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Coming Out of the Dark Age:

Recognising Difference, Making a Difference


What do we do when confronted by patients who act in self-destructive ways or impinge upon
us as therapists? There is a tendency to blame the patient and often the term ‘personality
disorder’ is used in that way. This often masks the genuine suffering that affects these people
and those around them. One way of understanding the situation may be to look at our reaction to
‘difference’ in the sense of the encounter with something unknown and unfamiliar. If this is looked
at as an opportunity to know more about the other person it can become a path to therapeutic
engagement rather than a trigger for therapeutic derailment.

W e all develop our own clinical

comfort zones; the range
of problems we feel familiar with,
In psychiatric training we are told
that, whereas people with illness usually
present themselves because they are
as the actual experience that occurs
between people in a space that is neither
purely ‘objective’ nor purely ‘subjective’,
and more or less competent to deal experiencing suffering, people with the ‘place where we live’ (Winnicott,
with. Often enough, however, we personality disorder often present 1971), the world of experience. This
find ourselves up against something because of the suffering they cause to realm includes the experience of self
unfamiliar. The experience of others. Inherent in such a view is a lack of and the awareness of other selves that
encountering such difference in recognition of the suffering of the person impinge upon and resonate with our
clinical practice might be compared to with the ‘personality disorder’. The own sense of self. The primary mode of
hitting a wall. We don’t know what’s tendency is also to view these problems apprehension here is empathic rather
happening and the person we are with as intractable and unlikely to benefit than objective. The atmosphere may be
does not seem to fit into what is known from hospital admission. Admissions are relatively calm (or at least manageable)
and familiar. We feel disorientated, kept brief to ‘prevent the development of on the one hand, or turbulent and
unable to act and incompetent. In dependency’. A common view amongst threatening on the other. If it is the latter
particular we might feel imposed staff is that these patients are ‘not really we have the sense of being impinged
upon, with the other person seeming sick’ and that they are ‘putting it on’. The upon and there is a sense of threat to the
to have expectations that we ‘fix’ this language that accompanies this kind of self. Empathic reflection may lead us to
unknown. view includes terms like ‘manipulative’, understand that the patient we are with
How do we manage this experience ‘attention-seeking’, ‘malingerers’, ‘bad also experiences some sense of threat to
if we don’t recognize what is in front of not mad’ and so on. In therapeutic terms the self.
us? In a social setting we might soon the way to justify this attitude is to see it When assessed from the viewpoint of
be inclined to ‘escape’ the situation. In as serving a ‘counter-regressive’ function pathologies of self, from an appreciation
the clinical setting we might be pushed that places pressure on the person to of intersubjectivity and empathic
towards an analysis that uses labels to ‘look after him- or her-self’. However understanding, we often reach the
categorize what we encounter. If these such justifications can veil a thinly- conclusion that people who have been
labels satisfy our concept of illness we disguised hostility to such patients, labeled as having ‘personality disorder’
may make a diagnosis that directs us to and reflect an avoidance of personal often have profound disturbances of
act in certain prescriptive and supportive encounter with the patient and a failure self related to backgrounds of trauma
ways learnt in our years of training. to engage. and neglect. A picture often emerges of
When people don’t fit neatly into the If one approaches the clinical a condition that reflects great need and
notions we have of illness we tend to encounter from the point of view where therapeutic engagement holds an
feel even more at a loss: at a diagnostic of intersubjectivity (Trevarthen, important key to outcome. The paradox
level this is when we enter the area of 1974) a different picture emerges. in the two types of assessment described
‘personality disorder’. Intersubjectivity can be understood is that although the objective mode is


