This second Volume of 2019, the year of the 70th Anniversary of the Association of Child Psychotherapists, brings a range of papers that show the breadth and distance travelled since then – and the ongoing preoccupations and complex efforts to understand our patients better. Papers in this edition come from authors working in Greece, Israel, the United Kingdom and the United States. The papers present perspectives on varied themes: the psychic work of the therapist; the different ways the developing mind works, and doesn’t work so well; the need and desire to research and extend our clinical and therapeutic understanding; the importance of the supervisory relationship in aiding our development as clinicians and thinkers; and the important question of our relationship to the socio-political environment and how it is expressed and explored in the therapeutic relationship. As well as our Book Reviews and Research Digest, we are also including a Commentary that looks back at our connections to past papers from Volume 1, as a way of marking the 70th Anniversary of the ACP.
We would like first to acknowledge how much work has been done by this edition’s contributors in working to establish consent for their papers to be published (this has been especially noted by some authors in the footnotes). We hope that it will be encouraging for potential contributors to know that more than one author, when requested by us to confirm a transparent agreement for the work to be published, went back to the family some time after treatment had ended, and were able to gain consent. Some authors found a way to create ‘composite’ descriptions of patients, or ‘thick disguise’ as described by Gabbard, while others had addressed consent for publications through research protocols from the outset. We are working to ensure that our standards for consent are respectful of our patients, and we are keen to continue to find ways to support authors in finding ways to share experience and knowledge in this context.
The Volume covers a range of papers. Several articles emphasise the importance of how the therapist uses themselves, and their own mind through memory, association, and even through song. We start with Yaakov Roitman’s paper, where the importance of the therapist’s memory and its relationship to reverie on behalf of the patient is explored. Linked to Bion and to Ogden, the writer makes a strong case for the need for the therapist to be as open as possible to the uncertainties of their own psychic activity, in order meaningfully to make space and sense for the contents of the patient’s mind. The clinical work, and the psychic work of the therapist that are described in the paper provide a powerful depiction of what is possible, when openness and honest scrutiny of the therapist’s experience are lent with generosity to the process of clinical work. Jocelyn Catty, describing the treatment of a troubled and traumatised adopted child, explores the place of musicality in the work, to understand this child’s breakdown, as experienced through the therapy. She first carefully explores this most intimate and early form of contact from a theoretical perspective, and then brings to life the powerful connections made possible through the use of her own mind’s openness to the music of her patient, and her own musical associations. Hillel Mirvis’s account of being locked out of the consulting room focusses on the detail of this most uncomfortable and familiar experience, providing material that both exposes the painful and unsettling communications that come with this kind of enactment, and also making constant links with those aspects of this experience that can helpfully be understood as countertransference.
The following two papers both focus on the flexibility of thought required by the therapist in working with hard to reach patients, drawing on the experience from work with such a child, and what is needed in a clinical relationship for it to be helpful. In Ruth Dergicz’s paper, the focus is on working with an autistic child, tracking carefully the process of finding ways to make contact and to understand, as part of a transformation of experience, with an emphasis on the need for flexibility in understanding the meaning of the patient’s different ways of using the therapeutic space and the objects (both human and inanimate) that come into that space. The focus on the detail and nuance of the clinical contact is key to the paper, and this is shared with the work by Keren Gamliel, who explores the question of her patient’s variable ability to mentalize, making the argument for the therapist to remain alert to fluctuating capacities for mentalization in their patients, with an accompanying need for fluidity in approach and ways of understanding experiences in the consulting room.
With the paper by Vassiliki Vassilopoulou and Effie Layiou-Lignos, the focus shifts to the supervisory relationship, providing an opportunity to explore in some detail the potential for looking at parallel processes. What emerges vividly, and resonates with the theme in other papers, is the importance of the honesty and openness of both therapist and supervisor in allowing feelings to be expressed and become thoughts that can be of use, ultimately, in the therapeutic encounter. The paper by Tracy Prout and colleagues, also featuring the work of both trainees in psychodynamic work and supervisor, explicitly explores the question of openness in the form of self-disclosure, but in the context of a political environment in the US that shapes and shades the world in which patients and therapists live. The paper raises interesting and important questions for psychodynamic and psychoanalytic clinicians from varying theoretical backgrounds about the extent to which real disparities, commonalities and intersectionalities need to be acknowledged in an increasingly unfair society, if meaningful work can take place.
Our final paper also features the work of a group of authors that includes trainees and experienced clinicians and researchers. Midgley et al., drawing on data coming from a major research study on adolescent depression, explore the therapist-patient interactions with a young person diagnosed with Depression as well as Borderline Personality features. The paper gives a succinct and clear account of the data, analysing different forms of therapist/patient interaction, and raising for discussion the possibility for learning more about adolescent BPD, and about therapist/patient interactions in adolescence. Some of this discussion and debate started during the blind peer review for the paper as it came through the Journal processes, so we hope to include commentary/debate on these important themes (and any others coming from work in the Journal) in future editions.
Our three Book Reviews differ in focus. Maria Papadima’s review of Margot Waddell’s ‘On Adolescence’ highlights the contribution the work makes to our understanding and our practice in relation to this most complex and challenging stage of development and state of mind, while Deborah Marks’ review of Patrick Casement’s book emphasises the importance of constantly re-examining our ways of relating to patients, whether children, adolescents, or adults. Finally, Katie Lewis’s review of Olga Jakoby’s letters, a moving and sad historical account of the final stages of a young mother’s life and her experience with terminal illness, offers a glimpse into an under-researched part of our work – the first person accounts of parents who are dealing with trauma, illness and loss, and their thoughts about how their experience may be impacting their young children.
The Research Digest, gathering together research related to process and outcome studies, brings together work from Germany, Italy, the United Kingdom, and the United States. The abstracts cover a wide range of themes, including work with chronic depression, treatment-resistance in adults and in children, the significance of parallel parent work, efficacy and effectiveness, attachment and countertransference, and the interpretation of endings.
We end with a Commentary by the editors on three papers from the first Volume of the Journal, published in 1963, in acknowledgment of the 70th anniversary of the ACP. The focus is on the child psychotherapist role across different settings, and perhaps we have been drawn to this emphasis because of the current uncertainty and turbulence in many social contexts on an international scale, in 2019. The impact on the mental health of children, young people, families and organisations of a social world with so much disparity, disconnection and fragmentation is significant, but can hopefully be mitigated by the connections that can be made between people of different orientations, disciplines and belief systems – and with our own history. We hope that different views and perspectives on what is offered in the Journal can also be shared, and we would welcome contributions, whether as further papers, letters to the Editor, or commentary.