The psychoanalytic method of treating mental disturbance goes back a hundred years. The aim has always been the same: to help people who suffer from states of mind that are a source of distress or that have resulted in distressing symptoms. Freud was the first medically trained neurologist to decide to use purely psychological means to help his patients. He discovered that certain physical disorders originated in the forces at play in the patient's emotional life. The symptoms of these patients, such as those paralyses which had no underlying neurological cause, could be understood as the result of conflicting impulses and feelings.

From this beginning a psychological theory developed which showed how, in a purely emotional sense, the individual became handicapped by his or her early life experiences. The emotional disturbances we now recognise as requiring treatment were also seen, like the physical symptoms, as deriving from conflicts arising between different parts of the personality and as resulting in painful emotional states due to their lack of resolution. The aim of psychoanalysis is to alleviate these painful states, as initially it had been the alleviation of physical symptoms. In doing so, it allows the person a new sense of freedom from fear and anxiety.

Many people are aware that their inner fears or anxieties, whether in their personal relationships or working lives, limit what they might otherwise have hoped to achieve. Psychoanalysis, through laying bare the underlying aspects of such fears or anxieties, enables the individual to feel more in charge of his or her own life and decisions instead of feeling controlled by forces within. From its beginnings, psychoanalysis has learnt to recognise the strength of the forces which drive individuals into destructive or self-destructive ways of relating and behaving. It has also discovered that given skilled help and the courage not to retreat, an individual no longer has to feel alone or ruled by his or her inner fears and anxieties.

In writing to his closest associate about his new discoveries in treating his patients, Freud ended his letters with the motto 'coraggio'. He was referring to the need for courage in the face of the scepticism and hostility of both the patient and society. The same forces that work in the individual mind to strive to avoid awareness of thoughts that give rise to anxiety are also at work in the collective mind of society. Freud's legacy enables other psychoanalysts to continue to find ways of helping individuals to a life that need not be dominated by past experiences. Psychoanalysis aims to offer the freedom to face whatever potential for pleasure or for pain the future may hold.

Since Freud, successive generations of psychoanalysts have extended the range of conditions that can be treated psychoanalytically. Most important is the treatment of children and adolescents. They too can be crippled by anxieties and severe depression. Psychoanalysts try to make available the understanding and help of psychoanalysis to the widest range of people while continuing to hold on to the 'courage' to extend our knowledge of the forces at work in the mind.

Eglé and Moses Laufer have written many articles together and individually. They are the authors of Adolescence and Developmental Breakdown and the editors of a subsequent volume of clinical studies Developmental Breakdown and Psychoanalytic Treatment in Adolescence (Yale University Press, 1984 and 1989). The Laufers are training analysts at the Institute of psychoanalysis.

Sigmund Freud, The New Introductory Lectures on psychoanalysis, Penguiun Books, 1991).

Joseph Sandler and Anna Ursula Dreher, What do Psychoanalysts Want? The Problem of Aims in Psychoanalytic Therapy (Routledge, 1996).

It is often contended nowadays that Freud is out of date. Is he? Yes and no. Ideas change and develop. Einstein does not make Newton out of date. The post-Darwinians of today do not invalidate Darwin's original ideas.

Later generations of analysts have disagreed with him in many areas. For instance, few analysts today, I think, agree with Freud's views on female development. But it is by using his basic ideas and method that they found evidence to contradict him. It would be a sorry state of affairs if Freud's work were used like a bible. Ideas must be judged on their merit, on their seminal influence and the further development of ideas. But certain basic discoveries, and theories based on them, once learned are forever. We learn things that we cannot unlearn, even if we wished to. I am sure that today's astronomy is very different from that of Copernicus. Nevertheless, once we learned that the earth is not flat, and not the centre of the Universe, it is something that becomes part of our everyday knowledge - it is never out of date. The same is true of some of Freud's basic ideas.

First of all, he stated that consciousness is not all of mind: that we have impulses, perceptions, phantasies and thoughts which we are not at the time, or ever, aware of. That knowledge has become part of our culture and view of minds. Of course, that knowledge was in some ways already available to many. We have always ascribed motivations to others, and very frequently unconscious motivations. According to the philosopher Donald Davidson, psychoanalysis is an extension of common sense. But it is Freud who went beyond this kind of intuitive understanding and made it part of our knowledge of the human mind that conscious processes are under the influence of deeper, sometimes more powerful, unconscious ones.