based on making discriminations and form and the potential is there for this 1985; Meares, 2000; Meares, 2005) and
distinctions, the notion of ‘self’ is left out to be recognized and elaborated. What is also notable for including a self that
and dismissed as ‘subjective’: hence in needs recognition for the therapist is the extends beyond the individual, the ‘social
this account all selves are the same and self of the other, and what constitutes self’ (James, 1890). In development
there is a failure to recognize ‘difference’ our work is the journey we make with those parts of the environment that are
in this field. The empathic mode, on that self. The capacity of the therapist familiar will become associated with
the other hand, is based on a primary that may be crucial to fitness for the a sense of self that extends beyond the
recognition of sameness, of common journey is not necessarily ‘expertise’ but bounds of the organism: the world
humanity that can be felt and expressed. rather what Keats termed a ‘Negative that is experienced with a ‘warmth and
familiarity’ that allows it to be owned
... we are told that, whereas people with illness as part of the self. Later this might be
expressed by the person as ‘my world’,
usually present themselves because they are that which is felt to be ‘mine’. The ‘social
self’ is the sense of self constituted by
experiencing suffering, people with personality the estimations of others, the extent that
we have become ‘held’ inside other’s
disorder often present because of the suffering minds. With the development of stranger
anxiety in the first year of life it might
they cause to others. Inherent in such a view be said that the infant begins a further
differentiation between ‘my world’ (‘my
is a lack of recognition of the suffering of the people’) and the ‘not-my world’ (‘not-my
person with the ‘personality disorder’. To a large extent this form of
distinction is reinforced by parents
However when we allow ourselves an Capability’... ‘when man is capable of and more generally by the culture:
intersubjective meeting point, or in other being in uncertainties, mysteries, doubts, it is considered essential for the
words to know the other as person or self, without any irritable reaching after fact developing child to be able to make this
what we meet is ‘difference’ : we find that and reason’ (Keats, 1818). differentiation in order to keep safe from
no two subjectivities are alike and we William James considered that the those with unknown or questionable
may find profound differences in world first, and greatest, distinction made in intent towards the child. In many cases
view and experience that can challenge the mind is between ‘me and not-me’ (we the cost may be that such distinctions
us at a deep level. might say, ‘self ’ and ‘not-self ’) (James, become cemented as discriminations
Making a distinction between primary 1890). His work is seminal to the concept and prejudices against those who strike
and secondary intersubjectivity may help of self employed in the Conversational us as different or in some way strange.
us prepare for one form of this challenge. Model of Meares and Hobson (Hobson, We no longer live in societies where it
Primary intersubjectivity refers to the
reciprocal interactive ‘dance’ within the
therapeutic relationship, that involves
attunement and responsiveness to the
other (Gallagher, 2005). ‘The defining
feature of secondary intersubjectivity is
that an object or event can become a focus
between people. Objects and events can be
communicated about…’ (Hobson, 2002).
In the former the dyadic relationship is
central and there is a relative absence of
any consciousness of any external reality.
In the latter there are both dyadic and
triadic forms of relatedness and a sense
of space.
Dynamic forms of psychotherapy
are based upon the empathic mode of
apprehension and rely upon the human
potential to transform experience
from static, descriptive, factual events
towards the realization that moments of
experience have a dynamic ‘liveliness’
that is meaningful (Korner, 2000).
Human experience has a narrative


