Editorial

The advent of 2013 may appear to bring little relief from the continuing economic constraints, reorganisation of mental health services and uncertainty regarding the future of psychoanalytic psychotherapy within the public sector. In the UK, the commissioning of all psychological therapies is being re-thought and the phrases ‘evidence based practice’, ‘treatment efficacy’ and ‘patient outcomes’ are foremost in the vocabulary of commissioners. It is therefore encouraging that psychoanalytically informed work, as described in the four main papers in this issue of Psychoanalytic Psychotherapy, continues to be delivered and developed despite, or perhaps in some cases, because of, these current challenges. Although describing work with different patient populations in different settings and indeed countries (a General Practitioner practice, an in-patient eating disorder unit in the UK, a subsidised psychotherapy clinic for young people in Sweden and a psychoanalytic practice treating English-speaking émigrés in Germany), all of the articles may be read and appreciated with this uneasy backdrop of environmental change in mind.

A common thread running through these papers, and a concept that is so fundamental to our work but is at risk of being lost in the current climate, is that of attachment. Inspired by the work of Balint, Smith in his paper describes the fragmentation caused by recent changes in the delivery of counselling and psychological therapies within primary care and makes a compelling argument for the continued centrality of the counsellor's role as an integral part of individual GP practices in providing effective short-term therapeutic work from a psychodynamic perspective. Fostering the patient's trust and developing therapeutic alliances between not only patient and therapist but also at a more systemic level in the multiple relationships between patient, counsellor and the GP practice as a whole allow the patient to experience the GP practice as a secure b