A Commentary on Patrick O'Neill's Negotiating Consent

I saw Allannah Furlong's review of Patrick O'Neill's book (published in the last issue of this journal) and then read Negotiating Consent. I had a number of reactions to the ideas that make up the book and to O'Neill's particular approach to psychotherapy. I wanted to make some comments, both as a means of contributing to a discussion about psychoanalytic ethics, and also to promote dialogue between my kind of psychoanalysis and a co-constructivist approach.

The book sees psychotherapy as the joint construction of an interpersonal field between patient and therapist. The parties are equal in the creative activity, even though their roles may be different. The precise nature of the roles is not very clear, and this is not the intention of the book. The book addresses negotiation in psychotherapy, and the ethical basis for that starting point. O'Neill assumes that a lot of psychotherapy takes place in ignorance of the need for negotiation at all stages. There may be therapies that do indeed ignore that apparent sine qua non. The therapy for which I was trained—psychoanalysis—does singularly address the need for negotiation between both parties. However, psychoanalysis, in the form that I understand it, is a negotiation over constructing new knowledge, knowledge that comes from joining the unconscious of one with the expertise of the other. O'Neill's therapy is different. It is concerned with the negotiation of different world views, more or less consciously held, on the part of patient and therapist. They are assumed at the outset to differ, and on the whole they are assumed to be capable of reconciliation, if sufficient goodwill is available. O'Neill is concerned with the goodwill of the therapist, who he believes may act in bad faith to assert his own views over the patient's.

O'Neill is particularly thoughtful about the way that an individual's world view is constructed in terms of narrative, and he takes support from the