I prepare this editorial when daily the world news reminds us of the ubiquity of our destructiveness to one another and our planet. The rich variety of writings in this issue is a welcome reminder of our creativity, ingenuity, our continual seeking to better understand ourselves and others, and seeking to enable the repair of the emotional damage we can inflict. Two of our papers present innovative and imaginative use of cards in psychodynamic therapy, another paper proposes a surprising development and use of Klein’s concept of the phallic mother, one paper revisits the concept of the superego by exploring its impact in supervision, and another studies the much neglected but all too familiar experience of why clients prematurely drop out of psychodynamic therapy, including thinking about how to alleviate dropout.
The Superego in Supervision, Censor, persecutor or protector by Christine Driver explores the multi-faceted nature of the superego and its impact in the supervisor and supervisee relationship. Importantly, she emphasises the ubiquity of the superego that it ‘affects every aspect of our lives, consciously and unconsciously’. Discussing the impact of the superego, she illustrates how it can act as a censor inhibiting either or both supervisor and supervisee in a way that could obstruct progress in therapy. Her vignette confirms the emphasis she places on the need for a reflective alliance to be fostered in the supervisory relationship. A supervisor may be experienced as a critical and persecuting superego, sometimes as part of the transference the supervisee might make to the supervisor, and/or in a parallel process, in which the supervisee might be re-enacting the aspects of the transference – counter-transference relationship with their client. Driver also reminds the supervisors of the challenge in supervision to remain vigilant in keeping an eye on their own ‘superego dynamics or persecutory anxieties’. Driver discusses a more benign superego in supervision which is especially important in relation to ethical matters and aspiring to and upholding the principles and standards of our profession. Throughout her discussion and illustration of these different facets of the superego in supervision, most helpfully, Driver sheds light on how complex and challenging the impact of the superego can be for supervisor and supervisee.
Rules of the game: Board game design as a directive therapeutic intervention by Elana Lakh reviews fascinating literature about the use of games in psychotherapy, including rule-based games and direct interventions, for a variety of different clients. Lakh presents a detailed case study of designing a ‘tailor made rule governed board game’ for a group of adolescent boys. The boys had histories of severe deprivation and were in long term individual psychodynamic residential therapy. The game was designed for a short-term group to help the boys make the transition from the institution when their individual therapy was drawing to a close. Lakh points out that designing a structured, directive approach for the board game meant ‘familiarity with the clients’ needs within the therapeutic setting and corresponds to specific therapeutic goals’. Whilst this structured approach’s emphasis in its interventions on conscious material differs from the more familiar psychoanalytic play therapy, Lakh points out that it also attends to unconscious material which emerges in how the clients respond to the interventions. There are descriptions of the cards which were made and designed by the therapeutic staff. and the rationale for the rules and directive interventions for these boys. In making these materials, there was close attention paid to the transference and counter-transference dynamics. In these details of the thinking behind and preparation of the game materials, Lakh shows the therapists’ sensitive concerns to create a safe space for these usually withdrawn and isolated boys in which to share their feelings about leaving their residential home and facing an unknown future.
Dropout from Psychodynamic Psychotherapies: A Systematic Review of Correlated Factors is by Payvand Jalali, Fariba Zarani, Leili Panaghi and Dennis Shelby. Their research paper summarises and addresses the omission of dropout research in most studies of psychodynamic psychotherapy which have focussed on outcome and effectiveness. Though significant proportions of clients were reported in those studies as leaving therapy prematurely, few examined why clients drop out. The authors made a careful selection of 14 studies from various countries in order to understand some aspects of those who dropped out. They found that aspects such as patient characteristics, needs, beliefs, and environmental factors were all important. They discuss how these findings relate to other research, and importantly, how their understanding from the study of these factors may be used to alleviate dropout rate. The authors also acknowledge the limitations of their study and the need for more multifaceted research, especially in the need to understand the impact of dropout on patients, therapists and therapy provision, and to pursuse study of how to reduce dropout.
