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Psychoanalysis as a Clinical Discipline

Freud's great innovation in the field of understanding mental life was to invite his patients to talk freely while he listened. This seemingly simple invitation is still the basis of the psychoanalytical method today. The task of the psychoanalyst is not only to listen carefully to the patient but also to try to understand, from what is being communicated verbally and non-verbally, their underlying emotional conflicts. Conveying this understanding through interpretations aims to help the patient gain insight into emotional states, and thereby relief and enrichment in personal and intellectual life.

Although this may sound simple, it is, in fact, a complex and difficult process, requiring considerable perseverance and attention by both patient and analyst. Intense feelings and anxieties are aroused in both participants which have to be carefully scrutinised and worked through.

Psychoanalysis is different, as a discipline, from Clinical Psychology and Psychiatry. It uses no other form of treatment, such as behavioural techniques or drugs. Psychoanalytical psychotherapy is a less intensive form of psychoanalysis; for example the patient having psychotherapy may have one, two or three sessions a week; a full psychoanalysis means that the patient attends daily sessions, usually five days a week, sometimes four. Some psychoanalysts practice psychotherapy; some do not.

People from all walks of life seek psychoanalytical treatment for many different problems. For some there is a very specific reason whilst others seek help as they  feel worried or depressed in a more general way, for example, feeling aimless or dissatisfied in their professional life, or unable to form satisfactory personal or sexual relationships often involving a repeated pattern, or aware that their life lacks sufficient meaning. The treatment is lengthy, requiring considerable commitment by both patient and analyst, and one should think in terms of years - there is no ‘quick fix’.  It is is also true, however,  that many individuals derive considerable help from one or more psychoanalytic consultations.  Fees are not set by the British Psychoanalytical Society and each analyst negotiates the fee with each patient but an average fee would be about £50 per session. Although psychoanalysis is only rarely available on the NHS/Public Sector, less intensive psychoanalytic psychotherapy is often available. Free or voluntary low contribution psychoanalysis is available at the London Clinic of Psychoanalysis.

The physical aspects of the psychoanalytical setting have not changed much since Freud’s day. The patient comes to daily sessions at pre-arranged times and lies on the couch while the analyst sits in a chair just behind the couch. The analyst does not make notes in the patient’s presence as this would interfere with the analyst’s capacity to give proper attention to what the patient is conveying. Notes are sometimes made after the sessions. It is the analyst’s responsibility to provide a consulting room that is comfortable, quiet, and as free from interruption as possible. Every session lasts 50 minutes and the analyst starts and ends on time. The establishment of this secure setting, together with reliable and predictable adherence to it by the psychoanalyst, is very important as it provides a containing structure within which the patient and analyst are able to explore and think about the patient’s difficulties.