Editorial

This issue of the British Journal of Psychotherapy spans a rich arc from assessment to ongoing work, evaluation and ending, across three clinical settings that the BJP has always been concerned with: individual practice, the organization of services, and group work.

Looking first at Individual Practice. Alistair D. Sweet, in ‘Elements of psychotherapeutic assessment and treatment with structured and under-structured personalities’, writes in part from an ego-psychological perspective. His central contention is that ‘a very careful and detailed analysis’ of the patient's level of structuralization - psychotic, borderline/narcissistic or neurotic - is required before a decision on the suitability of psychotherapeutic intervention can be made. Sweet argues that under-structured patients require a greater degree of supportive work, before movement towards a psychodynamically interpretative approach can be utilized. His purpose is to explore technical considerations in the treatment of ‘understructured patients’, particularly with regard to the organization of self and object representations, and the structure of defences. With less well-structured patients, he suggests, there tends to be a more pronounced vacillation in terms of adherence to the boundaries of the therapeutic frame. In a wide-ranging and meticulous survey, including brief but telling vignettes, he considers specific aspects of transference and countertransference phenomena in work with less structured individuals.

Next Yael Kadish, in ‘Autistoid psychic retreat in anorexia’, reports on her ongoing work with her adolescent patient ‘Amy’, who has been in once-weekly psychotherapy for just under two years but has recently increased to twice-weekly. Kadish argues that anorexia may be understood as a particular kind of autistoid psychic retreat, in which the patient is experienced as emotionally cut off by others, including her psychotherapist. Located within current debates on traumatic impingement on the moth