Gail Hornstein's lovely biography of Frieda Fromm-Reichmann convinced me that I must also read the latter's Principles of Intensive Psychotherapy, which I have now profitably done. In reading this latter work, I had constantly to remind myself that it was written in the 1950s (she died in April 1957)! It was astonishing to me at every turn how much of contemporary practice and current concerns she anticipated and was already engaged in. I will say more about this later. Let us begin with To Redeem One Person is to Redeem the World: the Life of Frieda Fromm-Reichmann for it is a moving, elegant, and gracious study of the life of someone who remains too little known even today.
This biography, whose compelling title is Talmudic in origin, takes us to the beginnings of Fromm-Reichmann's life in Germany where we get some crucial insights into her early family dynamics that seem--so Hornstein suggests several times, and convincingly--to have played no small part in shaping her career choice and actual clinical practice. Fromm-Reichmann was the sort of person who seems almost effortlessly to have put the needs of others ahead of herself.
After her move to America, she finds in Chestnut Lodge in Maryland what seems an almost Providential appointment so well suited for her unique gifts and limitations. It is hard, in reading of the uniquely free, creative, unrestrictive environment around the Lodge in the interwar and immediate postwar years, to restrain at least a touch of nostalgia for what seems a less straitened time before the orthodoxies of a strict Freudianism, or later a strict behaviorism and cognitive-behaviorism, set in.
When I picked up Hornstein's biography I expected that Frieda's marriage to her very famous first (and only) husband, Erich Fromm, would occupy more of the stage than it does. At least in Hornstein's telling the marriage--much of it lived in different countries--seems to have come rather quietly to a relatively mutual and amicable end, and Frieda does not seem to have bothered herself with romantic partners again, though Erich of course did at least twice more. (Erich has been the subject of at least three biographies that I know of. I think the Lawrence Friedman one, The Lives of Erich Fromm: Love's Prophet, excellent.)
I cannot do justice to the rest of the Hornstein biography so I will not try here. Let me instead reiterate my warmest recommendation that you read it. You will not be disappointed. I know I will leave it on my shelf in order to be able to come back to its riches and delights at some point in the future.
Let us now turn to Principles of Intensive Psychotherapy, which is--quite frankly--far better written than I expected. Fromm-Reichmann's style is not at all what is sometimes derided as Teutonic prose: leaden, verbose, impenetrable, abstruse. Quite the contrary: she is succinct (more so in the first half of the book, admittedly), cogent, and constantly supplying practical illustrations and applications based on her own long clinical career.
In addition, while clearly downplaying her own personality and unique contributions, one nonetheless gains throughout the book a considerable glimpse into the person of Frieda Fromm-Reichmann, and it is an attractive one. In fact, several times I thought of Peter Rudnytsky's observation about another clear, practical, cogent, and wonderful clinician I admire hugely--viz., Nina Coltart, whom I discussed here at length. Of Coltart he noted that
In reading the work of a psychoanalytic author, there is one question that I think we should ask ourselves above all others: would I want to be in analysis with this person? Is this someone I would trust to probe the innermost recesses of my psyche and with whom I would be likely to have a genuinely therapeutic experience?
One feels something quite similar in reading about Fromm-Reichmann, and with Rudnytsky one can also answer these questions in the affirmative.
It seems that much of her Principles reflects and retains her very considerable debts to, and her desire for expanding the insights of, Harry Stack Sullivan, which is no small thing for he is often confined to a footnote in recounting the history and intellectual development of psychoanalytic theory. In this regard, FFR and HSS alike rise and fall together.
They are clearly yoked in this book, and by the end of its brief introduction it is clear that FFR is a strong proponent of HSS's interpersonal theory. Indeed, upon finishing her thoughts here mine immediately turned to Winnicott: "there's no such thing as a baby!" With DWW, HSS, and FFR, one could thus insist "there's no such thing as a solitary patient who does not come into one's consulting room trailing a long line of entanglements with parents, siblings, authority figures and others." And this patient's interpersonal challenges will, of course, show up in the transference and counter-transference.
Anticipating by many decades the contemporary research that has shown, time and time again, how crucial the therapeutic alliance is to the success or failure of therapy, Fromm-Reichmann opens her book by insisting that "the first prerequisite for successful psychotherapy is...respect...[for] the mental patient" (xi). Such patients come, she notes, seeking not just insight, but also symptom relief and possibly personality change of some sort.
FFR made her bones, as it were, and her name treating psychotics and schizophrenics especially. From this she makes a striking comparison I've not heard before but whose logic makes sense to me: When it comes to the question of dreams, she notes that they "and psychotic productions are actually analogous" (xiii). We will return to the question of dreams late in the book, noted below.
