It is well-acknowledged that from the very inception of psychoanalysis Freud envisaged the discipline that he discovered and elaborated as being based and rooted in the scientific paradigm of the time in which he wrote, as well as being an art form that was derived from hermeneutic principles concerned with meaning, metaphor, and interpretation. There was at the time that Freud was writing a tension in these two seams that contribute to psychoanalysis, and this tension has continued to the present day. Some practitioners and writers lean heavily towards identifying psychoanalysis and psychodynamic psychotherapy and counselling as an art form, whilst others consider it vital that the discipline engages with scientific research and with establishing an evidence base that can demonstrate its effectiveness and efficacy to providers of Mental Health services, such as the NHS. Many psychodynamic practitioners will place themselves somewhere in the middle of these two contrasting positions and some will do so with varying degrees of comfort or unease. The articles and book reviews which appear in this issue of the Journal reflect this broad spectrum of positions on the discipline and its relationship with the contemporary scientific paradigms and the arts. Equally important to consider is the wider social, environmental, political and cultural context in which psychodynamic practitioners work and live. The continuing impact of the pandemic on our mental health, the terrifying plight of some interpreters in Afghanistan as it falls to the Taliban, and the climate emergency, are some of the associations in my own mind as I begin to write this editorial and each can be linked or associated to some of the contributions to this issue.
The first article in the Main section of the Journal is written by Hanoch Yerushalmi who is a member of the British Association of Psychoanalytic and Psychodynamic Supervision, and is entitled ‘On Translation and Supervision.’ The article is written in a style that is both eloquent and engaging and provides illuminating and erudite reflections upon the nature of supervision. The author employs the metaphor of translation, to convey the artform of supervision and the role of the supervisor in translating the meaning of the supervisee’s communications about the therapeutic encounter in a way that contributes a new perspective which enhances narrative coherence and widens the therapeutic story in accordance with formal analytic language and principles. It includes a sophisticated case vignette which illustrates the author’s thinking as a supervisor about the therapeutic encounter and the experience of his supervisee, drawing upon his own associations in a way that could readily be described as intersubjective or relational in nature whilst equally employing Post-Kleninan and self-psychology perspectives to elaborate his own conceptualisations of the supervisory process. The article is quintessentially concerned with meaning and interpretation and the author posits psychoanalytic practice as an art form which shares common ground with literary forms which celebrate creativity and subjective translation. The author nonetheless acknowledges that there are other more scientific perspectives based upon objective accumulated analytic experience and knowledge which also have their own validity and contribution to make to the psychoanalytic endeavour.
The second article in the Main section of the Journal is situated within such a definitively scientific paradigm. It is entitled ‘The effectiveness of short-term psychodynamic psychotherapy for depression and anxiety disorders’. The authors are Serhat Citak, Selma Hilal Avci and Burcu Bakar Kahraman from the Department of Psychiatry Istanbul Medeniyet University. Freud had been concerned to show that psychoanalysis could be understood within the scientific paradigm of his time and he understood that its legitimacy as an effective therapeutic practice for those with mental health problems and psychological symptoms depended upon it securing and maintaining this scientific recognition and acknowledgement in a way that was acceptable to the medical and mental health professions. The task of demonstrating the scientific effectiveness of psychodynamic practice is as pressing as ever in the contemporary era and as the authors indicate in the literature review of their research article it’s a task which is riven with controversy and debate. Within the NHS in the UK the development of NICE (National Institute of Clinical Evidence) guidelines has effectively meant that only those therapeutic modalities that can demonstrate an evidence base for specific symptoms can be offered to patients seeking assistance with mental health difficulties. The level of controversy that this has generated is evidenced by the way in which the consultations of the revised NICE Guideline for Depression which started in 2015 are now not due to be completed until 2022, in view of the critical scientific responses that resulted from the original consultation. The article is a very welcome contribution to the accumulation of evidence that demonstrates the effectiveness of short-term psychodynamic therapy for depression and anxiety. Employing measures that have acknowledged validity and legitimacy in outcome research such as the Beck Inventory for Depression and the Beck Inventory for Anxiety the authors include impressive statistics and a careful and rigorous analysis, which demonstrates the effectiveness of the therapy for these two conditions. The article adds to the repertoire of scientific research of psychodynamic therapy in a way that we can plausibly hypothesise Freud would have welcomed and recognised as a necessary and appropriate engagement with the realities of the medical and professional world concerned with alleviating psychological distress.