Secondly, I would put it that Freud introduced us to the understanding of more meaning. He discovered that apparently meaningless symptoms have a psychic meaning, of which the patient is not aware but of which he can be made aware by the psychoanalytical method. He made this discovery by doing something which was very new, namely, he simply listened to the patient. When many doctors would discard the hysteric's discourse as nonsense and of no relevance to his symptoms, Freud both observed the symptoms and listened carefully to what patients were saying. And in doing that, he discovered the underlying meaning that the symptom had for the patient. Freud understood both the non-verbal and the verbal communications. Starting from that point he found that in everyday life often our mistakes or general behaviour have a deeper meaning than we are aware of. He understood that thoughts and feelings banished from our consciousness express our selves in a symbolic way - they have their own language. Now that we have advanced more in understanding and in technique, of which we had the basis from Freud, and can treat pre-psychotic and psychotic patients, we are beginning to learn the language of the insane; and we can communicate with people whose behaviour, and thereby communications, are bizarre and appear to be meaningless. We can discover the emotional and intellectual meaning underlying the bizarre behaviour.

A third thing which I think is basic in psychoanalysis is the importance of childhood and child-development. Of course, again, in some ways it was common knowledge that the child is the father of the man. It took Freud to notice that children have powerful loving and hating and sexual impulses, and that children's minds are complex and full of conflicts, often banished from consciousness but remaining as a nucleus of the personality.

Psychoanalysis is both a theory of mind and a therapy. The therapeutic situation in the analytic consulting-room is our laboratory. Like all sciences, it is the laboratory technique that elicits and organises the data which enables us to form hypotheses, to be checked again with the data. In that, like all sciences, it is partly based on observation and partly on intuitive leaps which have to be checked and re-checked by observation.

It is often contended that psychoanalytical data are indirect. We observe certain facts, but it is our interpretation of those facts that is the basis of the theory. But I think the same is true of all modern science. A dot on a television screen tells the scientist about the existence of a new particle, or the speed of an element, etc. But this is very indirect data, and to interpret it we need even more theoretical knowledge than the analyst needs to interpret psychoanalytical data.

There is also the concern of a more practical nature; whether psychoanalysis as a therapy is now out of date. I do not think that it is. Most psychotherapies (except the behaviourist therapies) are essentially based on psychoanalytical ideas. Organic treatment, though often necessary in severe psychoses and mental defects, is only effective in symptom-suppression, and has side-effects on the mind. Psychoanalysis is the only therapy based on understanding the mind, and on a constant striving for more understanding. It is the only one that can effect lasting changes when successful.

Though the psychoanalysis of psychotics is still in its infancy, for character disorders, neuroses, difficulties in relationships, psychoanalysis is still to my mind the treatment of choice.

Hanna Segal was born in 1918 in Warsaw and she qualified in Medicine in Edinburgh in 1943. She trained at the Institute of psychoanalysis and she is qualified in adult and child psychoanalysis. Since 1952 she has been a training analyst. Some of her many papers are collected in The Work of Hanna Segal (1981) and Psychoanalysis, War and Art (1997). Her other books include Introduction to the Work of Melanie Klein (1964) and the Fontana Modern Masters Klein (1979).

Donald Davidson, Essays on Actions and Events (Oxford University Press, 1980)

Sigmund Freud, The New Introductory Lectures on psychoanalysis (Penguin Books, 1991)

Hanna Segal, Dream, Phantasy and Art (Routledge, 1991)

Richard Wollheim, Freud (Cambridge University Press, 1971)

The aim of the work of the psychoanalyst is to help the suffering patient understand himself and achieve self-knowledge, particularly of his previously denied and split-off aspects. The process is both time-consuming and difficult for the two participants.

The process takes place in a setting provided by the analyst: a quiet room; a couch and chair; a regular frequency of sessions, usually five times a week; and an attentive analyst who listens, reflects on the thoughts and feelings aroused in him, and attempts to understand the free-associations of the patient and convey this to patient, usually by interpretations. The analyst's work is to maintain this setting and his mental stance of free-floating attention and interpretation throughout all the vicissitudes of the analysis.

