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Appreciations first: To the Journal Editors for a fascinating collection of papers about different responses to trauma, to Alexandra de Rementeria for requesting short feedback pieces in response to these papers, and to Ricky Emanuel for his quite excellent paper linking the ‘bio-psycho-social’ aspects of trauma, to which we need to attend. We all learn through experience, and Ricky is indeed honest about what he would have done now, as opposed to then …
Emanuel dedicates his paper to the memory of the late Alan Shuttleworth. In his paper ‘A complex mixture of forces’, Shuttleworth argued that psychoanalytic theory by itself is not sufficient in order for us to be able to understand many of the complex, mixed states in children seen by our profession. He looked, for example, at the relationship of Kleinian thinking to attachment theory, and also took into account neuroscientific findings. (These are most admirably unpacked by Emanuel in his paper.) Shuttleworth argued:
Purely psychoanalytical theory, by itself, is not sufficient to understand many of the complex, mixed states carried by many of the children seen by child psychotherapists. Mixed forms of understanding are needed. Psychoanalytic thinking and ‘hard’ science are not the same as each other but need to be brought into active dialogue (p. 45).
As an instance of this, Emanuel’s paper looks at the relationship between Kleinian thinking and attachment theory, and argues that a mixed, inner world and environment-sensitive form of thinking, drawing on both Klein and Bowlby, has become characteristic of Kleinian child psychotherapy today. This established way of thinking is now being stretched, he said, in order to accommodate new thoughts.
Margaret Rustin (Dubinsky et al., 1997, p. 264) has written about ‘the most difficult cases’ that child psychotherapists see, ‘in which there is a complex mixture of forces at work’, all of them interacting with each other. These are children who carry more than one kind of dif