can be expected that eventually everyone capacity to make their needs known in family for a while but then left school.
will become familiar with all the ‘others’ a socially acceptable and articulate way. Her community case manager helped
in our cities and nations, and therefore Behaviours occur that are viewed by staff find her a youth refuge. With a shift
come to accept all as ‘belonging’ to a as self-destructive and ‘willful’, rather to ‘adult’ services, impulsive and self-
‘community’. Rather certain groups than as communications of need. On harming behavior escalated with several
and individuals become marginalized, the other hand frustrations emerge for hospitalizations. She renewed contact
or become ‘scapegoats’ that serve to both patients and staff that can lead to with her family, who again become
allow us a sense of ‘justification’ for our an escalating situation where lives can be involved with Emma although she wasn’t
prejudices. Pogue White (2005) describes endangered. There is a recreation of the allowed to live with them. She got the
the phenomenon as follows: developmental situation of too great an message that she would be a ‘danger to
expectation of maturity at a time when her brothers’.
‘in this culture, our main defensive the child (patient) is not able to deliver. One of the difficulties in working with
strategy in managing our overwhelming Emma is an 18 year old who presents Emma is her incapacity to express herself
diversity is to split into me-notme and frequently to the emergency department verbally. It is still relevant, although
hate everything not-me. The main after overdoses and self-inflicted injuries difficult, in the face of this relative
concern seems to be that embracing including self-laceration and internal ‘mindlessness’ to try to grasp Emma’s
not-me will forever alter me-as-I-know- injuries inflicted by swallowing sharp position from a phenomenological or
me-now.’ objects. She has been admitted and first person perspective. Such an account
spent a considerable time in a mental is broken up and inconsistent with little
For all of us, the world is not all health rehabilitation setting. Since cohesion or continuity. It might, at this
‘warmth and familiarity’. Indeed much of discharge the self-harming behavior has point, go something like this:
the world is sensed as ‘alien and foreign’. continued unabated. Looked at in an
The ‘stranger anxiety’ mentioned above objective sense she is described as having ‘Once I was a child in a family. There
becomes part of the structure of the dissociative episodes and there is debate was always f ighting. My parents
mind and there is an experience of the about whether she has depression, brief fought. I fought with my brothers. I
world and others that is sensed as ‘alien’. psychotic episodes or factitious disorder. was fighting to get what I needed. My
What is hard for us to recognize is that A plan is formulated for minimal father said he loved me, wanted to love
this is a part of our self-experience. This response to self-harming gestures and me. Told me that’s what he was doing.
notion of the development of an ‘alien to discharge her to the community once I didn’t know what he was doing.
self’ has been explored by Fonagy et al any medical problems are attended to. Something was going wrong between
(2002) and will be a major part of the self This plan was based on the premise that them. Mum got so upset. Must have
in cases where life has been dominated by hospitalization was fostering dependence had something to do with me. She
a traumatic range of experience. and that admission was only serving to took tablets in front of me. How could
The truth is that all people are reinforce the behavior. she do that? She got taken away. I got
different. The natural division into There are many Emmas that I have taken away. I got a new family for a
‘my kind of people’ and ‘not my kind encountered over the last twenty or so while. Then it was over, so that wasn’t
of people’ obscures this, whichever years. They test the limits of any service real. I’m really alone. I want my family
side of the divide one is on. In therapy, and it is not unusual to reach a point of back. Sometimes I feel like I’m a real
recognition and tolerance of difference therapeutic nihilism, as in this example. daughter but then I’m not allowed
allows sufficient differentiation for Diagnostic labels become therapeutically home. I’m too bad, too dangerous.
a rapprochement, or conciliation, unhelpful, but serve to sanction a Not a real daughter. Not a real person.
to become possible. An empathic withdrawal from efforts at engagement. I can’t stand that. I won’t stand
approach that emphasizes the agency Members of the service may have the for that.’ *
of the patient is most likely to achieve sense that ‘this is all that can be done’.
this end. In this article two cases are Taken from the viewpoint of objective So far the problem of Emma, a
discussed that illustrate both the history, Emma’s story is something ‘difficult patient’, has been approached
vicissitudes and potential benefits of like this: from the point of view of the psychiatrist
such an approach. The first example is For a time the family were together and staff attempting to help her. The
taken from an acute adult psychiatry with Emma being the oldest child. Her question might be asked with regard to
unit and the second from the world of mother and father fought frequently and the hospital setting: ‘What does it look
private psychotherapeutic practice. To her mother was often depressed, taking like to patients?’ One such account was
protect confidentiality all case material overdoses that resulted in hospitalization. provided by another patient, Keith,
presented is de-identified and some There is a somewhat uncertain history who was able to write a first person
is composite. of incestuous abuse from her father and account of his experience of admission
a history of aggressive outbursts. At during a psychotic episode. He was a
The hospital setting
age 13 she is removed from the family patient who did not suffer from chronic
In the hospital setting it is common home after a time when her mother was psychosis and whose problems would be
for a perceived ‘battle of wills’ to develop. hospitalized. Her two younger brothers classified under the rubric of ‘character’
On the one hand many patients lack the stayed at home. She lived with a foster or ‘personality’ dysfunction or disorder.


