This book is aimed at an introductory level, reviews relevant research literature about outcomes and has a clear clinical emphasis. It covers both working with adolescents and adults and adopts a broadly object-relational approach.

"Nature dictates that as individuals we are conceived, are born, and then at some point later die. The shape of the arc that we follow, involving growth and development with eventual decline, is something that we might all like to influence. It has been argued that the same basic curve, however, is followed by societies, civilisations and indeed organisations. How does an organisation influence its trajectory? How do organisations avoid the pull towards conservatism and protectionism associated with the developmental plateau found at the top of the curve? . I think that in this book Professor Alessandra Lemma has given us something of an insight into this process within one organisation, the Tavistock and Portman NHS Foundation Trust. In bringing together this collection of papers, Professor Lemma has undertaken the role of skilled gardener herself. The work of the Trust is now broad. Training and education makes up almost half of the activity, while Child and Adolescent Mental Health Services over half of the clinical work. Professor Lemma has, in this first volume, broadly focused her attention on our work with Adolescents and Adults She has clearly selected her authors for their quality and supported them with similar care. All of this is evident in the chapters that comprise this book, and in the description of an organisation struggling to evolve in a manner that links it inextricably to the communities and society within which it is situated as much as to its own history."From the foreword by Dr Matthew Patrick, Chief Executive, Tavistock and Portman NHS Foundation Trust"

Alessandra Lemma - Winner of the Levy-Goldfarb Award for Child Psychoanalysis

Under the Skin considers the motivation behind why people pierce, tattoo, cosmetically enhance, or otherwise modify their body, from a psychoanalytic perspective. It discusses how the therapist can understand and help individuals for whom the manipulation of the body is felt to be psychically necessary, regardless of whether the process of modification causes pain.

In this book, psychoanalyst Alessandra Lemma draws on her work in the consulting room, as well as films, fiction, art and clinical research to suggest that the motivation for extensively modifying the surface of the body, and being excessively preoccupied with its appearance, comes from the person s internal world under their skin. Topics covered include:

• body image disturbance
• appearance anxiety
• body dysmorphic disorder
• the psychological function of cosmetic surgery, tattooing, piercing, and scarification.

Under the Skin provides a detailed study of the challenges posed by our embodied nature through an exploration of the unconscious phantasies that underlie the need for body modification, making it essential reading for all clinicians working with those who are preoccupied with their appearance and modify their bodies including psychotherapists, counsellors, psychiatrists and psychologists.

These stimulating essays are evidence that 50 years after its publication Melanie Klein's Envy and Gratitude is still a rich source of psychoanalytic inspiration. Sixteen highly regarded analysts, representing a wide range of psychoanalytic thinking, provide new insights and highlight current developments without avoiding the controversies that surround the original publication. The clinical and literary material is engaging and illustrates the effect of theory on practice and the influence of practice on the evolution of theory.Contents:Foreword - R. Horacio EtchegoyenIntroduction - Priscilla Roth1) "Even now, now, very now . . ." On envy and the hatred of love - Ignes Sodre2) Envy, narcissism, and the destructive instinct - Robert Caper3) Envy and Gratitude: some current reflections - H. Shmuel Erlich4) An independent response to Envy and Gratitude - Caroline Polmear5) On gratitude - Edna O'Shaughnessy6) Keeping envy in mind: the vicissitudes of envy in adolescent motherhood - Alessandra Lemma7) Envy in Western society: today and tomorrow - Florence Guignard8) He thinks himself impaired: the pathologically envious personality - Ronald Britton9)

