The Measure of Meaning

A conversation about numbers, depth, and what we owe our patients

In a consulting room on the Rue de Rennes, a psychoanalyst sits with a woman who has been coming twice weekly for three years. Hélène, fifty-two, arrived with what her GP called "treatment-resistant depression." She had tried two antidepressants and six months of brief therapy. Nothing shifted. Now, after years of excavating childhood losses and a marriage that ended in silence rather than shouting, something has changed. Hélène still scores seventeen on the PHQ-9—moderate depression, the algorithm would say. But she laughs more easily. She has started painting again. Last month, she told her analyst: "I feel like I'm finally living in my own life."

What are we to make of this? The score says one thing. The woman says another. And somewhere in that gap lies a question that has animated European psychotherapy for decades: can we measure what matters in the consulting room?

To explore this tension, we invited two clinicians—composites drawn from many conversations—to think aloud together. Marie Dubois has practiced psychoanalysis in Lyon for twenty-five years, trained when Lacan's seminars still circulated like samizdat. Klaus Schneider is a German psychologist who has spent two decades researching cognitive-behavioural therapy and outcome monitoring. They disagree about much. They agree about more than you might expect.