En: The Body in Ed.: Guimón J, .Int. Congress Geneva 1996. Autogenic psychotherapy Basel, Karger, 1997, pp 176-181 and

AUTOGENIC PSYCHOTHERAPY AND PSYCHOANALYSIS José Luis González de Rivera

Initiated by J.H. Schultz in Europe, autogen- certain extent, many conceptual similarities. ic training is a form of which in- Although it is impossible to review both duces a slightly modified state of conscious- fields in a short chapter, I will elaborate on ness by passive concentration on selected some of the common areas. proprioceptive sensations. Schultz attrib- The Abreactive Phase of Psychoanalysis uted the therapeutic action of autogenic training to an increase on the self-regulatory The concept of neuronal excitation in capacities of the organism, operating response to external and internal stimuli through functional modifications in the cen- and its subsequent need for discharge is tral nervous system. basic to the development of psychoana- For a long time, it had been observed lysis. The pathological potentiality of undis- that many patients developed transient charged neuronal excitation is discussed by training symptoms, consisting of short-lived Breuer and Freud in their 'Studien liber motor, sensory, emotional or experiential Hysterie' [6]. According to them, a traumatic discharges. Those unwelcomed phenom- event that strongly aroused unpleasant ena were considered unavoidable side emotions in the patient may form the basis effects, which occasionally forced the dis- of the hysterical psychopathology. The continuation of treatment. A major advance mental representations related to the event came in 1961, when W. Luthe discovered became repressed and thus could result in the meaning of these autogenic discharges, hysterical symptoms or psychophysiological showing them to correlate with the symp- disturbances. toms, clinical course and traumatic history The cathartic method of therapy is the of the patient [1]. logical consequence of this theoretical for- The paroxysmal involuntary complex mulation. If the repressed memories of the manifestations, which could break through traumatic event could be brought back to the most relaxed state, were then consider- consciousness, and the associated affect ed as homeostatic adjustment reactions, allowed to discharge, a therapeutic result permitting the elimination of the neuronal should ensue. excitation associated to memory engrams The first difficulty, of course, was the re- of traumatic events. To exploit the potential sistance of the patient to reexperiencing therapeutic value of this discovery, Luthe [2, what he had already decided was better not 3] developed a new technique - autogenic to experience at all. To overcome this emo- neutralization - which encouraged the oc- tional resistance, Freud and Breuer made currence of autogenic discharges and as- use of a popular tool of their time, hetero- sured its management in a safe technical . When in a hypnotic state and en- environment. couraged to remember, the patient was The method was perfected and further often able to recall traumatic events, and to developed in Canada by Luthe and Gonza- release the accompanying affect by emo- lez de Rivera [4, 5], evolving progressively tional expression. Although a clinical im- into a complex and most effective form of provement usually followed the procedure, psychotherapy. Despite many differences in it was often short-lived. Furthermore, the technique and in approach, autogenic psy- hypnotic technique introduced problems of chotherapy and psychoanalysis share, to a its own.