The Digital Age is on the couch. Working today, it is essential that clinicians understand the world we live in. The transition from an industrial economy to an information economy impacts not just the external structure of society and commerce, but also the internal psychic economies of our brains and, inevitably, how clinicians conceptualise the analytic setting in which they practice as therapists and analysts. The Digital Age on the Couch seeks to understand more about how new technologies interact with the prerogatives of an individual's internal world, how they may alter psychic structure itself in fundamental ways and the implications this may have for the individual's functioning and for the operation of society. This book attempts, from the perspective of a working clinician, to make some sense of this. The impact of mediation via technology and the consequent disintermediation of the body represent central themes throughout, as they impact on the experience of embodiment, on the 'work of desire' and on the way new media influences psychoanalytic practice. New media offer opportunities for increasing accessibility to mental health care, including psychoanalytic interventions. However, this requires a sophisticated understanding of how to best create and safeguard the analytic setting. Alessandra Lemma here guides the clinician through an exploration of the limitations and risks of mediated psychotherapy, illustrated with clinical examples throughout. The Digital Age on the Couch offers an accessibly written guide to combining existing psychoanalytic theory and practice with the challenges presented by digital media. It will appeal to psychoanalysts, psychoanalytic psychotherapists and counsellors.

Minding the Body: The Body in Psychoanalysis and Beyond outlines the value of a psychoanalytic approach to understanding the body and its vicissitudes and for addressing these in the context of psychoanalytic psychotherapy and psychoanalysis. The chapters cover a broad but esoteric range of subjects that are not often discussed within psychoanalysis such as the function of breast augmentation surgery, the psychic origins of hair, the use made of the analyst's toilet, transsexuality and the connection between dermatological conditions and necrophilic fantasies. The book also reaches 'beyond the couch' to consider the nature of reality television makeover show. The book is based on the Alessandra Lemma's extensive clinical experience as a psychoanalyst and psychologist working in a range of public and private health care settings with patients for whom the body is the primary presenting problem or who have made unconscious use of the body to communicate their psychic pain. Minding the Body draws on detailed clinical examples that vividly illustrate how the author approaches these clinical presentations in the consulting room and, as such, provides insights to the practicing clinician that will support their attempts at formulating patients' difficulties psychoanalytically and for how to helps such patients. It will be essential reading for psychoanalysts, psychologists, psychiatrists, mental health workers, academics and literary readers interested in the body, sexuality and gender.

Alessandra Lemma - Winner of the Levy-Goldfarb Award for Child Psychoanalysis! Relating to Self-Harm and Suicide presents original studies and research from contemporary psychoanalysts, therapists and academics focusing on the psychoanalytic understanding of suicide and self-harm, and how this can be applied to clinical work and policy. This powerful critique of current thinking suggests that suicide and self-harm must be understood as having meaning within interpersonal and intrapsychic relationships, offering a new and more hopeful dimension for prevention and recovery. Divided into three sections, the book includes: a theoretical overview examples of psychoanalytic practice with self-harming and suicidal patients applications of psychoanalytic thinking to suicide and self-harm prevention. Relating to Self-Harm and Suicide will be helpful to psychoanalytic therapists, analysts and mental health professionals wanting to integrate psychoanalytic ideas into their work with self-harmers and the suicidal. This text will also be of use to academics and professionals involved in suicidal prevention.

Alessandra Lemma - Winner of the Levy-Goldfarb Award for Child Psychoanalysis

The contemporary relevance of psychoanalysis is being increasingly questioned; Off the Couch challenges this view, demonstrating that psychoanalytic thinking and its applications are both innovative and relevant, in particular to the management and treatment of more disturbed and difficult to engage patient groups. Chapters address:

• clinical applications in diverse settings across the age range
• the relevance of psychoanalytic thinking to the practice of CBT, psychosomatics and general psychiatry
• the contribution of psychoanalytic thinking to mental health policy and the politics of conflict and mediation.

This book suggests that psychoanalysis has a vital position within the public health sector and discusses how it can be better utilised in the treatment of a range of mental health problems. It also highlights the role of empirical research in providing a robust evidence base.

Off the Couch will be essential reading for those practicing in the field of mental health and will also be useful for anyone involved in the development of mental health and public policies. It will ensure that practitioners and supervisors have a clear insight into how psychoanalysis can be applied in general healthcare.

