Editorial

As practitioners of psychoanalytic psychotherapy the bread and butter of our quotidian work involves thinking, reflecting, feeling and focusing on our inner worlds and those of our patients, and we prioritise reflective forums in which we may continue this thinking about our patients with our colleagues. Yet for some individuals the very act of thinking is threatening as it risks putting the person in contact with fantasies, memories and affective states that may destabilize their psychic, and sometimes even physical, equilibrium. All of the papers in this issue are linked in their focus on applying psychoanalytic ideas to conditions - learning disabilities, psychosomatic illnesses, addictions and obsessive compulsive disorder - that many have considered resistant to psychoanalytic intervention. These resistances may take different forms, but at their roots are fundamental deficits and defences against thinking. Such resistances, however, may not only lie with the patients but may also be located in the therapists and clinicians in their reluctance to treat these patients who are difficult to engage, act out their impulses in risky ways, or express their distress in bodily symptoms and concerns; patients who seem unable to hold on to and reflect on their inner lives, and who engender complex countertransference reactions which may become manifest in beliefs that such patients are not amenable to a psychoanalytic approach at all. This therapeutic pessimism may be strengthened by the prevailing biological and cognitive paradigms that consider such conditions are best managed by medication or by solely focusing on the removal of symptoms and behaviours, rather than a more exploratory psychodynamic intervention.

It is therefore heartening that the papers in this issue collectively put forward convincing evidence that psychoanalytic thinking may offer a valuable contribution to conceptualizing and treating, albeit sometimes with a modified approach, patients with conditio