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The psychedelic state can be thought about as an interdependent intrapsychic, somatic, interpersonal and spiritual happening which encourages, perhaps both to the relief and dismay of those participating in the experience, the shocking and impressive emergence of one's unconscious desires and traumata's; a state which may be experienced as cathartic or healing, and as anxiety‐provoking and confusing. Often, in clinical trials investigating psychedelics in mental health conditions, these go hand in hand. Amid a renewed, at times hyperbolic, interest in psychedelics as a potential treatment for mental ill health, significant gaps of knowledge remain. Additional studies exploring the impact of the extra‐pharmacological factors and adjunct therapeutic models on treatment outcomes are needed. Drawing from psychoanalytic perspectives, this paper explores points of intersectionality between psychedelic therapy under investigation and psychoanalysis in the context of traumatic stress. To that end, the psychedelic state will be considered an attempt to make the unconscious conscious by immersing self in a bewildering waking‐dream to better tolerate reality; immersing self in a wilful state of vulnerability, to develop trust in one's agency and capacity to trust others; immersing self in an indescribable experience to learn how to redescribe, to self and to others the traumatic past. [ABSTRACT FROM AUTHOR]

At the site of interpersonal conflict resides the potential for learning. This paper presents psychodynamic theories, empirical research and a fictional case study of psychotherapy group supervision. Supervision is discussed in terms of teaching and learning, triangular relations, and group and organizational perspectives. We examine the interconnectedness of patterns of distress that emerge within dynamic relational systems at the levels of the macro-social, organizational, group and individual. The concepts of equivalence, parallel process and reflection process provide frameworks for this discussion. We explore the constraints and dynamic influence of the organization upon the supervision relationship and the ethical tensions that construct im/possible positions for the supervisor. The case study tells a fictional story of a supervision group situated in an organizational context - a university psychotherapy education programme. A collapse of the group into complementarity, that is into polarized conflicted positions, proffers a vitalizing opportunity for learning. Through the clinical discussion, we reveal how this is contingent on the group's capacity to think together about the meaning of their struggle and to transcend a binary conflict and achieve 'the third'. [ABSTRACT FROM AUTHOR]

The author addresses some issues regarding patients who relocate and who struggle with adaptation to a new reality. She argues that emigration is a complex psychological phenomenon that requires a therapist to pay special attention to the issue of language, difference and identity, and suggests that the issues of different culture and language in analytic psychotherapy need to be considered as part of a wider cultural context to which we all belong, rather than a specialized area of interest. The paper illustrates, through the clinical example of an East European male patient, that the psychic work of emigration can be understood as a process of integrating splits between pre- and post-migration selves. The author concludes that the analyst needs to let herself be involved as a 'real person' to reach the non-interpretative aspects of the patient's psyche through a mutuality of shared experience to promote a change. [ABSTRACT FROM AUTHOR]

This paper explores the dynamics involved for children growing up with a narcissistic parent. It suggests that as a consequence of a malignant identification children resort to compliance and sacrifice in varying degrees. Compliance, as part of the sacrificial dynamic, also serves as a means for identification, which in the absence of other emotional nurturance the infant and later the child is reluctant to relinquish. Drawing on the personal and professional experiences of both D.W. Winnicott and H.J.S. Guntrip the paper discusses the underlying conflict between absorption into and abandonment from the narcissistic parent. The psychotherapeutic relationship offers a space to acknowledge the systematic interconnectedness that is at the heart of the malignant identification and the terrible dependency involved. Through a good personal relationship a benign identification with the therapist can begin to replace what was previously so strongly held onto. Brief extracts from two incomplete psychotherapies with young men are used to illustrate certain aspects of the therapeutic work involved. [ABSTRACT FROM AUTHOR]

Focuses on the process of selecting the papers published in the 20th anniversary issue of the journal "British Journal of Psychotherapy." List of articles published in the previous issues of the journal.

abstract This paper discusses the use of Cognitive Analytic Therapy (CAT) with carers of people with dementia and raises the wider issue of service delivery and provision of psychological therapy services to carers. Carers experience loss and emotional pain (; ; ) while providing full-time care to the person with dementia who has complex and changing needs. This frequently results in major depression and anxiety, increasing the possibility of referral to mental health services. Treating carers' distress is vital not only for their mental health but to enable them to continue in their caring role, without which the current care system would collapse. This need is being addressed in Newham by the tertiary psychology service, Psychotherapy for Older Adults (PTOA), set up in 2006-07 to accept referrals of people over 65 with mental health problems. This paper outlines how the PTOA is well placed to identify and treat carers. We propose that CAT is an effective and flexible therapy in this setting, and illustrate this with a case study. Further research and models for psychotherapeutic service delivery for carers are required. [ABSTRACT FROM AUTHOR]