An important focus of this work is the gradual discerning of patterns in the associative material both in content and form. An example might be of a pattern of references to parental figures tending to arise at the end of sessions. It is reasonable to suppose from this that one of the patient's conflicts will concern separations from parental figures, represented in the transference by the analyst, and this will be interpreted to the patient. Following this, the analyst would then be watching to see the way in which the patient receives and responds to the interpretation. Does the patient perhaps accept it and reflect further on this issue? Does the patient agree but then proceed to change the subject? Does the patient overtly deny the interpretation? Does the patient become angry, sulky, etc., or feel attacked by the interpretation? From these various types of responses, further patterns become clear and gradually a dynamic framework of the ways of functioning of the patient's mind, of his unconscious phantasy life, emerges and develops around the complexities of the transference-countertransference relationship.

These complexities will contain the various means by which the patient will want to avoid the emergence of his anxiety-provoking, painful and disturbing ideas, impulses and emotions. They will vary from subtle defensive manoeuvres often aimed at misleading and tricking the analyst, to gross attempts to undermine and sabotage the analyst's skill and power to think, by severe acting-out. This can threaten the very structure of the analysis. In these circumstances, an important part of the work is to contain the intensity of his countertransference feelings in order to attempt to understand and interpret the dynamics of the situation. The danger to the analyst is of being taken over by the patient's projections and manipulations and simply reacting rather than containing and reflecting. The intense emotional strain on the analyst can be extremely taxing, particularly when even the breaks between sessions become filled with anxiety and concern about the patient and the analysis. The stereotype of the detached bearded psychoanalyst with his notebook bears little resemblance to the psychoanalyst at work.

The work of the psychoanalyst also takes him outside of the consulting room and into other work settings. It was Freud in 1919 who first recommended that analysts should find ways of using their skills for the benefit of those unable to afford psychoanalysis. This has led to the development of the many techniques which were originally derived from psychoanalytic techniques and insights. Psychoanalysts have been the leaders of these developments, which would include the various forms of individual psychotherapy, group analysis and therapy, marital therapy, family therapy, Balint groups for medical doctors, psychosexual medicine, and various forms of counselling. They have developed the new techniques and theories from the bedrock of one man's original work.

In addition these varied health settings, analysts are also working in universities (often in their original disciplines) and using their analytic knowledge to further these disciplines. It is of great interest to note that in the British psychoAnalytical Society about 80% of its members who reside in this country and are below retirement age are working in the NHS or in universities as well as in their consulting rooms. The isolated psychoanalyst in his ivory tower is another stereotype.

Harold Stewart is a training psychoanalyst at the Institute of psychoanalysis. He began his medical career as a general practitioner and he was Consultant Psychotherapist at the Tavistock Clinic, London. His recent publications include Psychic Experience and Problems of Technique and Michael Balint, Object Relations Pure and Applied (Routledge, 1992 and 1996).

Sigmund Freud, The Essentials of psychoanalysis, Selected and with an Introduction by Anna Freud (Penguin Books, 1991).

Harold Stewart, 'Problems of Management and Communication' in Psychic Experience and Problems of Technique (Routledge, 1992).

WENDY COPE is one of Britain's leading poets. Her books Making Cocoa for Kingsley Amis and Serious Concerns (Faber and Faber, 1986 and 1992) are both best sellers, and she has won several awards. She began writing poetry three months after the start of her analysis. A brief, moving - and amusing - account of her analysis will soon be published in Mind Readings (Secker, 1996). The following is an excerpt from a conversation with the Editor about the contention that an analysis is bad for an artist's creativity.

When I went into analysis there weren't any questions about whether it would be bad for me as a writer because I wasn't a writer. I was completely inhibited, paralysed really. I wanted to be a writer when I was a little girl but I'd forgotten about it. What happened was that quite quickly, within a few months, I began writing. I was getting in touch with some powerful feelings and I didn't know quite what to do with them. One afternoon I felt like writing a poem. I'll tell you what the important thing was - it was to do with my feeling that I had a right to my own way of seeing things. Up until then I had allowed other people to impose their view of things to such an extent that I didn't very often see things for myself.

The first breakthrough was to understand that I was entitled to my view of what was going on between me and the man I was involved with. I didn't have to accept his view and I didn't have to argue with him either. I was entitled to have my own view privately, which was not the same as his. I found that I wanted to write it down and that was, I think, the first poem I wrote.

