Academic journal article International Journal of Psychoanalysis

Selecting a Patient or Initiating a Psychoanalytic Process?

Academic journal article International Journal of Psychoanalysis

Selecting a Patient or Initiating a Psychoanalytic Process?

Article excerpt

Introduction

There are various routes by which an individual may embark on having psychoanalysis. Some start with a conviction that they wish to have an analysis; some may feel the need for some help with difficulties in their lives but have little if any idea of whether psychoanalysis is what might be the way forward. The former can usually readily find the contact details of an analyst through professional registers or relevant professional networks. For the latter, psychoanalytic communities need to find ways of providing sufficient information and opportunity for this potential population of anal- ysands to be able to make informed decisions. In Britain, the London Clinic of Psychoanalysis1 is a significant 'portal' between the public and the British Psychoanalytical Society, with very many people contacting the Clinic to find out about psychoanalysis, many going on to have a psychoanalytic consultation and then analysis, either through the Clinic at a low fee, or psychoanalytic treatment through its referrals service.

In this paper, I am addressing the way in which customary ways of 'assessing' potential patients for 'analysability' has perhaps created more hurdles for people to jump than opened gates for them to fruitfully pass through. In considering individual private practice, Levine (2010), Wille (2012), Rothstein (1994), Ehrlich (2004) and others, from various perspec- tives, have addressed the effects of this relative to the general decline in numbers of those seeking analysis. In this paper, I am considering institu- tional practice when it comes to assessment and selection, for example, where Clinics are attached to psychoanalytic institutions to provide training cases for candidates and other forms of low-fee treatment for prospective analysands (Crick, 2007).

I will be illustrating this by reference to the London Clinic of Psycho- analysis where the model for psychoanalytic consultations has been devel- oped in recent years. For many years, the Clinic assessed applicants who applied for low-fee analysis, selecting those who would be appropriate for analysis provided by candidates in training. With the aim of broadening the potential patient population to include those who may not otherwise have specifically sought out an analysis when looking for psychological help, but who might nonetheless be able to use an analytic form of treatment, the Clinic now offers a psychoanalytic consultation service for anyone wanting to explore their difficulties from this perspective. Experienced analysts see patients for a psychoanalytic consultation, usually over two sessions, and then discuss options for further treatment, which may include a low-fee analysis with a candidate in training or may be a referral into the private practice of a qualified analyst for analysis or psychoanalytic therapy. We now emphasize the consultation as a psychoanalytic experience for the prospective patient rather than as a meeting where the emphasis is on 'assessment' and 'selection' of the patient. Continual discussion and active learning from experience, recorded in papers (Crick, 2008, 2011; Crick and Lawrence, 2009), discus- sions, teaching, research (Perez et al., 2013; Reith et al., 2010, 2012) and audit, are essential to keep alive a culture that supports analytic work, guides and shapes development of services and thinking about technique and the aims of psychoanalytic consultation. To this end, the Clinic now also offers a post-qualification training in psychoanalytic consultation as well as opportunities for candidates to undertake psychoanalytic consulta- tions under supervision.

The Clinic model is to see psychoanalytic consultation as offering an opportunity to a person to have a psychoanalytic experience. We can see what an individual is able to do with it, what process it is possible to gener- ate and observe in the analytic setting offered in a particular consultation, and what recommendation it is then reasonable and helpful to arrive at in discussion with the potential patient. …

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