 actualize their real selves. Therapists must understand 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. The therapist's role is to assuage their 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 all[ies] of the endangered self, [they] will be able to support [their] patient[s] at this most trying time" (1999, p. 256).
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's belief in inherent constructive forces made her much more optimistic than Freud about the possibilities of psychotherapy. According to her, Freud did "not have any clear vision of constructive forces in man" and "had to deny their authentic character" (Horney, 1950, p. 378). For him, creativity and love were sublimated forms of libidinal drives, and a striving for self-fulfillment could only be regarded as "an expression of narcissistic libido" (1950, p. 378). For Horney, the goal of therapy was not to transform "hysterical misery into everyday unhappiness" (Breuer and Freud, 1936, p. 232) but to help people achieve the joy of self-realization.
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