Editor's Comments

We are delighted to be resuming publication of Clinical Commentaries following the appointment of our new editor for the section, Katya Orrell. Here we meet a patient in her early fifties, who grew up in poverty and had to take on adult responsibilities at an early age, who has been in once-weekly therapy for several years. The therapist reports ‘an overwhelming sense of stagnation’ in the work, ‘a sense of monotony and repetition’, while for the patient there is ‘emptiness, coldness and rejection’ during any silence. Our thought-provoking commentators take up different aspects of the situation, from contrasting theoretical perspectives. The patient may not have been able to use normal projective identification, her only recourse being to ‘attack the analyst with massive projective identification, resulting conversely in impairment of the analyst's ability to think’ (Konstantin Nemirovsky). Perhaps the therapy feels stuck ‘because the patient is bringing another person's pathology in place of her own’. The task then is to help her learn that ‘the therapist has another type of mind, one that is neutral and curious and that can support her to express deep pain safely’ (Emma Went). ‘With so many uses of the words “start” and “deliver”, in the patient's speech … one cannot help but think about the patient's early birth experiences and whether this woman's mother actually wished to “deliver” and permit her daughter to “start” her life’ (Brett Kahr).

Turning to our Theoretical Practice strand. Jan McGregor Hepburn searchingly re-evaluates Strachey's seminal work on the mutative interpretation, arguing that ‘the mutative interpretation continues to offer something potentially transformative’, but that the technique has to take account of ‘relational aspects of the treatment and the developmental issues of the patient’. Chris Brogan offers a meticulous examination of Winnicott's 1968 paper, ‘Sum, I am’, in the wider context of Winnicott's concept of unit status ‘and what mig