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The Interpretative Phase of out to be such distortions; new recognition Psychoanalysis had to be given to the pathogenic impor- tance of unacceptable impulses and wish- Hypnosis promoted strong dependency es in contrast to the previously held view of on the therapist, often with erotic overtones, real traumatic life events as sole determi- a situation that greatly interfered with the nants of psychopathology. The concept of abreactive process. Rather than uncovering psychic conflict was thus elaborated, to- his unconscious memories, the patient gether with that of the structural organiza- would tell what he felt the doctor wanted to tion of the psychic apparatus. hear, and superficial clinical change would The goals of psychoanalysis were ex- appear out of a desire to please the thera- panded to include not only the mere abre- pist, rather than from discharge of re- action of traumatic events, but also the re- pressed affects. This led Freud to abandon solution of intrapsychic conflicts and modifi- the cathartic method, especially after he cations of the personality of the patient, in discovered the phenomenon of transfer- particular of his defensive organization, by ence. means of interpretations and other interven- Although the emotional resistance to re- tions. member traumatic events could be tempo- rarily overcome by hypnosis, the patient The Autogenic State would again repress the uncovered memo- ries in his normal waking state, and the The autogenic state is a particular state attached affect would recover its pathogenic of consciousness, self-induced by the prac- potential. Furthermore, the unbearable tice of passive concentration on selected mental representations not only aroused an proprioceptive sensations. The objective unpleasant emotion, but also had the qual- physiological concomitants of the autogenic ity of being `incompatible with the dominant state have been reviewed in detail by Luthe mass of ideas constituting the ego' [7], and and Gonzalez de Rivera, and are similar to their logical incongruity, if not their unpleas- the response described by ant quality, would force them out of con- Benson et al. [10] with other forms of medi- sciousness. This resistance to accept in- tation. Subjectively, we may distinguish compatible ideas is of a plastic nature, and three types of changes during the autogenic is related to what Freud [8] termed `psychic state. The most important manifestation is inertia', that is, the resistance of libidinal of an affective nature, and consists in the impulses to abandon their previous objects reversal of the subjective experience of and modes of discharge, and, I may add, of to a state of psychophysiological the psychic structure to reorganize itself in relaxation. Whereas we can define anxiety order to include previously unacceptable as a vague and diffuse feeling that some- mental contents. thing very damaging is about to occur, After this discovery, the study and disso- relaxation can be defined as an equally lution of resistance and be- vague and diffuse feeling that everything is came the basis of psychoanalytic tech- in order and nothing bad could possibly nique, with the assumption that the uncon- happen [11]. The second most relevant scious memories would in this way come manifestation is of a cognitive nature, and under the conscious control of the patient. consists in a marked increase in the aware- However, resistance consisted not only of ness of internal processes. The autogenic the suppression of unacceptable mental state allows the subject to be more open to content, but also of a distortion of what was all inner experience, and, in the therapeutic expressed [9]. When the repressed ideas session, to maintain the attitude of a de- finally reached consciousness, they did so scriptive observer of his internal processes. in a disguised manner, and the analyst had In psychoanalytic terminology, we could say to interpret the real meaning of those elabo- that the ego, under conditions of reduced rations. anxiety, increases its observing function, Many reports of traumatic events turned decreases its defenses, and allows the

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passage into consciousness of previously of right-hemispheric functions, reported in repressed ideas, memories and impulses. individuals practicing autogenic training and The enhanced awareness of unconscious related approaches [14]. material and the increase in introspective Dreams, Autogenic and Free capacities is not restricted to what we may call the psychodynamic unconscious, but also includes awareness of engrams related Dreams, the `royal road to the uncon- to physical traumas (i.e., accidents, intoxi- scious', present, in disguised form, the cation), spatial relationships, and mnemonic dreamer's forbidden wishes and repressed material of nonverbal nature. The third conflicts. Free association of ideas connec- group of subjective phenomena during the ted with the dream's manifest content per- autogenic state consists in the autogenic mit the uncovering of the real wishes, im- discharges, which we have mentioned abo- pulses and conflicts at the source of the ve. While those discharges tend to be short- dream, transformed by the 'dream work' into lived and of the most varied nature in the the actual dream [15]. basic training method, they tend to develop The attitude recommended by Freud for into complex and vivid experiential se- the technique of free association is quite quences when the advanced methods of similar to the attitude of passive acceptance autogenic neutralization are applied. developed during the practice of passive concentration on the autogenic formulae. Verbalization of Inner Processes The verbal process of description of internal imagery and body perceptions during auto- Continuous verbalization of all sensa- genic neutralization is comparable to the tions, thoughts and feelings during the work of free association, but the contents, autogenic state is a mandatory requirement termed abreacts, are intermediate between of the method of autogenic neutralization, dreams and free association in the waking as it is in psychoanalysis. Freud [ 12] con- state. Abreacts are subjected to the same sidered that, to be conscious, an idea had mechanisms of condensation, displace- to be connected with the linguistic system, ment, symbolization and projection as or, stated in another way, a conscious idea dreams, but they tend to present repressed consists of the idea plus its verbal represen- conflicts and traumatic events in a less dis- tation. Of course, this does not mean that torted form. The verbal description of abre- only verbalized ideas can be conscious, but acts has a character of immediacy, being that the idea must be `verbalizable', that is, the description of something that is present amenable to linguistic expression. This is in the mind's eye, as opposed to the report- exactly what happens during autogenic ing of dreams, which is always done under abreaction, when visual images, sensory the influence of conscious censorship. and motor phenomena and their accompa- nying affects corresponding to stored neur- Insight and Working Through onal information become amenable to ver- Insight is defined as the awareness of re- balization and thus enter the field of con- pressed ideas, and of their attached affect. sciousness. The view that intellectual insight does not, In the light of current concepts of the im- by itself, neutralize disturbing neuronal en- plications of left and right cerebral speciali- grams was clearly stated by Alexander [ 6], zation, we may say that during the autogen- who introduced the concept of `corrective ic state the symbolic and intuitive elabora- emotional experience'. Freud [17] insisted tions stored in the right hemisphere become that, once obtained, the initial insight had to amenable to the scrutiny of the analytical, be followed by a period of working through, verbal left hemisphere [13]. Incidentally, this necessary to overcome the resistance of facilitation of interhemispheric communica- the psychic structure to make room for the tion is also invoked as the neurophysio- previously unacceptable ideas. He correla- logical correlate of the increased creativity, ted the process of working through with the presumably involving facilitated participation freeing of small quantities of affect stran-

