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From Hypnotic Suggestion

to Free Association: Freud
as a Psychotherapist, circa
18921893
Lewis Aron Ph.D.
Published online: 28 Oct 2013.

To cite this article: Lewis Aron Ph.D. (1996) From Hypnotic Suggestion to
Free Association: Freud as a Psychotherapist, circa 18921893, Contemporary
Psychoanalysis, 32:1, 99-114, DOI: 10.1080/00107530.1996.10746942
To link to this article: http://dx.doi.org/10.1080/00107530.1996.10746942

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99
LEWIS ARON, Ph.D.

FROM HYPNOTIC SUGGESTION TO FREE

ASSOCIATION: FREUD AS A PSYCHOTHERAPIST,

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CIRCA 1 8 9 2 - 1 8 9 3 ^

N THIS ARTICLE, I want to c e l e b r a t e o n e aspect o f Freud's creative

genius, and in doing so, I want to m a k e use o f F r e u d as a m o d e l for

c o n t e m p o r a r y students o f psychotherapy and psychoanalysis. My use o f

Freud in this way will, ironically, have subversive implications for psycho
analytic practice. T h e facet o f Freud's originality that I will focus o n is his
unsurpas,sed ability and determination to develop a way o f working as a
p,sychotherapist that was uniquely his own and that best e x p r e s s e d his
own

character. F r e u d

believed that

h e was discovering a scientific

method, an instrument that to a great extent eliminated o r m i n i m i z e d

what h e called "the subjective factor." Nevertheless, h e r e c o g n i z e d that to
work as a p,sychotherapist, different p e o p l e w e r e likely to n e e d varying
p r o c e d u r e s . In the third chapter o f Studies

on Hysteria

( B r e u e r & Freud,

1 8 9 3 - 1 8 9 5 ) , the case o f Miss Lucy R., Freud wrote, perhaps a bit sar
castically, in regard to the practice o f clinical hypnosis, that h e was sure
that many o t h e r physicians w h o practice psychotherapy c o u l d deal with
certain technical difficulties with m o r e skill than h e could. " I f so," h e
went on, "they may adopt s o m e p r o c e d u r e o t h e r than m i n e " ( p . 1 0 9 ) .
This c o m m e n t foreshadows his later remark, in the o p e n i n g paragraph o f
his ( 1 9 1 2 ) " R e c o m m e n d a t i o n s to physicians practicing psycho-analysis":
"I must, however, expressly state that this t e c h n i q u e has proved to b e the
only m e t h o d suited to my individuality; I d o not venture to deny that a
physician quite differently constituted might feel i m p e l l e d to adopt a d i f
ferent attitude to his patients and to the task b e f o r e him" ( p . 1 1 1 ) . In
deed, Freud was relatively o p e n - m i n d e d and even e n c o u r a g i n g o f experi
ments with psychoanalytic t e c h n i q u e , as long as they did not d i r e a l y
challenge his theoretical beliefs o r risk endangering the reputation o f the
' An earlier version of this article was presented at New York University Postdoctoral Pro
gram, Conference, The Psychoanalytic Century. Psyche, Soma, Gender, Word, May 6, 1995.

0010-753(V96 2.00 -I- .05

Copyright 1996 W A. W. Institute
20 W 74th Street, New York, NY 10023
All rights of reproduaion in any form reserved.
Contemporary- Psychoanalysis, Vol. 32. No. 1 ( 1 9 9 6 )

100

LEWIS ARON, P h . D .

psychoanalytic movement.^ Ironically, by taking Freud as a model o f a clini

cian w h o was iasistent upon working in a way that was personally satisfying,
s o m e o f us may find ourselves working in ways very different than Freud's,
using clinical techniques that are perhaps better adapted to our own charac
ters. (It must also b e r e m e m b e r e d in this context that Freud never seems to
have practiced as h e preached in his technical papers.) It is in this spirit that
I wish to celebrate Freud as a model o f a creative psychotherapist.
F r e u d himself, in a letter to J u n g o f February 17, 1 9 0 8 , declared that

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the "case histories in the Studies

are n o less antiquated than B r e u e r ' s

d i e o r i e s and are not worth translating" ( M c G u i r e , 1 9 7 4 , p. 1 2 0 ) . Luckily

for us, in spite o f Freud's 1 9 0 8 retrospection, t h e s e early cases have b e e n
translated and p r e s e r v e d s o that w e may c e l e b r a t e t h e m now, o n e hun
d r e d years later. 1 will focus h e r e o n Freud's d e v e l o p m e n t as a psycho
therapist up to and during the years 1 8 9 2 - 1 8 9 3 , when h e treated Lucy.
Lucy c a m e to F r e u d toward the e n d o f 1 8 9 2 and h e r treatment c o n t i n u e d
until early 1 8 9 3 . F r e u d probably w r o t e the case history in 1 8 9 3 . I c e n t e r
my study o n t h e s e years b e c a u s e they m a r k e d a turning point in the
d e v e l o p m e n t o f Freud's practice; it was at this time that he shifted from
hypnotism to a rudimentary form o f free association. In his description o f
Lucy's consultation hours, F r e u d indicates that in his work with her, by
the e n d o f 1 8 9 2 , h e still tried to induce hypnosis, settled for a nonsomnambulistic state, but did have h e r lie on the c o u c h , eyes closed. He says
she was in a state that may have differed very little from the normal o n e .
W h i l e the story o f Freud's a b a n d o n m e n t o f hypnotism has b e e n told
i n n u m e r a b l e times, I would like to tell it yet again, with the benefit o f the
availability o f r e c e n t historical scholarship, focusing o n Freud's struggles
at the very time h e was treating Lucy.^ At the onset, I want to acknowl
e d g e my i n d e b t e d n e s s to the ground-breaking work o f Henri Ellenb e r g e r , Peter Swales, and Albrecht Ilirschmuller. Much o f what I have to
say is taken directly from their work, and Peter Swales, in particular, has
most g e n e r o u s l y guided my understanding o f this period.'*
^ An excellent example of hi.s liberal attitude concerning technical innovation is reflected in
his tolerant stance toward Ferenczi's clinical experiments over many years, especially in
the 1920s. It was only when Ferenczi challenged Freud's clinical and developmental theo
ries and when Freud heard reports of Ferenczi's allowing his patients to kiss him that
Freud voiced any objection to Ferenczi's clinical experimentation.
^ It may be useful for me at this point to clarify my usage of the terms hypnosis and hypno
tism. Following Weitzenhoffer (1989), I will use hypnosis to mean an inferred psycho
physiological state, an altered state of con.sciousness, and I will use the term Irypnotism to
refer to its study, prtxluaion, and utilization.
* My thanks as well to John Kerr for sharing with me his insight into this early phase of
psychoanalytic history.