Resistance is encountered in psychotherapy in many different forms and can be seen as a survival strategy. This paper interprets the short story Bartleby the Scrivener by Herman Melville as a fictional case of defiant resistance which some patients develop to fend off external demands experienced as intolerable impingements. Clinical material from two particularly intractable cases of narcissistic damage is introduced in the second part of the paper to support the hypothesis that the therapist needs to contain and understand this kind of resistance as a defensive stance in the service of protecting a weak self structure, thereby making the patient feel held and enabled to shed the fear of impingement and to bear what Melville called the 'cosmic orphanhood' of man. [ABSTRACT FROM AUTHOR]

In this paper I discuss the diminishing role played by psychoanalytic/psychodynamic psychotherapy in public sector mental health treatment services and explore the impact of this on the psychoanalytic profession and its trainees. I draw on the discipline of pragmatics to argue that we need to move from a theory-based approach to clinical practice to a research-based model in which we draw on an integration of evidence from a range of disciplines to build an understanding of the developmental and neuroscientific basis of psychological and emotional problems, with a particular focus on complex PTSD and its overlap with borderline personality disorder. I discuss how process research and outcome studies provide additional tools to add to our understanding of the clinical interaction in the consulting room. I discuss the implications of these findings for clinical practice and the need for clinicians to begin to integrate research into their training and professional development. [ABSTRACT FROM AUTHOR]

Much has been written about the therapeutic alliance, and the concept has a long history in the psychoanalytic and psychotherapy literature. This paper endeavors to clarify certain aspects of the therapeutic alliance, and to highlight ways in which the concept is particularly important in the psychotherapy of suicidal patients. The realm of implicit relational knowing is emphasized as critical to understanding the therapeutic alliance and also as a major arena for psychotherapeutic change. A clinical example is presented of an intensive psychoanalytically oriented psychotherapy with a suicidal patient. The example demonstrates the importance of implicit relational knowing as essential to the therapeutic alliance as well as to psychotherapeutic change. [ABSTRACT FROM AUTHOR]

abstract The Labour government's response to the ) report was to implement the 'Improving Access to Psychological Therapies' (IAPT) programme within Primary Care Trusts in the NHS. In this paper, I argue that the IAPT programme's explicit commitment to 'well-being work' risks distorting the unconscious anxiety-containing function that society traditionally allocates to mental health practitioners. Drawing on the social defence paradigm of ) and later work by ), I use an organizational case example to explore some of the unconscious dynamics within an IAPT service and explore how mechanisms such as defensive splitting and projective identification within the multidisciplinary team result in psychotherapists coming to represent an unwanted, vulnerable and expendable aspect of the service. I contend that psychotherapists may serve an important function as unconscious ambassadors of a split-off affective aspect of IAPT primary care mental health services, and that as such they will urgently need to ensure they do not succumb to burnout or unhelpful ways of working and relating within the team. [ABSTRACT FROM AUTHOR]

This paper is an account of a programme of combined individual and group psychotherapy offered to borderline patients in an NHS setting. It is written from the perspective of an individual therapist and describes how he came to think of this therapy structure, which offers the patient two different therapy settings and a relationship with two different therapists, as a representation of the patient's entry into and negotiation of the Oedipus situation. The way each patient accommodates to this oedipal structure can be tracked by the therapists, and used in their thinking about and work with each patient. A case illustration is given of how one patient in the programme responded to the provision of two therapy modalities by massively and violently splitting her experience, denigrating and attacking one modality while appearing to value the other. The patient made no real progress until this splitting could be contained by the therapists. This allowed the patient to discover that there could be a generative fink between the two settings. It is argued that it was this experience which played a crucial part in enabling the patient by the end of the programme to derive some benefit from the therapy as a whole. [ABSTRACT FROM AUTHOR]

Freud's recognition that what cannot be remembered may well be repeated in action is useful for understanding the trauma and aftermath of the Controversial Discussions. I shall be concentrating on disavowal, repeating, working through and remembering in the evolving context of the process of the impact of the Discussions. I suggest that we can distinguish three phases of the impact of the Discussions: the first a silence as if the Discussions constituted something too traumatic or too shameful to speak about; the second a phase of mutual influence between two or more groups which constitutes one form of working through, an attempt to integrate (with its opposite a concentration on irreconcilable differences); and third a further stage of working through which is closer to remembering, treating the Discussions as a historical point of reference in the service of sorting out clinical and conceptual problems. [ABSTRACT FROM AUTHOR]

Presents information on the "British Journal of Psychotherapy." Role of the journal in the psychotherapy sector; List of organizations that supported the journal; Challenges faced in writing the articles published in the journal.

