Letter to the Editors from Ms Mary Boston, Devon, UK

I should like to comment on the interesting and innovative paper by Gunnar Carlsberg, ‘Laughter opens the door: turning points in child psychotherapy’ in the previous issue of this journal.

The author noticed that in the course of individual psychodynamic therapy with children, therapists often identified particular sessions where something qualitatively new occurred. He set out to research these ‘significant points’ with a view to increasing knowledge about processes of change. Critical of the usual outcome studies, he makes a case for a research method which ‘taps the rich clinical experience of skilled therapists — and which is in harmony with the psychotherapy process itself’.

The research was based on interviews with five therapists who were asked to make contact if they experienced one of these turning points in the course of their work. The therapists were then asked to produce process notes for the turning point session and for the two preceding sessions, to answer a questionnaire and also were interviewed one and two years later. A number of narratives were thus collected, which were analysed to discover common themes and underlying patterns.

This original paper raised many questions in my mind. I found myself wondering how many of my own cases, past and present, showed these turning points. Some did but in others, retrospectively I could not think of any. What about those steady, plodding cases where nothing new seems to happen yet some gradual change occurs? An advantage of this kind of research is that it encourages us to think about processes of change and to try to formulate what we are doing. A disadvantage seems to be the unpredictability of these turning points where surprise is a crucial element.

There is certainly a need for innovative methods of research. It is however difficult to generalize from Gunnar Carlsberg's material, not only because there are only five cases (which of course could be remedied