FREUD AS A P S Y C H O T H E R A P I S T

101

T o a n t i c i p a t e m y b r o a d e s t c o n c l u s i o n s , I will say that I b e l i e v e that

F r e u d ' s c r e a t i o n o f t h e p s y c h o a n a l y t i c m e t h o d w a s a u n i q u e , revolu
tionary, a n d p e r s o n a l l y e x p r e s s i v e d e v e l o p m e n t , a n d that by 1 8 9 3 h e
had e v o l v e d a distinctly p s y c h o a n a l y t i c b r a n d o f p s y c h o t h e r a p y , but
also that t h e d e v e l o p m e n t o f this form o f p s y c h o t h e r a p y w a s a p r o d u c t
o f its t i m e a n d a l o g i c a l o u t g r o w t h o f t h e Zeitgeist. L o o k i n g at F r e u d ' s
d i s c o v e r i e s in h i s t o r i c a l c o n t e x t d o e s n o t d i m i n i s h o u r a p p r e c i a t i o n o f
his a c h i e v e m e n t s , but r a t h e r e n h a n c e s o u r a w a r e n e s s o f h i s u n i q u e

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contributions.
O t h e r accounts o f Freud's a b a n d o n m e n t o f hypnotism have t e n d e d to
b l a m e Freud for t h e g e n e r a l d e c l i n e in t h e u s e o f hypnotism. That is, they
have suggested that hypnotism b e c a m e less popular b e c a u s e psycho
analysis b e c a m e the dominant form o f treatment.^ I will b e suggesting
that the causal flow was m o r e complicated, moving in both directions,
and that psychoanalysis itself c a m e about b e c a u s e o f a m o r e g e n e r a l
trend away from hypnotism and toward verbal psychotherapy c o n d u c t e d
in the awake state.
In 1 9 2 3 , F r e u d wrote, "It is not easy to overestimate t h e i m p o r t a n c e o f
the part played by hypnotism in t h e history o f the origins o f psycho
analysis. From a theoretical as well as from a therapeutic point o f view,
psychoanalysis has at its c o m m a n d a legacy which it has inherited from
hypnotism" ( 1 9 2 3 , p. 1 9 2 ) .
T o g o back in time, b e t w e e n I 8 6 0 and 1 8 8 2 hypnotism had fallen into
disrepute. This was a p e r i o d o f heavily o r g a n i c p.sychiatry, which placed a
strong emphasis o n n e u r o a n a t o m y and neurophysiology, o n heredity and
on theories o f degeneration, and in which t h e r e was little r o o m for men
tal events and for psychology. R e m e m b e r , after all, that it is not as if t h e s e
psychiatrists h e l d any real keys in their hands; attitudes o f pessimism and
dierapeutic nihilism d o m i n a t e d the p.sychiatric teaching hospitals o f t h e
time. B u t then, during t h e 1860s a n d 1870s, the Danish hypnotist Carl
Hansen stirred up a great deal o f popular and scientific interest in hypno
tism by traveling from city to city, performing public demonstrations. In
his autobiographical study, Freud ( 1 9 2 5 ) r e m e m b e r s that as a student h e

See, for example, the highly polemical Freud and Hypnosis by Kline (1958). But even the
most authoritative reviews of the history of hypnotism have taken this stand. For example,
Wolberg (1948), in his comprehensive KxlbooV. Medical Hypnosis, asserts that "the growth
of the psychoanalytic movement and the development of other forms of psychotherapy
reduced hypnosis to a place of relatively minor importance" (p. 12). More recently, in
their introduaion to the Handbook of Clinical Hypnosis, EUiue, Lynn, and Kirsch (1993)
similarly suggest that "After the abandonment of hypnosis by Freud, its clinical use vir
tually vanished for decades" (pp. 6 - 7 ) .

102

LEWIS ARON, P h . D .

had s e e n o n e o f Hansen's performances and "was convinced o f the genu

ineness o f die p h e n o m e n a " (p. 1 6 ) . Freud is referring to demonstrations
o f hypnotism given by Hansen in 'Vienna in 1880.*^
Up to and a r o u n d 1 8 8 0 , clinical hypnotism had still not b e c o m e wide
spread. T w o unrelated events o c c u r r e d in 1882 that w e r e to quickly raise
hypnotism into s o m e t h i n g o f a fad in European medical circles. First,
J e a n Martin Charcot, w h o had an international reputation as the greatest
neurologist o f his time, had b e g u n to e x p e r i m e n t with hypnotism

in

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1 8 7 8 , and o n February 13, 1 8 8 2 , h e read a paper to the Academy o f

S c i e n c e s that was to establish hypnotism as a legitimate subject o f scien
tific study. F r e u d ( 1 8 8 6 ) was to write regarding Charcot that h e had made
a scientific study o f hypnotism"a region o f neuropathology which had
to b e wrung o n the o n e side from skepticism and on the o t h e r from
fraud" (p. 1 1 ) . S e c o n d , it was in 1 8 8 2 that Hippolyte B e r n h e i m , a pro
fessor with an e x c e l l e n t reputation in the faculty o f m e d i c i n e at Nancy,
visited the country d o c t o r and hypnotist A. A. Liebault and b e c a m e a dis
ciple and proselytizer o f clinical hypnotism and the founder o f the socalled Nancy s c h o o l o f hypnotism. Freud was s o o n to b e directly influ
e n c e d by both o f t h e s e leading pioneers.^
In Vienna, Benedikt, a neuropathologist, had e x p e r i m e n t e d with hyp
notism from the late 1860s. B r e u e r , w h o was at that time his assistant,
warned B e n e d i k t to discontinue these e x p e r i m e n t s b e c a u s e h e was prac
ticing a form o f animal magnetism ( C h e n o k & D e Saussure, 1979, p.
1 1 5 ) . Benedikt vacillated in his opinions regarding

hypnotism.

