Commentary by a Member of the North of England Association for Training in Psychoanalytic Psychotherapy

My response to this paper is in two parts; some of my thoughts on the paper, and some of my thoughts about the question it poses. I do disagree with some of the paper's assertions and implications. The author outlines the various strands of thought he has had about this question, and suggests that as a profession we are not careful enough with what the question to increase brings forth about the patient and the treatment. I felt that the paper has a rather admonishing tone at times, and found myself wondering who the author has in mind. I believe that very few psychotherapists/psychoanalysts are as rigid as he describes, and I take a different view. I think he is implying that the views that psychotherapists hold about frequency are more akin to shibboleths - fixed and often outmoded doctrines which have to be adhered to rather than thought about. I see them more as fixed points of the compass the therapist uses to orient him/herself in order to have some framework; I do not believe this necessarily means that they are not thought about, or are not amenable to change. I am also not entirely clear what the author is saying about the value of psychoanalytic psychotherapy, and whether in fact he thinks it useful and appropriate in only a few cases.

There is a direct assertion in the paper which I did not agree with:

There is general agreement that psychotic patients have a poor prognosis when considered for psychodynamic therapy. The same applies to others presenting serious psychological disturbances (e.g. Asperger's syndrome, addictions, manic-depressive illness, personality disorders, etc.) and yet we can find that some of these patients may be quite keen to embark on psychodynamic therapy and may often want to continue having it for extremely long periods of time. I believe that even when both patient and therapist are happy with the progress of the work, i.e. there is improvement in some areas of the patient's life, the prognosis for change of the basic pathology is