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gulated by repression, similar to repetitive requirements for compliance and the giving microabreactions. up of resistances, for example, he also be- Because of the special psychological comes the object of negative feelings which characteristics of the autogenic state, in- often trigger transferential-like dynamics. sight is probably more easily achieved in Almost invariably, the image of the thera- this state than in the normal waking state. pist appears in the autogenic sessions, and The mental elaborations verbalized during the feelings directed at him are of a nature an autogenic abreaction are often of a dia- and intensity difficult to explain merely by phanous clarity as to the wishes, conflicts the therapeutic relationship. Occasional and impulses of the patient, so much so links in autogenic abreactions are seen bet- that interpretative activity, in the psychoana- ween sexual and aggressive impulses to- lytic sense, is reduced to a minimum. Of wards the therapist and similar feelings di- course, as in psychoanalytic therapy, there rected towards parents or other important are in autogenic abreaction occasional re- figures in the patients past. Be it as it may, sistances on the part of the patient to the the whole issue of transference undergoes free flow of his mental representations, and a process of self-regulatory deflation during this requires appropriate handling by the autogenic abreaction. The therapist pres- therapist. ents himself consistently as a guide and a teacher of the method, and constant em- Transference phasis is shifted to the patient's own stored A doctor-patient relationship always car- memories and experiences, and to his own ries with it a set of attitudes and feelings in self-regulatory, self-restorative capacities. the patient that do mot have to do with the Dependency is discouraged, and the role of objective perception of the therapist, but the therapist is generally that of a technical with preconceived ideas about projective advisor. Negative and positive transference, figures. This set of fantasies and impulses rather than interfering with and sometimes related to an earlier important figure are sabotaging or prolonging the therapy, would reactivated by the therapeutic situation and appear in the abreactions, becoming in this constitute 'transference'. Transference, con- way fully evident to both patient and thera- sidered by Freud in the beginning as an pist, and become neutralized through them- undesirable phenomenon and a form of re- atic repetitions, the main vehicle of auto- sistance, later became a cornerstone of genic neutralization during autogenic abre- psychoanalysis, and therefore of therapeu- action. tic value. Because of the special character- Conclusion istics of the psychoanalytic situation, mainly the neutrality of the analyst and his or her Autogenic neutralization during auto- refusal to provide instinctual gratification, genic therapy and psychoanalytic therapy the transference aroused is more intense had close theoretical roots initially, but fol- and clear-cut than in other therapeutic con- lowed a different technical development, texts, and is based more on the idiosyn- particularly evident in the use made of inter- cratic fantasies of the patient than on the pretations and in the handling of resist- real characteristics of the analyst. ances and transference. Despite many dif- In contrast to this, the therapist practicing ferences in technique and in approach, autogenic therapy approaches the patient in autogenic psychotherapy and psychoana- a consistent supportive and teaching atti- lysis share some conceptual similarities, tude, and his personality may come across discussed here in the light of the abreactive more readily than in the psychoanalytic and the interpretative phases of psychoana- situation. These factors tend to minimize lytic development, the verbalization of inner the range of the patients projections onto processes, the structure of dreams, 'abre- the therapist. However, inasmuch as the acts' (free associations during the autogenic therapist cannot fulfill every possible need state) and free associations during the of the patient, and must impose on him the waking state, the processes of insight and