After

m e e t i n g Charcot, h e s p o k e in favor o f hypnotism, but at other times h e

o p p o s e d the practice o f hypnotism and even its investigation. I will re
turn to B e n e d i k t later, b e c a u s e in his own opposition to hypnotism, he
was moving in a direction that anticipates w h e r e Freud w o u l d ultimately
go. With the help o f s o m e intervention by his teachers B r c k e and
Meynert, Freud was to b e awarded a travel grant from the University o f
Vienna to g o and study with Charcot in Paris, which h e did from late 1 8 8 5
to early 1 8 8 6 . It was B e n e d i k t w h o wrote a letter o f introduction

for

Freud to Charcot.
Freud had s e e n hypnotism being practiced in O b e r s t e i n e r ' s private
^ See Freud's letter to Eduard Silberstein, February 3, 1880.
^ Space does not permit me to discuss the differences between the views of the so-called
Paris and Nancy schools or to reflea on Freud's position on these differences. However,
Freud clearly summarizes his understanding of the differences in his (1890) review of
Forell's h>ook (p. 9 7 ) as well as in other places.

FREUD AS A P S Y C H O T H E R A P I S T

103

sanitorium for t h r e e w e e k s prior to his visit to Paris, and J o n e s ( c i t e d in

Chertok & D e Saussure, 1979, p. 1 1 6 ) believes that h e may have first tried
it at that time. Nevertheless, w h e n Freud left Vienna to g o to study with
Charcot, his intention was to study neuroanatomy; but by the t i m e h e left
Paris a few months later, his m i n d was filled with thoughts regarding
hypnosis, hysteria, and the n e u r o s e s . Undoubtedly, Freud's meeting with
Charcot had a profound effect on him, in spite o f the fact that, as Ellenb e r g e r has demonstrated, h e only actually studied with Charcot for a few

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weeks. T h e meeting, in E l l e n b e r g e r ' s ( 1 9 7 0 ) account, t o o k the form o f an

"existential e n c o u n t e r " (p. 4 3 6 ) and Charcot r e m a i n e d s o important in
Freud's estimation that in D e c e m b e r o f 1889, w h e n Freud's first son was
born, Freud n a m e d him J e a n Martin after his teacher.
Upon his return to Vienna, Freud was singing the praises o f Charcot, s o
much s o that this idealization o f Charcot contributed to getting him into
s o m e trouble with his colleagues. I am referring to ie infamous e p i s o d e
of Freud's reading his paper o n m a l e hysteria to the Society o f Physicians
in O c t o b e r 1886. Freud's colleagues w e r e offended by the credit that
Freud attributed to Charcot and to the way in which h e c o n s e q u e n t l y
devalued

their own

contributions and

understandings

(Ellenberger,

1970).
Freud o p e n e d his own private practice as a nerve specialist o n Easter,
1886, and was married that S e p t e m b e r . In that s a m e year, h e translated a
volume o f Charcot's lectures. Hysteria and hypnosis dominated Freud's
imagination, yet in his practice h e relied o n the then traditional tech
niques o f electrotherapy, hydrotherapy, massage, rest-cures, and perhaps
most importantly, suggestion and manipulation. In a letter to Fliess o f
D e c e m b e r 2 8 , 1887, Freud writes that "During the last few weeks, 1 have
taken up hypnosis and have had all sorts o f small but r e m a r k a b l e suc
cesses" ( q u o t e d in the editor's introduction to B r e u e r and Freud's
on Hysteria).

Studies

Given Freud's enthusiasm about hypnotism. Why did h e

wait almost a year and a half after o p e n i n g his practice b e f o r e beginning

to use the method?
It needs to b e r e m e m b e r e d that Freud was just beginning his p r a a i c e ,
had just gotten married, and would have b e e n reluctant to d o anything
overly controversial, particularly b e c a u s e h e had already b e e n involved
in two controversies, o n e about his use o f c o c a i n e and the o t h e r regard
ing his 1 8 8 6 paper on male hysteria, which had offended s o m e o f his
colleagues. R e m e m b e r , too, that the clinical use o f hypnotism still had
very strong o p p o n e n t s in Vienna, including Freud's t e a c h e r Meynert as

104

LEWIS ARON, P h . D .

well as Benedikt. F u r t h e r m o r e , it must b e understood that even Charcot

had not b e e n enthusiastically advocating hypnotism as a treatment pro
c e d u r e ; h e had only cautiously e n d o r s e d hypnotism for therapeutic pur
poses. F o r Charcot, hypnosis was mostly important as a m e a n s o f demon
stration and experimentation, b e c a u s e by using hypnotism with hysterical
patients h e c o u l d stimulate through suggestion the s a m e somatic symp
toms typical o f traumatic hysteria. In o u r efforts to understand Freud's
fledgling

efforts at utilizing hypnosis, it should not b e forgotten that at

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this time therapeutic practice for nervous and mental disorders was still
dominated by degenerationist thinking, and even Charcot's views on hys
teria w e r e quite s t r i a l y neurological. As Micale ( 1 9 9 5 ) writes, c o n c e r n i n g
die clinics o f Charcot and B e r n h e i m during this period, they w e r e "above
all sites for medical observation and experimentation. Generally speak
ing, the s e c o n d half o f the nineteenth century, while a major period o f
advancement in the etiological understanding o f disease, was not a great
age o f healing" (p. 2 6 8 ) . S o , Freud's therapeudc u.se o f hypnotism could
not