Incidentally, there's a point I want to make because I know that feminists worry about psychoanalysis, and I have certainly had some concerns myself. One thing analysis has done is make it a lot more difficult for men to exploit me and I would imagine that's true for quite a few women. So whatever your worries are about your analyst's theories about women, if in practice it has become a lot more difficult for men to exploit you, then that is a gain.

Being able to see things for myself, feeling I was entitled to my way of seeing things, was also very much bound up with getting in touch with my feelings, with my emotions. I imagine that very often in the early stage of analysis the patient says: 'no, I'm not angry - that would be unreasonable'. At a certain point I realised, and this was a revelation to me, that when someone asked me how I felt about something, I was coming up with a plausible answer but actually I didn't really know how I was feeling. I asked myself what would be reasonable. I thought I was telling the truth but then I realised that's not how I'm feeling, that's just what I think. I began to see that I did not actually know where to look for the answer to the question, 'what are you feeling?'

I didn't know that if you accidentally drop a cup of tea over someone it may mean that you're angry with them. Once you understand that, you notice what you're doing, and you notice what thoughts cross your mind. And those are clues and then you get better at it. I think I'm pretty well in touch with my feelings most of the time now. I don't usually have to wait till I drop something to find out that I'm angry.

I want to tell you about an afternoon when I sat in Battersea Park, looking at a tree. It was if this was the first time I'd been able to see a tree. How I felt about that tree, I realised, was mine and nobody could argue me out of it. It was an important moment, very moving. I sat there crying, and later that day I wrote a poem about that tree.

Truth to feeling is the important thing and that is why I don't see how analysis could make anyone a worse poet. Poetry is about telling the truth. The poet and the psychoanalyst are both seekers after truth.

Another parallel between analysis and writing poetry is that you have to be prepared for surprises. I think it was Robert Frost who said that there's no point in starting a poem if you know how it's going to end. It's a commonplace among poets that a poem takes on a life of its own. You have to be prepared for things to come up and for the poem to go off in a completely different direction from the direction you're expecting. And it's the same in analysis - you learn to expect surprises. You don't know what's going to come up and there's the same kind of excitement.

Some people are afraid that analysis or psychotherapy will make them more ordinary and boring. There's a problem about the word 'normal'. Some analysts, I think, use the word to mean perfect mental health. But to a lot of people 'normal' means ordinary and boring. They don't want to be 'normal', they want to be special. In fact, of course, if analysis helps someone to be more herself it'll make her more special.

The journey was difficult at first

Until I shipped my oars,

Let the river sweep me on,

Lifted my eyes from the dark brown water

And the search for rocks,

Saw the land, the sky, glide past.

My boat will complete the journey.

I do not know where the winding river leads.

I do not ask who will arrive.

I do not look downwards

As I reach the waterfall -

Midstream and faithful to the current.

There is no wind -

Only the power of the water.

Wendy Cope wrote this poem during the first year of her analysis. The Journey (copyright, Wendy Cope) is published here for the first time

JAMES MACKEITH is a Consultant Forensic Psychiatrist at the Bethlem Royal Maudsley Hospitals. Until recently he was Chairman of the Forensic Psychiatry Section of the Royal College of Psychiatry. His principal research interest is in the reliability of testimony. He has given evidence in a number of high-profile cases of miscarriages of justice including the case of Judith Ward, who made a false confession of terrorist offences. Here he offers his view of the value of psychoanalysis to clinical practice in forensic psychiatry.

Patients I encounter want to discuss the meaning for them of experiences in life, adversity and illness. This need should be met by somebody, no matter whether the illness and distress has arisen from psychological processes gone awry, or social and biological factors; usually it is thought to be a combination.

My own sub-speciality is forensic psychiatry - meaning psychiatry in relation to the law. Predominantly the work concerns the assessment and treatment of offenders. Many mentally abnormal offenders were themselves victims of deprivation or abuse in childhood before they became adult criminals. Consequently it is suggested that the sub-speciality is really concerned with cycles of victimisation. Some of our patients are perpetrators, some are victims but many are both. From a research viewpoint, valuable information has been obtained in the study of human development and the origins of criminality by means of addressing social group expectations, learning theory and cognitive development. But if we are to help the individual adult offender to understand himself we will have to try to discover the meaning for him of his criminal act. For this the ideas and methods of psychoanalytic practice are valuable.

