In order to do analysis, for Freud, what you need is inhibition, or symptom, or anxiety. Inhibition, symptom and anxiety are the bread that an analyst has to eat in order to earn his living. What does this mean?
If I experience a need, then, in trying to say what that need might be, I articulate the need as a demand. To the extent that I place that demand on an other who offers to meet that demand, I can expect to experience some degree of wanting or lacking in relation to what then happens. I am left with a continuing desire.
Analysts are in business, which means that they have to be able to relate their offering to the demands that individuals can make. So if I am suffering from some inhibition in my day-to-day life, some inconvenient or disruptive symptom, or some anxiety that has become unbearable, then the demand that I can make of an analyst is that there should be some alleviation of if not cure for my suffering. For this I can pay the analyst, my suffering being the bread that the analyst must eat if s/he is to earn her or his living.
This way of relating particular kinds of demand to particular kinds of offer is a way of organising demand that creates markets, in this case for analysis. It is a sign of our times that this way of relating suffering to the analyst’s offering is not as persuasive as it once appeared to be. A clue as to why this might be is in what Lacan said about the ways in which the analyst must pay (quoting from Fink’s translation of ‘The Direction of the Treatment and the Principles of Its Power’ in the Écrits pp 490-491, but with the sequence altered):
“Let us say that in the capital outlay involved in the common enterprise, the patient is not alone in finding it difficult to pay his share. The analyst too must pay: pay with his person, in that, whether he likes it or not, he lends it as a prop for the singular phenomena analysis discovered in transference; pay with words no doubt, if the transmutation they undergo due to the analytic operation raises them to the level of their effect as interpretation; and can anyone forget that he must pay for becoming enmeshed in an action that goes right to the core of being with what is essential in his most intimate judgement: could he alone remain on the sidelines?”
The analyst will get paid for time spent, although with short sessions this will not be at a fixed rate, and for words spoken within the context of the patient’s transference. The clue is in the challenge presented by the third way of paying, in which the analyst must pay with her or his being. The analyst must not only eat the bread but digest it too in the sense of incorporating something of the patient’s suffering into her or his own being. This is Winnicott’s ‘challenge of the case’ in which the analyst must go beyond what s/he knows if s/he is to help the patient, putting something of her- or himself ‘on the line’. Neither the analyst nor the patient can remain on the sidelines of the patient’s life. What is at stake here not only demands a different understanding by the patient of how needs become demands, but also of what constitutes the value of analysis itself.