Sigmund Freud (1856 to 1939) was the founding father of psychoanalysis, a method for treating mental illness and also a theory which explains human behavior.
Freud believed that events in our childhood have a great influence on our adult lives, shaping our personality. For example, anxiety originating from traumatic experiences in a person’s past is hidden from consciousness, and may cause problems during adulthood (in the form of neuroses). Thus, when we explain our behavior to ourselves or others (conscious mental activity), we rarely give a true account of our motivation. This is not because we are deliberately lying. While human beings are great deceivers of others; they are even more adept at self-deception.
Freud’s life work was dominated by his attempts to find ways of penetrating this often subtle and elaborate camouflage that obscures the hidden structure and processes of personality.
His lexicon has become embedded within the vocabulary of Western society. Words he introduced through his theories are now used by everyday people, such as anal (personality), libido, denial, repression, cathartic, Freudian slip, and neurotic.
The Case Of Anna O
The case of Anna O (real name Bertha Pappenheim) marked a turning point in the career of a young Viennese neuropathologist by the name of Sigmund Freud. It even went on to influence the future direction of psychology as a whole.
Anna O. suffered from hysteria, a condition in which the patient exhibits physical symptoms (e.g., paralysis, convulsions, hallucinations, loss of speech) without an apparent physical cause. Her doctor (and Freud’s teacher) Josef Breuer succeeded in treating Anna by helping her to recall forgotten memories of traumatic events.
During discussions with her, it became apparent that she had developed a fear of drinking when a dog she hated drank from her glass. Her other symptoms originated when caring for her sick father.
She would not express her anxiety for her his illness but did express it later, during psychoanalysis. As soon as she had the opportunity to make these unconscious thoughts conscious her paralysis disappeared.
Breuer discussed the case with his friend Freud. Out of these discussions came the germ of an idea that Freud was to pursue for the rest of his life. In Studies in Hysteria (1895) Freud proposed that physical symptoms are often the surface manifestations of deeply repressed conflicts.
However, Freud was not just advancing an explanation of a particular illness. Implicitly he was proposing a revolutionary new theory of the human psyche itself.
This theory emerged “bit by bit” as a result of Freud’s clinical investigations, and it led him to propose that there were at least three levels of the mind.
The Unconscious Mind
Freud (1900, 1905) developed a topographical model of the mind, whereby he described the features of the mind’s structure and function. Freud used the analogy of an iceberg to describe the three levels of the mind.
On the surface is consciousness, which consists of those thoughts that are the focus of our attention now, and this is seen as the tip of the iceberg. The preconscious consists of all which can be retrieved from memory.
The third and most significant region is the unconscious. Here lie the processes that are the real cause of most behavior. Like an iceberg, the most important part of the mind is the part you cannot see. The unconscious mind acts as a repository, a ‘cauldron’ of primitive wishes and impulse kept at bay and mediated by the preconscious area. For example, Freud (1915) found that some events and desires were often too frightening or painful for his patients to acknowledge, and believed such information was locked away in the unconscious mind. This can happen through the process of repression.
Sigmund Freud emphasized the importance of the unconscious mind, and a primary assumption of Freudian theory is that the unconscious mind governs behavior to a greater degree than people suspect. Indeed, the goal of psychoanalysis is to make the unconscious conscious.
Freud (1923) later developed a more structural model of the mind comprising the entities id, ego, and superego (what Freud called “the psychic apparatus”). These are not physical areas within the brain, but rather hypothetical conceptualizations of important mental functions.
The id, ego, and superego have most commonly been conceptualized as three essential parts of the human personality.
Freud assumed the id operated at an unconscious level according to the pleasure principle (gratification from satisfying basic instincts). The id comprises two kinds of biological instincts (or drives) which Freud called Eros and Thanatos.
Eros, or life instinct, helps the individual to survive; it directs life-sustaining activities such as respiration, eating, and sex (Freud, 1925). The energy created by the life instincts is known as libido.
In contrast, Thanatos or death instinct, is viewed as a set of destructive forces present in all human beings (Freud, 1920). When this energy is directed outward onto others, it is expressed as aggression and violence. Freud believed that Eros is stronger than Thanatos, thus enabling people to survive rather than self-destruct.
