Introduction to Psychotherapy, Part 1

English translation

AI-assisted English translation. The Japanese original remains authoritative.

An Introductory Course for Psychotherapists (1)

An Experience in Philadelphia

Seishu Hamano, writer and visiting professor at the State University of New York

1. Psychoanalysis and Psychology Are Different Things

Psychology is the study of joy and sorrow.
Psychoanalysis is no more than structural mechanics.

I often put it this way. I think it is because, as someone in a position to confer the designation of psychological diagnostician, I am continually moved by the wish that young people might somehow be of service to those who are suffering in the world.

There are too many doctors who give psychoanalysis priority over psychology. Patients are consequently treated coldly, by relentless logic; the more they are analyzed, the less they recover. Indeed, their symptoms become more serious. They resign themselves to the idea that their abnormality has reached a stage beyond remedy. The doctor's grave expression, too, sticks deep inside the patient. I advise replacing this with a theory of healing through a psychology with more color in it, but many will not listen. Most of them have themselves become patients who are already difficult to heal.

This happened in the psychiatric department of the Einstein Memorial Hospital in Philadelphia. My good fortune in being able to practice therapy at such a hospital came about while I was developing a discussion of psychotherapy with Professor L. Fiedler at the State University of New York at Buffalo. I became friendly with Freudians—scholars of Freud's school—on campus. Word spread through them as far as Philadelphia. While I was temporarily staying at the private home of the chief professor at this first-rate hospital, he sympathized with my theory and let me gain practical experience in therapy.

2. Work Out the Therapy from the Cases

I was the only therapist on that occasion. There were as many as thirty patients, mostly women. They sat in an orderly row on benches. When a nurse called their names, they stood up one at a time, sat down in front of me, and described their troubles: “I have insomnia”; “I wake up early in the morning and want to die”; “I suffer from auditory hallucinations”; “I bought my house at a bargain price, but in the middle of the night there are footsteps in the corridor … and the bedroom doorknob clicks …”

One must not generalize a concept by deciding that these are all needless anxieties, that these people plainly live in comfort, and so on. Unless one reads the subtle movements and fluctuations in their eyes, one cannot offer the best suggestion.

And one must make the diagnosis within the allotted time, or it will be resented. Taking longer increases the medical costs borne by the patient. In the American system, even patients waiting their turn are charged for the room in which they wait; one therefore needs to reach a conclusion promptly to avoid complaints.

I read the signs of disturbance in one woman's gaze. She was in her fifties and could not calm her flushed excitement, so I did a palm reading.

“Palm reading? Why? Are you a witch doctor?”

Translator's note: the source parenthetically glosses “witch doctor” as 魔女裁判, “witch trial.” That mismatch is retained here rather than silently repaired.

The middle-aged woman's eyes were full of astonishment. A doctor telling fortunes—how extraordinary! That was what her expression said.

“Your palms are red … but warm,” I said.

“You read fortunes from the color of the palm, instead of its lines?”

“The redness is proof that the blood is reaching the extremities.” I held her hand between both of mine; it certainly was warm. “That is a sign of health. Your illness does not have a physical cause. Your state of mind is not helping you. Live with more confidence. You are healthy; there is plenty more you can do. Keep that thought in mind and do your best, and your fortunes will open up wonderfully. I guarantee it.”

Her eyes suddenly brightened. “No one has ever said that to me before … thanks a lot!” Becoming animated all at once, she stood up and offered me her hand.

3. “Suggestion”: Indispensable to Diagnosis

Afterward, Professor Weiss telephoned to tell me that as many as eight patients had begun to recover following their consultations.

The same phenomenon had occurred in Buffalo, so it was what I had expected. But how would you understand it?

If a diagnostician provides analysis alone, patients only become more confused. To produce a hundred examples of symptoms—to carry out all that analysis—and then parade them all before the patient is the worst possible thing. What patients need is for you to narrow down the many cases, say only what is relevant, and offer encouragement suited to it. Unless that encouragement rests on a practical examination, it will not produce an effect. “Suggestion” can mean incitement and thus also carries an unfavorable sense. It is nevertheless important for psychotherapists always to analyze on scientific grounds and offer suggestions on the basis of those data.

A “suggestion” is advice directed toward what psychoanalysis calls the unconscious, and it becomes a powerful impetus toward recovery.

Conversely, there are utterances—signifiés—that become negative factors. These are things a therapist says without thinking. A typical example is the following, which must never be said in front of a patient:

“We have looked into various things and still do not really understand, but let us keep an eye on it for a while.”

With that one sentence from the doctor, the patient will probably say goodbye and leave. Why? Because they have heard such a stock phrase until they are sick of it. “Again? This is no good,” they think; their mood becomes withdrawn and they can no longer regain their footing by their own efforts.

(To be continued)