Demystifying the Talking Cure

In 1880, a 21-year-old Austrian woman named Bertha Pappenheim consulted Josef Breuer, her family physician, for a long list of symptoms for which no organic cause could be determined. These included mood swings, headaches, tunnel vision, paralysis, spasms, and a chronic cough. In repeated visits over two years, Breuer helped Pappenheim talk about traumatic life experiences. Her symptoms improved. She called her visits with Breuer “the talking cure,” a term Sigmund Freud later appropriated for psychoanalysis, the precursor of modern psychotherapy.

A century and a half later, as people are finding long waiting lists to begin the talking cure with a licensed therapist, we are still trying to understand what is curative about the talking cure. Though decades of research have revealed a great deal about which approaches are helpful for what problems in therapy, a mystery remains about therapy’s most active ingredient: the healing conversation at the heart of the therapist-patient relationship. The 2017 journal article “Talking cure models: A framework of analysis” stated, “Some kind of linguistic activity aims at some kind of experiential problem state of the patient and transforms the problem state in a curative way.” This made me laugh! It reminded me of physicist Arthur Eddington’s comment about the enigma of the Heisenberg uncertainty principle: “Something unknown is doing something we don’t know what.”

How is talking in therapy different from the talking we might do with family or friends? After 35 years of doing therapy and being a therapy patient several times myself, here are nine attempts to demystify the talking cure:

• Therapy is a series of non-ordinary conversations. By non-ordinary I mean that the talk in therapy is about things you usually try to keep hidden from most other human beings—or even from yourself.

• Therapy is a place to let go of an “it’s all good” way of presenting yourself. It’s a chance to talk about your experience of the first three words of M. Scott Peck’s The Road Less Traveled: “Life is difficult.” (Ten minutes into a session taking place on a porch under a propane heater in cold weather during the early days of the pandemic, a patient was still in ordinary talk mode. I asked, “Do you know what this heater runs on?” He said, “Propane, I presume.” I said, “Yes, propane, but therapy runs on just pain. I’m having trouble finding your pain today.”)

• Therapy is an opportunity to speak about what may feel unspeakable with a non-judging, compassionate human being who can help you hold in a new way what has kept you confused, hurt, ashamed, or stuck.

• Therapy is a human relationship to help you heal how you’ve been wounded in relationships, including the misunderstandings you have developed about your true worth.

• Therapy talk differs from ordinary talk because it is protected by complete confidentiality (except for a few legal exceptions) and by the understanding that the relationship will not extend to any other form, such as friendship, romance, or business partnership. By avoiding multiple roles it stays focused on its sole purpose: soul healing.

• Therapy talk is one-sided; that is, the focus of the conversation is always the patient’s healing. When the therapist shares personal experiences, it should be to further the patient’s healing process.

• Therapy is talking with a person outside what David Foster Wallace called the “skull-sized kingdom” in which each of us lives. A therapist is trained to point out things you may not be seeing, feeling, or putting together about your life story. This frees you to live a new story instead of continuing to loop through the old one. In computer terms, a therapist helps you see bugs in your inner operating system and begin the slow, patient practice of installing a better one. But this doesn’t happen overnight the way your smartphone updates its operating system!

• Therapy conversations can “cure” in the medical sense: A diagnosis is determined, treated, and successfully resolved. But much of the cure may be more like the original meaning of the word, which comes from the Latin noun cura, meaning “care.” The non-judging, compassionate caring that therapists offer can help you see that you don’t deserve the abuse you’ve lived through or the self-judgment you often heap upon yourself. Therapeutic caring can help you remember and live more from your sacred self, which remains unscathed under layers of struggles.

• Therapy invites you to be accountable to another human being for working on your life between conversations, much as you would need to practice piano between lessons with a teacher. This gives momentum to dealing with things that may be easy to avoid or put off for years.

Though the path to healing that she began with Dr. Breuer was long and bumpy, Bertha Pappenheim recovered from her multiple afflictions to become a writer and poet, an advocate for women’s rights, and the founder of a home in Germany for “endangered girls and unwed mothers.” She appeared on a postage stamp in 1954 as part of a “benefactor of mankind” series and was honored in 1997, 50 years after her death, with a memorial on the original site of the home she founded. The woman who helped discover psychotherapy and dubbed it the talking cure is a shining example of how deep human suffering can be healed and converted into compassion and service.