Editorial

The making of a therapist is one of the most complex accomplishments of human culture - it takes another therapist to hone the personality of the trainee into a fine tool. Or does it? Norman Macaskill reviews the balance of evidence in the literature. The complex, and in some ways contradictory, picture suggests there are many factors and some of these must be to do with the quality of the training therapist's work, the personality of the trainee, and various aspects of the interaction of therapist with patient. The negotiation of anxiety between the therapist and the patient, a topic of intense scientific and anxious interest in recent years, is captured in Marie-Christine Reguis's personal account of suffering her training. The anxiety of the psychotherapeutic situation is not, of course, confined to the patient, nor are the therapeutic benefits. The therapist's task is to turn the anxiety to benefit - not only in the winning of an essay prize, but in engaging the patient in a process of change.

Herbert Hahn describes the arduous process of engagement, simple enough in the sophisticated and leafy suburbs of north-west London. But, out there beyond the M25, where the maps say merely ‘there be dragons’, there are also therapists and they are engaging with patients. The capacity to meet a patient is the engaging of one unconscious with another. Do patients unconsciously know what to expect from interpretive understanding? - or do they need conscious induction into what to expect? I suppose it must be something of both, and we normally look to childhood and infancy to find a model for this kind of interactive contact that must happen unconsciously, intuitively. Andrea Pound and her colleagues have studied, in a quantitative way, the interaction between mothers who are depressed and their infants. There appears to be no simple causal link between depression and the interaction. Multi-factorial, over-determined and mutual forms of causality are the headache of the statis