The ego develops from the id during infancy. The ego’s goal is to satisfy the demands of the id in a safe a socially acceptable way. In contrast to the id, the ego follows the reality principle as it operates in both the conscious and unconscious mind.
The superego develops during early childhood (when the child identifies with the same sex parent) and is responsible for ensuring moral standards are followed. The superego operates on the morality principle and motivates us to behave in a socially responsible and acceptable manner.
The basic dilemma of all human existence is that each element of the psychic apparatus makes demands upon us that are incompatible with the other two. Inner conflict is inevitable. For example, the superego can make a person feel guilty if rules are not followed. When there is a conflict between the goals of the id and superego, the ego must act as a referee and mediate this conflict. The ego can deploy various defense mechanisms (Freud, 1894, 1896) to prevent it from becoming overwhelmed by anxiety.
In the highly repressive “Victorian” society in which Freud lived and worked women, in particular, were forced to repress their sexual needs. In many cases, the result was some form of neurotic illness.
Freud sought to understand the nature and variety of these illnesses by retracing the sexual history of his patients. This was not primarily an investigation of sexual experiences as such. Far more important were the patient’s wishes and desires, their experience of love, hate, shame, guilt and fear – and how they handled these powerful emotions. It was this that led to the most controversial part of Freud’s work – his theory of psychosexual development and the Oedipus complex.
To be psychologically healthy, we must successfully complete each stage.
Mental abnormality can occur if a stage is not completed successfully and the person becomes ‘fixated’ in a particular stage. This particular theory shows how adult personality is determined by childhood experiences.
Freud (1900) considered dreams to be the royal road to the unconscious as it is in dreams that the ego’s defenses are lowered so that some of the repressed material comes through to awareness, albeit in distorted form. Dreams perform important functions for the unconscious mind and serve as valuable clues to how the unconscious mind operates. On 24 July 1895, Freud had his own dream that was to form the basis of his theory. He had been worried about a patient, Irma, who was not doing as well in treatment as he had hoped. Freud, in fact, blamed himself for this, and was feeling guilty.
Freud dreamed that he met Irma at a party and examined her. He then saw a chemical formula for a drug that another doctor had given Irma flash before his eyes and realized that her condition was caused by a dirty syringe used by the other doctor. Freud’s guilt was thus relieved.
Freud interpreted this dream as wish-fulfillment. He had wished that Irma’s poor condition was not his fault and the dream had fulfilled this wish by informing him that another doctor was at fault. Based on this dream, Freud (1900) went on to propose that a major function of dreams was the fulfillment of wishes.
Freud distinguished between the manifest content of a dream (what the dreamer remembers) and the latent content, the symbolic meaning of the dream (i.e., the underlying wish). The manifest content is often based on the events of the day.
The process whereby the underlying wish is translated into the manifest content is called dreamwork. The purpose of dreamwork is to transform the forbidden wish into a non-threatening form, thus reducing anxiety and allowing us to continue sleeping. Dreamwork involves the process of condensation, displacement, and secondary elaboration.
The process of condensation is the joining of two or more ideas/images into one. For example, a dream about a man may be a dream about both one’s father and one’s lover. A dream about a house might be the condensation of worries about security as well as worries about one’s appearance to the rest of the world.
Displacement takes place when we transform the person or object we are really concerned about to someone else. For example, one of Freud’s patients was extremely resentful of his sister-in-law and used to refer to her as a dog, dreamed of strangling a small white dog.
Freud interpreted this as representing his wish to kill his sister-in-law. If the patient would have really dreamed of killing his sister-in-law, he would have felt guilty. The unconscious mind transformed her into a dog to protect him.
Secondary elaboration occurs when the unconscious mind strings together wish-fulfilling images in a logical order of events, further obscuring the latent content. According to Freud, this is why the manifest content of dreams can be in the form of believable events.
In Freud’s later work on dreams, he explored the possibility of universal symbols in dreams. Some of these were sexual in nature, including poles, guns, and swords representing the penis and horse riding and dancing representing sexual intercourse. However, Freud was cautious about symbols and stated that general symbols are more personal rather than universal. A person cannot interpret what the manifest content of a dream symbolized without knowing about the person’s circumstances.
“Dream dictionaries”, which are still popular now, were a source of irritation to Freud. In an amusing example of the limitations of universal symbols, one of Freud’s patients, after dreaming about holding a wriggling fish, said to him “that’s a Freudian symbol – it must be a penis!”
