Psychoanalysts and psychoanalytic psychotherapists work with people who suffer from a range of emotional problems including depression, phobias, anxiety, trauma and obsessions. Together with their patients, they explore how unconscious factors affect their behaviour as well as past and current relationships.
Psychoanalysis was developed in the late 19th and early 20th centuries by Austrian neurologist, Sigmund Freud. Several schools of thought later emerged, the most famous ones created by Carl Jung and Jacques Lacan.
Psychoanalysis is based on the idea that we are often unaware of many of the factors that influence our emotions and behaviour. In other words, our lives are shaped not only by conscious but also unconscious processes. Painful experiences from the past can be re-enacted in the present and cause emotional and mental distress, sometimes in the form of symptoms, difficulties in sustaining healthy relationships, depression or low self-esteem. As long as processes remain unconscious, it is very hard to free oneself of these difficulties, despite advice from friends and family or the strongest willpower.
Psychoanalysts provide a reliable and safe setting to help patients to become aware of their unconscious conflicts. The analyst and the patient (or analysand) develop a unique relationship where no judgments are made and whatever is said in a session is held in the strictest confidence. Analysts don’t give advice but encourage patients to talk freely and make sense of their experiences, dreams, fantasies, anxieties, feelings and memories. As patients speak about what concerns them, they can begin to work with their suffering rather than against it. As a result, emotional and physical symptoms are alleviated and patients can discover meaningful ways of conducting their life and relationships.
Psychoanalysis can help with:
- Trauma, anxiety, panic attacks
- Depression, feelings of loss and emptiness
- Problems with sexuality
- Difficulties in making or sustaining relationships at home or work
- Lack of confidence
- Difficulty in coming to terms with a life change such as bereavement, divorce or job loss
- Emotional issues expressed through physical symptoms
Psychoanalysis usually involves intensive work and requires an important commitment from patients in terms of time and energy. Patients can attend 50-minute sessions 2 to 5 times a week. The length of time a person may be in analysis is very variable and is determined by the individual’s needs.
Psychoanalysis is one of many different types of psychotherapy. Other therapies include cognitive behavioural therapy (CBT), cognitive analytical therapy (CAT), interpersonal psychotherapy (IPT), humanistic therapies, and family and marital (systemic) therapy. Psychoanalysis (or psychoanalytic psychotherapy) differs from other forms of psychotherapy in the following ways:
- Analysis often requires long-term commitment. It takes time to find a deeper understanding of oneself and make meaningful changes to one's life.
- Psychoanalysts don’t direct or prepare sessions in advance but work with whatever patients present.
- Patients often lie on a couch in order to facilitate free association of ideas.
There are around 300 qualified psychoanalysts currently working throughout the UK. Most of them are based in or near London.
In the NHS, salaries start at £21,200 for trainee psychotherapists. Qualified psychotherapists can earn between £35,000 and £45,000 per year and up to £70,000 at senior level.
In private practice, rates can vary between £30 and £100 per hour depending upon the circumstances of the patient: psychoanalysts usually negotiate the fee with patients who are in financial difficulty and can offer sessions for £10 to £15.
- Work on a one-to-one basis with patients to explore their issues
- Provide a safe environment for patients
- Observe patients and listen to them very carefully
- Encourage patients to talk about their feelings and behaviour
- Help patients to start dealing with their problems
- Strictly respect confidentiality
- Adhere to a code of ethics
- Discuss patient’s issues with a supervisor
- Undertake continuing professional development (CPD)
Applicants for psychoanalysis training must have a university degree. They may come from a range of different professions and often have previous training in a mental health profession (psychiatry, psychology, social work or nursing).