have

come

about

under

the

influence

o f Charcot. As

both

Hirschmuller ( 1 9 7 8 ) and Swales ( 1 9 8 8 ) concluded, in spite o f the fact

that h e was lecturing o n hypnosis by 1 8 8 6 , having b e e n influenced by his
trip to Paris, it s e e m s evident that his clinical use o f hypnotism did not
o c c u r for another eighteen months, and as w e are about to see, it was
m o r e the result o f the influence o f B e r n h e i m .
In any event, Freud began to e x p e r i m e n t with clinical hypnotism in
D e c e m b e r 1 8 8 7 , and h e later w r o t e ( B r e u e r & Freud, 1 8 9 3 - 1 8 9 5 ) that h e
began t o u s e B r e u e r ' s cathartic m e t h o d c o m b i n e d with direct hypnotic
suggestion in May 1 8 8 9 , in the case o f E m m y von N. Again w e must ask,
n o w that F r e u d was using hypnotism with his patients. Why the long
delay o f another year and a half b e f o r e h e w o u l d shift from pure hyp
notic suggestion to catharsis with suggestion? C o n t r a d i a i n g his earlier
remark, Freud later w r o t e in his Autobiographical
very first I m a d e use o f hypnosis in another

Study

that "from the

manner, apart from hypnotic

suggestion" ( 1 9 2 5 , p. 1 9 ) . This would imply that h e had b e e n using the

cathartic m e t h o d from the time h e began using hypnotism. Swales con
cluded that Freud probably had b e e n using B r e u e r ' s cathartic method
along with suggestion even b e f o r e May 1 8 8 9 , and certainly by that sum
mer. But again the question arises. Why w o u l d Freud have waited s o long
to use either hypnotism with suggestion a l o n e o r hypnotism with ca
tharsis, when Breuer had treated Anna O. during die years 1 8 8 1 - 1 8 8 2 and
had d e s c r i b e d the case to him as early as N o v e m b e r 1882 and throughout

FREUD AS A P S Y C H O T H E R A P I S T

105

1883? Presumably, by the time Freud o p e n e d his practice h e had b e e n

familiar with the idea o f the c a t h a n i c m e t h o d for a few years and w o u l d
have b e e n e a g e r to try it for h i m s e l f I can not develop this line o f
thought further h e r e , e x c e p t to say that a reading o f HirschmuUer ( 1 9 7 8 )
leads o n e to question h o w m u c h the story that w e have c o m e to k n o w o f
Anna O. was not the e n d result o f m u c h retroactive reconstruction by
Freud and B r e u e r that o c c u r r e d years after the actual treatment o f B e r t h a
Pappenheim.

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But let's look even m o r e carefully at the state o f hypnotism at this time
and at the c h r o n o l o g y o f Freud's use o f hypnotism. In Germany, in 1 8 8 8
and 1 8 8 9 , hypnotism gained m o m e n t u m through the w o r k o f Moll and
Forel, and in 1 8 8 9 Krafft-Ebing e m p h a s i z e d the medical and therapeutic
aim o f hypnotism. By 1 8 8 8 - 1 8 8 9 , the c e n t e r o f serious w o r k in hypno
tism had shifted from France to German-speaking countries, and further
m o r e it was now largely dominated by the influence o f B e r n h e i m .
In an article on "Hysteria" ( 1 8 8 8 b ) , F r e u d was already able to write that
in the direct m e t h o d o f treating hysteria w e look for the causes o f hyste
ria in "unconscious ideational life" (p. 5 6 ) , and h e credits B r e u e r with the
method o f leading patients u n d e r hypnosis back to the psychic origins o f
their symptoms. H e w r o t e that o n c e B e r n h e i m ' s ideas c o n c e r n i n g the use
of suggestion had m o r e deeply penetrated medical circles, direct sugges
tion would turn out to b e the best m e t h o d for treating hysteria. It is
completely unclear from reading Freud's paper ( 1 8 8 8 b ) how h e recon
ciled his understanding o f B r e u e r ' s ideas and m e t h o d with those o f Bernheim and the Nancy school.
Freud never regarded himself as particularly adept at hypnotism, and
h e tells us that h e went to B e r n h e i m in Nancy to p e r f e a his hypnotic
technique ( 1 9 2 5 , p. 1 7 ) . During the years 1 8 8 8 and 1 8 8 9 h e translated
B e r n h e i m ' s first b o o k . H e had contact with August Forel, a well-known
Swiss psychiatrist, and in July and N o v e m b e r o f 1 8 8 9 h e w r o t e a review
o f Forel's work on hypnotism. It was Forel w h o introduced him to Bernheim. By 1 8 8 9 , in his review o f Forel's Hypnotism,

about a year and a half

after beginning to e x p e r i m e n t with the clinical use o f hypnotism, F r e u d

would write quite authoritatively that h e himself had "reached an inde
pendent judgment in matters relating to hypnosis" ( 1 8 9 0 , p. 9 3 ) , and h e
asserts that his own patients improve through hypnosis.
If Freud was just beginning to use catharsis at this time, then what e l s e
had he b e e n doing with his hypnotized patients? Using hypnotic sugges
tion, he would emphatically deny the patients' symptoms, give them as-

106

LEWIS ARON, Ph.D.

surances, c o m m a n d s , explanations, and posthypnotic suggestions. In an

1891 article o n hypnosis, Freud adds that h e w o u l d question his patients
about the origins o f their symptoms, but to d o this they must b e som
nambulistic, otherwise they should not talk ( 1 8 9 1 , p. 1 1 2 ) . This is a criti
cal point for us to understand. It was believed that a hypnotized patient's
talking w o u l d b e likely to lessen the depth o f the trance, and therefore,
Freud c o u l d not use the cathartic m e t h o d with patients unless they w e r e
somnambulistic.** Freud correctly realized that most patients w e r e not

