Settings for Psychotherapy

Setting can be looked at on a number of levels. The most obvious is the institutional level, i.e. whether we practise as part of an agency, GP practice, church, student counselling service, or whether we offer our services privately. Among the important consequences of this distinction is the issue of whether patients do or do not pay for or can afford our services.

I think there are wider and also more specific senses in which the setting for psychotherapy is important. The wider setting includes the social and cultural context in which we practise and could include the political setting. I would like to start, however, with the setting in its narrowest sense - the way in which we set up our dealings with patients, irrespective of the institutional or cultural setting. This narrower sense of setting arises, to my mind, from the nature of what it is we think we are trying to do as psychotherapists.

I would suggest that our objective in psychotherapeutic encounter is to identify the unconscious phantasies and object relations which characterise the patient's inner life and his relationships with other people. We attempt to identify and interpret these phantasies and object relations as they manifest themselves in the patient's way of relating to us - in other words, in the transference.

There are fundamental differences between such a transaction and what would occur if the same two people met socially. We believe that the therapist will cloud and obscure the transference if he shares with the patient personal information or needs of his own. In a social exchange, when asked where you are going on holiday or if you have children, it is easy to reply. In psychotherapy your focus is on why these questions are being asked. It may be that the questions about your family, for instance, arise from oedipal anxieties which you may allay by telling the patient you are happily married with three children. But you could also be said to have put a piece of your personal reality in