Freud explored further, and it turned out that the woman’s mother, who was a passionate astrologer and a Pisces, was on the patient’s mind because she disapproved of her daughter being in analysis. It seems more plausible, as Freud suggested, that the fish represented the patient’s mother rather than a penis!
Freud attracted many followers, who formed a famous group in 1902 called the “Psychological Wednesday Society.” The group met every Wednesday in Freud’s waiting room. As the organization grew, Freud established an inner circle of devoted followers, the so-called “Committee” (including Sàndor Ferenczi, and Hanns Sachs (standing) Otto Rank, Karl Abraham, Max Eitingon, and Ernest Jones). At the beginning of 1908, the committee had 22 members and renamed themselves the Vienna Psychoanalytic Society.
Is Freudian psychology supported by evidence? Freud’s theory is good at explaining but not predicting behavior (which is one of the goals of science). For this reason, Freud’s theory is unfalsifiable – it can neither be proved true or refuted. For example, the unconscious mind is difficult to test and measure objectively. Overall, Freud’s theory is highly unscientific.
Despite the skepticism of the unconscious mind, cognitive psychology has identified unconscious processes, such as procedural memory (Tulving, 1972), automatic processing (Bargh & Chartrand, 1999; Stroop, 1935), and social psychology has shown the importance of implicit processing (Greenwald & Banaji, 1995). Such empirical findings have demonstrated the role of unconscious processes in human behavior.
However, most of the evidence for Freud’s theories are taken from an unrepresentative sample. He mostly studied himself, his patients and only one child (e.g., Little Hans). The main problem here is that the case studies are based on studying one person in detail, and with reference to Freud, the individuals in question are most often middle-aged women from Vienna (i.e., his patients). This makes generalizations to the wider population (e.g., the whole world) difficult. However, Freud thought this unimportant, believing in only a qualitative difference between people.
Freud may also have shown research bias in his interpretations – he may have only paid attention to information which supported his theories, and ignored information and other explanations that did not fit them. However, Fisher & Greenberg (1996) argue that Freud’s theory should be evaluated in terms of specific hypotheses rather than as a whole. They concluded that there is evidence to support Freud’s concepts of oral and anal personalities and some aspects of his ideas on depression and paranoia. They found little evidence of the Oedipal conflict and no support for Freud’s views on women’s sexuality and how their development differs from men’.
Early life and education
Freud’s birthplace, a rented room in a locksmith’s house, Freiberg, Austrian Empire (later Příbor, Czech Republic)
Freud (aged 16) and his mother, Amalia, in 1872
Sigmund Freud was born to Ashkenazi Jewish parents in the Moravian town of Freiberg, in the Austrian Empire (now Příbor, Czech Republic), the first of eight children. Both of his parents were from Galicia, a historic province straddling modern-day West Ukraine and southeast Poland. His father, Jakob Freud (1815–1896), a wool merchant, had two sons, Emanuel (1833–1914) and Philipp (1836–1911), by his first marriage.
Jakob’s family were Hasidic Jews and, although Jakob himself had moved away from the tradition, he came to be known for his Torah study. He and Freud’s mother, Amalia Nathansohn, who was 20 years younger and his third wife, were married by Rabbi Isaac Noah Mannheimer on 29 July 1855. They were struggling financially and living in a rented room, in a locksmith’s house at Schlossergasse 117 when their son Sigmund was born. He was born with a caul, which his mother saw as a positive omen for the boy’s future.
In 1859, the Freud family left Freiberg. Freud’s half-brothers immigrated to Manchester, England, parting him from the “inseparable” playmate of his early childhood, Emanuel’s son, John. Jakob Freud took his wife and two children (Freud’s sister, Anna, was born in 1858; a brother, Julius born in 1857, had died in infancy) firstly to Leipzig and then in 1860 to Vienna where four sisters and a brother were born: Rosa (b. 1860), Marie (b. 1861), Adolfine (b. 1862), Paula (b. 1864), Alexander (b. 1866). In 1865, the nine-year-old Freud entered the Leopoldstädter Kommunal-Realgymnasium, a prominent high school. He proved to be an outstanding pupil and graduated from the Matura in 1873 with honors. He loved literature and was proficient in German, French, Italian, Spanish, English, Hebrew, Latin and Greek.
