Chapter 2. Four Discussions

Questioner: I have been wondering why taking a history during an interview is important to me. I don't think I could give that up yet.

Bion: The first thing you have to consider is yourself and your way of working. If it is convenient to you to start off in some particular way you should do so. You can readjust it if you run up against a case in which it seems unsuitable. Patients are often used to this routine of giving a history, and you may as well let them feel at home by allowing them to do exactly that – otherwise it is so strange to them. If you start off by saying, “Now, what do you want?” or “What can I do for you?”, the patient may reply, “That's what I came here to find out”, and will not move from that point. You are straight away in the middle of a story without knowing anything of its beginning. The essential thing is to give patients as much help in that way as you can, because they are the people who don't know what they are up to. If it can ease the situation for them to follow the sort of routine they are used to that's a good idea.

Q: I would like to get a concrete idea of how you personally work with patients, to what extent you guide the direction of a patient's introspection and talk as opposed to letting the patient talk about what he or she wishes.

B: I would like to be able to say that I don't guide them, but in fact that is not true. It is a great mistake for an analyst to imagine that he doesn't. Theoretically you leave patients plenty of space to say whatever they like, but in fact your mere presence distorts the whole picture. They take one look at you and make up their minds either that they are prepared to talk to you, or that under no circumstances will they do so. The relationship between the two people is a two-way affair and in so far as one is concerned with demonstrating that

relationship it is not a matter of talking about analyst and analysand; it is talking about something between the two of them.

Q: Most people talk about perso