Why Caregivers Retrain as Psychoanalysts

Doctors, special education workers, psychiatric nurses, speech therapists: there exists a discreet but recurring phenomenon in the world of care. Trained, established caregivers, sometimes in the middle of their career, begin a personal analysis on their own account. And after a few years, some of them change profession. They become psychoanalysts.

It is a significant minority that recurs with a quiet regularity. This article tries to map the movement — not to suggest that all caregivers should become psychoanalysts, but to understand why, when the questioning goes to its term, it consistently points in that direction. The journey is not a rupture. It is an aboutissement.

The trigger of retraining: the caregiver's personal analysis

It all begins there. An educator, a doctor begins an analysis for personal reasons — a difficulty, a period of life. They think it will have nothing to do with their professional practice. They are mistaken.

The encounter with one's own unconscious changes everything

Analysis does one precise thing: it makes the subject discover that they are inhabited by an unconscious — not as a theoretical notion but as a direct experience. They discover that they say things they had not planned to say, that their most assured choices respond to logics they did not know. And from that moment, they can no longer look at their patients in the same way. The caregiver who until then saw a suffering person to be helped begins to see an entire subject, traversed by a psychic economy that overflows the explicit demand. What they were doing before — useful, helpful — begins to appear insufficient. Not wrong. Insufficient.

First wavering: hearing the patient's demand differently

What the patient asks for is not what they need

Honest clinical experience shows something troubling: what the patient asks for is never exactly what they need, and what they need is never exactly what they think. The patient who asks for their symptom to be removed actually holds onto this symptom through all sorts of ties they ignore. The patient who claims help tends to organize, without wanting to, the failure of this help. The patient who wants to be repaired would above all want, secretly, that nothing change.

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An impossible situation: hearing without being able to work

The caregiver who has not done analysis continues to take the demand at face value. They respond to it, they do their work, they really help — and at the same time, they constantly miss something they don't know they are missing. The caregiver who has begun an analysis, on the other hand, begins to hear what lies beneath the demand. They hear the paradoxes. They hear the obligatory passages of discourse that do not stand up. They hear what the patient says by saying something else. And they find themselves in an impossible situation: they are trained to respond to the explicit demand, but they now have access to something that is being said underneath, and their professional framework does not allow them to work at that level.

Second wavering: questioning one's own position as a caregiver

The savior, the repairer, the bearer of knowledge

Every caregiver occupies, whether they want to or not, a position vis-à-vis their patient. This position is not neutral. It is made of imaginary material — that is, identifications, fantasies, self-images that silently structure the encounter. The caregiver may imagine themselves as repairer, accompanying figure, witness, bearer of knowledge, savior, parental figure, ally against the system, guide. These positions are not bad in themselves — they are inevitable, and some are fruitful. The problem is not that they exist. The problem is that they operate without the caregiver knowing it.

This narcissistic dimension of the caregiver's position deserves to be worked through for itself — this is the whole stake of our article on narcissism and the death drive.

What analysis reveals about the origin of the desire to help

Personal analysis forces the caregiver to ask: what do I expect from this encounter? What does it come to fill in me? What would it do to me if one of them did not need me? These questions are unpleasant. And what analysis almost always reveals is that the caregiver's position is not only at the service of the patient — it also serves the caregiver's own anxiety, their need for confirmation, the repair of personal wounds. This does not disqualify the work. It simply makes visible what was acting without being known.

Third wavering: disentangling one's stakes from those of the patient

How the entangling of stakes damages the clinical encounter

As long as this mixing is not disentangled, the caregiver does not know exactly for whom they are working. They believe they serve the other, but they also serve — and sometimes primarily — something that concerns them. And this has very concrete clinical consequences. The patient senses confusedly that the caregiver needs them — that they need them to get better, that they need them to say certain things, that they need them to validate certain positions. And the patient, out of loyalty or out of concern not to disappoint, often arranges themselves to respond to this implicit demand. The care then begins to revolve around the caregiver, without either knowing that this is what is happening.

Analysis allows the disentangling to be done. It restitutes to the caregiver their own stakes as theirs — as belonging to their history, their structure, what concerns them — and thus frees the encounter with the patient from a charge it did not have to bear. Once this work is done, the relation to the profession changes profoundly. The caregiver stops looking in their patients for the resolution of questions that are their own. They can finally encounter them, in their proper singularity, without their own demand silently weighing on the exchange.

And it is exactly at this moment that a formidable observation appears: most of the professional frameworks of care offer no space for this disentangling. The caregiver who has done it for themselves finds themselves out of step with their colleagues who have not done it, with their institutions that do not ask for it, with a training that does not address the question. They know something that is not known around them, and this knowledge displaces them.

Fourth wavering: the institution is built to miss the essential

The last wavering is of a more structural nature. It is the one that touches the very form that care takes in contemporary institutions.

Protocols, diagnoses, care plans: the standardization machine

The caregiver in analysis begins to perceive, with growing acuity, the extent to which the institutional organization of care is built to miss what really matters. Protocols, standardized diagnoses, care plans, calibrated interview durations, assessments, evaluations, indicators — all this administrative and clinical apparatus has been designed to treat the patient as a generic case, traversed by nameable problems and addressable by reproducible solutions.

This critique of the dominant model, we have developed in our article on psychology as a pseudo-science compared to psychoanalysis — where we show how the appearance of scientific seriousness masks an operation that misses exactly what makes the human.