The first Open Space paper, Presentational Symbolism and the Anorexic True-Self: working with Metaphoric Associative cards by Ruth Zarchi, is an account of how ‘Metaphoric Associative Cards’, which present symbolic images, can be of value when used in psychodynamic therapy with anorexic patients. These cards include images ‘that represent situations and events in various aspects of life’. Zarchi’s therapeutic approach is from an understanding of anorexia as often linked with difficulties in using language to convey emotions. She describes how her therapy is underpinned by Winnicott and developments of his work. Contrary to what Zarchi describes as a prevailing view of anorexia as a breakdown in symbolisation, she draws on the work of a philosopher, Susanne Langer, to offer a different view which inspired the use of the MAC cards in therapy with anorexic patients. Langer’s concept of ‘presentational symbolism’ gives emphasis to ‘the crucial role of imagery as a catalyst for constructing narratives and imaginative fantasies’. Zarchi gives detailed clinical examples of her therapy with two patients which movingly illustrate how the cards enhance the patients’ communication of their feelings, and inform the interpretation of transference and counter-transference dynamics.
The second Open Space paper, The life-negating and life-affirming penis and its relation to diagnosis and medication by Maaike Engelen, proposes a development of Klein’s concept of the phallic mother to include a ‘preverbal experience of a psychic penis’ which ‘can be experienced as facilitating growth and supporting of wholeness; or experienced as a weakening and fragmenting psychic element that promotes death, decay and fragmentation’. She goes on to elaborate an unconscious infantile phantasy of a parent with a penis, vagina and breast with which infant or child identifies. Engelen argues that such an identification cannot be sustained by the infant, because the parents consciously relate to the child in terms of a split male or female identity. However, in her clinical practice, Engelen has observed the presence of an undifferentiated identity which was repressed. Thus, she proposes the ‘experience of a new-born, their agency and potency is the experience of the life affirming penis which is preverbal and repressed’, and she sees growing up ‘as a process of continuously reconnecting and reintegrating … (what) became partially repressed or fragmented’. Using a clinical example Engelen discusses the implications of her ideas in relation to aggression, diagnosis and medication.
Our book reviews section begins with a review essay Jung the Antisemite by Eric Bettleheim, discussing the book ‘Ant-Semitism and Analytical Psychology’ by Daniel Burston. Bettleheim discusses how Burston convincingly establishes Jung’s antisemitism evident from when he was a student at university and continuing ‘both before and after the Holocaust’. Drawing on a wide range of literary sources, Bettleheim discusses Burston’s understanding about the Jung’s complex relationship with Freud and the reasons why, contrary to Freud’s hopes, Jung finally dismissed psychoanalysis ‘as a science for jews not Germans’. Bettleheim summarises and comments on Burston’s views about the history of anti-semitism including observations about the current crisis in the Middle East.
The book reviews in this issue are:
Michael Parker reviews ‘Projective Identification: A Contemporary Introduction’ by Robert Waska;
Jackie Moon reviews ‘Psychoanalysis and Homosexuality: A contemporary introduction’ by Leezah Hertzmann and Juliet Newbigggin;
Monica Luci reviews ‘Trauma Flight and Migration: Psychoanalytic perspectives’ edited by Vivienne Elton, Marianne Leuzinger-Bohleber, Gertraud Schlesinger-Kipp, Vivian B. Pender;Format;
Helen Michaelson reviews ‘Hidden Histories of British Psychoanalysis’ by Brett Kahr;
Alexander Pearces reviews ‘Three Characters: Narcissist, Borderline, Manic Depressive’ by Christopher Bollas;
Moh.Ferdi Hasan, Muhammad Ash-Shiddiqy and Mohammad Rofiqi review ‘The Ecosystem of Group Relations: Culture, Gender and Identity in Groups and Organizations’edited by Coreene Archer, Rachel Kelly, Gordon Strauss, and Joseph Triest.