Discussion

It is indeed a pleasure to be asked to speak at a meeting of the American Psychoanalytic Association, but it is an especial pleasure to be asked to discuss a paper with which one is in entire agreement and therefore can only elaborate.

The London Clinic of Psycho-Analysis was opened on Freud's seventieth birthday, 6 May, 1926, the late Dr. John Rickman seeing the first patient at 8 a.m. on that day. Each member of the British Psycho-Analytical Society agrees to treat one patient at the Clinic, unless he is giving an equivalent amount of free time to other work on the Society's behalf. Patients pay the Clinic such fee as they can afford. Sometimes this is nothing; sometimes it is less than nothing, in so far as the Clinic pays the patient the cost of his fare to and from the Clinic. When the National Health Service Act came into force, the London Institute requested that the Clinic be not taken over by the Government; and this was agreed to. Eventually the Clinic received from the Government a certain sum per interview for a certain proportion of the patients treated. In 1952, when last I was Director of the Clinic, the Government was paying for approximately one-fifth of the patients treated. These patients were not allowed to pay the Clinic, but could make a gift to it.

In 1952 the number of adults on the waiting list of patients considered suitable for treatment was approximately 350. During the year about 125 patients were treated, approximately one-half of them at the Clinic itself, the remainder in private premises or by the courtesy of some hospital on hospital premises.

In London the average treatment was for two years (approximately four hundred hours), but the range was wide, extending from a few weeks to several years.

In Montreal a psycho-analytic clinic has been set up with the help of one of the hospitals associated with the University. Students collect money from patients on behalf of the hospital, the hospital giving a receipt, which is necessary