Introduction to Three Clinical Papers

A number of recent papers in this journal focus on how to work with patients with entrenched relational problems, whether or not conceived as early developmental deficit. Their contributions are influenced by developmental and neurological research and, equally, are informed by analytic experience. These include pieces by Astor (2011), Bisagni (2013), Colman (2013a and 2013b), Connolly (2013), Knox (2013), Meredith-Owen (2013) and Urban (2013). The three clinical papers in this issue continue this discussion.

Richard Mizen is an analyst speaking to the value of maintaining the traditional analytic frame; Richard Kradin is an analyst demonstrating the value of a Jungian spiritual approach as an alternative to traditional work; and K is a patient who describes the effectiveness for him of a direct experience of his analyst's subjectivity. For Mizen the emphasis is on the analyst bearing the patient's pain and interpreting his own; for Kradin it is on balancing the patient's pain with a recognition of the patient's internal spiritual qualities; and for the patient K it is the relief of pain arising from direct affective contact with the person of the analyst. Despite these differences their experience and thinking overlap in unexpected ways.

The title of Mizen's contribution - ‘On the capacity to suffer one's self’ - refers to the effect on the analyst of holding to an analytically interpretative stance in order to bring about change in a patient. Referring to the numerous approaches that address underlying faults in the patient's early experience, Mizen focuses not on causes but on consequences and draws upon what Esther Bick identified as the function of ‘psychic skin’. Those without a psychic skin lack the boundaries to be able to contain psychic experience and thereby to develop through learning from experience (as Bion put it), which can equally be thought of as acquiring authenticity, the ‘truth’ of what one is. Essential to Mizen's work is the use of projective an