Freud entered the University of Vienna at age 17. He had planned to study law, but joined the medical faculty at the university, where his studies included philosophy under Franz Brentano, physiology under Ernst Brücke, and zoology under Darwinist professor Carl Claus. In 1876, Freud spent four weeks at Claus’s zoological research station in Trieste, dissecting hundreds of eels in an inconclusive search for their male reproductive organs. In 1877, Freud moved to Ernst Brücke’s physiology laboratory where he spent six years comparing the brains of humans and other vertebrates with those of frogs and invertebrates such as crayfish and lampreys.
His research work on the biology of nervous tissue proved seminal for the subsequent discovery of the neuron in the 1890s. Freud’s research work was interrupted in 1879 by the obligation to undertake a year’s compulsory military service. The lengthy downtimes enabled him to complete a commission to translate four essays from John Stuart Mill’s collected works. He graduated with an MD in March 1881.
Early career and marriage
In 1882, Freud began his medical career at Vienna General Hospital. His research work in cerebral anatomy led to the publication in 1884 of an influential paper on the palliative effects of cocaine, and his work on aphasia would form the basis of his first book On Aphasia: A Critical Study, published in 1891. Over a three-year period, Freud worked in various departments of the hospital. His time spent in Theodor Meynert’s psychiatric clinic and as a locum in a local asylum led to an increased interest in clinical work. His substantial body of published research led to his appointment as a university lecturer or docent in neuropathology in 1885, a non-salaried post but one which entitled him to give lectures at the University of Vienna.
In 1886, Freud resigned his hospital post and entered private practice specializing in “nervous disorders”. The same year he married Martha Bernays, the granddaughter of Isaac Bernays, a chief rabbi in Hamburg. Freud was, as an atheist, dismayed at the requirement in Austria for a Jewish religious ceremony and briefly considered, before dismissing, the prospect of joining the Protestant ‘Confession’ to avoid one. In the event a civil ceremony took place on 13 September and a religious ceremony the following day with Freud having been hastily tutored in the Hebrew prayers. The Freuds had six children: Mathilde (b. 1887), Jean-Martin (b. 1889), Oliver (b. 1891), Ernst (b. 1892), Sophie (b. 1893), and Anna (b. 1895). From 1891 until they left Vienna in 1938, Freud and his family lived in an apartment at Berggasse 19, near Innere Stadt, a historical district of Vienna.
In 1896, Minna Bernays, Martha Freud’s sister, became a permanent member of the Freud household after the death of her fiancé. The close relationship she formed with Freud led to rumours, started by Carl Jung, of an affair. The discovery of a Swiss hotel guest-book entry for 13 August 1898, signed by Freud whilst travelling with his sister-in-law, has been presented as evidence of the affair.
Freud began smoking tobacco at age 24; initially a cigarette smoker, he became a cigar smoker. He believed smoking enhanced his capacity to work and that he could exercise self-control in moderating it. Despite health warnings from colleague Wilhelm Fliess, he remained a smoker, eventually developing a buccal cancer. Freud suggested to Fliess in 1897 that addictions, including that to tobacco, were substitutes for masturbation, “the one great habit.”
Freud had greatly admired his philosophy tutor, Brentano, who was known for his theories of perception and introspection. Brentano discussed the possible existence of the unconscious mind in his Psychology from an Empirical Standpoint (1874). Although Brentano denied its existence, his discussion of the unconscious probably helped introduce Freud to the concept. Freud owned and made use of Charles Darwin’s major evolutionary writings, and was also influenced by Eduard von Hartmann’s The Philosophy of the Unconscious (1869). Other texts of importance to Freud were by Fechner and Herbart, with the latter’s Psychology as Science arguably considered to be of underrated significance in this respect. Freud also drew on the work of Theodor Lipps, who was one of the main contemporary theorists of the concepts of the unconscious and empathy.
Though Freud was reluctant to associate his psychoanalytic insights with prior philosophical theories, attention has been drawn to analogies between his work and that of both Schopenhauer and Nietzsche. In 1908, Freud said that he occasionally read Nietzsche, and was strongly fascinated by his writings, but did not study him, because he found Nietzsche’s “intuitive insights” resembled too much his own work at the time, and also because he was overwhelmed by the “wealth of ideas” he encountered when he read Nietzsche. Freud sometimes would deny the influence of Nietzsche’s ideas.