The Digital Age is on the couch. Working today, it is essential that clinicians understand the world we live in. The transition from an industrial economy to an information economy impacts not just the external structure of society and commerce, but also the internal psychic economies of our brains and, inevitably, how clinicians conceptualise the analytic setting in which they practice as therapists and analysts. The Digital Age on the Couch seeks to understand more about how new technologies interact with the prerogatives of an individual's internal world, how they may alter psychic structure itself in fundamental ways and the implications this may have for the individual's functioning and for the operation of society. This book attempts, from the perspective of a working clinician, to make some sense of this. The impact of mediation via technology and the consequent disintermediation of the body represent central themes throughout, as they impact on the experience of embodiment, on the 'work of desire' and on the way new media influences psychoanalytic practice. New media offer opportunities for increasing accessibility to mental health care, including psychoanalytic interventions. However, this requires a sophisticated understanding of how to best create and safeguard the analytic setting. Alessandra Lemma here guides the clinician through an exploration of the limitations and risks of mediated psychotherapy, illustrated with clinical examples throughout. The Digital Age on the Couch offers an accessibly written guide to combining existing psychoanalytic theory and practice with the challenges presented by digital media. It will appeal to psychoanalysts, psychoanalytic psychotherapists and counsellors.

This book is aimed at an introductory level, reviews relevant research literature about outcomes and has a clear clinical emphasis. It covers both working with adolescents and adults and adopts a broadly object-relational approach.

Sexualities: Contemporary Psychoanalytic Perspectives presents a broad selection of contemporary psychoanalytic thinking on sexuality from a wide range of psychoanalytic traditions. Sexuality remains at the heart of much psychoanalytic theory and practice but it is a complex and controversial subject. Edited by Alessandra Lemma and Paul E. Lynch, this volume includes a range of international contributions that examine contemporary issues and trace common themes needed to understand any sexuality, including the basics of sexuality, and the myriad ways in which sexuality is lived. The clinical examples provided here demonstrate contemporary psychoanalytic techniques that uncover meanings that are both fresh and enlightening, and address heterosexuality, homosexuality, gender, and perversion from a psychoanalytic perspective. Divided into four parts, the book includes the following: Historical context Foundational concepts: Contemporary elaborations Homosexuality Perversion revisited Throughout Sexualities: Contemporary Psychoanalytic Perspectives the reader will find psychoanalytic wisdom that is transferrable to work with patients of all sexualities, and will see that the essentials of sexuality may be more similar than they are different for homo- and hetero-sexuality. Psychoanalysts and psychoanalytic psychotherapists, as well as academics interested in the subjects of psychoanalysis, gender, sexuality, or homosexuality will find this book an invaluable resource. Alessandra Lemma, PhD is Director of the Psychological Therapies Development Unit at the Tavistock and Portman NHS Foundation Trust. She is a Fellow of the British Psychoanalytic Society and Visiting Professor in the Psychoanalysis Unit, University College London. She is a Consultant Adult Psychotherapist at the Portman Clinic where she specializes in working with transsexuals. She has published extensively on psychoanalysis, the body and trauma. Paul E. Lynch, MD is on the faculty of the Boston Psychoanalytic Society and Institute, the Massachusetts Institute for Psychoanalysis, and the China American Psychoanalytic Alliance. He teaches about psychoanalysis, gender, and sexuality, and has been a popular speaker on issues of homosexuality and psychoanalysis. He is also a Clinical Instructor of Psychiatry at the Tufts University School of Medicine.

Minding the Body: The Body in Psychoanalysis and Beyond outlines the value of a psychoanalytic approach to understanding the body and its vicissitudes and for addressing these in the context of psychoanalytic psychotherapy and psychoanalysis. The chapters cover a broad but esoteric range of subjects that are not often discussed within psychoanalysis such as the function of breast augmentation surgery, the psychic origins of hair, the use made of the analyst's toilet, transsexuality and the connection between dermatological conditions and necrophilic fantasies. The book also reaches 'beyond the couch' to consider the nature of reality television makeover show. The book is based on the Alessandra Lemma's extensive clinical experience as a psychoanalyst and psychologist working in a range of public and private health care settings with patients for whom the body is the primary presenting problem or who have made unconscious use of the body to communicate their psychic pain. Minding the Body draws on detailed clinical examples that vividly illustrate how the author approaches these clinical presentations in the consulting room and, as such, provides insights to the practicing clinician that will support their attempts at formulating patients' difficulties psychoanalytically and for how to helps such patients. It will be essential reading for psychoanalysts, psychologists, psychiatrists, mental health workers, academics and literary readers interested in the body, sexuality and gender.