The account may provide an insight into make trouble. It hurts when I do it. It’s to see where they fit in, reacting against
the strangeness of the hospital milieu to hard. And I’m always fighting to stay any sense of being negated as a person.
one not familiar with it. alive ... even when I do that. I’ve always There is a difference from the perception
been fighting. I hate it when they are of the situation in terms of ‘presenting
‘I remember waking up thinking ‘I rough and hurt me when they do the problems, diagnosis and treatment’ i.e.
know this place, it’s familiar’. I saw it stitches like I deserve it or something. the primary perception is in personal
when I was little. At school I think. It Then they say I have ‘Borderline not technical terms. Overall there is the
looks kind of like a submarine. That’s Personality Disorder’ – they don’t sense of incompleteness in these accounts
a strange thought. Those pictures have a clue, that’s not me. I hear them taken from the hospital milieu.
on the wall ... like at kindergarten talking behind the curtain like they
The private setting

‘They think I do it on purpose, like I don’t feel Linda

Linda was referred for psychotherapy
anything or I just want to make trouble. It after a crisis involving conversion
symptoms and a suicide attempt in
hurts when I do it... they say I have ‘Borderline the context of a marital break-up.
Dissociative states, repetitive self-harm
Personality Disorder’ – they don’t have a and explosive rages and risk-taking
behaviors were identified in the course
clue, that’s not me. I hear them ... saying of therapy as having been present over
many years. There was a history of being
‘Why doesn’t she do it properly next time?’ the middle child in a large family with
a critical, ‘cold’ mother and a father
... No-one has ever asked me why I do it. I prone to alcohol abuse and punitive,
at times sadistic, physical abuse often
could die and they act like it is nothing.’ directed against the children. Linda had
mixed relationships with her siblings,
... all these people around. They all don’t think I hear, saying ‘Why doesn’t identifying herself most closely with the
seem to have different parts to play. she do it properly next time?’, stuff like sister next to her in age. They thought of
Like members of a family. That one that. No-one has ever asked me why I themselves as the ‘forgotten two’. There
is doing mother and this other one, do it. I could die and they act like it is was a history of sexual abuse at the hands
she’s an aunty I think ... a lot of them nothing. I’m fighting, can’t they see of a Sunday school teacher. Despite
are like brothers and sisters or kids that? Can’t anyone see me?* her difficult background Linda had
at school, grandma, teachers. It’s completed a degree and had a responsible
funny. Like a play. I wonder what Both of these accounts are professional position.
part I’m supposed to be. How do I descriptions from people struggling Therapy with Linda continued over
fit into this? Maybe it’s like a test or to maintain contact with the world of four years and was often a difficult
something. Maybe I can get them persons, trying to make sense of the journey. There was a gradual movement
to help me. That smell, I know that situation in interpersonal terms, trying towards integration of dissociated
smell – food, soupy food that smells
out the whole place and other smells
like toilets, poo I suppose. Where is
this place? I know it is hospital but
it’s like everywhere I’ve been, all put
together. She looks friendly, I’ll talk
to her. I need to tell her that I have a
home to go to and that I don’t need to
stay anymore. If I’m nice maybe she’ll
let me go. Those windows are round
like a submarine.’

