Editorial

In this issue of Psychoanalytic Psychotherapy we start with a paper by Siobhàn O'Connor, a previous contributor to the journal. She is a psychoanalyst who, unusually and importantly, works as an NHS consultant in general psychiatry on a ward for severely disturbed and violent patients. Her theoretical model informs her work in important ways and enables her to reflect on the complex ward dynamics of which she is a part. She has interesting things to say about the inevitably regressive aspects of a situation where patients have at times to be forcibly restrained by nurses. She discusses the complementary ‘parental’ roles, both assumed and enacted by nursing and medical staff on such a ward, and shows how psychotherapeutic interventions can still be made in this extreme setting.

Giovanni Zapparoli and Maria Gislon, also working with patients with severe disorder who are treatment-resistant, contribute two linked papers. In an account of an integrated, multidisciplinary model used by their innovative clinical research team in Italy, they describe an approach to assessment and treatment of such patients which is broadly informed by psychoanalytic principles, but which takes into account biological and social factors. Their particular emphasis is on the assessment of needs as subjectively perceived by the patient. They point out ways in which these may differ radically from the goals and needs often assumed by professionals on the patient's behalf, leading to apparently inexplicable resistance to treatment.

Gary Winship, also a past contributor, presents some interesting ideas about a torturous cycle of destruction and repair in drug addicts which he links to the myth of Prometheus. Vivid clinical vignettes are presented from his own NHS drug addiction service.

Stern's paper emerges from his work as a medical psychoanalytic psychotherapist consulting to a specialist hospital for diseases of the lower gut. His rich clinical material illustrates vividly the severe psychopatho