One historian quotes Peter L. Rudnytsky, who says that based on Freud’s correspondence with his adolescent friend Eduard Silberstein, Freud read Nietzsche’s The Birth of Tragedy and probably the first two of the Untimely Meditations when he was seventeen. In 1900, the year of Nietzsche’s death, Freud bought his collected works; he told his friend, Fliess, that he hoped to find in Nietzsche’s works “the words for much that remains mute in me.” Later, he said he had not yet opened them. Freud came to treat Nietzsche’s writings “as texts to be resisted far more than to be studied.” His interest in philosophy declined after he had decided on a career in neurology.
Freud read William Shakespeare in English throughout his life, and it has been suggested that his understanding of human psychology may have been partially derived from Shakespeare’s plays.
Freud’s Jewish origins and his allegiance to his secular Jewish identity were of significant influence in the formation of his intellectual and moral outlook, especially concerning his intellectual non-conformism, as he pointed out in his Autobiographical Study. They would also have a substantial effect on the content of psychoanalytic ideas, particularly in respect of their common concerns with depth interpretation and “the bounding of desire by law”.
Relationship with Fliess
During the formative period of his work, Freud valued and came to rely on the intellectual and emotional support of his friend Wilhelm Fliess, a Berlin-based ear, nose, and throat specialist whom he had first met in 1887. Both men saw themselves as isolated from the prevailing clinical and theoretical mainstream because of their ambitions to develop radical new theories of sexuality. Fliess developed highly eccentric theories of human biorhythms and a nasogenital connection which are today considered pseudoscientific. He shared Freud’s views on the importance of certain aspects of sexuality – masturbation, coitus interruptus, and the use of condoms – in the etiology of what was then called the “actual neuroses,” primarily neurasthenia and certain physically manifested anxiety symptoms. They maintained an extensive correspondence from which Freud drew on Fliess’s speculations on infantile sexuality and bisexuality to elaborate and revise his own ideas. His first attempt at a systematic theory of the mind, his Project for a Scientific Psychology, was developed as a metapsychology with Fliess as interlocutor. However, Freud’s efforts to build a bridge between neurology and psychology were eventually abandoned after they had reached an impasse, as his letters to Fliess reveal, though some ideas of the Project were to be taken up again in the concluding chapter of The Interpretation of Dreams.
Freud had Fliess repeatedly operate on his nose and sinuses to treat “nasal reflex neurosis”, and subsequently referred his patient Emma Eckstein to him. According to Freud, her history of symptoms included severe leg pains with consequent restricted mobility, as well as stomach and menstrual pains. These pains were, according to Fliess’s theories, caused by habitual masturbation which, as the tissue of the nose and genitalia were linked, was curable by removal of part of the middle turbinate. Fliess’s surgery proved disastrous, resulting in profuse, recurrent nasal bleeding; he had left a half-metre of gauze in Eckstein’s nasal cavity whose subsequent removal left her permanently disfigured.
At first, though aware of Fliess’s culpability and regarding the remedial surgery in horror, Freud could bring himself only to intimate delicately in his correspondence with Fliess the nature of his disastrous role, and in subsequent letters maintained a tactful silence on the matter or else returned to the face-saving topic of Eckstein’s hysteria. Freud ultimately, in light of Eckstein’s history of adolescent self-cutting and irregular nasal (and menstrual) bleeding, concluded that Fliess was “completely without blame”, as Eckstein’s post-operative haemorrhages were hysterical “wish-bleedings” linked to “an old wish to be loved in her illness” and triggered as a means of “rearousing [Freud’s] affection”. Eckstein nonetheless continued her analysis with Freud. She was restored to full mobility and went on to practice psychoanalysis herself.
Freud, who had called Fliess “the Kepler of biology”, later concluded that a combination of a homoerotic attachment and the residue of his “specifically Jewish mysticism” lay behind his loyalty to his Jewish friend and his consequent overestimation of both his theoretical and clinical work. Their friendship came to an acrimonious end with Fliess angry at Freud’s unwillingness to endorse his general theory of sexual periodicity and accusing him of collusion in the plagiarism of his work. After Fliess failed to respond to Freud’s offer of collaboration over the publication of his Three Essays on the Theory of Sexuality in 1906, their relationship came to an end.
