dds much fascination. Yet since we do not want to stimulate
mere curiosity but clear understanding of the elements, we avoid every
startling record. We confine ourselves carefully to those perhaps
trivial experiences which daily enter into the view of those who come in
contact with suffering mankind. There will be no startling stories of
dissociated personalities, such as appear perhaps every few years on the
horizon of the medical world, but we shall speak of those who every day
in every town carry their trouble to the waiting room of the doctor and
who might return more happily if he had more well-trained interest in
the psychotherapeutic factors. Yet before we analyze some typical
symptoms, it might be wise to review the whole series of means and tools
which the psychotherapist finds at his disposal.

VIII

THE GENERAL METHODS OF PSYCHOTHERAPY

The psychological work of the physician does not begin with his curative
efforts. Therapy is always only the last step. Diagnosis and observation
have to precede, and an inquiry into the causes of the disease is
essential, and in every one of these steps psychology may play its role.
The means of psychodiagnostic are not less manifold than those of
psychotherapy. Moreover there the technique may be more complex and
subtle. The whole equipment of the modern laboratory ought to be put at
its disposal. Perceptions and associations, reactions and expressions
ought to be examined with the same carefulness with which the
conscientious physician examines the blood and the urine.

A particular difficulty of the task more or less foreign to every other
medical inquiry is the intentional or unintentional effort of the
patient to hide the sources of the trouble and to mislead as to their
true character. Too often he is entirely unconscious of the sources of
trouble or else he has social reasons to deceive the world and himself,
and ultimately the physician. And yet no psychical treatment can start
successfully so long as the patient is brooding on secret thoughts at
the bottom of his mind. The desire to hide them may often be itself a
part of the disease. It is surprising how often unsuspected vistas of
thoughts and impulses and emotions are opened by an inquiring analysis
where the direct report of the patient does not awaken the least
suspicion. In the field of insanity, naturally the physician at once
goes to an examination on his own account, but in the borderland regions