The British Psychoanalytic Council (BPC) accredits institutions offering training in psychoanalytic psychotherapy and psychoanalysis:
- British Association of Psychotherapists
- Institute of Psychoanalysis
- Lincoln Clinic and Centre for Psychotherapy
- London Centre for Psychotherapy
- North of England Association for Psychoanalytic Psychotherapists
- Northern Ireland Association for the Study of Psychoanalysis
- Severnside Institute for Psychotherapy
- Scottish Institute of Human Relations
- Tavistock and Portman NHS Foundation Trust
- WPF Therapy / Foundation for Psychotherapy and Counselling
Training in work with children is offered by some of the societies above. The Association of Child Psychotherapists (ACP) is the professional organisation for Child Psychotherapists in the UK.
Training in work with couples is offered by the Tavistock Centre for Couple Relationships.
Training lasts at least four years. Students must undertake personal analysis for the duration of the training.
All psychoanalysts have to do CPD to extend their knowledge and understanding.
- Excellent listening skills
- Excellent observation skills
- Enjoy working with people who may be suffering from severe emotional problems
- Empathy but enough detachment to cope with emotional stress
- Be respectful, open-minded and non-judgemental
- Patience and positive approach
- Self awareness
- Mature and confident personality
- Good business and administration skills
Psychoanalysts usually work regular office hours, from 9am to 5pm. In private practice, they may work during evenings as well to suit patients’ timetables.
Being a psychoanalyst is both very demanding and rewarding, and you must be ready to go through intense and unpleasant experiences with your patients. That is why it is essential to have a support framework, i.e. to work with a supervisor (an experienced analyst) with whom you discuss clients regularly.
Psychoanalysis is almost always a second career: it requires a very mature personality and a thorough understanding of your own problems in order to understand those of another person.
Psychoanalysts can receive referrals by GPs or personal recommendations. If you work as a freelancer, building a network and good reputation is crucial for your practice.
Most psychoanalysts work in private practice and are self-employed.
It is also possible to work in the NHS. The Association for Psychoanalytic Psychotherapy in the National Health Service coordinates activities for psychoanalytic psychotherapists working in the NHS and other public services.
Psychoanalysts may choose to do further study and specialise in a particular area of work, such as child and adolescent psychoanalysis or couple therapy.
Experienced psychoanalysts may move into a teaching or supervising role.
David Morgan, is a psychoanalyst and psychotherapist based in London.
How long have you been in this particular job?
I have been a psychoanalyst for 18 years.
What did you do before this job?
I was a consultant clinical psychologist/psychotherapist in the NHS.
How did you end up doing this job?
I first got a degree in psychology and worked for many years in the NHS. I decided to leave because the bureaucracy of the NHS drove me away from my preference for socialist institutions. I prefer to have the freedom of my own independent practice. I am also someone who has built up a reputation of my own.
What do you do in a typical working day?
I see patients for treatment and assessment. I provide consultations for industry and health services. I write and think. I usual work about 10 hours a day.
What method of analysis do you use? For example have you trained in a Lacanian or Jungian school?
I trained with the British Psychoanalytic Society. I am a Kleinian but I am open to theories from other analytic thinkers and writers.
How do you find your clients?
I get patients referred to me by colleagues and through the reputation I have developed from lectures and writing.
What do you like about the job?
The experience of helping patients understand their minds in a profound way. I like to see real change and to immerse myself in the profundity of the issues around life and death that we all struggle with.
What do you dislike about the job?
Being inside my consulting room a lot. I have to ensure I get out and re-establish contact with the external world.
What advice would you give to someone thinking of doing this job?
Get experience either through a core profession such as social work, psychology or psychiatry. Or if you come from a non-clinical background but have a strong academic experience, look for honorary work within the mental health services in the NHS. Don’t forget that an important part of becoming an analyst is having your own analysis with an analyst.
What job(s) do you think you might do after this role?
This is my life now and I am in full time private practice.
Do you mind us publishing your salary / rate per hour - this is very helpful for job seekers?
I charge between £30 and £80 per hour. In the NHS, salaries vary between £30,000 and £70,000 per year for adult psychotherapists and psychoanalysts.