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Many years ago Freud (1923) told us that psychoanalysis was three different but related things: a form of psychotherapy, a method of psychological inquiry, and a theory of the mind. A decade ago Cooper and I (1978) added two others: an organized profession and a powerful movement within society. Today, in considering the critical issues that will shape the future of psychoanalysis, I would only add that the interrelations among these five, such as the effect of the structure of the profession on the method and the theory, or the effect of broad social attitudes on the utilization of the therapy, may have even greater impact than any of the five alone.
Most psychoanalysts spend most of their professional lives treating patients. Although the average American psychoanalyst may spend somewhat less time doing psychoanalysis than was true a few decades ago, there are many more psychoanalysts, and therefore the total number of analysands or hours of analysis in the United States seem to be steadily increasing (Panel, 1978). From all accounts the international trend is even more strongly upward. Of course, there has been a proportionally far greater growth in the use of other treatments in psychiatry, so that the increase in the number of individuals in psychoanalysis