Reflections on research and learning from the patient: the art and science of what we do

Over three decades ago, John Bowlby argued for psychoanalysis to seek beyond its own parameters if it was to maintain its claim to be a science. Since then there has been a wealth of relevant research from various fields. While this has been instrumental in the development of my own work, this paper concerns learning from the patient. The paper begins with a premise: interpretative analytic work requires three-dimensionality (self, other and object). Although interpretative work may be ingrained in our professional identity, this triangulation may or may not exist in our patients in any stable way. The paper continues with a brief developmental account of how early archetypally-shaped shifts in the infant's field of interest establish the experiential components of three-dimensionality. From there, observational and clinical material with a toddler and a young boy describe how early relational deficits hindered their capacities for three-dimensionality. Yet both were able to engage with the therapist and to become active in the creation of three-dimensionality within their own minds. Implied in this work are considerations for working with patients for whom interpretations do not work. Michael Fordham's comments on 'working out of the self' are linked with the art of what we do.