Freud's Free Clinics

1922
candidates, who were still in training and not yet full-fledged psychoanalysts,
could sign on with Hitschmann or, later, Wilhelm Reich, as assistant director
of the clinic, and contract to cover in kind the costs of their training. The particular
model of paying for psychoanalytic training by treating patients for
free or contributing financially to the clinic’s upkeep meant that candidates
who had undergone a training analysis free of charge would have to work at
the Ambulatorium two years without remuneration. 15 The advantages of this
formula were at least threefold. For the clinic it assured that all staffing needs
would be met. For candidates this plan sustained training analyses as a component
of psychoanalytic education. And for current and prospective
analysands these decisions implied that clinic patients deserve the same respect
and sense of professionalism all too often confined to private practice,
the same points on confidentiality and equitable treatment Ernst Simmel had
made in Berlin.
Eventually all analysts treated gratis at least one-fifth of their practice, an
unspoken custom shared by even the most accomplished doctors in Vienna. 16
In the privacy of their home offices or in the open and often less comfortable
rooms at the clinics, analysts were known to volunteer up to a full day of their
workweek. “Our pioneering analytic institutes of the past were poor,” Anna
Freud recalled years later, “and even to provide cases and treatment rooms for
supervised analytic work stretched their resources to the utmost.” 17 Helene
Deutsch, Wilhelm Reich, and Richard Sterba were repeatedly summoned to
undertake free analyses either at the Ambulatorium or in their offices. Lacking
their Berlin colleague Max Eitingon’s brilliant administrative skills but
nevertheless desperate for a policy that would fairly and systematically apportion
their patients, the Vienna society adopted the versatile Erlagschein
voucher system. Within a medical community like the clinic an authorized
signer could use the voucher to personally reimburse a colleague who had donated
time to treat a patient. Senior analysts thus gained a reprieve from volunteer
work, junior analysts were compensated for assuming extra clinical
hours, and the Ambulatorium was assured of a stable economic footing, at
least in the short run. Freud opted to participate in the Ambulatorium’s voluntary
self-funding (by way of the Erlagscheine), partly because he agreed
with this approach and also because, by 1922, the city’s professional classes
were no more exempt from postwar economic hardship than the workers
they treated.
But at times, the psychoanalysts decided, the formula would have to be
stretched, and a monthly cash contribution to the Ambulatorium could absolve
them from the responsibility of direct treatment. If Sterba’s memory
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