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The real patient fits into no box

But the real patient is never generic. They fit into no protocol. Their suffering, their resistances, their paradoxes, their singular relation to their own life — all of this overflows on all sides the frameworks in which one pretends to inscribe them. The honest caregiver has felt it for a long time. But they make do, because they have no choice, and because the institution repeats to them that this is what well-done work is: filling in the boxes, following recommendations, producing assessments.

Burnout, depression, loss of meaning: signs of an unresolved conflict

It is at this stage that many caregivers go through a moment of crisis. Burnout, depression, loss of meaning, feeling of emptiness. What is politely called "workplace suffering" is, in many cases, the expression of this unresolved conflict: having understood something about what care could be, and continuing to practice in a framework that forbids it being that.

Why retraining leads to psychoanalysis rather than elsewhere

Why psychoanalysis is the coherent framework

Psychoanalysis takes seriously that the patient speaks, and that what they say deserves to be heard without being immediately classified. It takes seriously that the subject is unconscious, and that what determines them plays at a level to which protocols have no access. It takes seriously the position of the analyst — that is, it demands of them a long and deep personal analysis, without which they cannot practice. It takes seriously time, framework, regularity, duration — those material conditions that make a certain type of work possible.

The caregiver who switches to psychoanalysis does not deny their original profession. They find its logical extension — the only place where what they have understood can continue to deploy itself without permanent contradiction. It is not a betrayal. It is a fidelity.

The patient is neither victim, nor sick, nor machine to repair

The figure of the victim to protect

The figure of the patient as victim has its historical legitimacy: it was necessary to do justice to suffering that was not recognized, to validate accounts that were not wanted. But when this figure becomes the main grid, it places the patient in a position of pure passivity in the face of an evil come from elsewhere, and removes from them any capacity for elaboration. The patient-victim has nothing to think about what is happening to them — they only have to be recognized as a victim. It closes the door to any possibility of subjectivation.

The figure of the sick person to cure

The figure of the patient as sick is the direct heritage of the medical model. It supposes that there exists a "healthy" state of which suffering would be the deviation, and that one must therefore treat the patient so that they return to the norm. This works for somatic pathologies. It works very badly for what belongs to the speaking subject — there is no objectifiable "psychic health" to measure against. What makes a subject suffer is not a dysfunction to correct but a symbolic formation that asks to be heard.

The figure of the pupil to re-educate

The figure of the patient as object to re-educate deploys itself particularly in cognitive-behavioral approaches, but it widely penetrates educational and medico-social institutions. The patient is taught to better manage their emotions, to better structure their thoughts, to better interact socially — transforming them into a pupil of a school they never asked to be part of. It radically denies that the symptom has something to say: it treats it as an error to correct rather than as a message to decipher.

None of these three figures holds up before real clinical experience. None respects what the patient is in truth: an entire subject, traversed by an unconscious, bearer of a history. The caregiver who has had the experience of this in analysis can no longer, in good faith, treat their patients as victims, as sick people, or as objects to be straightened out. They have seen something else — and they know it deserves a response that does not resemble any of the three.

What to do when one does not go to the end of the movement

Cynicism, burnout, flight: the exits of non-elaboration

The caregiver who senses confusedly that something is not right, but who does not have the tools to elaborate it, ends up developing one of several reactions. The first is cynicism: they decide that patients are disappointing, manipulative, ungrateful, and take refuge in a defensive posture that emotionally cuts them off from what they do. The second is burnout: they continue to invest as before but exhaust themselves to the point of breaking. The third is flight: they leave the profession, believing they are escaping the problem — which will reappear elsewhere, because what was working on them did not only hold to the profession.

None of these outcomes is satisfying. None addresses what was at stake. The only movement that really resolves the conflict, for those who have begun to encounter it, is to pursue elaboration — and psychoanalysis offers, more than any other path, the framework to do it.

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Retraining as a psychoanalyst as aboutissement rather than rupture

What makes the coherence of this journey is that it has nothing arbitrary. The doctor who becomes a psychoanalyst has followed, to its ultimate consequences, the demand that had made them choose care in the first place: to take seriously the suffering of others. And it is precisely because they refuse to renounce this demand that they orient themselves toward the only place where it can continue to incarnate itself fully.

This is why this retraining as a psychoanalyst reproduces itself with a quiet regularity. It is not the worst caregivers who make this journey. It is often the best — those who have taken their profession seriously to the point of encountering its depth. Psychoanalysis is not, for them, one discipline among others. It is the name of what their honesty has carried them toward.

References

• /Freud, S. (1912). Recommendations to Physicians Practising Psycho-Analysis. Standard Edition, vol. XII.
• /Freud, S. (1919). Lines of Advance in Psycho-Analytic Therapy. Standard Edition, vol. XVII.
• /Freud, S. (1937). Analysis Terminable and Interminable. Standard Edition, vol. XXIII.
• /Lacan, J. (1953). The Function and Field of Speech and Language in Psychoanalysis. In Écrits, Norton.
• /Lacan, J. (1958). The Direction of the Treatment and the Principles of Its Power. In Écrits, Norton.
• /Lacan, J. (1964). The Seminar, Book XI: The Four Fundamental Concepts of Psychoanalysis. Norton.
• /Lacan, J. (1967). Proposition of October 9, 1967 on the Psychoanalyst of the School. In Autres écrits.
• /Lacan, J. (1969–1970). The Seminar, Book XVII: The Other Side of Psychoanalysis. Norton.
• /Mannoni, M. (1979). La théorie comme fiction. Freud, Groddeck, Winnicott, Lacan. Seuil.
• /Oury, J. (1976). Psychiatrie et psychothérapie institutionnelle. Payot.

Léo Gayrard, clinical psychologist and psychoanalyst