The papers and articles in this edition rest on the work that has been done by my predecessor Jo Russell in the editorial role, showing a range of preoccupations and perspectives, from an international field of authors. Two of the papers, ‘Different perspectives in measuring processes in psychodynamic child psychotherapy’ by Fredrik Odhammar et al. and ‘Towards emotional containment for staff and patients: developing a Work Discussion group for play specialists in a paediatric ward’ by Anggielina Trelles-Fishman, were originally destined for the most recent special edition (issue 44.3), focussed on experiences of asylum-seeking and refugee children. Although these papers have been accessible online, we are late to publish them now and include here both an apology and excerpts of Jo Russell’s original editorial comment on them. These papers:
‘ … focus in their different ways on the process of therapeutic work. In Anggielina Trelles-Fishman’s paper on developing a work discussion group for hospital play specialists, we find an account of a rather heroic attempt to offer a home for the pain of working with the suffering children of a paediatric ward. In the group’s early stages, she found that ‘focussing on the worker’s feelings for too long would be met with a slight lowering of the heads and silence’. However, as the group develops, an atmosphere of trust is gradually established. Its members begin to feel able to bring their own feelings to the group and thus, importantly, to their work. One member’s developed trust in her own emotional response is such that she actively crosses medical protocol to save a young boy’s life. This paper is written with the compassion and humanity the writer evidently brings to her group.
The second … contributes to the literature on what we might measure and how we might measure it in order to understand processes of change in child psychotherapy. In discussing different perspectives, Fredrik Odhammar and Geoff Goodman identify reflective functioning as a key factor in a number of treatment approaches. In a link with the book Robert Fleming reviews in this issue [issue 44.3], they look at the shift from interpretation of content towards mentalization, affect regulation and the here-and-now relational process between child and psychotherapist. They study several measurement tools involving a number of elements for which a therapeutic interaction can be coded over time. Although the paper aims to offer a metaview, the assessment tools for the ‘examined psychotherapy’ did not seem to take into account the frame of the therapy or of the study. It is a complex endeavour: the psychotherapy is filmed throughout and the question of how this might affect results, especially for example, on interaction structures such as ‘the power struggle’ is not asked or answered. Overall, though, the writers underline the need for flexibility, ‘metacompetence’ and an increasing focus on process, both in measuring and in offering child psychotherapy.
It is a great pleasure to have these papers in this first edition in my editorial role. They represent the continuity that all those working on the Journal hope to provide, while also continuing to take forward the spirit of innovation and lively discourse that so characterised the Journal under Jo Russell’s stewardship.
There is no pre-determined special theme governing the papers and articles in this first edition of 2019 but viewed as a whole, they do convey the complexity of the contemporary world in which children and young people develop, and the ongoing intimacies of our relationships with ourselves and each other.
Dr Einat Yehene and her co-authors explore the relationship to the body and what it represents, in the context of the trauma of burns injuries. At the same time, we have the opportunity here to learn about the work and the thinking of clinicians working in Israel alongside paediatric colleagues. The authors sensitively track the development of a young adolescent in his psychotherapy, as he works through the impact of severe facial burns, having first set the theoretical stage for us carefully through referencing key psychoanalytic perspectives on the skin, on trauma and on the possibility of a return to a developmental trajectory, scarred but not distorted by damage to the real and psychic skin.
From Lida Anagnostaki and her co-authors we hear about the complex interplay between the internal world and the stresses of post-austerity Greece, where the protective social skin that should support and contain the growth and creativity of families is under enormous strain and cannot always remain intact; a concern for all of us in the international community. The authors carefully set the context, by reviewing work on brief under-fives interventions, and lay out the structures that informed their research into the experience and impact of their brief model of work with parents and under-fives, focussing on parental stress. The persuasive evidence emerging from their review is brought to life with a vivid case example that illustrates powerfully the interconnections between internal tensions and external stresses imposed by social forces, and the way in which this model of work can have an impact.
Our authors in this edition are also illustrating the different vertices from which it is possible to explore the field of work. Dr Joshua Holmes discusses some significant themes arising from a sample of work undertaken by a range of published clinical work with adolescents with eating disorders. But by undertaking a meta-analysis in this way, he also encourages us to situate ourselves in a different place in relation to the work. He thus shows how we can broaden the possibilities for developing theory based on clinical work when the single case study has become increasingly complex to publish without proper consent. His careful analysis of the ways in which the sampled authors account for their own experience of their patients with eating disorders raises interesting questions about the impact of the ways in which we try and make contact, as well as the ways in which our perceptions about patients may inform the relationship, without our awareness. By taking a collective and comparative look at work in this area, Holmes allows us to see things we might not otherwise have seen. Using this data, he then plays with the metaphor of the ‘Trojan Horse’, highlighting the delicate balance required for both therapist and patient in developing a relationship that allows for mutual trust, in a psychic environment where the constant fear and suspicion about what is being communicated can bring patients close to death and therapists close to despair.
The Research Digest further encourages us to look beyond what we know from within the consulting room, by gathering together research relating to ‘drop out’ from treatment. The range of studies included in the Digest underlines the significance of ‘dropping out’ as a phenomenon helpfully understood as a communication – whether a communication about the patient or client’s internal or developmental state, or with the studies looking at ‘cultural competence’, a communication about how we as clinicians need to develop and learn.
Our two book reviews point to the breadth of interests within the psychoanalytic child psychotherapy community, and the different ways we can make links between what we read and how we think about clinical work. Adam Duncan’s review of Mentalization-Based Treatment for Children (MBT-C), A time-limited approach by Nick Midgley et al. gives a helpful and clear account of a text offering the opportunity to learn about a model of treatment that draws on its psychoanalytic roots and adapts them. Duncan both informs us about the model described in the text but also encourages a dialogue with it in the spirit of ongoing enquiry, to improve how we meet the needs of patients and develop our own clinical minds.
Maria Papadima’s review, at first sight, seems very different, with a moving account of her reading of ‘Where Reasons End: A Novel’ by Yiyun Li, a Chinese-American author. What the reviews have in common is the link that Maria makes with clinical work, illustrating skilfully how we can always find ways to connect what we read with how we understand the relationships in the consulting room. This semi-biographical novel explores the experience of losing a son to suicide, and in her review, Maria both conveys the poetic and heartbreaking style of the author and also makes links to her own experience in working in a clinical service with suicidal adolescents. The review allows the reader to develop an interest in the book, but also to consider current attitudes to suicide (the ‘zero suicide’ agenda), as a defence against the unthinkable and unbearable from which this author doesn’t hide.
The next edition of the Journal, which we hope to publish in early September, will be another collection of articles covering a range of subjects and themes. The third edition of 2019 will focus on how we approach, think about and work with difference – of all kinds, including importantly race, sexuality, class, gender, age, disability, as well as the differences we encounter in our work in organisational contexts. We welcome any papers looking at this area of our practice and theory, as it is currently a significant gap in our developing body of thought within psychoanalytic child psychotherapy.
It is important, however, that our interest in different points of view, diverse experiences, and competing priorities for the development of our shared profession is sustained in the work of the Journal in every edition. In my role as Editor, I will be working hard to ensure that we continue to be able to extend the discourse, to include voices that have very different things to say, whether from different international perspectives or from close geographical neighbours inhabiting very different parts of the psychoanalytic community. We hope to be able to regularly include a ‘Clinical Commentary’ section, and would welcome ‘Letters to the Editor’ from you, if an article provokes a response that can take our shared dialogue further. At a time when the world seems to be closing down on creative debate, we need to be ready to continue to have passionate new conversations, and hopefully, the Journal can be one of the places where different voices can be heard.