ABSTRACT
There is a tendency to think that psychotherapy services are for less disturbed patients, but psychotherapists who have worked in the National Health Service (NHS) know just how foreign this is to their clinical experience. The term "assessment" reinforces the idea that a patient is being subjected to an examination that he or she might pass or fail. This is likely to be especially unhelpful for very troubled patients, for whom the dice are already heavily loaded towards this disturbing binary view. It might be thought that someone's availability to understanding co-varies with severity of psychopathology in a linear way. One might suppose that the more severely ill a patient, the less that person's capacity for being interested in him/herself. This turns out not to be the case. Sometimes patients are referred for their having suffered sexual abuse, as if this alone constitutes justification for the referral.