Development of psychoanalysis
In October 1885, Freud went to Paris on a three-month fellowship to study with Jean-Martin Charcot, a renowned neurologist who was conducting scientific research into hypnosis. He was later to recall the experience of this stay as catalytic in turning him toward the practice of medical psychopathology and away from a less financially promising career in neurology research. Charcot specialized in the study of hysteria and susceptibility to hypnosis, which he frequently demonstrated with patients on stage in front of an audience.
Once he had set up in private practice back in Vienna in 1886, Freud began using hypnosis in his clinical work. He adopted the approach of his friend and collaborator, Josef Breuer, in a type of hypnosis that was different from the French methods he had studied, in that it did not use suggestion. The treatment of one particular patient of Breuer’s proved to be transformative for Freud’s clinical practice. Described as Anna O., she was invited to talk about her symptoms while under hypnosis (she would coin the phrase “talking cure” for her treatment). In the course of talking in this way, her symptoms became reduced in severity as she retrieved memories of traumatic incidents associated with their onset.
The inconsistent results of Freud’s early clinical work eventually led him to abandon hypnosis, having concluded that more consistent and effective symptom relief could be achieved by encouraging patients to talk freely, without censorship or inhibition, about whatever ideas or memories occurred to them. In conjunction with this procedure, which he called “free association”, Freud found that patients’ dreams could be fruitfully analyzed to reveal the complex structuring of unconscious material and to demonstrate the psychic action of repression which, he had concluded, underlay symptom formation. By 1896 he was using the term “psychoanalysis” to refer to his new clinical method and the theories on which it was based.
Freud’s development of these new theories took place during a period in which he experienced heart irregularities, disturbing dreams and periods of depression, a “neurasthenia” which he linked to the death of his father in 1896 and which prompted a “self-analysis” of his own dreams and memories of childhood. His explorations of his feelings of hostility to his father and rivalrous jealousy over his mother’s affections led him to fundamentally revise his theory of the origin of the neuroses.
Based on his early clinical work, Freud postulated that unconscious memories of sexual molestation in early childhood were a necessary precondition for psychoneuroses (hysteria and obsessional neurosis), a formulation now known as Freud’s seduction theory. In the light of his self-analysis, Freud abandoned the theory that every neurosis can be traced back to the effects of infantile sexual abuse, now arguing that infantile sexual scenarios still had a causative function, but it did not matter whether they were real or imagined and that in either case, they became pathogenic only when acting as repressed memories.
This transition from the theory of infantile sexual trauma as a general explanation of how all neuroses originate to one that presupposes autonomous infantile sexuality provided the basis for Freud’s subsequent formulation of the theory of the Oedipus complex.
Freud described the evolution of his clinical method and set out his theory of the psychogenetic origins of hysteria, demonstrated in several case histories, in Studies on Hysteria published in 1895 (co-authored with Josef Breuer). In 1899, he published The Interpretation of Dreams in which, following a critical review of existing theory, Freud gives detailed interpretations of his own and his patients’ dreams in terms of wish-fulfillments made subject to the repression and censorship of the “dream-work”. He then sets out the theoretical model of mental structure (the unconscious, pre-conscious and conscious) on which this account is based. An abridged version, On Dreams, was published in 1901.
In works that would win him a more general readership, Freud applied his theories outside the clinical setting in The Psychopathology of Everyday Life (1901) and Jokes and their Relation to the Unconscious (1905). In Three Essays on the Theory of Sexuality, published in 1905, Freud elaborates his theory of infantile sexuality, describing its “polymorphous perverse” forms and the functioning of the “drives”, to which it gives rise, in the formation of sexual identity. The same year he published Fragment of an Analysis of a Case of Hysteria, which became one of his more famous and controversial case studies. Known as the ‘Dora’ case study, for Freud it was illustrative of hysteria as a symptom and contributed to his understanding of the importance of transference as a clinical phenomenon. In other of his early case studies Freud set out to describe the symptomatology of obsessional neurosis in the case of the Rat man, and phobia in the case of Little Hans.
Transference is the process by which patients displace onto their analyst feelings and ideas which derive from previous figures in their lives. Transference was first seen as a regrettable phenomenon that interfered with the recovery of repressed memories and disturbed patients’ objectivity, but by 1912, Freud had come to see it as an essential part of the therapeutic process.