Ms D had over her 15 years from childhood to the date of presentation been involved in counselling, dynamic, supportive and cognitive–behavioural therapy. She was still ‘symptomatic’ and referred for ongoing depression and what were non-specific anxieties. She was an intelligent, well-composed young woman with an impressive level of insight into what therapy entailed and what ‘their’ goals were. She also understood what her goals were.

What she did not know was whose ‘thoughts’ they were. She struggled with what some of the counsellors said and why therapists ‘contradicted’ one another. She did not know what to think and often visualised the therapists to ‘figure out’ what they would have advised. She would nod to what was being said and often associated the memory of the person with the nature of the problem and the solution. During our encounters I would ask her what she liked and what she enjoyed when with people.

Ms D is one of many ‘graduates’ that one sees in clinic and it is astounding to see what are possibly dysfunctional schemas acquired in the course of long-term therapy. It raises questions about inter-therapist variations and their impact on young minds; but more importantly, on how this ‘alters’ patterns that may have been transient to a temporary crisis prior to engagement in therapy. Does therapy in early years solve or create dysfunctional schemas?

Are we getting to the point where therapy will be seen as potentially having more profound side-effects than psychopharmacology?