Alessandra Lemma - Winner of the Levy-Goldfarb Award for Child Psychoanalysis! By now the internet and other forms of virtual communication have been in place for at least twenty years. However, surprisingly little has been written about the use of new technologies in the psychoanalytical literature. As such, Psychoanalysis in the Technoculture Era is a timely exposition on the subject of both virtual and analytic space. Bringing together the work of several psychoanalysts, the Editors Alessandra Lemma and Luigi Caparrotta illustrate how new technologies have become an integral part of our everyday lives and how they have silently and subtly permeated the psychoanalytic setting. The contributors explore how new technologies have affected psychoanalytic practice and discuss the advantages and disadvantages of its use. Psychoanalysis in the Technoculture Era unravels some of the meanings of virtual world terms, and opens this field to greater scrutiny, stimulating and promoting discussion about new technologies in psychoanalytic practice. This book will be of interest to the psychoanalytic community including psychotherapy professionals, psychoanalysts, post graduate, graduate and undergraduate students.

Alessandra Lemma - Winner of the Levy-Goldfarb Award for Child Psychoanalysis! By now the internet and other forms of virtual communication have been in place for at least twenty years. However, surprisingly little has been written about the use of new technologies in the psychoanalytical literature. As such, Psychoanalysis in the Technoculture Era is a timely exposition on the subject of both virtual and analytic space. Bringing together the work of several psychoanalysts, the Editors Alessandra Lemma and Luigi Caparrotta illustrate how new technologies have become an integral part of our everyday lives and how they have silently and subtly permeated the psychoanalytic setting. The contributors explore how new technologies have affected psychoanalytic practice and discuss the advantages and disadvantages of its use. Psychoanalysis in the Technoculture Era unravels some of the meanings of virtual world terms, and opens this field to greater scrutiny, stimulating and promoting discussion about new technologies in psychoanalytic practice. This book will be of interest to the psychoanalytic community including psychotherapy professionals, psychoanalysts, post graduate, graduate and undergraduate students.

Alessandra Lemma - Winner of the Levy-Goldfarb Award for Child Psychoanalysis

The contemporary relevance of psychoanalysis is being increasingly questioned; Off the Couch challenges this view, demonstrating that psychoanalytic thinking and its applications are both innovative and relevant, in particular to the management and treatment of more disturbed and difficult to engage patient groups. Chapters address:

• clinical applications in diverse settings across the age range
• the relevance of psychoanalytic thinking to the practice of CBT, psychosomatics and general psychiatry
• the contribution of psychoanalytic thinking to mental health policy and the politics of conflict and mediation.

This book suggests that psychoanalysis has a vital position within the public health sector and discusses how it can be better utilised in the treatment of a range of mental health problems. It also highlights the role of empirical research in providing a robust evidence base.

Off the Couch will be essential reading for those practicing in the field of mental health and will also be useful for anyone involved in the development of mental health and public policies. It will ensure that practitioners and supervisors have a clear insight into how psychoanalysis can be applied in general healthcare.

'This challenging and ambitious book captures the variety and richness of contemporary clinical developments in the Tavistock and Portman Clinics in relation to work with young adults. It sets these developments in lytic and systemic principles that are the centra up over their long and distinguished history. Th that face the Clinics from the evidence-based for resources with forms of practice that are outlines the adaptive and innovative ways to this competitive situation, for example by the context of the collective I underpinning of the Clinics'e book sets the scene for the practice approach and from validated by this approach. in which the Clinics have e development of an internet- based service for young adults, the application of mentalisation-based antisocial patients, and the use of dynamic interpersonal therapy as a br This book will be an inspiring guide and rallying call for practitioners in health field, who face the same inexorable competition for resources in therapy in the NHS and public services.'

