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Michael Barkham's and Bob Hobson's papers in the journal on the rationale of the Two Plus One model of psychotherapy and the account of the therapy with a patient clarified for me a major difference in stance and attitude between my understanding of dynamic psychotherapy, whether radical or conservative, and that of the two authors. It seems to me that this therapy is essentially behavioural and directive, and that this has major implications in terms of Barkham's proposition that the model will ‘enable investigations to be made on psychodynamic processes which will be technically heightened by the short duration of therapy’. Psychotherapy research needs to address itself to defining accurately the nature of the processes that are involved if any general conclusions of value are to be drawn. The assessment of the effectiveness of any model of psychotherapy needs to compare and contrast and to define difference in relation to other models.
For more than thirty years I worked with Brief Psychotherapy, as it is now called, in the NHS using the Jungian analytic approach in individual and group analytic therapy. My experience does not suggest that patient satisfaction evaluates therapy as Barkham seems to suggest in quoting Silverman and Beech, nor that single session improvement of necessity tells us much of what has taken place for post hoc is not as we all know propter hoc. Kate Wooff and I (Dick & Wooff 1986) followed up patients who were admitted to a time-limited programme of twelve weeks of group psychotherapy, and found that those who dropped out of the therapy expressed as much satisfaction with their life situation as the the full participators in the therapy. This was surprising in view of the fact that the drop-outs had significantly increased their use of the inpatient, out-patient and day-patient psychiatric services compared with the year prior to their admission to the Wilton Unit. This was in contrast to those who completed therapy, the majority of whom h