Editorial

Whilst there continues to be an imperative for psychoanalytic psychotherapy to demonstrate its efficacy and cost-effectiveness in order for it to survive as a treatment offered within the public sector, too much of a focus on objective measurement and outcome may fail to capture the more subjective, yet vital, processes that occur in the intimacy of the therapeutic encounter. The papers in this issue, in their exploration of the unconscious dynamics underpinning the analytic process, challenge the prevailing paradigm of positivism and causal determinism in which all observations are assumed to be capable of being objectively defined, validated and applied reliably. Grappling with complex theoretical concepts, the authors attempt to capture the elusive and subjective nature of a deeply personal human contact, and in doing so, expose the limitations of over-reliance on objective measurement of the therapeutic method.

Thus, Penelope Crick, in her eloquently argued paper ‘Thinking about judgement in psychoanalytic assessment and consultation’, explores the nature of clinical judgement and decision-making in the psychotherapeutic assessment of patients. She considers both the external and internal pressures that may push ‘judgement’, which remains a flexible and open process, into a more rigid and closed system of ‘judgementalism’, which constrains and interferes with a fair valuation of the patient's capacities and difficulties. Crick demonstrates how unconscious subjectivity forms an essential element of the practice of psychoanalytic assessment, and how awareness of subjective processes facilitates negotiation of the ‘emotional storm’ between the two participants in the initial therapeutic encounter so that clinical judgement, rather than judgementalism, prevails.

Noreen Giffney continues the theme of the therapist's receptivity to the patient's communications in her paper ‘Bion's discourses of desire’. Taking Bion's much quoted saying ‘without memory and desire’, Giffn