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Christopher Bollas begins his latest book by revealing that at the time when he was studying history and Puritan ‘miscreants’ at University and was also ‘caught up in the passions of the Free Speec...

I offer some psychoanalytic perspectives and hypotheses to contribute to understanding why family interventions are rarely offered in psychosis. This is despite decades of evidence that family difficulties often predate onset of psychosis and that skilled family interventions are at least as effective as medication in reducing relapse rates. I contend that it is often unbearably disturbing for some families to even consider the possibility of having contributed to the vulnerability of a member to psychosis and that professionals fear accusations of ‘blaming’. Multisystem defences, involving both families and professionals, shift explanations for psychosis, reducing them as a disorder of brain chemistry and somewhat exclusively allowing the logical consequence that only pharmacological interventions ‘make sense’. I summarize the unfortunate consequences of these defences and suggest that there is denial of the important difference between describing possible family environmental contributing factors in psychosis and attributing ‘blame’. Whole team training that involves families and social networks in a highly respectful and humane manner overcomes some of these obstacles. Several decades of increasingly successful research in the Finnish psychodynamically orientated ‘need-adapted approach to psychosis’ resulting in recent more global interest in open dialogue indicate an effective way of engaging families and of achieving superior outcomes in returning individuals to social engagement as students or to employment.

There is limited empirical evidence as to how psychodynamic therapy should be conducted when working with people who experience psychosis. We describe here a three stage Delphi study exploring the degree of consensus about this among an international group of experienced psychotherapists. Of the 52 participants who received the survey questionnaire, 41 (78.8%) responded in the first round and 30 (57.6%)responded in the second. The participants agreed on many aspects of therapy, including aspects of classical technique (e.g. requirement for consistent setting) and some supportive modifications (e.g. therapists not restricting themselves to remaining emotionally neutral), but consensus was not received for other supportive modifications (e.g. guiding the patients if they are unsure of what to talk about). Participants commented that the technique should be adapted to individual needs. We believe that the findings have implications for therapy and research.

Alcuni recenti editoriali del British Journal of Psychiatry hanno argomentato che la psichiatria sta attraversando una crisi, e che tra le soluzioni vi sarebbe un rafforzamento della sua identita come essenzialmente "neuroscienza applicata". Senza sminuire l’importanza delle neuroscienze e della psicofarmacologia, gli Autori sostengono che la psichiatria deve superare l’attuale paradigma tecnologico dominante. Questo rifletterebbe maggiormente le evidenze empiriche e servirebbe anche a rafforzare una collaborazione piu significativa col movimento degli utenti dei servizi psichiatrici. Vengono presi in rassegna vari studi controllati randomizzati (RCT) che mostrano l’efficacia degli interventi non specifici e non tecnologici.

Psychoanalysts suggested psychological work with families where a member has a psychosis back in the 1950s and 1960s. The paper gives a brief historical outline and then describes a number of reasons – including compatibility with NICE Guidelines – why a psychodynamic approach should be made available. A case example is given of psychodynamic family work in an Early Intervention in Psychosis service where the father of three children had a protracted psychosis and the mother's own history had played into a lack of expectations of her husband; this couple dynamic played an important role in infantilizing the patient rather than supporting him in his role as father and husband. Psychological work that involved the mother was an essential key to supporting her husband's development and confidence with substantive benefits to all members of the family including the children.

The paper focuses on some psychological factors specific to the psycho-developmental tasks involved in ageing that may lead to a considerable loss of resilience and psychological breakdown for the first time since becoming adult. Issues connected with the potential increase of dependency, especially physical dependency are often central. The paper gives an account of reasons why this may be more threatening to some than others including the reawakening of childhood failures of dependency and also identifications with disturbing dependency experiences of late life of one’s parents.

There has been growing appreciation of the role that a range of psychological treatments have to play in the treatment of the psychoses. Pharmacological approaches usually assist in containment of the more florid psychotic symptoms but psychological approaches can be most useful in aiding the patient and the family in facilitating a fuller psychosocial recovery as well as themselves contributing to symptomatic improvement and reduction in relapse rates. This article describes both the common and distinguishing features of a range of important psychological therapies some of which should be part of everyday practice and some of which require more specialist training and made available to patients when needed. It emphasises the centrality of building durable relationships with the patient and his or her family or carer, the importance of identifying the stressful and protective factors that are relevant to each individual and tailoring the type of intervention according to the capacities and readiness of the patient (the need-adapted approach). The article outlines these according to setting (individual, group and family) and according to modality: psycho-dynamic, cognitive and systemic. Brief vignettes are given. The potential psychological impact of psychosis on professionals and their organisational functioning is acknowledged.

SUMMARY In this article, some of the developmental issues that are confronted in the later phases of life are discussed. I describe the inevitable (a) reawakening of the internalisation of earlier dependent state, and (b) identifications with the dying experience of key other persons. I show how both points may cloud external reality and give rise to symptoms. I also dwell on how the difficulty, if not impossibility, for the unconscious to know about nothingness (‘not experiencing’) means that the concept of death cannot be fully grasped. The study of any individual's anticipated ‘life after death’ is therefore potentially of great clinical significance and of relevance to the provision of care for the elderly.

This is a masterly contemporary clinical, empirical and theoretical overview of borderline personality disorder (BPD). The author was considerably involved in the differentiation and professional recognition of the condition more than 20 years ago.[⇓][1] ![][2] Whatever your

The EFPP is a British initiative concerned with public sector psychoanalytic psychotherapy that seems to have touched upon a recognised need in our European neighbours and colleagues. Its origins are inextricably linked with the development of the Association for Psychoanalytic Psychotherapy in the British Health Service (the APP).

Summary In this paper I shall be discussing only a few of the many aspects of dependency in later life that cause difficulties for some elderly persons and for their younger therapists. I shall be particularly emphasising the fear of dependency in both partners in the therapeutic relationship, and the central role that this fear can play in both bringing the elderly person to the mental health professional for help, and in interfering with the provision of help.