Lay analysis is psychoanalytic treatment carried out by someone who is not a physician. In a less common sense, it is a treatment carried out by someone who has not received the necessary training in the practice of analysis. The term was first used by Freud in The Question of Lay Analysis (1926e), where he vigorously asserted that in the practice of psychoanalytic treatment, what mattered was good training, independent of diplomas obtained beforehand. He had already expressed a similar view in a prefece to Eitingon's report (1923g) and in a preface to a book by Aichhorn (1925f).
On July 18, 1926, the newspaper Neue freie Presse published a letter from Freud correcting some inexact information regarding a lawsuit filed against Theodor Reik for the illegal practice of medicine. In it Freud reaffirmed that a nonphysician could be a psychoanalyst, citing both Reik and his daughter Anna Freud, but he added that he did not refer to such psychoanalysts cases that were serious or complicated by somatic factors. Freud had always held this position and asserted it since the beginning of the Vienna Psychoanalytic Society, to which he liberally admitted non-physicians. In 1905 a member of the society, Max Graf, who was not a doctor, conducted, under Freud's direction, an "analysis" of his own son, "little Hans."
Thus the issue of lay analysis was raised early in the history of the psychoanalytic movement. Freud vigorously defended his position in 1926 because at that time the conflicts that developed around this issue took a serious turn. As a group Viennese psychoanalysts, among whom were a number of nonphysicians, supported Freud's position. In contrast, the Americans, under the influence of Abraham Arden Brill, wanted to bar the practice of analysis to anyone who was not a doctor. In Great Britain, Ernest Jones took a middle position, but mistrusted the nonphysicians, whom he thought must be carefully controlled. At issue in this debate were not only theoretical positions (is psychoanalysis a medical discipline, a therapy?), but also legal issues, which varied from country to country.
At the end of 1926, Ernest Jones and Max Eitingon organized a major discussion among members of the International Psychoanalytical Association so that a decision could be made on the issue at the Innsbruck congress planned for September 1927. There twenty-eight contributions (published by the two official organs of the association, the Zeitschrift für Psychoanalyse and the International Journal of Psychoanalysis ) were presented and discussed without an agreement being reached. The congress adjourned with a compromise: Each national society could follow its own policy. Jones emphasized the dangers of such a solution for the cohesion of the association, which was in fact on the verge of collapse over this issue and, some time later, over problems of training.
There were two aspects of the problem: training issues and theoretical issues. On the level of training institutes and their policies for the selection of candidates, France and other countries de facto aligned themselves with Freud's position. In contrast, the powerful American Psychoanalytic Association resolved to admit nonmedical analysts as late as 1988 only after long and costly legal battles. Weighing heavily on this question were factors of medical, psychological, and cultural history, of sociology, and of law that varied greatly from country to country.
On the level of theoretical justifications, two conceptions of psychoanalysis were opposed here. For some, psychoanalysis is a therapy that seeks to care for, and if possible cure, mental problems, even minor ones. Thus it can only be legitimately practiced by a doctor, preferably a psychiatrist, who has the necessary training to give a diagnosis and referral for analysis, and then to treat the patient with the broad-mindedness and accountability that doctors have. In France, Sacha Nacht defended this position. For others, however, analytic treatment is above all a personal experience, a liberation from the conflicts that restrict the ego and burden the mind, emotional life, and relations with others. Freedom and personal enrichment are the major aims, and any shortsighted preoccupation with a "cure" risks becoming an obstacle to good psychoanalysis. One could even argue that psychiatric training, which predisposes the physician toward diagnosis and treatment, is a handicap for the psychoanalyst. In psychoanalysis, the crucial references are cultural, even philosophical. In France, this last point of view was maintained, not exclusively but most brilliantly, by Jacques Lacan.
By 2005 the debate had largely quieted down. There seems to be general recognition that what is essential is good training in the theory and practice of analysis, especially the indispensable requirement of a personal analysis. But opinions continue to differ on what is the best preliminary training. In this respect, the debate is no longer over the question of physician versus nonphysician, but rather concerns the question of psychiatrist or clinical psychologist. Quite possibly psychoanalysis will benefit from the confluence of these two other therapeutic traditions.
See also: American Psychoanalytic Association; International Psychoanalytic Association; National Psychological Association for Psychoanalysis; Question of Lay Analysis, The ; Reik, Theodor; SchweizerischeÄrztegesellschaft für Psychoanalyse; Training of the psychoanalyst.
Freud, Sigmund. (1923g). Preface to Max Eitingon's Report on the Berlin Psycho-analytical Policlinic. SE, 19: 285.
——. (1925f). Preface to Aichhorn's Wayward youth. SE, 19: 271-275.
——. (1926e). The question of lay analysis. SE, 20: 179-258.
Perron, Roger. (1990). Médecins et non-médecins dans l'histoire de la Société psychanalytique de Paris. Revue internationale d'histoire de la psychanalyse, 3, 167-198.