Editorial

The editorial for the last issue was written by Journal editor Maria Papadima, in which she announced that she is moving on after eight years of tireless service. Throughout this time, she has brought enormous generosity and warmth to her work, fostering lasting links with authors all around the world, many of whom paid tribute to her at a recent leaving party. All mentioned her meticulous attention to detail and the care she took over authors’ work and their relationship to their writing. Her pleasure in facilitating creativity in others, often through rigorous challenge, has been enlivening and enriching for all of us lucky enough to have her help with our writing. I also want to thank her personally for her generous support to me in my role. Fortunately, she will remain in the Journal as Commentaries Editor.

I have been with the JCP for a much shorter time, but it is also time for me to step down. We both leave in high spirits, confident that the Journal is in safe hands with the team we leave at the helm. I want to thank them, Rachel Acheson, Krisna Catsaras and Lucy Mills for bringing energy, humour, wisdom and razor-sharp thinking to our team. Also, I want to thank the wider Journal Group for their important work and encouragement and the ACP for listening and being responsive to the needs of the Journal.

I am delighted to announce that Rachel Acheson has been appointed as Editor in Chief of the JCP. Drawing on her knowledge and experience as an editor and the robust relationships she has developed, I know she will take the Journal from strength to strength.

This issue has an interesting mix of papers and a commentary. The commentary is from Gillian Sloan Donachy and continues the conversation about consent for publication of clinical material. She offers some thoughts on the contribution from Michael Garcia on this topic in issue 49.2, drawing out some of the contextual differences that might contribute to different ways of thinking about this topic. The first paper, by Andrew Dawson and Lynda Ellis, is an exciting challenge to our discipline to own our desire and capacity for leadership. Having just attended a Group Relations Conference on the theme of autonomy and dependency, this feels very live for me. Through a review of the papers in this Journal, on the subject of leadership in child psychotherapy, the authors identify themes that help us to understand why we may struggle with being explicit about our degree of influence in our teams and, our reticence to name and nurture this influence as leadership. While they found:

a few exceptional accounts of leadership activity, […] overall the theme is implicit […] there was a tendency to attribute leadership to individual characteristics and to the historical heroes of psychoanalysis and this raised the question of how to claim a leadership aspect in contemporary practice.

They conclude that:

We need to put to rest our aversion to leadership based on split-off aspects of our selves relating to authority, ambition, power and to accept that managing these aspects of our selves, without splitting and projection, is best practice in psychoanalytic terms.

They argue that we need to embrace our ‘dual-citizenship’ as psychoanalytic clinicians and leaders, without feeling that the tension needs to be collapsed to one or the other identity.

Elizabeth Edginton argues for a similar sort of duality in our approach to research, inviting us to bring our psychoanalytic selves to engage with a diverse range of research methods. This, she suggests, would allow our profession to utilise the RCT methodology, rather than reject this approach as incompatible with our way of working. She models, rather elegantly, that it is possible to bridge different worlds in a meaningful way, by using 17^th Century poetry to explore themes emerging from the history of child psychotherapy research. This summary sets out the context for her own RCT on short-term psychoanalytic work with children and parents around challenging behaviour. Hers was a feasibility study, and while the results did not warrant a full-scale RCT:

it has recently been selected as one of eight RCTs on ‘complex interventions’ in the UK for a five year National Institute of Health Research funded study (NIHR301709) on developing statistical methods for empirically optimising complex interventions in health and social care, in order to create a step-change in the way in which RCTs for complex interventions are designed and statistically analysed.

She concludes on the positive note that:

… .one of the key outcomes of the TIGA CUB feasibility RCT will, then, hopefully be that, by engaging with RCT methodology, CAPPT will be able to influence RCT methodology’s future design and development. I, for one, cannot think of a better long-term outcome of TIGA-CUB than that.

Like Dawson and Ellis, Edginton is asking our discipline to own our authority and be explicit about our actual and potential contributions in the wider contexts we operate in.

