Psychoanalysis is a specific approach to the understanding and treatment of mental functioning and disturbance. Freud showed that consciousness is not all of the mind; we have impulses, feelings and thoughts that we are not at the time, or ever, aware of. This knowledge has become part of our culture and of our view of the mind. He also introduced us to the understanding that apparently meaningless symptoms have a psychic meaning, of which the patient is not aware, but of which he or she can become aware by the psychoanalytic method. 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.

The term ‘psychoanalyst’ is often used rather indiscriminately. Strictly speaking, a psychoanalyst must have undergone and completed a training approved by the International Psychoanalytical Association (IPA). This is a world-wide body whose role is to maintain professional and training standards. In the UK full psychoanalytical training, recognised by the IPA, is provided and run only by the British Psychoanalytical Society, which was founded in 1919. There are many similar societies world-wide, whose training standards are monitored by the IPA. Former distinguished members of the British Society include Michael Balint, Wilfred Bion, John Bowlby, Anna Freud, Ernest Jones, Melanie Klein and Donald Winnicott.

The Origins of Psychoanalysis

Freud's first great innovation in the field of understanding mental life was to give people suffering from neurotic problems the opportunity to talk freely while he listened. It was a very simple idea, but as a formal, worked out method it was quite new. This is still the basis of the psychoanalytical method today. Using this technique, Freud and his colleagues came to realise that symptoms, such as depression, severe anxiety, phobias, obsessional behaviour, and so on, could be expressions of highly charged conflicting impulses and fears. Many aspects of these were outside the patient’s awareness; they were unconscious and therefore not known to the patient. Through his work with patients, Freud also began to recognise that other, ordinary, mental activities involved the use of representations or symbols of deep psychical events. Dreams, for example, could be understood as symbols for complex mental activities which derive from current external events in the patient’s life and reverberate with hidden wishes and deeper early experiences. It was also recognised that patients gained relief when they became aware of the hitherto unconscious wishes and conflicts that were expressed in symptoms or in dreams. Thus the task of the psychoanalyst was, and is, not only to listen carefully to the patient but also to try to understand, from what is being communicated verbally and non-verbally, the 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.

Quite early in his investigations, Freud discovered that the ideas a patient may have about the analyst were themselves akin to symptoms, so that the relationship between them could be seen as an arena in which aspects of the patient’s character and experiences were brought into play. As this was immediate and shared by both patient and analyst, it was seen as a uniquely valuable tool in gaining understanding of, and mastery over, unconscious problems. Thus the understanding of what is happening between patient and analyst has become one of the keystones of the psychoanalytical method. It is referred to technically as the analysis of the transference.

People from all walks of life seek psychoanalytical treatment for many different conditions. It may be for a very specific reason such as obsessional behaviour, phobic anxieties, or psychosomatic disorders. However, the patient may often feel worried or depressed in a more general way, for example, feeling aimless or dissatisfied in his or her professional life, or unable to form satisfactory personal or sexual relationships. The treatment is long and painstaking -  there is no ‘quick fix’ - and it is a considerable financial commitment as psychoanalysis is not usually available on the NHS, although less intensive psychoanalytic psychotherapy is sometimes offered in the public health sphere. (Free or voluntary low contribution psychoanalysis is available at the London Clinic of psychoanalysis.) Fees are not set by the British Psychoanalytical Society; each analyst negotiates the sessional fee with each patient.

The psychoanalyst holds a position of great responsibility towards the patient, in much the same way as a doctor does, and such a position is open to mishandling and abuse. For this reason the selection for training in psychoanalysis is rigorous and the training itself lengthy and closely supervised. The psychoanalyst must have not only considerable theoretical and technical knowledge but also as much self-knowledge as possible. A long personal analysis is, therefore, an essential part of the training. The analyst needs to interact closely with the patient, to some extent put him - or herself in the patient’s shoes. However, in order to help patients towards greater understanding of the problems and of their own contribution to them, the analyst must also be able to retain a position of an interested and non-judgmental observer. This requires personal and professional discipline, one aspect of which is reflected in the careful attention to the setting.

The Setting

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.

Contributions of Psychoanalysis 
to the understanding of emotional life

The psychoanalytical concepts put forward by Freud and developed by later analysts have greatly enriched our knowledge of mental functioning and human relationships. For example, Freud began to understand that the child’s relationship to parental figures is the prototype of all subsequent relationships; these involve, throughout life, feelings of rivalry, jealousy, concern, guilt, love and hate. He described this in terms of the Oedipus complex and considered it to be central in our understanding of ordinary emotional life.