Principles drawn from psychoanalytic practice help us to understand both the offender and our experience of him. A person working closely with offenders should find the task demanding, emotionally stressful and perplexing. One might say that if not, why not? The nature of the crimes committed and the on-going difficult behaviour of the criminal can evoke feelings which obscure clear thinking. The problem can be addressed if one struggles to identify and understand one's emotions. Psychoanalytic practice requires thoughtful attention to what is called transference and counter-transference. An offender may engender hostility. Another encourages injudicious trust. These influences may interfere with the application of sound common sense to a particular case. Since the price of errors in assessment and judgement can be costly, for example when the release of a potentially violent offender from hospital or prison is being reviewed, these possible distractions from one's task and responsibilities should be seriously addressed, not lightly discounted. I believe that the skills of a psychoanalyst can be usefully deployed in the training and advisory support of people who work with offenders, especially the mentally disordered.

A further point concerns the offender's ownership of responsibility for his actions. Our society has expectations that the criminal should experience guilty feelings concerning the crime. Expressions of remorse are assumed to be persuasive when sentencing or later decisions about release from custody are considered. In a lecture in 1956, the psychoanalyst Edward Glover drew attention to Edmund Burke's statement from 200 years earlier that "guilt resides in the intention". However, psychoanalysts since Freud in 1916 have suggested that criminal acts can arise from a pre-existing sense of guilt of which the offender is not conscious, even an unconscious intention. This idea can help us to address some of the mysteries which are presented to us by offenders and which we should, with them, try to comprehend. Some offenders without constitutionally determined developmental disorder convincingly but mystifyingly report an absence of the guilty feelings anticipated by others. Psychoanalytic concepts can assist the therapeutic work of exploring such a mystery. For example, I have been impressed that a victim of parental childhood abuse can take upon himself the bad aspect of the parent which can lead in adult life to puzzled indifference about the suffering caused to others. Guilty feelings can only be experienced with the revival of hope and aspirations about good relationships.

These and other central psychoanalytic ideas, which are often complex have important antecedents. For example, poets in their supercharged speech still offer us an economical account of these human predicaments. In Milton's Paradise Lost, Lucifer says: "So farewell hope, and with hope farewell fear, Farewell remorse: all good to me is lost; evil be thou my good". Even in a secular age, I do not think that the concept of guilt should be considered without remembering the Judaeo-Christian heritage and the old religious idea of the problem of estrangement from God. It seems that psychoanalytic theories are reminiscent of older theological concepts, now concealed as unconsidered assumptions and intertwined with other modern ideas.

Psychoanalytic concepts about guilty feelings are also useful. People suffering from severe depressive illness, for example, express morbid guilt feelings about what they have done. Reassurance does not work. The patient's sense of guilt is clearly conscious and declared. In contrast, the concept of unconscious guilt can be put to work to explain why a well regarded, conscientious and self-denying citizen commits an out of character crime, not apparently to his advantage. In such a case when a personal crisis is followed by a crime, treatment using psychoanalytic insights may provide convincing evidence of a life-long sense of guilt never previously contemplated by the person, and this may help him to find meaning behind what he has done.

In other words, a psychoanalytic approach can inspire useful thinking when one struggles to comprehend criminal behaviour which defies commonsensical understanding. Psychoanalysis does not offer excuses for offenders, nor is it an esoteric pursuit for meaning for its own sake. For unless an offender can find an understanding of his thoughts and actions and so confront the meaning of the harm he has done to himself and to others, there is no prospect of giving an explanation for the crime. Society expects expressions of remorse, but for this to occur an awareness of guilty feelings is the prerequisite.

It is good news that the value of the contribution of psychoanalysis to the practice of forensic psychiatry is increasingly recognised.

RICHARD WOLLHEIM taught philosophy at University College, London, from 1949 to 1982, and was Grote Professor of Philosophy of Mind and Logic from 1962 until 1982. He is now Professor of Philosophy at the University of California, Berkeley. A Fellow of the British Academy and of the American Academy of Arts and Sciences, Richard Wollheim is the author of numerous books including Sigmund Freud (Fontana, revised edition 1991), Art and its Objects (Cambridge University Press, 1980), The Thread of Life (Harvard University Press, 1982), Painting as an Art (Princeton University Press, 1987) and The Mind and Its Depths (Harvard University Press, 1993).