A second account relates to someone

who, like Emma, had an acquaintance
with hospitals in the context of self-
laceration: for our purposes she can be
called ‘Emma 2’ :

‘They think I do it on purpose, like I

don’t feel anything or I just want to


states. Some passages from the second up sounds a bit violent though.’ which disturbs us because it takes us
and third years of therapy illustrate L: ‘I know how to deal with that ... I really beyond the zone of human comfort.
this transformation. The first passage talked about something today.’ As described by Levinas we are talking
describes a more or less hallucinatory There was a shift that involved less about an awareness within being that is
experience that dominates consciousness. acting out in terms of self-harm although unavoidable, although we may seek to
In the next exchange she is talking at the same time there were complaints avoid it. It is the horror of the night that
about experiences of ‘altered states’ after of somatic symptoms, notably headaches. insinuates itself into being, although in
anxious interactions with males. In the Interestingly Linda felt this as a kind the ‘objective light of day’ it disappears,
third passage she describes a shift in of progress. seemingly ‘nothing’. This anonymous,
self experience. 3) L: ‘I’ve been getting headaches lately. I impersonal presence may come to
1) ‘My little man came back. It was really haven’t had headaches like that since I was dominate consciousness. If it dominates
vivid. I could see – it was way down there with George (ex-husband). I used to get the horror is that the person is
like distance perspective. I could see him them all the time. When he left they stopped. ‘stripped of their subjectivity’ (status as
– he was short and fat and I could see They’re bad – I feel really sick, I vomit person / selfhood).
his smile and I knew what was going to and I have to lie down. I think about my It is this depersonalization that
happen. I said ‘no, don’t do that – stop father when I have headaches. When I was is presented to the therapist as an
it’ but I knew it would happen and yes seventeen, I’d just started university, I had ‘it’. The likely response when we are
he got into my mouth – in between my a really bad headache. I was lying down. I presented with an ‘it’ is that we apply
teeth…then it went further, right into my remember that my father sat down beside me. a technical approach: we may want to
head. I felt like I couldn’t move, couldn’t I really loved him then - just sitting beside me. remove it or disarm it with available
do anything – when you feel something I thought he was really caring.’ technologies. Both patient and therapist
so intensely you can’t do anything. It Next session: ‘I’ve been thinking a lot may be motivated in this direction.
was like something eating away inside. about it. I think it is a kind of progress that The psychotherapist, however, will
Really disturbing…there was something I’ve had the headaches. Like I was out of also approach the situation from the
sinister…he had arms – I hadn’t noticed the dark ages. I hadn’t thought of it having empathic perspective and recognize a
before – behind his back ... I can see that to do with relationships but when you said task of re-humanizing experience.
some of the things relate to Mr Campbell that it made sense. Do you know what I In the case of Emma interaction
(Sunday school teacher) but it doesn’t feel mean –it’s been like being in the dark ages.’ with staff is dominated by behavior
quite – I’m really unsure.’ In this case progress may have been that demands action and there is
2) L: ‘I get this numb feeling. My hands realized consciously as being able to limited verbal communication.
go all scrunched up. I think I’ll never ‘contain’ explosive feelings rather than When looked at as a condition to ‘fix’
come out of it ... that I want to be like that discharging the feelings in action, even there is an expectation of ‘cure’ from
forever ... I get into a frenzy ... feel like a though pain is still felt at a somatic level. physical treatments. When looked at
little child and I’ll run up and down on as communication, Emma’s behaviors
the spot…sometimes I do other things. I seem to have meaning in particular
find myself like this – doing things in this ‘When the forms of things are dissolved with respect to the relationship with her
state and I don’t know how it’s started, it in the night, the darkness of the night, mother. There is, of course, a longing for
just has…I hit my head against the wall which is neither an object nor the quality the ‘all-giving’ mother and a reaction
sometimes…I keep doing it and doing it. of an object, invades like a presence to the perception of the ‘frustrating
I keep going ’til I’m exhausted and then I ... this nothing is not that of pure other’ that becomes generalized to those
just lie down. Things build up inside until nothingness. …this universal absence in contact with Emma. The response
I’m exploding. I’m thinking about Tom.’ is in its turn a presence, an absolutely to frustration is not that, however, of a
Therapist: ‘You feel frightened and do unavoidable presence... The rustling of ‘person like any other’, but rather that
something to make yourself feel better- the there is... is horror …it insinuates of someone who loses their sense of
to get some relief? (Linda nods) You keep itself in the night. …To be conscious is to themselves, shifting into the ‘horror’ of
going until you get some relief.’ be torn away from the there is, since the being stripped of subjectivity.
L: ‘When I get sexual feelings…I don’t like existence of a consciousness constitutes The form of relatedness being sought
them…they frighten me…feel I’ve got to a subjectivity, a subject of existence, by Emma is a relationship of persons:
get away. It’s different when I’m like that that is to some extent a master of being, the ‘I-thou’ relationship (Buber, 1947).
– there’s more of a rhythm to it.’ already a name in the anonymity of the Ultimately this involves an unconditional
T: ‘There’s a rhythm to sexual night. Horror is somehow a movement acceptance of the person as person.
arousal also.’ that will strip consciousness of its very This refers to something essential to
L: ‘When I get sexual feelings they’re ‘subjectivity’.’ (Emmanuel Levinas, people related to the total dependence
not like that… they’re sharp…out of my 1946). on the other characteristic of human
control…I’m frightened …like they’re infancy. Of course this is felt, in the
controlled by something outside me.’ The aspect of the clinical encounter countertransference of staff members to
T: ‘When you get frightened you do that I wish to highlight is the experience be an overwhelming and unreasonable
something that you feel is more under of ‘difference’ in the sense of the demand, one that tends to be resisted or
your control. The way you work yourself ‘uncanny’ or strange, the alien: that responded to with either undue efforts


