Correspondence

Dear Editor,

I was grateful for the review of Concerning the Nature of Psychoanalysis: The Persistence of a Paradoxical Discourse (British Journal of Psychotherapy 2021, 37 (1): 159-61), and the author's appreciation of my book. Unfortunately, the review contained a number of misleading statements and misrepresentations. I will limit myself to clarifying one of them.

Diana Birkett states that ‘… Kohon makes a passionate plea for the unique qualities of psychoanalysis, and against the requirement for accountability that he feels is imposed by the mental health establishment’ (Birkett, p. 159, emphasis added). In the context of the express complaints of nurses, psychologists and psychiatrists working in the NHS concerning the interminable demands to fill in forms, I argue that: ‘While the requirement to document events occurring with patients as well as assessments and treatments is a necessary form of accountability, the bureaucratic exaggeration of these processes undermines the clinical expertise of the clinicians involved’ (p. 87).

I also argue that ‘… the ethical issue of professional accountability in psychoanalysis, important as it is, has been (mis)used to hide institutional conflicts. Accountability has been erroneously confused with measuring the outcomes of therapeutic intervention …’ (p. 88-9). Furthermore, I clearly accept in my book that, if psychoanalytic-inspired treatments are to be used in the NHS, they would be expected to provide evidence of effectiveness. Nevertheless, given the nature of the psychoanalytic discipline, objective evidence through empirically demonstrable results is not easily achieved. My book aims to show why - at least, in part - that is so.

According to Bion, there is only one experience, ‘that … which the analyst … had with his patient’ (Bion, , p. 7). It is up to the individual psychoanalyst to legitimize that experience, and to account for it. Hence, the value of the single case study.

At no point do I oppose, dismiss or minimize