The traumatic effects of prolonged separation between mother and infant, as in hospitalisation for instance, have long been recognised by psychoanalysts and this has led to radical changes in the management of children in hospital. Later followers of Freud, such as Anna Freud, Melanie Klein and Donald Winnicott, came to realise, particularly through their work with children, that experiences of early infancy, though lost to the conscious mind in adulthood, nevertheless live on in the unconscious and continually affect and shape relationships and behaviour in everyday life. For this reason it is considered important as part of the psychoanalytical training for the student to observe, on a weekly basis in an ordinary family setting, the development of a baby from birth to one year old. The student’s observations are discussed in a weekly seminar group and in this way the student not only learns about early infant development but also gains the valuable experience of making detailed observations in an emotionally charged situation where a friendly and interested distance must be maintained.

In more recent years, some psychoanalysts have undertaken the treatment of highly disturbed patients suffering from disorders such as schizophrenia and manic depressive states, and have contributed enormously to the understanding of mental illness. Psychoanalysts now are also much more aware of the existence of psychotic processes and areas in more ‘normal’ or neurotic individuals.

Applied Psychoanalysis

In general, psychoanalysts regard the intensive work with individual patients on a daily basis as the core of their professional life. However, many psychoanalysts work part-time in other fields, such as psychiatric hospitals and units, child guidance clinics, special schools, consultation centres and prisons. Psychoanalytic concepts have been valuable in furthering the understanding of group processes, especially in institutions and industrial organisations. Psychoanalysts also contribute to the training of university students, educationists, GPs, psychiatrists and social workers by bringing a specific psychodynamic viewpoint to these specialities. A newly established MSc course at University College London is mainly taught by psychoanalysts trained at the Institute of Psychoanalysis. Many analysts also contribute to the supervision of other mental health professionals.

The British Psychoanalytical Society

In 1924 the British Psychoanalytical Society established the Institute of Psychoanalysis to administer its burgeoning activities. One of its most important functions is the training of future psychoanalysts. Students come from all over the UK and the world. Anyone wishing to train must have a good university degree or its equivalent, as well as having worked in a relevant professional field such as psychiatry, psychology, social work, higher education, etc. The training is designed both for students who live in and around London and for students who live and work far enough from London to make it impossible to be here on a weekly basis. Until December 1999 there is also a special adaptation of the training for qualified psychotherapists who live more than 200 miles from London and who have already had a full personal analysis. Further information about all aspects of the training is available in a separate booklet.

The Institute also runs two post-qualification training courses, one for full Membership and one in Child and Adolescent Psychoanalysis.

In addition we organise conferences, scientific meetings, lectures and regular seminars on psychoanalysis and related topics, not only for members of the Society but also for other professionals and the public. The Institute of Psychoanalysis News and Events, published three times a year, was launched in 1996 and consists of information about the Society and a diary of events.

The Society has the well-earned reputation of being the world’s foremost publisher of psychoanalytic literature. The 24-volume Standard Edition of the Complete Psychological Works of Sigmund Freud was translated and produced by its Publications Committee, and a new edition is under way. A new series of psychoanalytic books, The New Library of Psychoanalysis, was started in 1987. The Institute is responsible for the long-standing and well-regarded International Journal of Psychoanalysis. In 1997, in partnership with the American Psychoanalytic Association, it produced a CD-ROM containing all the articles published in six leading psychoanalytic journals before 1995.

As a professional body, the Society’s function is to assist its members in their analytic work and to maintain high professional and ethical standards. In addition to being a member of the IPA, the British psychoAnalytical Society is a founding member of the British Confederation of Psychotherapists (BCP). The Society and the Institute are private charitable foundations and are independent of funding by the government or other outside organisations. They are committed to equal opportunities in all areas of their activities.

The London Clinic of Psychoanalysis

This important part of the Institute was established in 1926. The aims of the Clinic were to enable psychoanalytic treatment to be available to those who would not otherwise be able to afford an analysis. It has expanded since then, and now provides full analysis to adults, adolescents and children. Treatment is free, though patients are asked to make a voluntary contribution to cover running costs.

The Clinic is staffed by the Director, the Physician-in-Charge of the Child and Adolescent Department, members of the Clinic Directorate, psychoanalysts, and students under supervision. Patients are seen daily, usually on the Clinic premises, and should expect to be seen for at least two years and usually longer.