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This issue of Psychoanalytic Psychotherapy contains a spectrum of papers, from accounts of direct clinical work, to examples of the application of psychoanalytic thinking in a range of Health Service settings. This latter sort of work, where we use our psychoanalytic skills to teach and support other professionals in their work, providing a framework which can give a space for creative thinking, is often neglected in accounts of services. Reviews of the ‘effectiveness of psychotherapy’ should always (but rarely do) take into account this relatively hidden but important and influential part of our work.
Elder's paper, originally given at a meeting in honour of Enid Balint's work, traces the development of the Balints’ work with GPs, and describes, from his own intimate perspective on the work, her influential and distinctive contributions. Lotz gives a useful account of the ways the chaotic inner world of the schizophrenic may be projected and enacted in the acute psychiatric-ward milieu. He then discusses different ways in which a psychoanalytic perspective may be brought in to help. Goodwin's topic is the strain of the dual role of clinician-manager in the NHS, which she examines using psychoanalytic ideas about social defence systems.
Three clinical papers follow. Firstly, Bateman's account of the treatment of an adult patient in whom, Bateman argues, an important but silent type of breakdown, in the form of inappropriate conformism, had taken place in adolescence. Then Kennedy draws on both his work with severely broken-down families at the Cassel Hospital, and an adult analytic case, to discuss clinical issues involved in working with ‘the abused mind’. Finally, Ezquerro gives a lively account of an outpatient psychotherapy group, and his struggles as a trainee with accommodating and making use of two differing theoretical models of group work.