The Birth of Relationship Therapy: Carl Rogers Meets Otto Rank

In most sectors of “mainstream” psychoanalysis worldwide, interest in the work of Otto Rank has almost faded from view. There have been notable journal tributes—including a highly informative issue of American Imago edited by Peter Rudnytsky in 1984, honoring Rank as a founder of that journal in 1912, and a special issue in 2012 of the American Journal of Psychoanalysis, edited by Judith Dupont, titled “Recognizing Otto Rank, an Innovator.” There is a good 1985 biography, Acts of Will: The Life and Work of Otto Rank, by E. James Lieberman, and another, published in 1958 by Rank’s colleague from Philadephia, Jessica Taft. Robert Kramer, whose book I am reviewing here, is one of a handful of current leading scholars of Rank, and in chapter iii, “Otto Rank, Midwife of the Subject,” he usefully lists other writers interested in Rank, with dates of their papers and summaries of their contributions.

Kramer teaches leadership and transformative action at George Washington University and American University in Washington, D.C., and is a visiting professor at Eotvos Lorand University in Budapest. He has co-edited, in a volume published in 2012, the two hundred fifty letters that passed between Freud and Rank from 1906 to 1925, documenting their close collaboration, their thinking, and their clashes (Lieberman and Kramer 2012). Also noteworthy is a 1996 book that makes Rank’s rather tortuous writing and ideas accessible to the anglophone reader. Kramer now gives us this slender but intense, well-written, and fascinating book that is mostly about Rank’s contributions, but additionally notes his influence on Carl Rogers’s humanistic client-centered therapy and Rogers’s turn to transcendence, especially at the end of his life. Kramer suggests Rogers and Rank as seminal hidden contributors to the relational trends that shape much of contemporary psychoanalysis. Rank has a stronger claim I believe, as he was steeped also in the field of psychoanalysis.

Kramer alludes throughout his book to elements of Rank’s history. Once preeminent as Freud’s designated “heir” (following the 1913 ouster of Jung, the first “heir”), Rank is today mostly remembered as the first paid secretary of the Vienna Psychoanalytic Society in its transition from the Wednesday Society in 1908. He wrote most of those wonderful notes in the four volumes of Minutes of the Vienna Society, edited by Nunberg and Federn (1974), a society that spanned three decades from 1906, interrupted by the First World War, and dissolved by the Nazis in 1938. Rank, young, diligent, and brilliant, was an impoverished early protégé and follower of Freud, who encouraged his University of Vienna education, where he graduated with a degree in philosophy and ultimately became a scholar, conversant with wide swaths of art, music, literature, and philosophy. Rank was thus a foundational psychoanalyst and, very close to Freud, cofounded the International Psychoanalytical Association in 1910. Freud even “analyzed” him in some fashion during their period of disagreement (Roazen 1990). Eventually he was angrily ejected in 1925 by Freud’s inner circle, the “Secret Committee,” of which he happened to be a member. Freud viewed his developing take on the fundamental importance of “preoedipal” theory, and hence the vital importance of the mother, as threatening Freud’s own grand scheme of psychic development, by challenging the centrality of the father and thereby the oedipus complex. Rank also questioned the increasing length of psychoanalytic treatment. Given his theoretical emphasis, treatment should be short and should mimic the basic rhythm of conception, pregnancy, and birth, further reworking the relational challenge of attachment and separation. This too was enraging to the inner circle, especially to Abraham and Jones. Sándor Ferenczi, another member, was Rank’s writing partner. Ferenczi thus fell afoul of Freud at the time of Rank’s “disgrace” in 1924. But he backed off sufficiently to stay in favor with the Master. Ferenczi withdrew from Rank, and subsequently snubbed him. Rank wrote plaintively, after this hurtful exchange in a New York street, that he used to be his best friend. Long after Ferenczi’s death, he has been reclaimed (in the U.S. in the 1980s) by the analytic mainstream for his “heretical” preoedipal work, which shed light on the foundations of the relational field and on trauma—work begun with Rank back in the day. He thus far has eclipsed Rank in contemporary psychoanalysis.

