Editorial

This issue of the Journal opens with three rich papers in our core ‘Clinical Practice’ strand; in all of them, the clinical material is embedded within a central theoretical debate. The papers address the erotic in the consulting room, from a relational perspective; work with substance misusers, from an attachment perspective; and work with disabled patients and their families, from the perspective of the classical distinction between mourning and melancholia.

In the first of them, Paul Renn explores theoretical and technical differences between relational and traditional approaches within contemporary psychoanalysis, in a subtle and wide-ranging exploration of the ‘relational challenges of sexuality in the consulting room’. The paper is in part a development of previously published work concerning a patient who expressed a desire to have a sexual relationship with him. Making use of the work of Fonagy and Target and their colleagues; the Boston Change Process Study Group's work on ‘moments of meeting’; developments within attachment theory; relational ideas about the therapist as ‘an active participant in a more intimate two-person relational process’; and acknowledging recent work - by Gabbard and his colleagues - on questions of self-deception in transgression of ethical boundaries, Renn poses the potentially uncomfortable question: whether the necessary injunction to do no harm can slide into a ‘defensive mind-set of “take no risks”’. As Renn writes, he knew that his response to his patient had to be ‘real and heartfelt, rather than defensive or judgemental’. His is a thoughtful discussion, acknowledging the importance of clinical playfulness while remaining vigilant about (actual) boundaries between patient and therapist.

Next, Alistair D. Sweet's focus is the assessment and treatment of chronic and relapsing substance misusers from the perspective of attachment theory, and prior studies on the attachment patterns in children of substance abusing parents. Sweet s