Editorial

There have been several changes at the journal recently. I am sad to report that our editor, Jessica Yakeley, left her post at the end of 2021. Jessica took up the role of editor in 2012, writing her first editorial in 26–04 which was published in December that year. Over the ensuing period she has published three books based on special issues of the journal: ‘Forensic Psychotherapy’ (Yakeley & McGauley, 2018), ‘Psychoanalytic Perspectives on Fundamentalism, Radicalisation and Terrorism’ (Yakeley & Cundy, 2019) and ‘The Social and Interpersonal Origins of Depression Today’ (Clarke et al., 2020). Jessica has been an inspirational leader for the journal, overseeing its ongoing development for a decade. On a personal note Jessica has been a positive and supportive colleague, initially helping me to settle into my role as assistant editor, and then encouraging me to expand and develop the tasks for which I have been responsible. Jessica will be greatly missed, and all involved in the journal are immensely grateful for her work here.

Also leaving us is Arabella Kurtz, Book Reviews Editor, who has recently taken up a role in Northamptonshire as lead of a new NHS Staff Health and Wellbeing Service. The book reviews section has flourished under Arabella’s guidance. A particularly significant development was the ‘book review essay’, a new category that enables authors to reflect on their own personal and clinical experiences in the context of two or more books on a specific subject. I am pleased that this issue includes a review of Arabella’s recently published book ‘How to run reflective practice groups’ (Kurtz, 2020).

I am delighted to welcome Rachel Hodgins into the role of Book Reviews Editor. Rachel is a Clinical Psychologist in Psychoanalytic Psychotherapy currently working at the Tavistock & Portman NHS Foundation Trust. Like Arabella, Rachel’s first degree was in English. She has previously peer reviewed articles for the journal, and also contributed a book review essay. Rachel has already begun commissioning reviews, and hopes to implement some exciting developments in our relatively new social media profiles. Rachel is a friend and former colleague and I look forward to a fruitful working relationship here at the journal.

This very full issue begins with a focus on the psychosomatic. In the first of our articles Elias Seidl, Dirk Schwerthoffer and Otmar Seidl report on a study conducted in Munich which explored the role of psychodynamic factors in tinnitus aurium. Tinnitus is the conscious perception of an acoustic sensation in the absence of a corresponding external stimulus. It is experienced relatively commonly (10–15% of the population) but causes significant distress to 1–2%. In this study 99 outpatients at an ENT clinic completed a psychodynamic interview examining trigger situations, parents’ parenting style, ‘relation to hearing’ personality, and individual conflict dynamics associated with the onset and course of tinnitus. Besides organ-related triggers, the authors identified conflict-laden stresses as trigger situations. Compared with the general population, patients with tinnitus showed less overt aggressiveness and more social orientation. They also experienced higher levels of state and trait anxiety. Inhibition of aggression was a major psychodynamic factor in the development of tinnitus. A conflict of autonomy was found in the majority of cases. The authors conclude that these results underline the significant contribution of psychodynamic factors in tinnitus. They look beyond the presentation of individual psychodynamic factors and instead formulate tinnitus as an overall construct of a psychosomatically explainable illness. The authors make a plea for health care providers to consider the psychodynamic dimension of tinnitus in addition to providing the usual behavioural therapy.

In the second article Javier Malda Castillo and colleagues report on a pilot study of the effectiveness of Intensive Short-Term Dynamic Psychotherapy (ISTDP) as a treatment for dissociative seizures. They used a mixed methods case series design to follow the progress of 17 patients in secondary adult mental health care and specialist neurology services. Data were collected from patient reported outcome measures and qualitative reports of their experiences of therapy, interpreted using thematic analysis. Compared to the outcome measures completed before treatment there were improvements at the end of the treatment which were maintained at one month follow-up. Healthcare utilisation was also reduced, including less use of acute medications, fewer attendances at A&E and lower usage of the crisis-line.

The thematic analysis revealed five themes. Of particular note, patients described an increased ability to recognise triggers and warning signs, and an increased awareness of emotional avoidance and its role as a seizure trigger. Positive outcomes of therapy were reported including fewer seizures and increased control over them, as well as the more general benefits of improved intra- and inter-personal relationships. Taken in conjunction with little adverse effects of treatment, the authors conclude that these results provide preliminary support for the safe use of ISTDP in this complex group of participants, and suggest that further research using larger controlled and randomized studies is warranted.