This article discusses the connection between the compulsive use of toxic substances and the shortcomings of the family environment. It provides a detailed account of the author's experience with an adult patient in a psychoanalytically oriented mental health care institution in France and argues that drug abuse can be conceived as a self‐calming strategy and an effort to be without the other. The coexistence of neurotic and psychotic mechanisms in the patient's mental function is highlighted and discussed in the light of structural psychopathology. Finally, French institutional psychotherapy, as a dynamic and tolerant form of psychiatry that emphasizes multi‐transference in response to the split‐off elements of the psychotic ego, highlights the pertinence of treating psychotic drug addiction in a pluralistic framework. [ABSTRACT FROM AUTHOR]

Introduces a series of articles on psychotherapy.

Introduces a series of articles which deals with body countertransference, psychotherapist-patient relations, and other issues related to psychotherapy.

Three interacting challenges are facing all aspects of health care in the United Kingdom: financial restraint in the context of a global economic downturn; a move to services being commissioned and decommissioned by primary care Clinical Commissioning Groups; and a need to provide evidence based practice through 'payment by results'. Psychoanalytic psychotherapy faces more difficulty than most services in mental health, with long and frequent criticisms of it being expensive and under-researched; and it is not as well understood by GPs as cognitive behavioural therapy, with which it is frequently unfavourably compared. This review provides an overview of the existing evidence for psychoanalytic psychotherapy, identifying strengths and areas that are under explored. We also argue that psychoanalytic psychotherapy has a unique clinical role but this will need to be clearly stated in the future, and promoted by clinicians to encourage future commissioning in the UK. [ABSTRACT FROM AUTHOR]

abstract The introduction, funding and roll-out of the NHS's Improving Access to Psychological Therapies (IAPT) programme represents one of the biggest changes to mental health service provision ever seen in the UK. Drawing on Hinshelwood's (1994) notion that public mental health services may be regarded as a defence against overwhelming anxieties relating to psychological fragility and emotional distress, I explore the tendency for IAPT services to systematically disavow feelings of loss and vulnerability in both staff and patients. I propose three mechanisms by which this disavowal occurs: the promotion of a consumerist ethos and a 'patient choice' agenda; the deployment of discourses minimizing notions of fragility and dependence; and the proliferation of bureaucratic and surveillance systems aimed at continually monitoring and evaluating staff and clinical activity. Drawing on Freud's (1917) distinction between mourning and melancholia, I go on to argue that a sense of unconscious loss may come to be constitutive of the culture within IAPT services where the institutionally-sanctioned repudiation of containment cannot be spoken about, addressed or mourned. Through a short case example, I illustrate the way in which organizational melancholia may be hidden within the structures of an IAPT service and enacted by both staff and patients. [ABSTRACT FROM AUTHOR]

abstract The author explores the subjective and objective nature of time in relation to brief psychotherapy, the contemporary contexts for this work and the impact of research on the changing culture of provision of counselling/psychotherapy. She describes clinical treatment using a brief Dynamic Relational approach with a traumatized patient in primary care who presents with panic and depression. Through this case she illustrates the most significant points of technique in her interpretation of this approach: assessment through interactional aspects of the first and second meetings, further assessment through history-taking and the development of narrative, forming a collaborative focus based on a maladaptive relational pattern, selective inattention and benign neglect, interpretative 'action', termination and the collaborative therapeutic summary and use of other attachment figures available in the primary care team setting, particularly during the termination phase. The patient's unconscious and conscious internalization processes enable brief treatment to be durable, and it is argued that depth can be achieved. The author contends that brief therapy requires specific techniques but also makes connections with long-term analytic work, for example, the parallel between Bion's concept of the 'selected fact' and the 'focus' in brief therapy. [ABSTRACT FROM AUTHOR]

Presents information on psychotherapist Wilfred Bion. Difference of the techniques of Bion from other therapists; His views on X-ray machines; Remarks on the profession of analysis.

Psychoanalysis is approached from the perspective of linguistics. It is argued that analysis is concerned with a type of communication different in nature and logic from that of the natural sciences. The characteristics of analytic language are illustrated by comparing poetry and psychoanalysis. Transference is discussed as a special type of metaphor; ambiguity is seen as an intrinsic aspect of aesthetic language; wholeness is held to be a goal of both therapy and the arts. The relevance of this view to recent findings in neurophysiology and ethology is discussed. [ABSTRACT FROM AUTHOR]

Discusses brief work in educational therapy to resolve cases of loss and failure of containment. Definition of educational therapy; Information on educational therapy and its relationship with brief work; Details of a case of loss and failure of containment.