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this hypnotizable. This w o u l d have meant that catharsis o r any talking

therapy w o u l d only b e useful with very few exceptionally hypnotizable
patients. S o long as F r e u d was relying o n direct suggestion, the depth o f
the patient's trance did not matter very much, b e c a u s e the patient did not
have to talk; but with the cathartic method, the patient had to b e verbally,
cognitively, and affectively active, and s o if hypnosis was necessary, then
patients n e e d e d to b e in a very d e e p o r somnambulistic trance. In prac
tice, Freud would not always get a d e e p trance. This is what drove him to
go to B e r n h e i m to learn to p e r f e a his hypnotic t e c h n i q u e in 1889.
Freud's dissatisfaaion with his skill as a hypnotist and his ultimate shift
away from hypnotism w e r e b o t h due in part to his r e q u i r e m e n t that his
patient b e m o r e verbally active. Freud did not want to b e the o n e doing
all o f the talking; h e wanted to listen to his patient, s o that h e himself
c o u l d learn. This represents a major turning point in his use o f the
method, and w e will return to this shortly.
What did F r e u d a a u a l l y learn from his visit to B e r n h e i m ? Freud ( 1 9 2 5 )
later wrote that his visit to B e r n h e i m in 1889 taught him the limitations o f
hypnotic suggestion (p. 2 1 ) . I think that the visit to Nancy was pivotal for
Freud, b e c a u s e Freud clearly got the idea from B e r n h e i m , although Bernheim had not yet articulated it in this way, that h e could do psycho
therapy, which was at the time synonymous with hypnotherapy, without
inducing formal hypnosis. A n u m b e r o f things point in this direction.
Freud had brought a patient o f his (Anna von L i e b e n ) with him to Nancy
for B e r n h e i m to hypnotize; B e r n h e i m failed to hypnotize her and told
F r e u d that h e had his greatest success with hospitalized patients. Bernh e i m taught that hypnosis was easier to induce in p e o p l e accustomed to
passive o b e d i e n c e , and h e had p o o r results with p e o p l e in the higher
and wealthier classes. It must b e c o n s i d e r e d that the working class and
peasantry tended to b e in far greater awe vis-a-vis physicians and edu"* Somnambulism refers to a very deep state of hypnosis in which the chief feature is sponta
neous amnesia.

FREUD AS A P S Y C H O T H E R A P I S T

107

cated p e o p l e generally. Liebault, from w h o m B e r n h e i m had learned hyp

notism, was a country d o c t o r w h o s e patients w e r e largely p o o r city p e o
ple and local peasants w h o paid only what they c o u l d afford t o nothing at
all. Keeping in m i n d that Freud was in private practice and that his clien
tele c a m e predominantly from the upper and upper-middle classes, w e
can s e e that Freud would have had to modify his approach to make it
m o r e useful with these patients. O n his visit to Nancy, Freud was im
pressed with B e r n h e i m ' s contention that posdiypnotic amnesia, the sine

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qua non o f somnambulism, was not c o m p l e t e , that with concentration,

the pressure technique, and skillful questioning, the patient c o u l d re
m e m b e r what had o c c u r r e d even while in hypnosis. It struck Freud tiiat
o n e could access the u n c o n s c i o u s directly through c o n s c i o u s n e s s , with
out bypassing c o n s c i o u s n e s s through hypnosis.
B e r n h e i m ' s theory that hypnotism was nothing o t h e r than suggestion
led the way for the a b a n d o n m e n t o f the n e e d to formally induce a hyp
notic trance. If hypnosis was not a special altered state, but was rather just
die product o f suggestion, then the possibility was o p e n e d to not induce
a formal state that m i m i c k e d sleep, but rather to attempt to use sugges
tion directly. This was the d i r e a i o n that B e r n h e i m was ultimately to take,
making less and less use o f hypnotism. By 1892, B e r n h e i m suggested that
the word hypnosis

b e d r o p p e d in favor o f the term state

of

suggestion.

Years later, B e r n h e i m w o u l d write that "modern psychotherapy, emanci

pated from hypnotism, is the creation o f the Nancy s c h o o l " ( q u o t e d in
Ellenberger, 1970, pp. 8 0 4 - 8 0 5 ) .
By the time o f B e r n h e i m ' s next b o o k ( 1 8 9 1 ) , which Freud translated in
1892 (cited in Ellenberger, 1 9 7 0 ) , B e r n h e i m maintained that therapeudc
success was not directly related to the depth o f hypnotic sleep. Most
subjects, h e n o w taught, remain partially c o n s c i o u s during hypnosis, and
most hypnotic p h e n o m e n a can b e obtained with the subject awake. Ulti
mately, B e r n h e i m ' s position led him t o c o n c l u d e that hypnosis was not a
special state, and that all o f the p h e n o m e n a d e s c r i b e d by the term

hypno

tism could have b e e n discovered in the waking state.

In a lecture o f April 27, 1 8 9 2 , to the V i e n n e s e Medical Club, Freud
e s p o u s e d B e r n h e i m ' s view o f hypnotism and advised physicians to g o to
Nancy to learn it ( E l l e n b e r g e r , p. 4 8 5 , f 2 8 8 ) . And as late as in his 1 8 9 3
paper on clinical hypnotism, Freud used B e r n h e i m ' s m e t h o d and not
catharsis (Freud, 1 8 9 2 - 1 8 9 3 ) .
Let m e then put forth my o w n r e c o n s t r u a i o n o f Freud's d e v e l o p m e n t
as a hypnotist thus far. Having begun with a strong neurological and

108

LEWIS ARON, Ph.D.

somatisist approach to hysteria and hypnosis, Freud began using hypno

tism cautiously, along with the standard and m o r e acceptable methods o f
treatment o f the day. He s o o n felt increasingly frustrated with these
m e t h o d s a n d b o r e d by them as w e l l s i n c e they did not shed any light
o n the origins o r meanings o f hysterical symptoms. While it was under
Charcot's influence that h e b e c a m e seriously interested in the p h e n o m e
non o f hypnosis and the descriptive diagnosis o f hysteria, it was under
the influence o f B e r n h e i m that Freud began to think psychologically

