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John Hughes – A couch up a Public Health Psychiatrist’s Sleeve


THE LETTER 12 Spring (1998) pages 99-105


Working psychoanalytically with non fee-paying patients in the public health sector presents certain problems. Many subjects have been patients of the psychiatric services for years, even decades, and as an analyst one is regarded: i) invariably, as yet another in a long line of medical practitioners, and ii) always, as a member of a support ‘team’. Very few patients would be familiar with or interested in the distinction between counselling, psychotherapy and psychoanalysis, being principally interested in alleviation of anxiety. However, despite these and other problems, results can be achieved, and perhaps the non-payment of fees is not such an insurmountable problem. I would suggest that it is the transference that provides the opportunities; and within the context of a public health setting, the absence of payment doesn’t seem to become an impossible obstacle in the development of the transference.


For just over three years I have been working with medical card patients, seeing each patient twice a week, at a public health ‘community mental health day centre’, a unit ancillary to one of Dublin’s Psychiatric hospitals. A consultant psychiatrist refers patients from amongst those who attend his nearby clinic.

A couch up a Public Health Psychiatrist’s Sleeve

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