Rank, twenty-eight years younger than Freud, and Ferenczi’s junior by eleven, maintained his challenge to Freud and cut ties. His wife, Beata, said Freud’s cancer in 1923 also prompted the fracture between them (Roazen 1990). Rank left for Paris with his wife and seven-year-old daughter in 1926 (though, according to Roazen, Beata kept returning to Vienna and Freud’s circle, was eventually alienated from Otto, became a child analyst, and moved to Boston in 1936). She and Otto were divorced just before his remarriage and untimely death in 1939. ¹ Rank often visited America, had many American patients in Paris, but essentially struck out on his own from the psychoanalytic group. He became very successful and popular in the U.S. during the 1920s and 1930s until his death. His work lived on, especially among social workers such as Jessica Taft, his biographer of 1958, with whom he had worked in Philadelphia, in the School of Social Work. Rank styled his own enterprise “psychotherapy” rather than psychoanalysis, and is best known as one of the first existential and humanistic psychotherapists. But the book that caused the conflagration with Freud was The Trauma of Birth (1924).

In most sectors of contemporary “mainstream” psychoanalysis, Carl Rogers is seldom mentioned. However, Kramer agrees with some who believe he was “the most influential psychologist in American history” (p. 13), enjoying an ongoing reputation. As I looked at the title of this book, I confess I had only a dim memory of his name as an inspirational therapist from the 1970s, a kind of “Mr. Rogers” of therapy, when many schools of psychotherapy were flourishing in the social turmoil amid hippies and “make-love-not-war” mantras. Kramer notes that unlike Rank, Rogers dealt with a therapist’s recommended unconditional love and acceptance of the patient’s individuality, but did not include the Rankian “daimonic.” (I think “aggression” might commonly cover this term.) Kramer believes Rogers was influenced by an exposure to Rank’s teaching over one particular weekend in 1936, in Rochester, New York, where Rank had been invited by Rogers and a social work colleague who had known Rank in Philadelphia. Rogers mentions Rank only a few times in his writing, and Rank never mentions him. But Kramer is struck by a statement that Rogers made about being transformed by this teaching. He detects similarities with Rank in Rogers’s description of the therapeutic encounter as his client-centered therapy—for example, in the goal of giving birth to oneself with the therapist as midwife, and in his fascination with transcendence.

The book has twenty-six chapters of just a few pages each. Many titles are startlingly direct quotes from people’s reactions to Rank, such as that of his ex-patient, Anais Nin: “I sense an Intelligence Rendered Clairvoyant by Feeling” (chapter v). “What Does a Woman Want?” the title for chapter vi, is a quote from a lecture of Rank’s discussing Freud’s lack of understanding in that area. “I Became Infected by Rankian Ideas” (chapter xx) brings us Rogers’s voice, introducing his transfiguring reaction to meeting Rank, while finally, “I Was Born beyond Psychology” (chapter xxvi) is a concluding Rogerian statement, binding Rank’s latter-day and Rogers’s pre-death ² epiphanic sensations of awe and intimations of oneness with the universe, and the smallness but uniqueness of each human being. Kramer’s talent for titles packed with arresting feelings is instanced by a marvelous 2015 paper, titled partly in Freud’s voice, “‘I Am Boiling with Rage’: Why Did Freud Banish Rank?” I believe that this writerly touch conveys the urgency of one of Rank’s preoccupations—his distress that there was no room for feelings, and therefore no theory of feelings, in Freud’s oeuvre.

