Contemporary situation of psychoanalysis and psychoanalytical therapies in France

Abstract

Even if psychoanalysis no longer prevails with the extraordinary enthusiasm it inspired after World War II, it still retains an important place for many in the mental health field. This paper’s objective is to describe the current situation of psychoanalysis and psychoanalytic therapies in the French health system, showing how, in our country, it has developed to this unique position. So far, influenced by the evolution of psychoanalysis in France, historical, cultural, and societal factors added with a strong lobby from psychodynamic scholars and strong support offered by clinical psychology, psychoanalysis and psychoanalytic psychotherapies have maintained a significant practice framework in France. Despite being challenged by the dominant global position of DSM psychiatry and cognitive psychology, psychoanalysis’ influence remains strong as it does not affect only psychology and psychiatry but also extends to the humanities and social sciences. New practice types and future directions for psychoanalysis and psychoanalytic therapies are then discussed.

Keywords:

• psychoanalysis
• psychoanalytic psychotherapy
• historical evolutions
• France
• psychotherapy

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. This late creation contrasts with the quicker creation in England (1913) of the International Psychoanalytic Association (IPA) (1910) shortly after the creation of the Viennese Psychoanalytic Society (1908).

2. With the financial and political contribution of Princess Marie de Bonaparte (1882–1962).

3. Some debates were focused on the institutional role of the Institute of Psychoanalysis and in particular its ability to provide access to the psychoanalysis title. Nach was in favour of an access reserved to the medical profession, while Marie de Bonaparte took a more moderate position.

4. When the International Congress of Psychoanalysis was held for the first time in Paris in 1938, strong dissensions appeared between the Europeans who were in favor of psychoanalysis being practiced by non-physicians and Americans who insisted on retaining a medical identity to psychoanalysis. French psychoanalysts took an active part in this controversy defending the European position, with motives more linked to the influence of its psychologists’ followers (Botbol, 2021; Freud, 1926).

5. The APF has been integrated into the IPA shortly after its creation.

6. Lay analysis refers to analysis conducted by non-medical professions such as psychologist, psychotherapist but also Linguist, mathematicians …

7. The equivalent of NICE in United-Kingdom.

8. Aside with the development and diffusion of various therapeutic orientations (CBT, Hypnosis …).

9. In many Centres Médico Psychologiques (CMP), it is not uncommon that access to a psychiatrist (after an initial assessment made by a nurse) would be principally based on the need for pharmacological treatment.

10. However, access to the master’s in psychology is only possible after the validation of a licence in psychology (including a significant number of internship hours). It is also important to mention that the number of available places, especially in clinical psychology, is very small, leading to strong competition for access to the master’s degree.

11. The salary of clinical psychologists is low in the public domain (between 1400 euros at the start of their career and 3000 euros and the end). Moreover, the universities have and still graduate a lot of clinical psychologists (several hundred clinical psychologist in some universities, probably more than 2000 clinical psychologist each year), which has for consequence that most of clinical psychologist have difficulties to find a job and also explain why their salary remain very low. On the contrary, the number of psychiatrists decrease, and they find very easily a job in the public domain even if they are also suffering from a decrease of the quality of their working environment for the reasons described above.

12. Some therapists working before the publication of the 2012 decree were however confirmed as a psychotherapist (without the necessity of the theoretical and clinical training) by a specialised commission.

13. The notion of hospital sector has been associated with that of poles since the HPST law (2009) and the previous publication of specific orders. There are now different levels of institutional organisation leading to specific care pathways for certain pathologies (e.g., psychosocial rehabilitation pathway formalised at the ‘pole’ level but based on a sector logic).

14. Consequently, the CMP must ‘classify’ the most urgent demands, reduce the duration and the frequency of their therapies, and thus the quality of care. As the number of psychiatrists is also decreasing (they can sometimes see more than 500 patients per year), some of them have no other option to limit their intervention to a global evaluation of the patient and use the prescription of drugs.

15. Some mutual insurance companies start to offer flat-rate reimbursements for a predefined number of consultations per year.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.