Our third article, by Rebecca Philipp and colleagues, describes the provision of a course of a short-term supportive-expressive psychotherapy for patients with terminal cancer. Using examples from eight therapy sessions with a male patient with avoidant attachment behaviours, the authors illustrate some potential treatment challenges from a psychoanalytic perspective. The authors found that ‘attachment avoidance’ subsumed different defence mechanisms, which helped the patient to reduce his fear associated with (1) feelings of dependency through the defence of denial, (2) overwhelming distress through either isolation of affect or displacement, (3) feelings of guilt and shame through the defence of repression, (4) regulating his interpersonal relationships through his use of projective identification. Adding psychoanalytic interpretations to the existing material helped to identify rigid defence mechanisms that interfered with his ability to share his fears about death and dying. The low intensity therapy setting provided a reliable and tolerable therapeutic relationship. Contributing to the understanding of the specific challenges in treating avoidant patients, the authors underline the importance and feasibility of establishing a holding environment and fostering a positive transference relationship to engage in a joint mourning process.

Continuing the focus on psychotherapies for health conditions, Ahlquist and Yarns report on delivering emotional awareness and expression therapy (EAET) for chronic pain during the COVID-19 pandemic. EAET was developed by Lumley and Schubiner (2019) to target the trauma, stress, and relationship problems that are found in many people with ‘centralized’ psychosomatic conditions. The social distancing requirements of the pandemic required the authors to move their experiential group treatment online. The authors were, at first, unclear whether patients’ emotional expressions (which are of great importance to the success of many psychodynamic therapies) could be facilitated using online video sessions.

The article begins with a review of the literature focused on emotional expressions in psychotherapy and implementing psychodynamic therapy online. The authors then describe their clinical experience of delivering EAET online. They use verbatim examples from their therapeutic work to discuss the barriers that they encountered, and also illustrate, ultimately, the success of the approach. The authors describe the potential to facilitate powerful emotional expressions in online video sessions when conducting a psychodynamically-informed treatment. They examine the possible applications for online video treatments to provide emotionally focused, psychodynamic psychotherapy and enhance its teaching and training. Although they describe some limitations of their specific approach, their experience supports the potential efficacy of experiential, emotion-focused psychodynamic therapies delivered online.

The next article also reports on adjusting a treatment model, this time from an individual to a group treatment. Dynamic interpersonal therapy (DIT) was developed by Lemma et al. (2010) for individual clients. Here, Julie Folkes-Skinner and Letitia Collins report on their pilot project which set out to evaluate whether DIT could be adapted to group psychotherapy. They ran three consecutive groups in an NHS IAPT service over two years. The groups were facilitated by accredited DIT therapists. The delivery of key aspects of the model were changed, including the formulation of the IPAF and the Goodbye Letter.

Twenty-seven patients were offered treatment. The participants completed the PHQ9 and the GAD7 at assessment and then weekly. The scores were used to evaluate the impact of Group DIT (GDIT) on client symptoms. The results suggest that DIT can be adapted to a group setting and that this way of working may have significant benefits for patients. 74% of patients who completed the treatment scored above caseness on the PHQ9 and 58% on the GAD7. As this was a pilot study with small sample size and no control group, these reductions in patient symptoms cannot be reliably attributed to GDIT. However, the authors conclude that their results offer good support for the use of GDIT, and suggest that further, larger scale research of this model is warranted.

In the following article, Torben Heinskou and Ulla Charlotte Beck explore the relevance and meaning of mentalizing in leadership and management roles, and suggest that the theory and practice of mentalization can be helpful in understanding the construction of shared meaning in the organization. Recent theoretical developments clearly describe how failures in mentalizing in social systems lead to a predominance of actions and non-verbal communications. The ability to reflect and investigate reality in a playful way in the social community becomes suspended, which can lead to authoritarian practices.

The concept of authority is central in organizational work and in leadership roles. The relations that exist in organizations are multiple and can be vulnerable to failure and misunderstandings. The authors suggest that an effective leader must have both self-awareness and awareness of others and take into consideration that behind actions there are mental states, emotions and thoughts, wishes and needs. The leader must be able to take relevant action for which they will be held responsible by the organization. They conclude that in order to act and to understand the consequences of one’s actions it is crucial to have an open mind to oneself and to others. Reduced capacity to mentalize may undermine change and the function of the work-group, leading to irrationality and deadlocks in the organization. The ability to mentalize leadership can stimulate a potential space in the organization for new and non-rigid modes of experiencing.

In our final article, ‘The Interchange in Art-Psychotherapy’, Liam Bierschenk investigates the state of mind of the creator in the art-making phase of art therapy, by reference to the interchange with the looking/talking phase. He draws on Kleinian, post-Kleinian and mentalization theories to explore this interchange within the concept of a triangular relationship between creator-artwork-viewer, as well as the three ‘waves’ of art therapy theory and practice. In his conclusion, Bierschenk uses mathematical abstraction to describe the recursive sequence of art-making and looking/talking about the art and to pose questions about what might be occurring during these processes. He suggests that this could serve as a framework for further investigations from various theoretical standpoints.

Disclosure statement

No potential conflict of interest was reported by the author(s).