Rank’s 1924 The Trauma of Birth had claimed that the inchoate experience of being born is the major nidus of massive anxieties of every kind—the result of being violently cast out of the vaginal canal from the uterine coziness of the mother’s body, into an alien atmosphere, forced to breathe and left starkly alone till reclaimed in some fashion by the mother’s arms and breasts. Gradually the agentic creative journey in Rank’s “Will therapy” was a seeking but not quite finding the original bliss, thus making oneself into a fully functional adult, inevitably to end in separation and death. This template served Rank as a dialectic between separation and merger (though I notice the words merger, fantasy, and mourning never appear in Kramer’s text). These primal birthing forces between the individual’s push away from “the other,” and yet necessary pull toward “the other,” were for Rank patterned in the here-and-now therapist/patient relationship. These were the keys both to the individual’s problems with guilt and anxiety, and their healing potential. The ultimate creativity to express oneself in the here and now, and seek reunion, was the work of “the artist” (elastically located within all people). Most modern analysts would instantly recognize these intrapsychic and interpersonal dilemmas as the deep ambivalence of an archaic register of psychic life. They would likely agree with Rank and Ferenczi, that oedipal interpretation as due to castration, rather than separation anxiety, would be off the mark here, and might represent a rigid “classical” analysis. It was Ferenczi, apparently, who gave us the concept of “classical” analysis, compared to his own practice (Roazen 1990). By now, alas, “classical” risks deteriorating in some circles into a shorthand put-down of Freud.

A series of quotations from Kramer about how Rank thought, makes a straightforward logic among the several points Kramer repeats, eloquently despite the repetition. The points link from the imagined experience of the infant being born, through the vicissitudes of distance and closeness in the earliest of relationships with the mother as the template of subsequent ones; emphasis on the here and now between therapist and client; a universal constancy of rhythms from birth though death. The forces within these latter opposing trends were creative vs. daimonic, within “the artist.” One becomes an artist of living, if all goes well.

Rogers’s client-centered therapy was conceptualized also as man ultimately giving birth to himself—or finding the self. Empathy was crucial—defined as the therapist’s lending himself by identification with the patient, so that the patient could find his own creative center. The patient’s past was not important for either Rank or Rogers—only the here and now in an egalitarian “authentic” (or, for Rogers, “real” and “transparent”) relationship seeking only a present and future. The determinism of Freud’s analytic theory was challenged by Rank. Freud’s idea of a “psychic reality” as it relates to the body’s development was also regarded as limited in its singular devotion to the originary universe of biological birth.

Rank’s estimation of his own views vs. the limitations of Freud’s is well highlighted by Kramer. For example, Rank said, “Clients need a relationship . . . not an interpretation” (p. 9). Kramer translates: “Only by being oneself within relationship, by accepting one’s own difference and having it accepted by another, can a person discover the capacity to re-create him- or herself” (p. 10). Rank said it was because Freud was so self-centered that he focused the analysand on transference and transference interpretation. He strongly claimed that Freud considered all feelings “irrational.” Freud’s aim in analysis, Rank argued, was to get rid of feelings, so that the person could be calm and rational, a good outcome of treatment. I do not agree with this reading of Freud, especially in his pre-1908 texts about women (Balsam 2017), or his work on anger or mourning, as well as love and loss. I see it as a matter of differing emphases. However, it does give one a chilling pause to read in Kramer what apparently Anna Freud said to Max Eitingon about her father, and presumably about her analysis with him: “Papa makes it clear that he would like to get to know me as much more rational and lucid than the girls and women he gets to know during his analytic hours, with all their moods, dissatisfactions and passionate idiosyncrasies” (p. 45; quoted from Young-Bruehl 1988, p. 156).

While these trends, if debatable, are definitely visible in Freud’s work, Rank’s critique of Freud’s supposedly narrow view of the unconscious seems unfair. It was Freud, after all, who wrote of the “navel” of the dream. The mutual hatred and disillusionment that had erupted over this “son’s” challenge of “the father” seems to have left each man significantly underestimating the other. Freud’s henchmen erected a wall of hostility toward Rank, falsely alleging that he suffered from manic-depressive psychosis and that it was his and his wife’s unbounded greed for money that took them to the United States (Roazen1990).