The third article in the Main section of this issue is entitled ‘An undermined therapeutic alliance; a case study’ written by Paola Miano, Gaia di Salvo and Massino Lavaggi. This is an article with considerable contemporary significance, as it addresses the topic of providing psychodynamic psychotherapy for Intersex individuals and those with Variations of Sex characteristics. The article focusses upon the traumatic effect of early medical interventions in an infant’s life such as genital cosmetic surgery and how such experiences in turn can later in life have a profound effect upon the therapeutic alliance when the adult begins psychotherapy. The article occupies a position in which the meaning of early experience and its impact upon the transference and the therapeutic alliance are explored in a way that is oriented towards the notion of psychodynamic practice as part of the humanities and the arts. Equally the authors acknowledge the value and importance of a scientific basis to our knowledge and they highlight how research that gathers data about the long term psychological implications for individuals who have Variations in Sex Characteristics is needed to deepen practitioners’ understanding of the condition and inform their therapeutic practice. Overall the authors take a perspective on psychotherapy that draws from both the arts and science. The article includes a case example which is both emotionally moving and highly informative. It describes how a child born with ambiguous genitalia underwent a feminising genitoplasty during the perinatal period that involved the removal of the male genitalia. This medical procedure traumatised the child who subsequently identified as male. Later as an adult the trauma of this cosmetic surgery which of course took place without the child’s consent, is hypothesised as having undermined the therapeutic alliance when as an adult the individual began psychotherapy. The authors describe the reflective, empathic and containing stance they adopted to gradually establish a working alliance and how in time the idealised view that the client adopted in relation to his parents became more realistic in acknowledging the responsibility that they had had in consenting to the original cosmetic medical procedure. The article also makes an important contribution to deepening our understanding as psychodynamic practitioners, of the stigmas and negative judgements based upon heteronormative attitudes, to which people with Variations in Sex Characteristics can be subjected, and how Intersex experience itself can be seen positively to disable the binary differentiation between male and female.
The final article in the Main section of the issue is entitled simply ‘Isabel Menzies-Lyth’ and is authored by Julia Segal. The article is a personal account of Julia Segal’s experience of being supervised by Isabel Menzies-Lyth from the time she started working as a counsellor for the self-help charity Action and Research for Multiple Sclerosis which was run by and for people with Multiple Sclerosis. It is a fascinating and at times a riveting read as the author describes not only her experience of the wisdom and insightful reflections of her supervisor Isabel Menzies-Lyth, but also the historical development of counselling in the 1980’s in the particular context of offering counselling in a self help organisation for people with Multiple Sclerosis. As an historical narrative and a description of the meaningful contributions of her supervisor to her therapeutic practice the author can be said to align herself closely with the notion of psychodynamic practice as an art form. Moreover many of the contributions that Julia Segal describes Isabel Menzies-Lyth having made as a supervisor, could readily be termed translations in the way that Hanoch Yerushalmi uses the term in his own paper ‘On translation and Supervision’ in this issue. Nonetheless the organisation for which Julia Segal worked comprised a Research unit and Isabel Menzies-Lyth was a social scientist as well as a psychoanalyst. Significantly Julia Segal goes on to describe how she completed outcome measures with each of her clients though she adds the caveat that outcome measures fit uneasily with clients whose health condition results in a sense of ‘living with loss’ and a ‘failure to cure’ as intrinsic to the therapeutic experience. The article is replete with many examples of the author’s own profound wisdom and depth of experience and knowledge of working with clients who have Multiple Sclerosis as well as their families. In particular, she illustrates an effective and humane application of an essentially Kleinian conceptual framework to working with clients who have Multiple Sclerosis, one that affords a sophisticated depth of understanding of their difficulties and the impact that the illness could have upon their minds and their interpersonal and familial world. The article also includes a number of intriguing illustrations of the application of a psychodynamic understanding to organisational processes, which of course would be expected in a paper entitled ‘Isabel Menzies-Lyth.’
