Editorial

Writing about dreams in this issue, Anne Samson tellingly observes that they ‘reveal to us truths about ourselves that we are not yet ready to admit, or ideas that are not yet clearly articulated’. This difficulty or uncertainty about the psychic issues facing us can be seen not only in the dream-state, but in the very uncertainty which may bring a patient to their first meeting with a psychotherapist. As Fiorenzo Ranieri writes of his patient Mr R, in the article which opens this issue, ‘Extreme risk seeking addiction: theory and treatment’: ‘When I asked what had brought him to me he was not able to give me a precise answer, and yet I also soon felt the sensation of pain and suffering which went with him’. John R. Giugliano's patient Jay presented with the statement: ‘There is something wrong with me and no one can find it’. He meant something physically wrong. Giugliano's paper contines the theme of addiction, with a clinical focus on a gay patient who engaged in compulsive sexual encounters, in ‘Self-psychological treatment of a sex addict with sadomasochistic behaviours: a case report’.

Sensations of pain and suffering can be conceptualized in a number of ways, and this issue of the Journal offers a variety of ways in. There are two, detailed clinical narratives, from different theoretical perspectives within psychoanalysis: Steiner's psychic retreat and the mentalization of affect, in Ranieri's moving account of Mr R's solitary windsurfing and courting of danger in the sea; Kohut's view of narcissistic disturbance as ‘central to the psychopathology of the addict’, with a self-psychological perspective on sex addiction as a repeatedly unsuccessful attempt at ‘remedying central deficits in an uncohesive psychic structure’, in Giugliano's meticulous exploration of Jay's ‘constant feelings of emptiness and insecurity’. Both clinical narratives depict psychic change, with signs of some return to what Ranieri refers to as the ‘living world’: for Mr R, when he began t