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about the dynamics o f hypnotism.' O n c e Freud was able to s e e that hyp

nosis was largely a psychological p h e n o m e n o n , he was able to begin to
m o v e b e y o n d the formalistic induction o f trance. Freud, I believe, was
mostly interested in investigating the p.sychological origins o f his patients'
symptoms, their m e m o r i e s . B r e u e r had b e e n lucky in his work with
B e r t h a Pappenheim b e c a u s e s h e went into d e e p trance states sponta
neously. As a matter o f fact, as HirschmuUer ( 1 9 7 8 ) emphasizes, it was
only after s h e went into trances by herself, spontaneously, that B r e u e r
began to induce hypnosis in her. Freud went to B e r n h e i m in the h o p e
that h e would learn to d e e p e n his patients' trance states, s o as to allow
the patients t o talk t o him and thus investigate the origins o f their symp
toms, and then eliminate the symptoms through suggestion. Instead,
Freud learned that h e c o u l d have his patients talk with him directly,
while awake, and a c c o m p l i s h as much.
Freud was not a l o n e in c o m i n g to these conclusions following his ex
p o s u r e to B e r n h e i m . Freud was a m o n g a n u m b e r o f leading hypnothera
pists w h o w e r e attempting to develop methods o f psychotherapy that did
not rely upon formal hypnotic induction. B e r n h e i m , by showing that hypn o s m w a s a psYcV\o\ogica\ p h e n o m e n o n n a m e \ y , that it was a form of
i n t e e r s o n a l s u g g e s t i o n c r e a t e d the possibility for the shift from hyp
notic suggestion to verbal psychotherapy in the waking state. B e r n h e i m
s h o w e d that the distinction b e t w e e n states o f c o n s c i o u s n e s s was not ab
solute, and that through an act o f will, patients could recall what hap
p e n e d in hypnotic amnesia.
F r o m 1 8 8 9 to 1 8 9 2 , following his e x p e r i e n c e with B e r n h e i m and coin
ciding with his treatment o f Anna von Lieben, w h o Peter Swales ( 1 9 8 6 )
has d o c u m e n t e d as the patient Freud brought with him to Nancy, Freud
w o u l d place less and less emphasis o n hypnotic trance and m o r e and
^This is so in spite of tlie fact that, as Gauld (1992) points out, it is an oversimplification to
de,scribe Bernheim's theory as "psychological" since his early speculations as to the nature
of the hypnotic state were neurophysiological.

FREUD AS A P S Y C H O T H E R A P I S T

109

m o r e on understanding the m e a n i n g o f symptoms and tracing their ori

gins. Freud may have stopped trying to hypnotize her, o r perhaps h e just
stopped worrying about the depth o f h e r trance state. If patients c o u l d
o v e r c o m e hypnotic a m n e s i a w h i l e awake, then they c o u l d o v e r c o m e
o t h e r motivated forgetting o r repression while awake as well. As Swales
( 1 9 8 6 ) has d o c u m e n t e d , Freud used the pressure t e c h n i q u e that

he

learned

re

from

observing

Bernheim; he

questioned

and

probed

lentlessly, and free association asserted itself m o r e o r less spontaneously

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in Freud's attempt to unravel the most intricate threads o f his patient's

memory.
T h e claim that I a m making is that by the early 1890s, largely due to the
impact o f B e r n h e i m ' s teachings, a n u m b e r o f leading

hypnotherapists

w e r e quickly abandoning the hypnotic p r o c e d u r e and evolving a variety

o f forms o f talking therapies that w e r e c o n d u c t e d in the waking state.
T h e s e practitioners were, e a c h in their own way, evolving from hypno
therapists to psychotherapists. T o s o m e d e g r e e w e must take into consid
eration h e r e that hypnotism had i n d e e d attracted a lot o f quacks, real
quacks, w h o t e n d e d to bring it into disrepute, o r at least to foster suspi
cions and mistrust a m o n g the public and within the medical community.
As Swales remarks, by the early 1890s hypnotism was far from b e i n g a la

mode.

Freud's development o f the free association m e t h o d and o f psy

choanalysis was a part o f this trend in the late 1880s and the 1890s and, in
this respect, it was absolutely a part o f the

Zeitgeist.

However, Freud was

eager to substitute something for hypnotic suggestion that was m o r e his

own, and the very specific form that Freud's psychotherapy was to take
was highly distinct and reflected his o w n personal c o m p l e x synthesis.
Let m e give a few e x a m p l e s to d o c u m e n t this trend that I am describ
ing o f hypnotherapists w h o w e r e evolving into psychotherapists, largely
under the influence o f B e r n h e i m , during the early 1890s. Following his
brief visit to Nancy in 1 8 8 9 , Freud c a m e to Paris, in the c o m p a n y o f
B e r n h e i m and Liebault, to attend the first International Congress o n Hyp
notism. It is unclear w h e t h e r Freud was in attendance w h e n H. B o u r r u
and P. B u r o t p r e s e n t e d a joint paper. However, these authors had pub
lished their ideas in a b o o k the year before, and what is most important
is that these ideas w e r e in wide circulation at the time. B o u r r u and Burot
p r o p o s e d that the retrieval o f traumatic m e m o r i e s and the relieving o f
the associated m e m o r i e s , both within and outside o f hypnosis, was cura
tive. T h e s e authors e m p h a s i z e d the return to origins as well as the n e c e s
sity for a kind o f discharge o r e x p l o s i o n ( s e e E l l e n b e r g e r , p. 7 6 0 ) .

110

LEWIS ARON, Ph.D.

At the s a m e congress, A W. van Renterghem and F. van Eeden de

s c r i b e d their Clinic o f Suggestive Psychotherapy. E l l e n b e r g e r suggests
that this may have b e e n the first time that the w o r d 5)/\>

was

used in a c o n g r e s s (p. 7 6 0 ) . T h e s e two D u t c h m e n w e r e u n d e r the influ

e n c e o f B e r n h e i m and established their clinic in 1887. Van Eeden pre
ferred not to put his patients into a d e e p o r somnambulistic state, be
cause h e b e l i e v e d that this interfered in furthering his aim o f enlarging
the s p h e r e o f effectiveness o f the patient's will. Instead, h e developed the