If it was Yalom who made famous and widespread the recognition of the importance of paying attention to the here-and-now in the psychotherapeutic relationship, it was FFS who anticipated him by decades: already by p.4 of Principles she is insisting that we must pay serious and regular attention to "the reality of the actual experience between therapist and patient in its own right."
This takes us to her second chapter, explicitly focused on the role of the "doctor" in the therapeutic relationship. Here she issues a welcome and forthright reminder that no therapist or doctor worth his or her salt will be trying to impress a patient with his technical brilliance or intellectual prowess or theoretical genius, all of which she regards as displays of "irrational authority" (17) that will set therapy back, not advance it. (In a similar way and for similar reasons, at the end of the book, she stoutly insists that the doctor should not give advice for that infantilizes the patient.)
Much as I have more recently heard the great Adam Phillips regularly remind us (especially in his Unforbidden Pleasures), FFS was, in the 1950s, insisting that the therapist must resist "fantasies of omniscience" and illusions of "perfectionism" (18). This must go hand-in-hand with the humble admission of mistakes, which we now know, thanks to decades of research after her death, is a key part of sustaining and repairing the therapeutic alliance. (On the question of the alliance I have recently found Jeremy Safran's book Negotiating the Therapeutic Alliance: A Relational Treatment Guide very insightful and helpful.) Such admission of therapeutic mistakes, Fromm-Reichmann helpfully reminds us, really must be done "in a matter-of-fact and nonmasochistic manner" (20). Therapists, confessing missteps, do not need to lose control of their own masochism and turn themselves into penitential flagellants!
Chapter three is where I detected what I take to be the clearest and closest influence of her sometime husband, Erich Fromm. She notes here that the therapist must be free enough to stand above and at some remove from the pressures of conventional thinking and "authoritarian values" and their demands for obedient conformity. They must also help their patients do the same thing if that is what the patient wants. To do so, she continues a little later, requires in the therapist "mature love" based on "stable self-respect."
Chapter V, "The Initial Interview," begins by reminding us (again, decades ahead of this becoming a commonplace!) that "psychotherapy is a mutual enterprise, if not a mutual adventure" (45). In other words, Fromm-Reichmann is quietly moving beyond what is often called the one-person psychology of classical analytic approaches into the two-person and inter-personal approaches that would not really become mainstream, at least in America, until forty years after her death.
Again, in the 1950s FFR was ahead of the modern fixation on having goals for therapy, which she explicitly addresses a number of times. For her these seem to have been very important for she was operating--as a striking footnote on p.61 called me up short to see--in an era before the Diagnostic and Statistical Manual of the American Psychiatric Association had been invented--much less ballooned to the massive thing it is today (about which its sometime editor, Allen Frances, has had some critical things to say in Saving Normal). Later (p.143) FFR notes the importance--which seems standard today--of regular review of treatment plans to avoid therapeutic drift.
Returning, late in the book, to the topic of dreams Fromm-Reichmann again says several very useful and striking things, starting with: "Dreams are frequently used by the sleeper as a means of conveying something to the therapist which the patient has been incapable of conveying while awake" (163). More strongly still, she goes on to note that "the mental operations of the sleeper frequently excel in wisdom and insight those which he is capable of accomplishing while he is awake" (169). (I know this to be true from the very first dream I had back in the fall of 1994 immediately upon entering into psychoanalysis. Fromm-Reichmann, a little later, notes that you should always pay attention to the first dream in therapy for it often indicates the central struggle of the patient's life, and its theme will recur in therapy.)
She goes on, in the same practical and hands-on way she uses throughout the book, to offer an approach to dreams which very much accords with my own as both patient and therapist: the challenge of interpretation. Here she says that "the greatest source of help in this endeavor is the patient's own associations to his dreams." This, as an analysand, I found invariably helpful to decoding most--but not all--parts of dreams that would otherwise have been rather recondite in meaning.
If there are--and frequently this is the case--parts of dreams that prove elusive to association and interpretation alike, she recommends a useful tip: have the patient tell the dream a second time, and this time, as therapist, pay very close attention to any alterations in the second re-telling for such alterations are very likely "deserving of the therapist's special attention." In the end, it is not necessary, she says, to interpret every detail of every dream.
Overall, Principles of Intensive Psychotherapy holds up astonishingly well. Yes, the language (almost always "the doctor" or "the psychiatrist") is sometimes stilted and perhaps overly formal, and not all the details in her chapter on interpretation and its techniques would be widely practiced today. But overall a book that has now been in print for over sixty years remains fresh and challenging, reflective of the wisdom of an extraordinary woman whose therapeutic endeavors with some of psychiatry's sickest patients would prove redemptive indeed. Let that be counted unto her as righteousness, and may her memory continue to be blessed.
