psychoanalytic therapy proceeds in the absence of experts. It is not a ‘healthcare profession’, for it does not profess to know what ‘health’ means when ‘health’ is said to be lacking. Consequently, there is no pre-existing set of criteria with which to measure the success or failure of the work once it has ended.

To say that there are no experts in analytic therapy does not mean of course that no expert is called for. Typically, the patient arrives in therapy hoping to address their ‘complaint’ to someone who understands what is wrong, and has the wherewithall to provide what is missing. But, unlike the therapies which can be conducted with the help of a manual, psychoanalysis views this appeal as part of the transference, that is, as a demand by the patient which is both understandable and even necesary for the process to get underway (since it is the motor for the work at the beginning of analysis), but still

insists that this is a demand which must not be met. The nature of the complaint and the particular form the appeal for help takes, together with the conscious and unconscious expectations regarding how this appeal will be answered, constitute important elements of what needs to be elucidated through the analytic work. Contrary to the ‘healthcare professional’, the analytic therapist does not set to work to make the person feel better and does not take the removal of symptoms to be the most important aim of the work.

To some extent psychoanalysis has to accept the charge that it makes people feel worse, at least for a period. After all, it seems to be designed for the purpose of bringing to the fore hitherto unacknowledged, often very intense wishes, wishes the analyst will acknowledge but cannot, and must not, satisfy. Furthermore, as the work progresses the patient may realise that significant change

involves considerable sacrifice: the relinquishment of regressive wishes and secondary gains derived from suffering, etcetera. ‘Getting better’, in analytical terms, is always to some extent a process of disillusionment and disappointment.

The deep respect for the individuality of each person, the appreciation of the complexity of their conscious and unconscious thoughts, wishes and intentions as well as the acknowledgement of the particularitites of their life circumstances combine to rule out any notion of psychotherapy as the application of a standard procedure, even as far as the frequency and length of the therapeutic work is concerned. Ideally psychoanalytic therapy evolves in an open-ended time frame where the end of the work emerges as an important part of the process.

Thus the frame of the therapeutic work too sets