BRITISH JOURNAL OF PSYCHOTHERAPY

EDITORIAL

Volume 12, Number 4, Summer 1996, pp.433-434

On the face of it, it looks as if the central place of sexuality in psychoanalytic theory has been eroded away together with the shiff from phallocentrism to matrocentrism over the course of the century. It is startling to think that a theory firmly founded on biology, the libido and psychosexual stages leading to genitality could evolve into something apparently so different, focused on the infant-mother relation and a life and death drive. What has happened to infant sexuality, or adolescent and adult sexuality for that matter, as major factors in psychopathology? Can sex have become, in our liberated culture, something we take for granted, or so peripheral as to be marginalized out of the picture of psychoanalytic concerns, giving precedence, perhaps, to issues around aggression?

From a number of viewpoints within psychoanalysis sexuality remains central, notably seen as essential in theories about hysteria and perversion. For the BJP 1995 Annual Lecture last October, Juliet Mitchell and Estela Welldon teamed up to speak about these areas, locating the source of symptoms and personality disturbance in sexual conflict and anxiety. It seems to me that further effort to develop and enrich our understanding of mature sexuality needs to be made, in order to round out and articulate a fully fledged object relations theory, perhaps following the lead of Ethel Spector Person on romantic love and Otto Kernberg on the erotic.

In the first paper in this issue, Alan Lidmila writes about the term 'psychodynamic', employed so ambiguously and often politically. He suggests a more precise reformulation of the term that recognizes the diversity of analytic practice. The next paper looks at how psychoanalytic concepts have permeated our language to create clusters of meaning. Moving into the area of discourse analysis, Ian Parker relates the way in which psychoanalysis has entered postmodern culture and language in the form of 'discursive complexes', organized systems of meaning that construct objects and determine realities. He focuses on three of the 'discursive complexes' originating in the therapeutic that have shaped postmodern culture: intellectualization, transference and trauma.

Laurie Jo Wright's prizewinning essay is about her lingering countertransference reaction to a character in a novel, the grandmother in Eva Figes's The Tree of Knowledge. This character stayed with her and prompted her to explore as a case history a fictionalized woman, the poet Milton's youngest daughter, whom she was initially only too glad to 'put back on the shelf' after reading the novel. Wright's imagination and clinical interest were compellingly caught up by Figes's convincing capture of the dynamic unconscious of this character in images that, behind her plodding adult existence, brought alive a small child's attempt to cope with an early, emotionally abusive environment.

We offer two papers that provide empirical findings in important areas. A research

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study was carried out at the Cassel Hospital by Marco Chiesa, Eduardo lacoponi and Mark Morris on the utilization of health services affer inpatient treatment. The study evaluated the impact of a year of treatment on patients who were diagnosed as personality disorder, finding that the demand on services, prescribed medication, medical visits, hospital admissions, and time away from work, all significantly decreased compared to a control group, showing cost benefits of treatment. Not surprisingly, the only (non-significant) increase was the number of visits to GPs for psychological support. This gives some substance to the notion ofpossible savings for the NHS as a result of psychological treatments.

Then, we have an experimental design measuring countertransference reactions by milieu therapists, conducted by RoIf Holmqvist. The data was collected by means of feelings checklists, conceptualized by Winnicott's idea of the treatment area as 'potential space', an 'intermediate area' saturated with affects and emotional reactions in both therapist and patient. The therapist's habitual way of reacting, the 'average, expectable' countertransference is compared to unusual countertransference reactions, with the argument that it is only possible to assess the importance of countertransference within the context of habitual patterns and personal emotional style. Some emotional reactions may be commonplace or trivial for one therapist, but highly significant for another, such as anger or hate towards the patient. Thus, it would be an error to speak of a standard countertransference experienced by therapists in relation to a particular patient. The measures were used to assess the personal pattern for each therapist: the statistical averages, variances and interaction effects created a distinct picture of each therapist, and showed their different countertransferences to each patient, which could, by the average feelings evoked in therapists, be of help in the diagnosis of the patient. When the general patterns have been controlled for, the uniqueness of the countertransference feelings becomes visible, in a study that demonstrates a promising methodology of potential use in psychotherapy research.

We include two articles on specialist areas of psychotherapy, work with victims of torture and with HIV and AIDS clients. Andrea Sabbadini writes about his experiences with two people who had escaped from situations in which they had been traumatized by torture, connected with the Society for the Victims of Torture in London. Chris Purnell writes of his experiences in setting up a counselling service for people with HIV/AIDS-related problems based on Bowlby's attachment theory.

We have another contribution to the NVQ debate by Margaret Smith, and, finally, an article by Chris Evans on how the Internet works and how to access the BJP Table of Contents for each issue and the guide for contributors. We have entered the 21st century.