Psychoanalytic Psychotherapy Now: Where do we fit in?

In accepting the challenge to think about the future of psychoanalytic psychotherapy, I began by thinking somewhat from the outside. This was not because I regard myself as on the outside, quite the opposite, but because a lot of the work that I do is at the interface between our discipline and other settings. Thus I engage daily with the perspectives of university students and staff, as well as with colleagues in the public and voluntary sectors. I also had in mind conversations with a couple of journalists who had asked me for sound-bites and got bitten in return – I asked them what they thought about psychoanalysis1 and psychotherapy. So, below I try to consider how we may seem from the outside as well as how we see ourselves.

I am also going to build on the gender metaphors introduced by Mike Brearley (“a man's statement”) and Matthew Patrick (who spoke of intercourse, receptivity and taking things in).2 I will suggest that we may unconsciously fear that our profession has lost the potency and muscularity that Freud gave it originally. Our chosen work may even on bad days feel castrated, feminised and in danger of ‘rape’ – or at least corruption – by the sort of plain, simple and sanguine forces Mike Brearley conjured up: cognitive behaviour therapy, bureaucrats with spreadsheets, outcome researchers and definers of competences. We can feel very weak and exposed, and although partly a phantasy this is also based on reality. We are faced with change which brings serious losses and no guarantee of gains; it may seem that we have a guarantee of loss in fact, and only the possibility of gains. I agree with those who believe that we have to engage positively with the brave new world. I think we can in fact do so with potency and confidence, in no way losing what we might think of as the feminine qualities; what we need to lose are not genders, or gendered phantasies, but the caricatures of gender often contained in more paranoid anxieties. We may notice what happens