The Freud Museum

Events Archive

20 November 1999

The Future of Psychotherapy

Conference Report

Freud described psychoanalysis as a theory, a therapy and an instrument of research. Since his death it has also become, in Auden's words, a 'whole climate of opinion'.

In this conference we considered psychoanalysis along these parameters and looked at its future prospects. How will the profession develop in the next twenty years? Will psychoanalysis and psychotherapy become irrelevant? Will it be subsumed under a new science of psychobiology or psychopharmacology? Will it simply stop being interesting to people? On the other hand, as we move into the new millennium we might see an ever growing interest in psychic reality and a greater need for understanding it. Will psychotherapy extend its institutional base and function in society? What will be the new topics of theoretical interest and types of therapeutic intervention? Will psychoanalysis expand its domain further into the universities and create new methods of investigation? Will institutional changes engender changes in analytic technique?

These were some of the questions addressed at the conference by four distinguished speakers: Anna Ursula Dreher, Jeremy Holmes, Susie Orbach and Julian Lousada.

In the first talk of the day, 'Changing Aims in Psychoanalysis', Anna Ursula Dreher showed how concepts in psychoanalysis changed in relation to theory and practice. This fluidity may come into conflict with the current requirement for measurement of outcomes and the demand for explicit treatment aims. She showed how aspects of contemporary culture - 'flexibility', lack of connectivity, lack of long-term purposes - may militate against some of the fundamental aims of psychoanalysis. Moreover there are a spectrum of treatment aims in analysis (both conscious and unconscious) which change during the course of the treatment. And there are no simple answers to what we mean by 'health' and 'normality'.

Jeremy Holmes changed his title from the intriguing 'Prediction and the Unpredictable in Psychotherapy' to the hopeful 'A National Psychotherapy Service - Is it Possible?'. He began his talk with a little bit of analysis of his phantasy of the paper - 'cybertherapy'?, universal psychotherapy? - before acknowledging the basic truth that psychotherapy - looking at mental pain - will never sit comfortably with society. He elaborated this thesis through a historical overview of the influences which have shaped psychotherapy in the UK and offered suggestions for a psychotherapeutically informed psychiatry and a new kind of relation between psychotherapy and the NHS (National Health Service), which recognises the real social costs of mental illness and the 'cost effectiveness' of psychotherapy.

In the afternoon Susie Orbach, one of the founders of the Women's Therapy Centre in London, explored the ways in which psychotherapy has been integrated into cultural practices and the possible ways psychoanalytic knowledge can be used in the political and economic fields. Her title illustrated the huge scope of such an enterprise , 'The clinic, the nursery and the world bank: Psychotherapy and social institutions'. Using the recent Paddington train crash as an example, she noted how the reporting of emotions and emotional expression is now an accepted part of such tragedies. She showed that psychoanalysis can become another tool of both understanding and transformation in relation to social organisations. In many situations, such as 'post-conflict societies' in which trauma, violence, appropriation and loss are dominant themes, social rebuilding requires a simultaneous rebuilding of the psychical health of the nation. Unusually for a psychoanalytic conference, she ended her talk discussing irrigation projects in India - what psychological understanding is required to 'get things done'?

'Getting things done' was a theme of Julian Lousada's paper 'The State We're In' in which he pointed out that the government regulation of psychotherapy services may have a negative effect on the essential value of psychotherapy. Julian Lousada is the chair of the adult department at the Tavistock Clinic, London. In a sustained polemic he argued that the trend to turn patients into 'customers' and the service into a 'commodity' is the greatest present threat to psychotherapy. By fostering this 'business state of mind' psychotherapy becomes entirely concerned with instrumental objectives, without real emotional investment. These effects have come about through a change in the form of government intervention. Whereas government used to organise the 'means of production' or supply of services, it is now more concerned with specifying outcomes - "Where government was, now audit and regulation is". This affects not only service provision, but the training of therapists. Lousada pessimistically anticipated that the 'caring professions' may be veering towards a state of mind which itself is scared of forming relationships - the deathknell, surely, of psychotherapy as we know it.

As might be expected the papers left much to ponder. In many ways the question boils down to this: Changes are happening in psychotherapy. Some of them seem positive, some seem negative, it may even be too early to tell which is which. But how can psychoanalysis and psychotherapy adapt to these changes and still retain core values, aims and techniques which are worth preserving and fighting for in the future?

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