The ‘Real’ Therapist

Dear Editor

Could I use your correspondence column to put forward a view on a point Dr Bateman raises in his interesting article, ‘Integration in psychotherapy: an evolving reality in personality disorder’ (BJP 17(2): 147-156).

In discussing what seems to help, he says, ‘The active ingredient is the tripping up of the unconscious, being faced with the unexpected, and seeing things in a new light’ (p. 153). I see that as part of an understanding of what is happening in terms of what is going on within the patient, but I wonder if there may be more to it if one thinks in terms of something that is happening between the therapist and the patient. I have been gradually coming to suspect that one of the things patients look for is what might be called the ‘real’ therapist, by which I mean the person the therapist actually is, as opposed to the ‘professional’ person the therapist has been taught by their training to be.

To explain the point in more detail: when Dr Bateman wonders if it is the surprise of the therapist doing something different, i.e. a cognitive therapist using interpretation or a therapist who uses a transference focus using a cognitive intervention, that helps, I would agree. But I think it is not just that the ‘unconscious is tripped up’. I think the surprise is that the therapist lays aside their normal ‘professional’ way of working and uses an intervention that comes from the ‘real’ person of the therapist. The idea is similar to that put forward by Symington in his paper ‘The analyst's act of freedom as agent of therapeutic change’ in The British School of Psychoanalysis: The Independent Tradition edited by Gregorio Kohon , and I have come across similar examples from other therapists and in my own work.

I am not for one moment suggesting that technique should be set aside. But I do think that patients are continually interested in who this person really is that they find themselves in therapy with, and that meeting the ‘real’ person can, at times, help.