Editorial

It is pleasant to find objective evidence of the beneficial outcome of psychotherapy. Alasdair Macdonald devised an interesting measurement: the numbers of visits to the general practitioner before and after treatment. This is a useful measurement as it overcomes the bias laid on conscious assessment by the patient which is inherent in ‘consumer satisfaction’ studies. The fall in those visits which he found even after the briefest psychotherapeutic treatment is important clinically, as well as administratively.

The preferred method of assessing outcome which psychotherapists usually adopt is an attempt at gauging change in the internal world of the patient. More or less unmeasurable quantitatively, much of the psychotherapy literature is trying to describe qualitative assessments of the internal world of patients. In Sue Gottlieb's paper she describes the nature of possible internal change in a patient who has suffered a significant early deficit. The object's capacity to function as a transformational object significantly affected the internal world and its state of integration in the face of experiences to be metabolised. Maxine Anderson takes up a very similar theme but looks at it in terms of an essential conflict, rather than an historical deficit. The capacity for the object to perform the same containing (transforming) function is in this case hampered by the attacks upon that object. These two papers taken together pursue opposite trajectories in the deficit-versus-conflict debate; and they bear comparison on this dimension.

The burden of responsibility placed on a defective external object is emphasised by Paul Tibbles and Gillian Russell. They show the way a schizophrenic girl deals with an uncommunicative (uncontaining, or defectively transforming) mother through generating a symbiotic world to live in. It appeared that all three parameters - the daughter's schizophrenia, the mother's uncommunicativeness, and the symbiosis between them - changed together (a