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In my many years as a practitioner and administrator, I have seen psychoanalysts move from purveyors of orthodox psychoanalysis for a privileged few to, at present, the providers of psychodynamic psychotherapy to masses of patients. Three forces have been at work to push us in this direction: one, our psychoanalytic sages who critically evaluated psychoanalytic orthodoxy and offered creative insights for change; two, the explosive developments of neurobiology; and three, the forces of socio-economic change. It is the third of these forces, the socio-economic, that has occupied my interest and work for the past 20 years, and it is these forces that I will be primarily discussing today.
There is, however, a constant interrelationship among these three tracks. As psychoanalysts, we are physicians practicing in an everchanging environment, affected by society and affecting it in turn. We cannot say, “Stop the world I want to get off.” In truth, we are a small voice within a vast society; our challenges as doctors involves finding out how best to meet our patients’ needs, how to maintain quality care, and how to work within the ever moving world.
A major focus amongst psychoanalysts has been on the subject of changes in psychoanalytic practice styles that are now in abundant evidence. In this presentation, I will begin with a brief economic history of psychoanalysis and follow with a description of the current systems of delivery of Mental Health Care. Next, I will present the current changes observed in practice styles; I will then take a look at issues for the future; and I will close by presenting my recommendations as to how we might meet some of the current and future developments in psychoanalysis.