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working through, and the handling of trans- autógena; in de Rivera JLG, Vela A, ference. The autogenic state is a state of Arana J (eds): Manual de Psiquiatria. technical 'regression in the service of the Madrid, Karpos, 1980. ego' characterized by a reversal of the sub- 6. Breuer J, Freud S: Studies in Hysteria. jective experience of anxiety into a state of New York, Nervous and Mental Disea- psychophysiological relaxation and increas- se Publishing, 1936. ed awareness of internal processes. The 7. Freud S: Project for a Scientific Psy- ego, under conditions of reduced anxiety, chology. Standard Edition, vol 1, p 283. increases its observing function, decreases 8. Freud S: From the History of an Infan- its defenses, and allows the passage into tile Neurosis. Standard Edition, vol 17, consciousness of previously repressed p 7. 9 ideas, memories and impulses. Traumatic 9. Freud S: Freud's Psychoanalytic Proce- events are thus recovered into conscious- dure. Standard Edition, vol 7, p 249. ness, albeit distorted by the influence of 10. Benson H, Beary JF, Carol MP: The repressed impulses and wishes. The thera- relaxation response. Psychiatry, 1974; peutic effect is achieved by (1) the neutrali- 37: 37-46. zation of traumatic emotional experiences, 11. González de Rivera JL, García-Trujillo and (a) the progressive reorganization of MR: La experiencia de relajación: apli- the psychic structures to include previously cación del cuestionario de estados de unacceptable mental contents. conciencia a sujetos en Entrenamiento Autógeno y otras formas de medita- References ción. Psiquis 1996; 17:1-11. 12. Freud S: The Unconscious. Standard 1. Luthe W: The clinical significance of Edition, vol 14, p 161. various forms of autogenic discharges. 13. Galin D: Implications for psychiatry of Proc 3rd World Congr Psychiatry. left and right cerebral specialization. Toronto, University of Toronto Press, Arch Gen Psychiatry 1974;31:572. vol 3, pp 485-488, 1964. 14. González de Rivera JL: Estados de 2. Luthe W: Autogenic Therapy: conciencia y creatividad. Rev Psicol Treatment with Autogenic Gen Apl, 1978;33:415-426. Neutralization. New York, Grume & 15. Freud S: The Interpretation of Dreams. Stratton, 1973. Standard Edition, vol 3 and 4. 3. Luthe W: Autogenic Therapy: Dynamics 16. Alexander F: The development of psy- of Autogenic Neutralization. New York, choanalytic therapy; in Alexander F, Grume & Stratton, 1970. French TM (eds): Psychoanalytic The- 4. Gonzalez de Rivera JL: From Schultz rapy. New York, Ronald Press, 1946. autogenic training to Luthe's autogenic 17 Freud S: Remembering, Repeating and psychotherapy. Psiquis 1982;3: 16-22. Working Through. Standard Edition, vol 5. Gonzalez de Rivera JL: Psicoterapia 12, p 147.

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