Psychoanalytic Psychotherapy: Past, Present and Future

In 1895 Freud presented his paper ‘Project for a Scientific Psychology’, an ambitious attempt to construct a neuro-psychological theory of mind. His abandonment of the project and his discovery of psychoanalysis led to major discoveries about unconscious mental processes, psychic determinism, infantile sexuality and remarkable insights into our internal worlds which are a framework for understanding various aspects of human behaviour. These discoveries have profoundly affected our culture and have led to psychoanalytic treatments being available in the NHS in modified form. Freud's’ work was found to be radical and disturbing, resulting in hostility and resistance which is still with us today over a century later. Resistance to the pursuit of knowledge about the self remains ubiquitous.

Over the last century new areas of knowledge have developed leading to an array of new clinical treatments from medication to a range of psychological and psycho therapeutic treatments. Psychoanalytic psychotherapy has to make its case in a crowded and rivalrous therapeutic domain.

In the public sector the modernist philosophy has been the key influence. Modernism is a product of the enlightenment espousing emancipation through knowledge, but to some extent has been usurped with increasing emphasis on reason, order and stability. It is based on the belief that logical rules that can be measured lead to rational assumptions that can explain the world (Muir Gray 1999). The government of the day is investing great hope that this will bring a rational/scientific base to the practice of medicine and become the engine for improvement in standards of clinical practice. However, as with most things in life, new ideas or developments, can be used both constructively and unconstructively. A commonly expressed anxiety is that this vehicle could be used as a mechanism for rationing both care and the provision of clinical services.

The recently published National Service Fram