Freud’s unconscious fear of females as a manifest shortcoming, vividly appreciated by Rank and recorded by Kramer, I believe has merit. However, when I first read Rank’s Trauma of Birth I called him “a man of his time” (Balsam 2013), as he too showed little interest in females’ subjectivity about their own bodies, in spite of—in my take—the rare and precious virtue of his investigating childbirth and its impact. Instead, the focus was specifically on an imagined sense only of “the child,” akin to Freud’s own misogyny. This contrasts, say, with Julia Kristeva’s account (2014) of psychic origins in this interactional birthing moment that interests Rank, where she includes the psyche of the birthing mother. Was there perhaps an evolution after 1924 in Rank’s writings about empathy, a greater awareness of the female body? Kramer does point to Rank’s sensitivity to females.

The commonalities between Rogers and Rank seem most marked in Kramer’s account of their shared interest in oneness with others and nature, a sense of awe, fear, and high gratification. A sense of mystery about our human existence flooded both writers, especially Rogers, and the therapeutic role of all-embracing love loomed large, for Rogers more than Rank I think. I have noticed that some analysts when old or frail similarly confront mortality, imbued with a life spent with fellow humans on this same journey toward death, seeking meaning at life’s end. Intriguingly, they seem to include allusions to the ineffable in their writing and thinking. I would instance Hans Loewald’s final book, Sublimation (1988), which one could relate to Rankian ideas, though they are not mentioned; Janine Chasseguet-Smirgel’s last book of horrors (2005), about the world’s fate regarding body-mind dualism, in which she launched salvos at the postmodern approach to gender and reproduction; Julia Kristeva, now over eighty, who is taken with fears of mass destruction of the human psyche’s subjectivity by a malignant digital world; and the seventy-nine-year-old Christopher Bollas (2018) on the same theme. Still others urgently warn us about our blind destruction of nature and thus ourselves. Vast philosophical ideas, intriguing and not easily dismissed.

Rank did not know he approached death when it came for him at the early age of fifty-five, but earlier, according to his wife, he had been extremely fearful when in 1923 Freud became ill and was expected to die (Roazen 1990). Separation fantasy and feelings, and ideas and fears of death, are well known to us by now, and most look to Freud for their introduction. Though interested in “the uncanny,” and telepathy, he famously denied awareness of the “oceanic feeling,” which may have added to his intolerance of Rank. Kramer highlights Rogers, creative in old age, sharing Rank’s sense of the cosmos, in the oceanic sphere of the transcendent. Rogers, on YouTube in 2012, conveys excitement about people giving birth to themselves, sharing the spiritual view, with Rank, that “by doing so . . . the person affirms the loan of life, a loan that is fated to be repaid in full at the end—‘returned,’ so to speak, to the cosmos, to the ALL” (Kramer, p. 92; quoted from Rank 1936, p. 155). It is clear that many literary clients of Rank, including Anais Nin, Henry Miller, and D. H. Lawrence, as well as the choreographer Martha Graham, thrived on and were helped by sharing this point of view. Rank had a proclivity for, and a romantic idealization of “artists,” even though he wrote as if all humans were artists in their own right.

“Rank was no wordsmith” (p. 49), writes Kramer, but to him we owe the concept “preoedipal”; the word “denial” conceptualized as deeper than repression; the concept of “the end-phase” of treatment and words to describe it (p. 99); the positive valence of “resistance,” as a sign of health, as “will justification” (p. 100), unlike Freud’s take on it (p. 76); mutuality of “love” in the therapeutic encounter, but with more balance toward the patient’s love, I believe, than in Ferenczi’s mutual analysis; an emphasis on “attachment” before Bowlby; an emphasis on “empathy” as healing, prescient of Kohut and self psychology; and a global emphasis on the importance of feelings and a focus on the here and now that present-day schools of analysis like the contemporary Kleinians would appreciate. Kramer writes of this aspect of Rank’s thinking: “that awareness of being alive has suffered . . . deeper repression than even the repression of Oedipal sexual wishes or pre-Oedipal deficits of the self” (p. 61). Those features are all significant contributions to our field, which has absorbed many of them, or developed them, mostly without attribution. Kramer has done us a great service in keeping Rank’s contributions alive, rightly drawing our attention to our ongoing debt to his vision. Rogers’s therapy is described as a graphic example of this influence, so pervasive yet so silent about the act and interpsychic impact of childbirth in the newer schools of psychoanalysis.