On the couch

Traditionally, university psychology and medical psychiatry have found Freud's legacy unpalatable. Yet he has usually been proved right - and these establishments wrong - about many fundamentals: that we have an unconscious, that our care in the early years profoundly affects our adult lives and that therapy is the best treatment for most mental illnesses.

Peter Fonagy is the main reason these fundamentals are increasingly accepted in this country. As Professor of Psychoanalysis at UCL, he has created a whole department doing research that challenges the establishment on its own empirical, scientific grounds. Now, as co-director of the Anna Freud Centre (AFC), he is spreading practical therapeutic applications of these ideas, from SureStart (government help for low-income parents) to health services, contradicting the idea that analysis is only for the rich. …

He is forcing the psychiatric establishment to accept the power of modern psychoanalytic treatments. For example, a series of studies … proved that the most effective treatment for borderline personality disorder is a psychoanalytic therapy he specially developed.

Not only did it work, it was as cost-effective as conventional treatments (pills, cognitive therapy) because it avoided the consequences of failed treatment. Brief use of the initially cheaper but more superficial cognitive therapy for such patients can actually make them worse. …

Especially, through the revamped AFC, Fonagy is dragging the establishment into the 21st century. The message to psychiatry, academic psychology and analysis is simple: much more research should start from studies of the impact of parental care on children; and, hard scientific evidence testing theories should underpin therapies.

Oliver James, 'The Observer'