to fulfil the patient’s need, or punitive experience, let us say Emma 3, kept are relatively stable and that the evidence
responses that seek to ‘do away with’ self-harming and presenting as ‘unsafe’ of change with psychotherapy is limited,
such a troublesome interaction. with the result that she required a long particularly with Cluster A and C
In the case of Linda we see more period in hospital. I found myself in the personality disorders. Interestingly
verbal elaboration of a story involving role of ‘container’ both for the hostile the evidence is most convincing for an
‘horror’ : an account of being dominated projections of staff who felt admission improvement through psychotherapy for
by experiences that have taken on the to be unjustified and Emma’s own the Cluster B group, often the patients
characteristics of a waking ‘nightmare’ chaotic, dangerous behavior. Prolonged about whom therapists and mental
invading consciousness akin to the containment in hospital, limited health staff feel most pessimistic. He
unavoidable presence of Levinas’ ‘night’. individual psychotherapeutic work stresses that therapists should have
In the account of subjective experience with Emma and with her family were ‘scaled down expectations’ and be satisfied
expressed in the ‘little man’ description all elements that probably contributed with helping ‘patients to reach a better
we also recognize something unique to to eventual progress. After her final level of functioning’.
In the clinical examples given we
see patients afflicted by the break up
In therapy, recognition and tolerance of of self-experience into disconnected,

difference allows sufficient differentiation depersonalized states. There is a basic

deficit that requires responsiveness at

for a rapprochement, or conciliation, to the level of primary intersubjectivity.

