Psychiatric News January 19, 2001
Volume 36 Number 2
© 2001 American Psychiatric Association
p. 18
Listening to Teenagers: A Lesson From Freud
Leon Hoffman, M.D.
The beginning of the 21st century finds many people focusing on the flaws of Sigmund Freud’s psychoanalytic technique, forgetting his revolutionary innovation of a century ago. Freud learned that to understand and effectively treat a patient, a doctor has to listen to his patients.
This contribution represented a quantum leap in psychological treatment, which far outweighs the impact of his technical errors. Learning about and teaching psychoanalytic issues has made it clear to me why generations of psychoanalysts have continued to be fascinated with Freud’s case histories. Freud’s capacities as a writer allowed him to convey the rich fabric of a person’s psychology. Only by understanding the unique aspects of a person’s life and mind can we begin to make judgments on how best to help people.
Prior to the development of psychoanalysis, writers and poets—through the various personas in their artistic productions—were the only ones who demonstrated the capacity to convey people’s inner lives. Freud said that his case histories read more like novellas than medical presentations, which are dry and sterile. Freud has been lambasted for his patriarchal ways, and his treatment of his famous patient, the adolescent girl Dora, has been criticized. However, people tend to forget that at that time, 100 years ago, Freud was learning, and the significance of the psychological state of adolescence was yet to be understood.
It is to his credit that he left us an enormous wealth of written clinical material that allows us to learn from his errors. In Freud’s description of his treatment, we learn about Dora’s family constellation. Her father was having an affair with a Frau K, the wife of his friend, Herr K. We also learn that Herr K had made seductive passes at this young girl. The father tells Freud that Dora just imagined that Herr K tried to seduce her and stresses that his relationship with Frau K was honorable. He tells Freud that Dora got her strange sexual ideas from reading Mantegazza’s Physiology of Love, a medical hygiene book of the time popular with young people. Freud writes after hearing from the father: "I had resolved from the first to suspend judgement of the true state of affairs till I had heard the other side as well."
How many turn-of-the-last-century men would have made that comment? How many would have thought to take into consideration the young woman’s side of the story and not just simply believe the father? This is the central message for us today, a message that is central for all who work with teenagers: parents, teachers, physicians, and therapists. The message that we learned from Freud is this: listen to what the child is communicating to you.
The communication may be with direct words, with actions, or in some other disguised manner whose code is very difficult to decipher. Parents, particularly when entangled in messy interactions with their teenagers, are often placed in positions in which they may be provoked not to listen. At those times, taking a step backward may be useful in regaining their composure.
When Dora turned to a male family friend her father’s age, the way young girls may turn to teachers, family friends, or clergy, she yearned for a relationship with a substitute man, a father figure, in which she felt accepted as a person and not as a sexual plaything. She wished to be loved, admired, paid attention to. She did not get those responses from her father, Herr K, and eventually not from Freud either, because his technique at that time resulted in a treatment in which he spoke much too openly about sexual wishes and fantasies to this young adolescent girl. He was not cognizant of all the other aspects of a relationship between an adolescent girl and her father and father-substitutes (the psychoanalyst, for example).
Fortunately for us, we can learn from Freud’s oversight. We can learn how emotional upheavals can be created in girls who have been neglected, misunderstood, or ignored by their fathers. It turns out that Dora heard the Ks talking about divorce and knew about her father’s affair with Frau K, a situation to which we are not unaccustomed during our own time, when children know more about the complicated and complicating issues in our lives than we might wish.
It became clear to Freud that Dora’s father wanted to protect his relationship with Frau K and, in addition to wanting to help his daughter with her problems, brought Dora to Freud so Freud would eliminate Dora’s "imaginary" thoughts about Herr K. Although Freud also eventually came to betray her, he actually listened to Dora, believed her, and despite many, many statements to her, which by today’s standards of treatment would be considered antitherapeutic, he spoke to her in a way that allowed her to sense that her feelings were her own. 
Footnotes
Dr. Hoffman is codirector of the Parent-Child Center of the New York Psychoanalytic Society and chair of the Committee on Public Information of the American Psychoanalytic Association.
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