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Thus, Freud considered that psychoanalysis is more a form of ‘secular pastoral work’ than a quasi-medical activity. Freud’s first cases were those who presented with apparent medical problems which turned out to be expressions of emotional distress and mental conflict. They were to be resolved not by a medical intervention but by talking. As the afflicted person talked, under the particular invitation to talk freely of whatever came to mind, his or her underlying distress would become apparent. The analyst is a skilled listener. Whilst it is true that the analyst will, from time to time, provide interpretive comments designed to help the analysand become more aware of what is hidden in his or her discourse, the essential skill is that of listening.
Freud does acknowledge some mental conditions that are of a medical nature:
“I also share the view that all those problems which relate to the connection between psychical phenomena and their organic, anatomical and chemical foundations can be approached only by those who have studied both, that is by medical analysts.” [p 257]
Part of the context for Freud’s writing his paper on lay analysis was the resolution passed by American analysts that the practice should be restricted to medical doctors. One might reasonably surmise that such a resolution was motivated partly by concerns of a financial nature and wishes to protect professional territory. However, this would also have helped foster the implicit idea that psychoanalysts were ‘treating’ medical conditions – as opposed to engaging in a ‘secular pastoral’ activity. Medical treatment attracts higher status and fees than pastoral work.
The inclusion of psychological therapy as a ‘health profession’ might be appropriate in those instances where the practitioner claims to offer ‘treatments’ for people with a diagnosed mental health condition. Would this be the case with Jungian analysts, Lacanian psychoanalysts, existential psychotherapists? Do such people consider they are operating as a health profession and providing treatment for ICD10 diagnostic conditions? Are they instead more concerned with assisting people in a personal exploration of the mind, life, and its meaning? Is the exploration of archetypes, the collective unconscious, and the social unconscious, an aspect of ‘health care’? Was Erich Fromm a health care practitioner?