A Struggle for Communication with a Patient in an Intensive NHS Psychotherapy

Abstract

In this paper, Bion's triad of papers ‘On arrogance’, ‘Attacks on linking’ and ‘A theory of thinking’ (1957, 1959, 1962) are drawn on to trace through and discuss how patient and psychotherapist learned to work together in the course of a three-times-a-week NHS psychotherapy, which lasted for just under two-and-a-half years, terminating with the ending of the therapist's training. Attention is paid to the constant oscillations of work with the patient, a young man, in which his narcissistic and grandiose defences, while crude and precarious, were clung to by him, and returned to throughout the work but with lessening conviction. These often apparently random oscillations could be understood in terms of what Bion describes as apparently scattered references to curiosity, arrogance and stupidity, which none the less provide the evidence of a continuing psychological disaster. Throughout were reminders of the limits to an NHS training psychotherapy, which could not be open-ended and which was brought to an end at a point at which the patient and psychotherapist had learned to talk to each other.