Anonymity, Neutrality, and Confidentiality in the Actual Methods of Sigmund Freud: A Review of 43 Cases, 1907–1939

OBJECTIVE: The aim of this historical study was to examine the methods actually used by Sigmund Freud in his practice of psychoanalysis in his mature years (1907–1939) and to assess the relationship between these methods and Freud's published recommendations concerning anonymity, neutrality, and confidentiality. METHOD: The authors used both published and unpublished sources, including reports or autobiographies by analysands, letters by analysands, interviews of analysands, letters by Freud, published works by Freud, and clinical records of subsequent treatment. RESULTS: Information concerning Freud's actual methods was found in 43 cases, including 10 clinical psychoanalyses, 19 didactic analyses, and 14 with combined clinical and didactic purposes. These 43 cases probably encompassed a majority of Freud's psychoanalytic hours during these years. Deviations from Freud's recommendations were found to the following extent: for anonymity, 43 cases (100%); for neutrality, 37 cases (86%); for confidentiality, 23 cases (53%). In addition, there were significant extra-analytic relations between Freud and 31 of these analysands (72%). CONCLUSIONS: These results show a substantial disparity between Freud's recommendations and his actual methods. Freud's prescribed method, as defined by his recommendations, was not tested or used in his practice. Freud's actual method was never explicitly described in his writings and cannot be replicated. (Am J Psychiatry 1998; 155:163–171)