It is widely said that Freud altered, altered for ever, our conception of the human mind.

How did he do this, and what is the result? On this matter there are two prevalent views.

One is a more extreme view, the other a more moderate view, and paradoxically, it is the more extreme view that trivialises Freud's achievement. The more moderate view gives real substance to what Freud said, and it places him where he liked to claim that he belonged: amongst the philosophers and poets, whose insights he made available to science.

The more extreme view, of which we find the elements in Wittgenstein and the contemporary American pragmatist Richard Rorty, is that Freud reconceptualised the mind from scratch. Having brought it and its contents under totally new categories, he then produced a totally different form of explanation for what goes on in the mind and how the life of this mind develops. And, if Freud managed to conceal this aspect of his work, it is only because he continued to use some of the old mental vocabulary. He still talked of "motive" though in fact he explained what occurred in the mind in overtly mechanistic ways, and, as to the contents of the mind, Freud retained the common sense vocabulary of the mind, "intention", "desire", "belief", but, in prefacing each term with the predicate "unconscious", he completely subverted its meaning. In introducing the unconscious, he isolated each term from the evidential base in terms of which we normally understand it.

If Wittgenstein and Rorty were right in thinking all this, it would indeed be hard to see what the value of Freud's theory was. It would be difficult to know how it added to the sum of human knowledge.

But in fact there is little to suggest that this is the most convincing way of understanding Freud's views.

Certainly, there is reconceptualisation, but, alongside reconceptualisation Freud also introduced new phenomena that can be thought of as extending the contents of the mind: that is the kinds of thing that the mind contains. He discovered the defence mechanisms: projection, introjection, splitting, denial, repression. He greatly enlarged our understanding of anxiety. He linked up different modes of pleasure-seeking, he associated them with parts of the body that also serve the basic functions of life, and so he proposed that they should all be regarded as parts of sexuality. And, where others had merely detected ill-assorted patterns of untoward behaviour, part voluntary, part involuntary, he filled in the picture and identified true pathological unities with underlying causes and charateristic histories: he called these neuroses and psychoses, and was more interested in the structures he found than in the labels he gave them.

I have in effect been spelling out the moderate view of Freud's contribution to knowledge: indeed the only view on which he can be held to have contributed anything to knowledge. And what justifies this conception of Freud, what allows us to think of him as truly a discoverer - a view that used to be thought of as the height of philosophical naivete - is that what he claimed to discover in the mind interacts, from the very beginning, with what the mind is ordinarily thought to contain. Memories lead to neurosis: psychoses interfere with love and work. It is these links that warrant the claim that Freud enlarged the ordinary conception of the mind.

It is a startling fact about the mind, very obvious when you think about it, but a source of continuing torment to philosophers, that our conception of the mind has, not so much two parts to it, as two aspects. One aspect arises when we, as friends, as novelists, as scientists, as social workers, look upon another as an object of affection or inquiry, or amusement or compassion. The other aspect arises when we pause and confront ourselves: when we wonder whether we are angry, or why we are sad, what it is to be awake, or whether at this very moment we are dreaming. It used to be claimed that this aspect of the mind came into focus with introspection: others, with the sanction of the great Montaigne, have suggested that it is inseparable from living.

It is often overlooked that Freud no less radically altered our conception of the mind as grasped from the inside. In his paper 'On Narcissism' (1914), Freud pointed out how, at any rate in our more troubled moments, we seem to experience what we are thinking or doing by means of a voice inside us saying, "He, or she, is thinking this, is doing that". And in The Ego and the Id (1923) he postulated what he clumsily described as an "agency" inside us that has the role of criticising, upbraiding, cajoling us. From these and other observations, some gleaned from clinical experiences, others hastily embedded in theory, Freud elaborated our "inner" conception of the mind in a way that supplements what he did to our "external" conception. It is massively important, and it displays the mind like a great studio of voices, some more, some less, amenable to reason. All are really saying more that they seem to be saying.

