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This paper raises many interesting and important issues relating to contemporary psychotherapeutic practice, and they are worthy of more attention than can be given here. While I found myself in agreement with many of the attitudes and positions adopted by the author, I would like in this
response to focus on one theme running through the paper which seems to me controversial.
This has to do with the idea of what the patient needs, to be understood in analogy with a medical patient who has been given a diagnosis from which, in general, the appropriate treatment can be inferred. I do not think there is an objective way to assess a patient's psychotherapeutic needs. Even if we exclude the greater part of professional opinion that has little sympathy for psychoanalytic psychotherapy, and consider the opinions of like-minded people, we shall find considerable disagreement about both the appropriateness of psychotherapy and, if it is indicated, the preferred frequency of sessions.
That is not to say that one or other of these opinions might not be the right one, but I think it is the patient who needs to decide what level of commitment they wish to give to the kind of internal journey offered by psychoanalytic psychotherapy. I am suggesting the issue is not what the patient needs so much as what the patient wants. Many different factors will be relevant when a patient makes a decision about what he or she wants, and once embarked on therapy a patient may wish to alter the level of commitment, as expressed in the frequency of sessions.
The issue of what the patient needs is linked in the paper with the classification of patients according to a two-by-two matrix. On the one hand, patients are seen either to be bringing a well-defined conflict, or to be presenting with a more generalized existential conflict. On the other hand, patients are seen either as being able to work with insight, or unable to so work. From this patients can be placed in one of four categories, and to