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methods o f having patients "passive lying still with c l o s e d eyes," and h e

avoided using the terms hypnosis
psychotherapy

o r hypnotism

and preferred the term

( q u o t e d in Gauld, 1992, p. 3 4 0 ) . Van Renterghem, while

still using hypnotism, taught that hypnotic suggestion was not enough. He
emphasized that o n e must locate the underlying causes o f the p r o b l e m
and try to alleviate it. Van Renterghem and Van Eeden's work was well
known a m o n g their contemporaries, b e c a u s e o f the detailed statistics
they published regarding their success rate.
Earlier I m e n t i o n e d the work o f Benedikt in Vienna and his ambiva
l e n c e regarding hypnotism. Benedikt had b e e n attracted to hypnotism
following his e x p o s u r e to Charcot, but h e was c o n c e r n e d about the deep,
almost mystical d e p e n d e n c y o f the patient o n the hypnotist. By 1 8 9 1 ,
Benedikt argued vehemently against hypnotism and in favor o f psycho
therapy o n a c o n s c i o u s verbal level. Interestingly as well, Benedikt sug
gested that the actual cause o f hysteria was either a psychic trauma o r a
functional disturbance o f the genital system o r the sexual life, and he
emphasized the e x t r e m e importance o f the patient's fantasy life ( s e e
Ellenberger, p. 7 6 4 ) .
As further e v i d e n c e o f h o w prevalent was the trend away from trance
induction, c o n s i d e r this statement by Strmpell in his inaugural lecture
as vice-rector o f the University o f Erlangen, in November o f 1892, titled
"On the origin and healing o f diseases through mental representations."
H e said, "No healing o c c u r s through hypnosis that c o u l d not have b e e n
caused by o t h e r m e a n s " ( q u o t e d in Ellenberger, p. 7 6 6 , f 73) Ellen
b e r g e r concluded, "Thus w e can s e e that in 1 8 9 2 t h e r e was a c h o i c e o f
psychotherapies ranging from hypnotic suggestion and catharsis to the
combination o f supportive, expressive, and directive therapy" (p. 7 6 7 ) .
By reducing hypnotism to suggestion, B e r n h e i m m a d e hypnotism less
appealing to those physicians trained in a somaticist tradition, w h o might
have b e e n m o r e a t t r a a e d to it as a m e t h o d for exploiting a neuropathological condition, as it had b e e n presented by the Paris school. O n

FREUD AS A P S Y C H O T H E R A P I S T

111

the other hand, by eUminating the n e e d for a formal hypnotic i n d u a i o n ,

and by pointing out the lack o f correlation b e t w e e n hypnotic depth and
effectiveness o f suggestion, B e r n h e i m m a d e possible the m o r e d i r e a ap
plication o f verbal psychotherapy in the awake state. B y explaining hyp
notism in terms o f suggestion, a vague p h e n o m e n o n itself not m u c h un
derstood, B e r n h e i m inadvertently brought the focus o f attention o n t o a
psychological and interpersonal p h e n o m e n o n , namely suggestion. In his
preface to the translation o f B e r n h e i m ' s first b o o k , entitled

Suggestion,

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Freud ( 1 8 8 8 a ) presents a penetrating critique o f the idea o f suggestion.

At the e n d o f 1892, w h e n h e is treating Lucy, and still in 1893, w h e n h e is
writing the c a s e history, Freud moves back and forth b e t w e e n his use o f
suggestion to eliminate symptoms following B e r n h e i m , his remaining
loyalties to Charcot ( w h o died in 1 8 9 3 ) , and his own d e v e l o p m e n t o f
B r e u e r ' s cathartic method. It is only by the e n d o f 1892 that Freud largely
gives up direct suggestion, u n d e r B r e u e r ' s influence, and even following
this, Freud publishes a case in which h e relied o n direct suggestion.
Gradually, Freud relied m o r e on "concentration" and the pressure tech
nique, and then o n directed and increasingly free association.' Each step
in this development leads to increased activity o n the part o f the patient
and to the furtherance o f the patient's "ego autonomy." T o review, from
Charcot, Freud took his interest in hysteria and hypnosis; from B e r n h e i m ,
h e totik the recognition that hypnotism was unnecessary, and that h e
could look to the psychological t o explain the apparent

phenomenon;

and from B r e u e r h e took the idea o f catharsis and its implication that h e
should listen at length to his patients.
By 1892, a n u m b e r o f the leading practitioners o f hypnotism, following
B e r n h e i m , w e r e e x p e r i m e n t i n g with conducting psychotherapy with pa
tients awake. Freud was the most important o f diese pioneers. "What
Freud did, in e s s e n c e , was to take the freedom offered by B e r n h e i m ' s
elimination o f the n e e d for a somnambulistic patient and to construct a
method that allowed him to listen to his patients, to all o f them, w h e t h e r
somnambulistic o r not, for an e x t e n d e d p e r i o d o f time. F r o m a hypnotic
In the interest of space I have not been able to discuss the widespread popularity of the
notion of catharsis in the 1880s, following the republication of Bernay's book on catharsis
in 1880. Clearly, this played a key role in the development of Breuer's caartic tech
nique. For more on this, and for a better understanding of Breuer's influence on Freud,
see Hirschmuller (1978) and Swales (1986, 1988). I have likewise not discussed the sim
ilarities to Freud's work in the approach of Pierre Janet. This is because my focus here
has been on the move away from hypnotism, and while Janet's work overlaps Freud's in a
number of ways, Janet continued to rely on hypnotism as a method, although by the turn
of the century he was using a wide assortment of therapeutic techniques.