In Freud's later writings and in the mature work of Melanie Klein, the identification of these voices, which evade strict individuation, and the attempt to trace them to their origins in the life of the individual - a project recalling in certain ways Freud's early attempts to trace the symptoms of hysteria to their origins - have not only enriched psychoanalytic theory, but have given fresh meaning, fresh weight, to the claim that psychoanalysis has altered for ever our conception of the human mind.

A warning: What psychoanalysis has done for the "inner" aspect of this conception has been as much open to distortion and to exaggeration as what it did for the "outer" aspect. Psychoanalysis, it is said, has dissolved the unity of the self. Each one of us is not one, but is many.

Many what?, we might ask. We are certainly not many minds. For what Freud and Klein drew upon was experiences of a kind that are intrinsic to single minds. What they used these experiences to show is, not that we are not single but that we are not simple. And that is a proper conclusion. Arguing that the complex character of the "inner" mind negates the unity of the self is like arguing that every leopard is many leopards because it has many leopard-like spots.

ALICIA ETCHEGOYEN, Physician-in-Charge, Child and Adolescent Department, the London Clinic of psychoanalysis, addressed some concerns parents often express when they consider bringing their child for a psychoanalytic assessment.

It is not unusual for parents to worry whether or not their child is normal, but if you are worried it is sensible to discuss the situation with an experienced practitioner who is specially trained to understand children and their problems. A child psychoanalyst will have this experience and training. The analyst may recommend an assessment.

An assessment involves learning about the child's early development and present day functioning, both cognitive and emotional. It also involves learning about his or her relationships within the family, the school and the wider social world. A thorough assessment may take three or four consultations, involving the parents or the whole family and the child. In the case of a young or school age child the parents may be seen first, followed by one or two individual meetings with the child. In the case of adolescents it may be advisable to see the young person first and to involve the parents later, with the adolescent's agreement. In some cases, psychological testing may be required. School or other specialist reports are useful sources of additional information.

In certain cases it can be an advantage if the assessor has a medical training. This is because many children's problems involve psychosomatic or physical symptoms. At the London Clinic of psychoanalysis children are assessed by a psychoanalyst with a medical qualification. Non-medical psychoanalysts will know when to consult a medical colleague during assessment or treatment.

Individual interviews with the child are crucial to gaining an understanding of the troubling emotions and thoughts which bring the child to the consultation. When appropriate, play material is provided to facilitate the expression of feelings and unconscious thoughts. A psychoanalyst will pay close attention to both the child's conscious and unconscious communications in order to build up a picture of the child's subjective world. The aim of the assessment is to begin to develop an understanding of the child's inner world and so determine what internal and external factors are thwarting the child's natural development. This understanding is essential to recommending the treatment that will best foster the child's psychological and emotional growth.

It is often assumed that a psychoanalyst will only recommend intensive (four or five times a week) treatment: this is not so. The purpose of an assessment is to address the unique qualities of each child and his or her problem. A standard recommendation of child analysis would make a travesty of this process.

A treatment recommendation is informed by an opinion of what is the best treatment - the 'ideal recommendation' - and what is possible in the light of the given circumstances (availability of treatment, costs, and so on) - the 'realistic recommendation'. In discussing what is desirable and what is possible it is important for the assessor to convey a firm professional opinion (in relation to the 'ideal recommendation') and a flexibility which takes into account limiting factors arising from the child's psychological makeup or external circumstances. Hopefully, this can create a climate of trust and co-operation that will enable the parents and child to follow the recommendation or to come back later if they do not feel ready to take up treatment.

F.H.G Balfour, represented the British psychoAnalytical Society in the British Confederation of Psychotherapists from its inception until 1996.

Psychoanalysts have never assumed that the particular conditions required for psychoanalysis would allow the procedure to be available to all those in psychological difficulty. The nature of the work means that it cannot be as widely available as psychotherapy. As a consequence, psychoanalysts have been at pains to disseminate the insights of psychoanalysis as widely as possible.

Psychoanalysis has developed to become separate and distinguishable from other psychotherapies. The difference in the emphasis on understanding and on the process of the work, more characteristic of psychoanalysis, and the emphasis on the therapeutic aim of the work, which is more characteristic of psychotherapy, become amplified once they are expressed in clinical practice. However much they remain grounded in day-to-day practice of psychoanalysis, psychoanalysts in Britain have made an additional contribution to the development of the applications of psychoanalysis.

