Later Reflections on the Paper

‘Patients not ready for interpretation’ was the topic I was puzzling over more than any other, 20 years ago. Why weren't they ready? What is ‘ready’? Should we persist in interpreting, or adapt to their ways? For me the topic seemed an important one at that time. What has changed since then, in our attitudes and our practice?

I was thrilled when I learned that my paper on this topic was to be included in the commemorative issue of the BJP. But re-reading gave me a shock - nothing to do with the main issues, but how I now regret my accounts of ‘Rose’ and ‘Ken’! Like many others, I now think we not should indulge in these general accounts, brief or lengthy, even when ‘Rose’ and ‘Ken’ agree to them, unless there is some precisely formulated reason for them. In this paper they do not further the argument in any precise way.

I am now also embarrassed to note how little I trusted the common sense of BJP readers - how I conscientiously spelled out some obvious considerations! Or was that necessary 15 years ago?

But I think the paper does retain some merits. There are, alas, still many psychoanalytically-oriented psychotherapists whom I like and respect, to whom I rarely refer prospective patients because I fear they might regard them not primarily as suffering people but primarily as people likely to be devious, stubborn and self-deceiving, with a major interest in outwitting their therapist. While I agree that ‘the heart is deceitful and desperately wicked’, and that many patients need at times to be managed by having their evasive manoeuvres interpreted, nevertheless it still seems to me counterproductive to react to these manoeuvres as moral flaws rather than defences against pain. There are still therapists with this attitude, though fewer, I think. I do not think that an editor of the BJP would now write (as one did in ), that this paper is about ‘patients who stubbornly refuse to accept their unconscious motives and phantasies’ (my italics). At that time, few who read t