112

LEWIS ARON, P h . D .

technique, which was first thought to b e important because o f its neuroanatomical and neurophysiological underpinnings, Freud developed a
m e t h o d that would ultimately turn out to b e important b e c a u s e it al
l o w e d o n e p e r s o n to understand and influence a n o t h e r psychologically.
With the a b a n d o n m e n t o f hypnotism, and the shift in interest away from
the depths o f trance and the forms o f c o n s c i o u s n e s s and to the contents
o f the patient's history and dynamics, m u c h was gained, but there was
also m u c h lost. It is only now, a century later, that as analysts w e have

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o n c e again b e c o m e quite interested in o u r patient's states o f conscious

ness. F o r e x a m p l e , witne.ss the rising interest in the p h e n o m e n o n o f dis
sociation. In a r e c e n t article, cowritten with Annabella B u s h r a (Aron &
Bushra, 1 9 9 5 ) , w e have e x a m i n e d this r e s u r g e n c e o f interest by contem
porary psychoanalysts in states o f consciousness. T h e r e w e c o n c l u d e d
that o n e important contribution o f the p.sychoanalytic setting, as devel
o p e d by Freud, was that it created the conditions w h e r e i n both patient
and analyst c o u l d m o v e freely back and forth b e t w e e n a wide variety o f
mental and behavioral states; that is, the analytic situation allows for mu
tual and optimal levels o f regression within the analytic dyad.
With the shift from hypnotism to free association, the change was not
only from n e u r o l o g y to psychology, but practically, Freud's work re
v e r s e d the general flow o f the conversation b e t w e e n the patient and the
doctor. Instead o f using hypnotism to put the patient into a passive sleep
like state, in w h i c h she was to listen to the d o c t o r as he told her what she
felt and what to do about it, Freud (following B r e u e r ) developed a
m e t h o d in which the doctor was to listen to the patient as she told him
about h e r life, and thus, as J e s s i c a Benjamin ( 1 9 9 5 ) described, patients
w e r e transformed from passive objects o f his investigations to b e c o m e
speaking subjects. O f c o u r s e , as J o h n Forrester ( 1 9 9 0 ) points out, Freud
maintained his authority, in that it was h e w h o decided what the patient's
stories meant; nevertheless, a crucial step had b e e n taken in destabilizing
the .structure o f authority relations between d o c t o r and patient.
Freud's m e t h o d permitted him to b e very m u c h him.self as a therapist.
His tendency was to b e an e x p l o r e r , an investigator, an archeologist, a
puzzle solver, and the traditional m e t h o d s o f his day not only did not
work, but h e frankly admitted that they b o r e d him, b e c a u s e they did not
permit him to use these aspects o f himself fully. T h e m e t h o d that he
d e v e l o p e d had the distinct advantage, as h e pointed out repeatedly, that it
was at o n e and the s a m e time a m e t h o d o f treatment and o f investigation
and research. T o put this differently, Freud was c o m f t m a b l e with the fact
that the m e t h o d met his own n e e d s as well as the n e e d s o f his patients.

FREUD AS A P S Y C H O T H E R A P I S T
The

113

m e t h o d o f psychoanalysis, the free association m e t h o d in e v e n its

rudimentary form, and its a c c o m p a n y i n g t h e o r y o f n e u r o s i s , particularly

the e m p h a s i s o n defense, was uniquely Freud's own. W h i l e very m u c h a
part o f the Zeitgeist, by 1 8 9 2 - 1 8 9 3 F r e u d evolved a way o f w o r k i n g that
met his o w n n e e d s , interests, and p e r s o n a l r e q u i r e m e n t s . T h e s e condi
tions i n c l u d e d that the w o r k h e was c o n d u c t i n g b e interesting a n d chal
lenging to him, and that it allow him to utilize his c o n s i d e r a b l e investiga
tive and analytic talents. F r e u d w r o t e in an 1 8 9 7 letter to Fliess, " o n e

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always r e m a i n s a child o f his age, e v e n in what o n e d e e m s o n e ' s very

own" (Masson, 1 9 8 5 , p. 2 7 7 ) . By 1 8 9 3 , w h e n h e writes t h e c a s e history o f
Lucy, F r e u d is w e l l o n his way to d e v e l o p i n g his very o w n m e t h o d o f
psychotherapypsychoanalysis.

century

later,

we

celebrate

that

achievement.
REFERENCES
Aron, I.., & Bushra, A. (1995). The mutual regulation of regres.sion in p,sychoanalysi.s. Pre
sented at the Division of Psychoanalysis (39), Spring Meeting, Santa Monica, CA, on April
28, 1995.
Benjamin, J. (1995). Between body and speech: The primal leap. Keynote Address. New
York University Postdoctoral Program, Conference, The psychoanalytic century: Psyche,
soma, gender, word. May 4, 1995.
Breuer.J., & Freud, S. ( 1 8 9 3 - 1 8 9 5 ) . Studies on hysteria. Standard Edition, 2.
Chenok, L., & De Saussure, R. (1979). The therapeutic rei'olution. From Mesmer to Freud.
New York: Brunner/Mazel.
Ellenberger, 11. (1970). Ihe discovery of the unconscious. New York: Basic B<x)ks.
Forrester, J. (1990). The seductions of psychoanalysis. Cambridge: Cambridge University
Press.
Freud, S. (1886). Repon on my studies in Paris and Berlin. Standard Edition, 5:3-18.
Freud, S. (1888a). Preface to the translation of Bernheim's Suggestion. Standard Edition,
12:73-88.
Freud, S. (1888b). Hysteria. Standard Edition, 1:39-62.
Freud, S. (1890). Review of August Forel's Hypnotism Standard Edition, 1:89-102.
Freud, S. (1891). Hypnosis. Standard Edition, 1:103-114.
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Freud, S. (1912). Recommendations to physicians practicing psycho-analysis. Stattdard Edi
tion, 1 2 : 1 0 9 - 1 2 0
Freud, S. (1923). A short account of p.sycho-analy.sis. Standard Edition, 19:191-212.
Freud, S. (1925). An autobiographical study. Standard Edition, 20:3-76.
Gauld, A. (1S>92). A history of hypnotism. Cambridge: Cambridge University Press.
Hirschmuller, A. (1978). The life and work of Joseph Breuer. New York: New York University
Press.
Kline, M. V. (1958). Freud and hypnosis. New York: An Agora Softback (reprinted, 1S)66).
Masson, J. M. (Ed.) (1985). The complete letters of Sigmund Freud to Wilhelm Fliess: 18871904. Cambridge, MA: Harvard University Press.
McGuire, W. (Ed.) (1974). The Freud/Jung letters: The correspondence between Sigmund
Freud and C. G. Jung. Princeton, NJ: Bollingen Series XCIV.

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LEWIS A R O N ,

Ph.D.

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