The next paper describes a piece of qualitative research, employing a single case study design to track a mother’s changing narration of her child, across 20 sessions of an MBT group for mothers of infants where maltreatment has taken place. The emphasis is on maternal representations of the child, rather than observed behaviour. Specifically, the study is interested in how such change emerges in a group. The paper offers a clear description of the Narrative Processes Coding System, for those interested in knowing more about established qualitative methods of therapy research, and a brief introduction to Thematic Analysis, a form of data analysis used in a great number of fields since the 1970s. The aims of the study were modest and the findings unsurprising, but change was demonstrated. As such, this study is a good exemplar of the slow and meticulous work of formal research, something it has in common with psychoanalytic psychotherapy.

Perhaps at the opposite end of the spectrum of single case studies, is Carolyn Hart’s description of her work with an 11-year-old girl with autism. Embracing her subjectivity as the sharpest tool in her psychoanalytic toolkit, Hart invites us to join her in her confusion and disorientation as she tries to ‘learn how to speak alien’. ‘Alien’ here represents two separate but linked unknowns. The first is the unknowable perceptual experiences of those whose neurology diverges from our own and the second is adaptation of technique. Because adaptation of technique is done through trial, error and intuition, it cannot be known before it is created. What Hart illustrates in this paper is the power of negative capability. Her willingness to stay with her own sense of lack, her courage to resist drawing on familiar technique as a shroud against her vulnerability, is what protects a space for something to emerge between them despite the ‘language’ barrier. Through this willingness to learn from her patient about what it is they need, they discover that music transcends this barrier. This put me in mind of Malloch and Trevarthen’s (2009) research into the musicality of vocal interactions between some newborns and their carers.

In the next paper, I describe my own attempts to acknowledge and grapple with my conscious and unconscious racism as it manifests in my clinical work. I offer nothing new in terms of the application of psychoanalytic theory to this problem, as most of what I say was set out by Frantz Fanon in 1986. I do also use more contemporary thinkers, such as Ronald Britton (2004) and John Steiner (1999), to make sense of my personal experiences and associations, but, if there is any value in this paper, it is that I am trying to get into the habit of noticing and taking responsibility for the ways in which I participate in and benefit from the status quo. I know that doing this publicly risks doing further harm in ways that I explore in the paper. However, I hope it does enough good, in supporting other White therapists to ‘turn their good eye’ (Steiner, 1999) to this dynamic in their clinical work, to make it worthwhile.

Mary Short’s paper is about work with a mother and her toddler, who was understood to be the replacement child after the loss of a child. This paper was given at the ACP conference a couple of years ago. Part of the reason that it has taken some time to reach our pages is that the author needed space to think about whether it would be ethical to discuss the paper with the mother, in order to gain consent to publish. The careful thought this needed seems to have paid off, and Short concludes that there were actually unanticipated benefits to her getting back in touch with the family. Her description of joining a perinatal team, where the parent is the index patient, resonated for me. I too have found that a CAMHS perspective, with its focus on the infant, is both wanted and resisted. I found Short’s use of Winnicott’s ideas around the use of an object particularly helpful:

… the object needed to be destroyed, survive and still be present. I sat on, feeling useless, but wanting to be involved, and a few minutes later the practitioner walked over to where I was sitting, and wondered if there was anything I could offer in this case.

Lida Anagnostaki and Theofania Antypa present a reflective account of a work discussion group set up for staff at a nursery in Athens. Their purpose is to begin to explore whether educationalists, given some short-term training in the model, can facilitate a work discussion space for their colleagues, if closely supervised by a psychoanalytic clinician. The authors are an experienced nursery teacher, who had two years of work discussion seminars as part of a master’s degree which also covered psychoanalytic theory, and a child and adolescent psychotherapist who acted as supervisor. They describe this as ‘action research’:

We can define action research as the study of a psychosocial condition, with the goal of improving action within this condition. Therefore, it has elements of producing meaning, as well as involving an intervention aimed at change.