This will often be felt as an unreasonable
become possible. An empathic approach demand by therapists. Empathic
attunement will involve the sense of
that emphasizes the agency of the patient participation in the life of the other and
holding an image of the other as person.
is most likely to achieve this end. However, analysis is ‘not re-mothering as
is sometimes imagined, since the signals
upon which the ordinary, devoted, and
Linda. Through a process of conversation discharge from hospital I maintained ‘good-enough’ mother depends are no
involving recognition and the bringing contact with Emma for some months but longer present, or are used in a distorted
of the material of depersonalized horror then lost contact for perhaps a year and way. The means of connection have been
into the intersubjective realm (i.e. taking a half, until I met her by chance at a café. lost’ (Meares, 2005). Attunement and
it out of the purely subjective sphere) we She made a point of coming over and connection will only be possible within
see the beginning of a differentiation that thanking me. She did look very different a framework that is sustainable for both
can be sensed as real rather than being from the Emma I had known and she was patient and therapist.
sequestered in a purely subjective space. beaming as she showed me her new baby. Connection with many traumatized
There is a prevailing pressure Her partner stayed in the background patients involves engagement with
in psychiatry at present to practice but smiled in greeting from a distance. otherness in the sense of that which is
‘evidence-based medicine’. Inevitably The evidence in the case of Linda impersonal or depersonalized and felt
this leads to an emphasis on practices was less dramatic. She moved away as ‘the dark’ or alien. The key to this
where cause and effect are relatively from therapy partly because of a change connection lies in the area of language:
easily measured and outcomes are judged of job. About two years later I was the conversation. However this is not
in terms of ‘state’ characteristics i.e. ‘Is surprised to receive a phone call from simply word-play. We will understand
the depression score less?’ , or ‘Is the person Linda through the hospital where I was language as connection better if we
‘ functioning’ better?’. In psychotherapy working. She wanted to let me know that think of language as a ‘form of life’
literature there has often been a tendency she was still working on her problems (Wittgenstein, 1963). Wittgenstein
to describe dramatic changes and psychic and that she thought the work we had is referring to the range of human
transformations that don’t always done had been helpful. A simple vote of expressiveness and to language from its
‘stack up’ when it comes to attempts at thanks I guess. It seemed to me that a most visceral form, ‘the cry of the infant’,
objective measures of outcome. This is continuing process of healing had been right through to its more abstract and
perhaps understandable when literature established and the phone call gave me symbolic forms.
is understood at the level of subjectivity a welcome sense of ongoing connection If we can hold this in our minds
and the drama of the inner world. As even after such an absence in Linda’s then we see even ‘acting out’ as
I have emphasized ‘intersubjectivity’ life. Outcomes like procreation or communication, and we preserve the
I will present some ‘evidence’ that simply a sense of connection don’t often possibility of empathic engagement
is somewhere ‘in between’ the dry figure in ‘objective studies’ , although with our patients. We can help our
statistics of ‘objective’ measures and the they are probably very significant for patients out of the darkness. Results
sometimes fantastic transformations of psychotherapists at a personal level. will be unpredictable and at times
the inner world. In a recent review Paris (2004) disappointing. All relationships fail
One of the Emmas of my clinical suggests that many personality disorders at some level. However when we are


persistent we will find that there are signs The nature of the problem Buber Fonagy, P., Gergely, G., Jurist, E., Target,
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Levinas Reader, Blackwell, 1989.
of hearing the authentic voice of the from the lens of objectivity. We need to
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* Endnote
difficulty of technological advance American Journal of Psychotherapy, 58 (4),
outstripping human adaptability. The The two passages marked with an asterisk 420-429.
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importance of his ‘I-thou’ dialogue lies Pogue White, K., Surviving hating
patients. The point of such an exercise
in the human need to turn to each other is not accuracy but rather the holding of and being hated. Contemporary
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rather than to see technology as an mind. (see Korner, 1993) Trevarthen, C., Conversations with a two
‘answer in itself’. His sense of ‘spirit’ is month-old. New Scientist, 62, 230-235.
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Dr Anthony Korner is Coordinator of the Master of Medicine (Psychotherapy) program of the University
of Sydney at Westmead Hospital, a consultant psychiatrist for Sydney West Area Health and a psychiatrist
and psychotherapist in private practice. He is also the Australian Vice-President of the World Council for
Psychotherapy and chairman of the organizing committee making a bid to hold the World Congress for
Psychotherapy in Sydney in 2011. His research interests are in psychotherapy and philosophy.