I will approach the topic of therapeutic action from a historical perspective. Any inclusive discussion of psychoanalysis requires attention to theory, method, and process.

Historical period What guidelines help analysts make effective choices? What explains the therapeutic efficacy, the mechanism of action, of effective approaches? These two questions have been asked persistently since Breuer’s empirical success listening to Anna O. Anna O.’s metaphoric formulation was to a chimney sweep, while Freud’s equally metaphoric connection was to catharsis. Both metaphors were about extruding memories that were noxious or toxic. The emphasis then shifted to the abreaction and release of strangulated affect that had resulted when powerful emotions triggered by traumatic experiences overwhelmed the nervous system’s adaptive capacity at the time. The specter of the hypnotist or mesmerist haunted these conjectures. Freud feared that critics would say the therapeutic agent was influence, not “real” change, not science. Nonetheless the theory of memories that haunt and affects that are unable to be expressed at the time of traumatic events remains valid. Additionally the method of one-person talking freely and another listening attentively and caringly and even the process of release and relief remain fundamental for psychoanalysis.