Editorial

Welcome to the first issue of 2023. The APP recently changed its name, rebranding as the Association for Psychoanalytic Psychotherapy in the Public Sector. One of the reasons for this name change was a recognition of the breadth of settings beyond the NHS which use applied psychoanalytic thinking and practice. This includes not only the UK public sector but also numerous international settings, some of which were described in our recent ‘State of the Psychoanalytic Nation’ series of special issues (Cundy, 2022; Yakeley, 2020, 2021). The journal aims to reflect this scope, and welcomes contributions from around the globe. To this end Golan Shahar was appointed to the newly created role of ‘International Editor’ last year. Consequently I am delighted that this is a truly international issue, with each article originating from a different country.

In our first paper, Nicole Canin (UK) offers a 25-year scoping review of psychoanalytic journal articles on premature birth from 1997 to 2021. Her findings highlight the trauma of premature birth, both for the infant and its parents. Prematurity may also place the parent-infant relationship at risk. The therapeutic imperative of interacting with the infant as a person is strongly emphasised. The evidence suggests that working in the NICU is emotionally challenging. However, a case is made for the critical role that psychoanalytic practitioners can play in supporting those impacted by premature infancy. Canin identifies gaps in the literature describing the experiences of siblings and fathers of premature infants, and the intersubjective processes that occur between premature infants and their parents. She highlights an overall lack of articles on the topic of prematurity, perhaps a consequence of the intensity of emotional pain inherent in working in this field, and argues that this area requires further attention given the prevalence of prematurity and its profound impact on infant development and parenting.

The second article, by Fabiola Cortezia and Tagma Donelli from Brazil, continues our focus on the new-born. In ‘Parent-infant psychoanalytic psychotherapy when child development is at risk: process assessment’ they present a case study of a baby, her parents and a psychotherapist to describe the process and therapeutic interventions when child development is at risk. Developmental risk was assessed using the Risk Indicators for Child Development (IRDI). Thirty parent-infant psychotherapy sessions conducted over nine months were recorded in audio and video for subsequent analysis and classification by two independent observers. Frequency analysis and qualitative analysis of the collected data were performed. The results showed that there was a change in the types and number of therapeutic interventions used over the course of the treatment. The interventions which occurred the most were those specific to parent-infant psychoanalytic psychotherapy when child development is at risk, referred to as prosody. The authors recognise that there is still much to be explored, and further studies are needed. They acknowledge that their findings may be specific to this particular family-psychotherapist setting and that other interventions may be required in work with different families and/or psychotherapists.

Our next article, from Sweden, contributes to the rapidly growing evidence base for remotely delivered psychotherapy that has been published in this journal since the COVID-19 pandemic (Ahlquist & Yarns, 2022; Ahlström et al., 2022; Zoumpouli, 2020). ‘Using psychodynamic principles in guided internet-delivered therapy (IPDT)’ by Daniel Maroti, Henrik Hallberg, Karin Lindqvist and Jakob Mechler discusses whether two important facets of psychodynamic therapy, the therapeutic relationship (especially the transference) and emotional processing, are applicable and useful in IPDT. They propose that the therapist should not be limited to a mainly supportive role in IPDT. They illustrate how working with the transference relationship and facilitating deep emotional processing is possible in IPDT, potentially adding to the effect of solely taking a supportive stance in guiding through the self-help material. They suggest that unguided treatments might make less sense when based on psychodynamic theory due to the lack of a therapeutic relationship and conclude by stating that future research on IPDT could use dismantling designs to establish which therapeutic techniques are associated with change.

The final article is entitled ‘Mentalization based supervision’ by Henning Jordet and Morten Kjølbye, from Norway and Denmark respectively. The authors highlight a paradox in that Mentalisation Based Treatment (MBT) is taught largely through supervision but there is no consensus on what constitutes MBT supervision. They discuss the focus, goals and means of providing mentalization based supervision in the context of current clinical practice and theory of mentalization. They propose a dimension where the goal of stimulating mentalization is always in focus, which they illustrate in a sequence from a supervision session. The authors offer a ‘recipe’ for Mentalization based supervision, and conclude that it is possible to define what Mentalization based supervision is and how it differs from other forms of psychotherapy supervision. Primarily the supervision aims to enhance the supervisee’s ability to mentalize the patient and to use this ability in the next session with the patient. This can be achieved in several ways which require some central competences on the part of the supervisor such as the ability to implement theoretical knowledge in clinical practice, modelling the mentalizing stance and mentalizing the relationships both between the therapist and the patient, and between the supervisee and supervisor. Additionally the supervisor requires the ability to use the structure in the supervision as a means to enhance mentalizing. Jordet and Kjølbye conclude that there is a need for further research and hope that their article will instigate a focus on mentalizing-based supervision.