The Open Space section comprises three articles the first of which is entitled ‘ “Human Kind cannot bear very much reality” T.S. Elliott.’ The dilemma of remembering forgotten time.’ It is written by Natasha De Meric. The inclusion of the quote by T.S Elliott in the title is indicative of the almost literary style in which the article is written. As such it can be posited that the article is quintessentially positioned to contribute to psychodynamic practice as an art form. The article is beautifully written and the author writes movingly and candidly about her own subjective feelings and experiences as she engages with her client in the therapy sessions, and conveys an approach to the therapeutic encounter that can be appropriately described as intersubjective in nature. The article begins with reflections upon the dilemma arising from a need to revisit and meaningfully process traumatic past childhood experiences on the one hand, with the fear of being retraumatised in facing painful realities in the way that is highlighted by the line from T.S. Elliott, on the other. The case example which forms the basis of the article concerns a client who has had a traumatic childhood relationship with her own mother but is terrified of exploring this in her therapy sessions. The article interweaves an account of the therapy sessions, the client’s narrative of her life, and the authors reflections upon her own associations, feelings and life experience as she endeavours to make sense of her own countertransference feelings, evoked in the therapeutic encounter, in a way that ultimately enables her client to face her own traumatic past, and begin to have conversations in her current life with others, including her mother and her own teenage daughter, about her traumatic past. The article is an enrichment in itself and will rewardingly enhance the therapeutic endeavours of psychodynamic practitioners who engage with its creative insights.
The second article in the Open Space section is entitled ‘Psychodynamic Psychotherapy and the Rorschach: A centenary love affair’, and is written by Erik Hammarstrom. The reference to a love affair in the title implies a narrative and emotional connection and indicates that the article will be orientated towards the arts. The Rorschach is contrastingly a psychological test which has been very rigorously researched and as the author points out many of the variables used in the tests have a high degree of scientific validity. As the article unfolds it is clear that the author is comfortable in both the scientific aspects of the test as well as ways in which the variables can be used to elaborate meaningful constructions of narrative and storylines that have significant resonances with Freud's and Jung’s psychology of dreams. The author provides illuminating short vignettes, some of which show the use of the Rorschach codes in a more scientifically based way whilst others illustrate the way in which metaphors that emerge in the conversation between the client and the therapist as the client engages with the test can evoke associations and narratives that are poetic or dreamlike in their form and richly meaningful for the psychodynamic practitioner. The author convincingly demonstrates how the Rorschach can be employed by psychodynamic practitioners to enhance the process of assessment and enrich the therapeutic process.
The final article in the Open Space section is by Roger Lippin and is entitled ‘Later reflections on the Lockdown’. It’s a sequel to an earlier article that he wrote for the Journal at the start of the first Lockdown and which was very well received by the readership of the Journal. The article which appears in this issue was written in February 2021 when the UK was undergoing its third lockdown. The article highlights the powerful impact of the Covid-19 pandemic upon the psyche, shaping the anxieties that individuals have experienced, particularly in relation to the fear of unwittingly contaminating others especially those with whom a person is closely attached. Disentangling a realistic fear of harming a parental figure through the transmission of Covid, from unconscious aggression towards the same person is one of the therapeutic dilemmas that the author identifies and explores. The use of technology, a product of scientific endeavour, has made it possible to conduct therapy sessions online via our computers. The author employs a telling metaphor of an ‘endless hall of mirrors’ to describe how friendships that have been sustained remotely online are then described remotely via a computer screen in an online therapy session. The author also highlights the concept of projection and how connecting with others online via a two-dimensional computer screen is likely to impact upon our perceptions of others, to stimulate projective processes, rendering them in some cases more pernicious. This resonates with the two-dimensional nature of the Rorschach tests which of course is intended to evoke projective processes and dreamlike associations. The article also explores the meaning of dystopian dreams during the pandemic, his own intersubjective associations to these dreams and the historical resonances of the impact of the plague in an earlier epoch. Drawing from the arts and the humanities the article is essentially concerned with exploring the meaning of living and working during the pandemic, at a time when paradoxically we have depended upon science and technology to sustain our very ability to live, work and connect with others.
