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Some years ago a medical student in twice-weekly, private psychotherapy had the following dream: he emerged from my consulting-room located, it seemed, at the top of a beautiful, white, marble staircase. As he descended the stair he felt gratitude for a good session mixed with apprehension and sadness about the two-day gap before the next one. He was expecting to meet his father and younger twin brothers in the hallway and to go with them to watch a video of Startrek. Instead, he found himself beckoned by a group of ‘domestics’ who, flattering him with the title ‘doctor’, lured him down into the basement where homosexual activities were taking place in undifferentiated groups behind screens.
Leaving you for the moment with your own thoughts about this dream, I should establish my central interest: an engagement not so much with what people do (only verifiable, where psychoanalysts are concerned, in the crudest terms - ‘extrinsic criteria’ - like number of sessions, sitting or lying down etc.) but with how they think, and with the implications of that. The relationship between psychoanalysis and psychotherapy which I shall be exploring here does not involve discussion about ‘pure’ and ‘impure’, gold or alloy, nor about ‘standards’, but about structures of feeling, matters of openness, accessibility, creativity - ‘growth’. It is about what constitutes ‘the work’ - a question sharpened, indeed profoundly affected, by the implications of the distinction between psychoanalysis and psychotherapy in terms of the ways in which that division articulates how people think, and how people's thinking, in turn, structures the division.
First we need to consider what is a psychoanalytic mode of thought and how it is engendered. When Bion says in Experiences in Groups that, ‘We have to recognise that perhaps the members of the group assume too easily that the label on the box is a good description of the contents’, he is speaking with characteristic self-irony of the kind which must