You’ll Never Walk Alone

In the second half of 1880, Dr Joseph Breuer attended Bertha Pappenheim, who was suffering from a severe cough. Breuer decided Bertha’s complaint was a typical tussis nervosa, a nervous cough. Breuer doesn’t tell us how he arrived at that assessment. More importantly, he doesn’t explain how, as a general practitioner, he came to consider Bertha’s physical symptoms from a psychological perspective.

This is not an academic question. It is conceivable that another practitioner could have prescribed medicine for Bertha’s cough and left it at that. Bertha’s life, and the history of the treatment of mental illness, would have been very different.

It is also conceivable that if Joseph Breuer was attending Bertha at a different point in his professional career, he would have taken a different tack.

Right at the beginning of psychoanalysis, we see that the character of the practitioner is fundamental to how a therapy proceeds. This is not to say that knowledge and experience are not important. They are part of the make-up of the therapist, one aspect that determines how he or she will respond to the patient.

Joseph Breuer probably had no idea what he was letting himself in for when he decided to treat Bertha’s tussis nervosa. Soon his life was turned upside down as huge demands were made on his time. His physical and emotional resources would be tested as Bertha’s mental health declined. At times, he was lost and out of his depth and forced to rely on gut instinct.

The degree to which Breuer was able to meet these challenges is evident in how he managed to help Bertha. His responses to her somnolent states and daydreams (see Daydream Believer blog) allowed her to feel safe. When appropriate, he had the sensitivity to sit back and let Bertha guide the therapy. Despite being out of his depth, he was able to stay in touch with Bertha’s emotions as she faced frightening psychological issues. Having negotiated all this, he was able to create a relationship with Bertha which was therapeutic and led to a new way of thinking about the mind.

Every psychotherapy places similar pressures on the therapist. In fact, it could be argued that if these challenges are not part of the work, then the success of the therapy will be limited. That is, the therapist has to be disturbed by the patient and taken to places beyond their knowledge and experience. They have to develop a particular working relationship with every individual patient.

This is the reason some psychotherapy trainings demand the therapist undertake their own personal psychotherapy. It is why therapists are in regular supervision with an experienced peer and why they develop supportive relationships with their colleagues. It is also why they continue to broadening their theoretical knowledge by attending seminars. They are strengthening their ability to understand themselves, and to be open to their patients and create working relationships.

Maybe therapy trainings should include time as a supporter of the Liverpool Football Club. Here they are at the Melbourne Cricket Ground.