Sharpe, E. (1950) Psycho-physical problems revealed in language: an examinationof metaphor. In R. Fliess (ed.), The Psychoanalytic Reader. London: Hogarth.

Strachey, J. (1934) The nature of the therapeutic action of psychoanalysis. Inter-national Journal of Psycho-Analysis 15: 127–59.

Trilling, L. (1950) The Liberal Imagination. London: Secker & Warburg.Wing, K.K. & Brown, G.W. (1970) Institutionalism and Schizophrenia. London:

Cambridge University Press.Winnicott, D.W. (1971) Playing and Reality. London: Tavistock.

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POSTSCRIPT: ‘I WAS SO MUCH OLDER THEN . . .’

If I were sent this article to review by the BJP today I suspect I would siton the fence about whether or not to recommend publication. Followingconventional etiquette I would start by finding a few things about it to praise:quite interesting in a slightly off-beat way, good discussion of the poem, notbadly written although occasionally somewhat pompous especially in theopening page, clinical examples competently handled (but has he got writtenpermission to publish these details?).

Then I would start to pull it apart. What exactly is the author trying to sayand where precisely is he (assuming it is a he as BJP articles are, of course,anonymized) coming from? Is he a middle-grouper, a Jungian, an interper-sonalist, or what? Why all this emphasis on Rycroft, a somewhat marginalfigure? Why not talk about psychotherapeutic process in its own terms,without having to muddy the waters by bringing in poetry for goodness’ sake– most people hate or ignore the stuff anyway? And all this psycho-therapy/neurology stuff at the end seems rather out of date – hasn’t he heardof Solms (1997), Schore (2003), Gerhardt (2004) et al.?

Well, what was I trying to say, and where was I coming from? At one levelthe latter is fairly straightforward: I was (literally) coming from therapy withCharles Rycroft, and wanting to fly the Rycroftian flag (see Pearson 2004)– my post-therapy positive transference/idealization at that stage stillsomewhat unresolved. At another, I was simply following my own personalform of eclecticism and wanting to see if one could think about psycho-therapy in the same sort of terms as poetry. The question remains – whyshould one have wanted to do that?

I suppose my answer would be that the paper was an early attempt totackle a problem which I continue to see as largely unresolved: the hugediscrepancy between psychoanalytic theory and what actually goes on in theconsulting room between patient and therapist. And, in a Rycroftian way, Ithink there is an inherent difficulty for psychoanalytic theory in theorizingitself. Turning to a discipline outside psychotherapy for illumination was anattempt to overcome this problem.

I continue to see ‘reading’ a session and reading a poem as analogous.One sits with the patient. One listens – with the whole of one’s being. That

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means not just noticing what the patient says and does, but also attendingto one’s own inner response – physical, emotional, intellectual – to one’sperceptions. This requires the capacity to live with an inherent paradox – orambiguity. To be present to the patient means simultaneously absentingoneself from one’s preoccupations, worries, desires, while being utterly athome with oneself.

As with responding to an artistic creation, there is an inner response,untheorized, raw, intuitive, coming from the depths of one’s being – from‘below’. This might be a physical sensation, a pricking of the eyes, an appar-ently irrelevant image, a feeling of boredom or excitement. This is the bodilycomponent which is the basis of metaphor.

Then, from somewhere laterally, ‘left field’ as the American baseballmetaphor has it, a spontaneous thought will arise: ‘This patient doesn’treally want to be here today’, ‘She is holding back tears, I wonder why?’ or‘Things seem awfully flat today, what is going on?’

At this point theory – which I conceptualize in the paper as essentiallymetaphoric – floats in, as it were, from ‘above’: ‘This is clearly a defenceagainst intimacy’, ‘The patient seems to be moving from paranoid-schizoidto depressive position thinking’, ‘An obvious case of avoidant attachmenthere’.

The therapist’s mind then has the task of synthesizing all this into a helpfulresponse. This might consist of an interpretation (‘I get the feeling there isa lot of sadness behind all that’, or ‘I wonder if you felt pretty pissed off withme for not being there last week just when you needed someone to be therefor you, a bit like you might have felt when your Dad was away at sea andyour mother got ill’); a quasi-verbal utterance (‘Mmmm . . .’), or despite alot of active inner speech on the part of the therapist, no external verbalresponse at all (‘When in doubt do nothing’, as one of my psychotherapyteachers always used to say), although attentiveness and compassion mightbe communicated via body posture and facial expression.

The paper could be seen as an attempt to carve out a space for qualitativeresearch that is sufficiently near experience to be valid, sufficiently under-pinned theoretically to be reliable. It naively attempted to dispense with theboth weighty superstructure of psychoanalytic theory, and the reductionismof quantitative psychotherapy research. Towards the end it was a tentativegroping for a more nuanced neurobiological approach that might encom-pass the subtleties of interpersonal interaction.

It was the beginning for me of a journey through attachment theory(Holmes 1993, 1996, 2001) which in its most recent manifestations showshow the technology which has illuminated the minutiae of mother–infantinteraction can also be used to study patients and therapist as theycommunicate (Diamond et al. 2003). This work suggests that in helpfultherapies there is a mutually interactive process of adjustment and adap-tation between therapist and patient which cannot be predicted from the

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psychological sophistication (as measured by the Adult Attachment Inter-view) of either alone. Most people have one or two favourite poems, butcan be helped to expand their repertoire of appreciation through practicalcriticism. Similarly therapists can widen the range of people they are ableto help through training, not so much in theory, but in understanding howbetter to ‘mentalize’ (Bateman & Fonagy 2004), i.e. to think about them-selves and their reactions, in the minute-to-minute movements of therapysessions.

My initial recommendation therefore would have been a radical re-writeand re-submit. But, on reflection and mentalization, let it stand. ‘I’myounger than that now . . .’ (how I wish!).

Jeremy Holmes

References

Bateman, A. & Fonagy, P. (2004) Psychotherapy for Borderline Personality Disorder.Oxford: Oxford University Press.

Diamond, D., Stovall-McClough, C., Clarkin, J. & Levy, K. (2003) Patient–therapistattachment in the treatment of borderline personality disorder. Bulletin of theMenninger Clinic 67: 227–59.

Gerhardt, S. (2004) Why Love Matters. London: Taylor & Francis.Holmes, J. (1993) John Bowlby and Attachment Theory. London: Routledge.Holmes, J. (1996) Attachment, Intimacy, Autonomy. New York: Jason Aronson.Holmes, J. (2001) The Search for the Secure Base: Attachment Theory and Psycho-

therapy. London: Taylor & Francis.Pearson, J. (2004) Analyst of the Imagination: The Life and Work of Charles Rycroft.

London: Karnac.Schore, A. (2003) Affect Regulation and the Repair of the Self. New York: Norton.Solms, M. (1997) The Neurophysiology of Dreams. New York: Lawrence Erlbaum.

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