Editorial

We are at an important moment in the history of child psychotherapy, facing a number of challenges inside and outside the clinic as we find our place in the current world of services for children and young people. Some of the challenges of working as a child psychotherapist today are reflected upon in the papers in this volume, together with insights into organisational and clinical ways forward that integrate psychoanalytic thinking with that of other disciplines, for example contemporary development research.

In our opening paper, Jo Russell examines some gaps between psychoanalytic theory and clinical practice in relation to what she calls ‘a dissociative internal landscape’. For children and young people with such inner worlds, she found, Klein’s traditional analysis of the deepest anxiety through interpretations, examination of resistances and persistent tracing of the transference seemed to be inflammatory. One is reminded of Anne Alvarez’s patient, for whom ‘some of [her] interpretations seemed to make him more mad’ (1997, p. 762).

Russell traces the relational roots of such a presentation, weaving together development research, attachment theory and psychoanalytic thinking in a sensitive and illuminating account of the kind of psycho-biological history which establishes a dissociative inner landscape. She suggests that in these cases we need an approach which responds to the dysregulating bodily presence of relational trauma, while holding onto the crucial psychoanalytic tool of articulating the negative transference at a time and in a way that feels useful for the child in the room.

The paper contrasts the notion of reality and believability with the notion of truth, in the context of a child’s traumatic and chaotic relational world. The understanding is that for these children, the only way of communicating the truth of contradictory and mutually exclusive aspects of relational experience may be through enacting wildly different self states.

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