There are two Book review essays in this issue of the Journal. The first book review essay is authored by Liz Omand and is a review of a new book by the eminent psychoanalyst John Steiner entitled ‘Illusion, Disillusion and Irony in Psychoanalysis.’ The review and the book itself address questions of depth of meaning and are clearly positioned within the arts and literature. Steiner draws upon Milton’s ‘Paradise Lost’, Keat’s ‘Ode to a Nightingale’ as well as the novel ‘Don Quixote’ by Cervantes to illustrate the pain and difficult feelings of shame and humiliation that can arise as human beings face reality and experience a sense of disillusionment and the resultant letting go of illusions and idealisations. Irony has a place in this process of disillusionment and emerges especially as a reader considers the travails of Don Quixote. The book inspires the reviewer to illustrate these themes in two engaging case examples of her own, drawn from her clinical practice as a student counsellor. She ends by noting that this new book by Steiner contains a greater recognition of the impact of external reality and trauma than his earlier works, which nonetheless have been equally inspiring to her clinical practice.
The second book review essay is written by David Hayter. The book he reviews is entitled ‘Silence and Silencing’ in Psychoanalysis and is a collection of papers on the subject of silence, edited by Dimitrijevic and Buchholz. The reviewer positions himself as a practitioner interested in the varied meanings of silence and the way in which it may be experienced by individuals both within and outside of the therapeutic setting. The individual chapters detail the manifold ways that silence can be meaningfully understood, linking back to the earliest experiences of the mother–infant relationship, shaped by the wider culture, as well as its spiritual connotations. The reviewer introduces his own subjective experiences and associations to silence to embellish and enrich the review essay. The book engages both with the way in which silence in the therapeutic relationship can facilitate developmental transformations, but also how it can be used in a way that repeats an original traumatic experience. The review essay is replete with the reviewers own sophisticated reflections on the subject of silence in a way that will foster the reader's own interest and curiosity.
The five book reviews in the issue mostly cover themes that relate primarily to psychoanalysis as an art form concerned with meaning. Amber Segal reviews a book entitled ‘Psychoanalytic Reflections on Writing, Cinema and the Arts: Facing Beauty and Loss,’ by Paola Golinelli. Simon Sadler reviews a book entitled ‘Holism, possibilities and problems’ by Christian McMillan, Roderick Main and David Henderson, eds. Jenny Hogan reviews a book entitled ‘Exploring the Emotional life of the Mind: A psychodynamic theory of emotions’ by Daniël Helderman. Sarah McMichael reviews a book entitled ‘Psychodynamic Approaches for the Treatment of Drug Abuse and Addiction Theory and Treatment’,by David Potik. Brian Turton reviews a book entitled ‘Toward a Social Psychoanalysis: Culture, Character, and Normative Unconscious Processes’, by Lynne Layton, and edited by Marianna Leavy-Sperounis.
This is a rich and enriching issue of the Journal and so it is timely to finally add a welcome to Marija Stojkovic and Hanoch Yerushalmi who have recently joined the editorial team of the Journal as Submission Editors and with whom it has been a pleasure to work, in this the first issue of the Journal to which they have contributed, in their new roles. It is also fitting to thank Nadine Moore and David Henderson who contributed creatively to the Journal during their time as Submission editors.