They conclude that the intervention did achieve some change in the capacity for reflective practice in the group, but they also note the challenge of ‘holding’ such a group with minimal training and stress the importance of personal analysis for containing what is stirred, particularly in supervision.

Anna Cohen’s paper about work with gender questioning young people is refreshing in its refusal to engage with the polarised debate going on in our field, and beyond. At first, I had been concerned about the lack of reference to the existing literature but came to understand that this was intentional and helpful. Indeed, it is the way that she stays close to the patient and the material that reminds us that the work is still child and adolescent psychotherapy as we know it, however much the storm rages outside the room. I also welcome her invitation to use our own experience of becoming gendered, something we may not have given any conscious thought to, even in our analyses. She argues that doing this:

… compels the therapist […] to focus reflexively on how their own sense of their identity as person with a particular gendered body developed, and the points at which perhaps their experience could have been different. I think this is the beginning of being able to understand what our gender questioning clients are saying.

She speaks helpfully to some very ordinary anxieties we might have about this work:

we may be aware of our own discipline’s disturbing and very recent past, in stigmatising women, gay people, and people of colour, and may wish very much not to do the same to gender questioning young people. As a result, we may end up feeling uncertain about how we should work with gender questioning young people and find it more straightforward to focus on all the related issues that a young person may bring to therapy.

Similarly, Jennifer Browner’s review of ‘Time to Think’ by Hannah Barnes is balanced and anchoring, which is very helpful in the tempestuous climate around gender identity. She identifies what the book does well and notices what is left to do, which is to explore in more detail, with genuine curiosity, the experience of those young people who have a positive experience of gender fluidity and/or varying degrees of transition. In this Journal we have mostly heard from those working with young people where gender identity was understood as part of a defensive organisation, which it seems is a common problem that clinicians are working with. I hope that if there are clinicians working with trans and gender fluid young people and don’t understand this aspect of their patient’s identity as problematic, that they would feel able to share their experiences too. We are receiving submissions from non-ACP members working with this patient group, but we are particularly keen to hear from more child and adolescent psychotherapists who are working with these issues in generic clinics everywhere.

Michael Rustin offers a concise yet detailed summary of the content and immense value of a collection of papers on forgiveness, edited by Ronald Britton. He particularly commends the successful use of art, which is used more than clinical material to illustrate the ideas put forward. Although Rustin does miss clinical vignettes, he thinks they were omitted due to restrictions on space. I wonder if using illustrations from beyond the consulting room is also a way of freeing our patients from the burden of illustrating all our (public) clinical conversations with one another?

Rachel Acheson reviews ‘Supervision in a Changing World’, edited by Julie Kitchener and Deirdre Dowling. She offers a brief description of each chapter and captures a sense of the breadth of the book exploring, as it does, the experiences of both supervisor and supervisee in varied contexts. She draws attention to the fact that relatively little has been written about this vital aspect of all child and adolescent psychotherapy. The review captures something lively and intimate, and I had a sense of anticipatory excitement, the feeling of a veil being lifted. Supervisory relationships can be some of the most pleasurable and rewarding we have in our work and perhaps we have felt a little shy about opening up about them.

Rachel Acheson dedicates this entire Research Digest to a closer look at some of the studies included in the recent systematic review and meta-analysis of psychodynamic interventions for children under the age of five and their caregivers. She stresses that:

The findings contained in this review increase our evidence base as a profession and this awareness can embolden us to speak with authority when we contribute to the development of services.

Acheson explores the pros and cons of taking an inclusive approach to what constitutes psychodynamic and psychoanalytic interventions, when selecting studies for a systematic review. She also points out the growing evidence base for psychoanalytic parent-infant interventions compared to that for individual work with under-fives, and wonders what the implications might be for child psychotherapy trainings, particularly given the difficulty of finding intensive under-five cases.

It seems fitting to end with Rachel Acheson’s Research Digest as she will be opening the next issue with her Editorial. I wish her and her capable team all the very best.