Editorial

I am writing this editorial as England endures a third period of lockdown and once again my NHS clinic has been compelled to close its doors to patients. The experience of the first lockdown, now almost a year ago, is a distant memory. Back then I had naively hoped that lockdown might increase the time available to authors for writing, and lead to an increase in submissions to the journal. As we now know, the complexities of remote working have often demanded more, rather than less, of our time. Consequently the work of the authors, reviewers, editorial and production teams has taken longer than usual, resulting in some delays in publishing our journal in 2020. As we adjust to the ‘new normal’ these challenges are being resolved, and we hope to return to the usual publication schedule in 2021.

Remote working has also challenged us to find new and creative ways to continue to offer psychoanalytic psychotherapy within the public sector. The first of the papers in this issue, by Angeliki Zoumpouli, seeks to answer the question ‘Is a “good enough” experience possible for patients and clinicians through remote consultations?’ In 2018 this journal published a review essay by Malika Verma entitled ‘Screen relations: the limits of computer-mediated psychoanalysis and psychotherapy’ (Verma, 2018). At that time remote therapy was rarely offered, except in circumstances such as geographical distance between patient and therapist. Verma described her experience of being the only psychoanalytic psychotherapist offering treatment in Southern India. Just two years later the provision of treatment via video call is familiar to the great majority of clinicians. Recognising the ubiquity of this type of practise, Zoumpouli sets out to describe how remote therapy can provide a ‘good enough’ experience for both patients and clinicians. Drawing on psychoanalytic and neuroscientific literature she uses four clinical examples to offer conceptualisations intended to optimise the experience of remote therapy for both patient and practitioner. She concludes with some practical suggestions to clinicians and more tailored and specific advice to psychotherapists.

One of the many tragic consequences of COVID has been the impact of lockdown on the prevalence of domestic violence. Refuge, the UKs largest single provider of specialist domestic abuse services and sole provider of the National Domestic Abuse Helpline, has seen a sharp and escalating rise in demand for its services (Refuge, 2020). During the initial stages of the Covid-19 crisis Refuge reported around 50% increase in demand to its Helpline and a 300%+ increase in visits to its National Domestic Abuse Helpline website. Demand has spiked again significantly: calls to the Helpline have risen to a weekly average increase of 66% and visits to their website have seen a phenomenal 950% rise compared to pre Covid-19. Whilst the vast majority of victims of domestic violence are women, services for male victims have seen similar increases in demand (BBC, 2020). Our second paper is therefore a timely investigation of this subject. ‘An unthinkable and unbearable injury: Psychoanalytically-oriented qualitative research with men who have experienced intimate partner violence’ by Laura Philpott and John O’Connor, reports on a psychoanalytically informed qualitative study (conducted before COVID) of men’s experience of intimate partner violence within the context of a heterosexual relationship. In the themes that arose, a strong sense of the unthinkable and unbearable nature of such an experience was highlighted, alongside a sense of the insidious and destructive nature of such violence, leaving in its aftermath deep feelings of shame, confusion, depletion, terror, and hurt. The resultant difficulties for the individual, wider society, and clinician are explored.

The third paper in this issue takes us from the victims to the perpetrators of crime. Giulio de Felice and his colleagues describe an experience of group supervision with the staff of an Italian Secure Psychiatric Unit. Using clinical material their paper, ‘A psychoanalytic contribution to the understanding of criminal tendencies’ considers the concepts of containment, symbolisation and psychic vitality in formulation and treatment in the forensic setting.

Jeremy Clarke continues his book review essay with part two of ‘Some very important people are depressed; get over it!’ Clarke reports on memoirs by Andrew Solomon and Lewis Wolpert. These narrative reviews seek to achieve scientific objectivity from the perspective of personal experience, undertaking to analyse what they discover about depression – its causes and types; treatments; and how to prevent its recurrence. Clarke proposes that Solomon and Wolpert’s reviews anticipate the aspiration for evidence-based clinical guidelines to capture the sum of scientific knowledge about depression. He concludes that through the significant overlaps in what they collectively recommend for the treatment of depression we can see a converging consensus, albeit briefly, at the turn of the 21^st C., in mainstream and expert opinion. Clarke continues to develop his thesis of what types of evidence should inform practice. He argues that it is time that psychoanalytic practitioners now include the social determinants of stigma more fully in their theoretical and clinical formulations. The third and final part of Jeremy Clarke’s review essay is due to be published in the next standard issue of the journal.