In Praise

Dear Editor

The Eighth Annual Lecture of the British Journal of Psychotherapy, with Peter Fonagy and Anthony Ryle presenting their ideas on psychoanalysis, cognitiveanalytic therapy, mind and self, was an intellectual feast. Thank you for making it possible. Anthony Ryle gave a clear if necessarily brief account of CAT techniques, their effects on patients, and the theoretical framework which forms their context, with an acknowledgement of indebtedness to Fairbairn, Guntrip and Winnicott. Peter Fonagy started from a consideration of the nature of mind and of self, within which context he made a number of points, the most interesting of which, from the point of view of comparison with the other speaker, concerned the depth at which he thought psychoanalysis could operate, relative to the more ego/superego-based CAT. He postulated deeply ingrained stimulus-response sequences of an object-relations kind which needed time and specifically psychoanalytic techniques, if the therapist were to reach and somehow modify them with some confidence that they would not eventually re-appear in the patient's behaviour.

Both speakers were careful to say that they were presenting unproven hypotheses which at present, in the absence of facts, could only be supported by (equally unproven) theoretical structures. Contributors from the audience in my view were less careful, and often seemed to me eager to set the two speakers by their ears.

Sitting with patients the next day, I found myself thinking at times that what was happening between them and me just at this moment would be recognised by both speakers as therapeutic, and could be described by either in terms of their own theories. This person, telling me now that ‘the kid in me is just too large, and gets hurt because other people do not like her to be there … she needs to be controlled somehow’- was she recognising something about her upbringing which had made her engage in unnecessarily difficult-to-be-with procedures at the present