As a consequence, the benefits of psychoanalysis have been extended beyond the boundaries of clinical psychoanalysis. One effect has been the establishment of a number of psychoanalytic psychotherapy institutions for which psychoanalysts have provided central aspects of the training both within the National Health Service and outside it.

The recommendation made in the government commissioned report by Sir John Foster in 1971 was that, for the public protection, psychotherapists should be registered. Since the field of psychotherapy had increased substantially post-war, and even since the publication of the Foster Report, the problem of creating a body, or bodies, to contain the large number of institutions concerned presented considerable difficulties.

Historically, the absence of an indicative register regulating psychotherapy has meant that a psychotherapy institution has been able to claim any title which it believes corresponds to its theoretical preference and its clinical practice. The problem that has arisen from this is that the public cannot know how such claims are to be judged. The British psychoAnalytical Society and its collegial institutions believe that it is essential that the long-established mental health institutions must play a part commensurate with their experience to help define the field.

The consequence of this view has led the British psychoAnalytical Society, together with adjacent psychotherapy institutions with a similar orientation in theory and practice, to establish the British Confederation of Psychotherapists. The Confederation is a relatively homogeneous grouping of the pre-eminent psychoanalytic psychotherapy institutions in the United Kingdom. The more heterogeneous umbrella body which aims to encompass the other legitimate psychotherapies in Britain is the United Kingdom Council for Psychotherapy. The purpose of both the BCP and the UKCP is to inform and protect the public and to define and codify the rules which govern the profession in an appropriate way.

The government has encouraged these developments but has made it plain that before statutory registration can even be considered it is necessary that the profession be seen to be self-regulating. In the public interest, umbrella bodies have to demonstrate a capacity to maintain order and discipline in the profession and their registers have to stand the test of time.

JONATHAN SKLAR is Chairman of The Regional Development of Psychoanalysis Committee.

In 1950 only 14% of the members of the British psychoAnalytical Society, 16 psychoanalysts, were in practice beyond London. By 1979 this figure had dropped to a mere 7%. This decline was alarming because the British psychoAnalytical Society has always wished to see adult, adolescent and child psychoanalysis become readily available throughout Britain. And while the British psychoAnalytical Society had helped psychoanalysis flourish in London and had played a major role in establishing psychoanalysis abroad, it was felt that the Society was failing those people who lived beyond London. In addition, because psychoanalysts were not taking up Health Service or University posts outside London, the teaching of doctors and other health practitioners was often being left to non-psychoanalysts. The feeling of crisis was made worse by the fact that there was no quick solution: it was not clear what, if anything, the Society could do to solve this problem.

By 1985 an annual Cambridge Colloquium was established so that interested psychoanalysts could meet to work on this problem. This led to a number of practical proposals. In the first instance, it was agreed that the secure development of psychoanalysis required groups of psychoanalysts, rather than lone individuals, practising in areas outside London. The hope was that in time, these psychoanalysts would become training analysts and with assistance from London, operate local psychoanalytical training schemes.

The only regions where this strategy seemed achievable were Scotland and Northumbria. Scotland and Northumbria had a group of psychoanalysts who had worked together and developed two related institutions in the previous decade. These were the Scottish Institute of Human Relations (SIHR) based in Edinburgh and the Scottish Association of Analytical Psychotherapy. Unfortunately, there were not members in these areas who were under 60. In 1987 we inaugurated special temporary measures in order to produce a group of Associate Members in the North, by upgrading a small number of carefully chosen psychoanalytic psychotherapists already practising there. These particular trainees on the Sponsored Training would be required to reach the standard of theory, practice and involvement expected of any Associate Member of the Society. If and when any such Associate Member wished to become a Full Member or a training analyst, the standards expected would be identical to those for any applicant of the Society.

The Sponsored Training will have to end in 1998. By 1997 eight of these trainees, now including some from Northern Ireland, had qualified and six more were in the process of doing so. This year the Education Committee set up a working party to put forward suggestions for a parallel training in psychoanalysis suitable for students who live and work outside London. Regional candidates, once accepted, would have more individual programmes of supervision and seminars in tandem with personal psychoanalysis. Telephone and video links are being suggested as well as some weekend events in London.

The task of making psychoanalysis more readily available beyond London is not simple but a start has been made, and we are determined to take it further.