Alessandra Lemma - Winner of the Levy-Goldfarb Award for Child Psychoanalysis

Under the Skin considers the motivation behind why people pierce, tattoo, cosmetically enhance, or otherwise modify their body, from a psychoanalytic perspective. It discusses how the therapist can understand and help individuals for whom the manipulation of the body is felt to be psychically necessary, regardless of whether the process of modification causes pain.

In this book, psychoanalyst Alessandra Lemma draws on her work in the consulting room, as well as films, fiction, art and clinical research to suggest that the motivation for extensively modifying the surface of the body, and being excessively preoccupied with its appearance, comes from the person s internal world under their skin. Topics covered include:

• body image disturbance
• appearance anxiety
• body dysmorphic disorder
• the psychological function of cosmetic surgery, tattooing, piercing, and scarification.

Under the Skin provides a detailed study of the challenges posed by our embodied nature through an exploration of the unconscious phantasies that underlie the need for body modification, making it essential reading for all clinicians working with those who are preoccupied with their appearance and modify their bodies including psychotherapists, counsellors, psychiatrists and psychologists.

These stimulating essays are evidence that 50 years after its publication Melanie Klein's Envy and Gratitude is still a rich source of psychoanalytic inspiration. Sixteen highly regarded analysts, representing a wide range of psychoanalytic thinking, provide new insights and highlight current developments without avoiding the controversies that surround the original publication. The clinical and literary material is engaging and illustrates the effect of theory on practice and the influence of practice on the evolution of theory.Contents:Foreword - R. Horacio EtchegoyenIntroduction - Priscilla Roth1) "Even now, now, very now . . ." On envy and the hatred of love - Ignes Sodre2) Envy, narcissism, and the destructive instinct - Robert Caper3) Envy and Gratitude: some current reflections - H. Shmuel Erlich4) An independent response to Envy and Gratitude - Caroline Polmear5) On gratitude - Edna O'Shaughnessy6) Keeping envy in mind: the vicissitudes of envy in adolescent motherhood - Alessandra Lemma7) Envy in Western society: today and tomorrow - Florence Guignard8) He thinks himself impaired: the pathologically envious personality - Ronald Britton9)

Sexualities: Contemporary Psychoanalytic Perspectives presents a broad selection of contemporary psychoanalytic thinking on sexuality from a wide range of psychoanalytic traditions. Sexuality remains at the heart of much psychoanalytic theory and practice but it is a complex and controversial subject. Edited by Alessandra Lemma and Paul E. Lynch, this volume includes a range of international contributions that examine contemporary issues and trace common themes needed to understand any sexuality, including the basics of sexuality, and the myriad ways in which sexuality is lived. The clinical examples provided here demonstrate contemporary psychoanalytic techniques that uncover meanings that are both fresh and enlightening, and address heterosexuality, homosexuality, gender, and perversion from a psychoanalytic perspective. Divided into four parts, the book includes the following: Historical context Foundational concepts: Contemporary elaborations Homosexuality Perversion revisited Throughout Sexualities: Contemporary Psychoanalytic Perspectives the reader will find psychoanalytic wisdom that is transferrable to work with patients of all sexualities, and will see that the essentials of sexuality may be more similar than they are different for homo- and hetero-sexuality. Psychoanalysts and psychoanalytic psychotherapists, as well as academics interested in the subjects of psychoanalysis, gender, sexuality, or homosexuality will find this book an invaluable resource. Alessandra Lemma, PhD is Director of the Psychological Therapies Development Unit at the Tavistock and Portman NHS Foundation Trust. She is a Fellow of the British Psychoanalytic Society and Visiting Professor in the Psychoanalysis Unit, University College London. She is a Consultant Adult Psychotherapist at the Portman Clinic where she specializes in working with transsexuals. She has published extensively on psychoanalysis, the body and trauma. Paul E. Lynch, MD is on the faculty of the Boston Psychoanalytic Society and Institute, the Massachusetts Institute for Psychoanalysis, and the China American Psychoanalytic Alliance. He teaches about psychoanalysis, gender, and sexuality, and has been a popular speaker on issues of homosexuality and psychoanalysis. He is also a Clinical Instructor of Psychiatry at the Tufts University School of Medicine.

I was most impressed by the author's thoroughness in writing this book. She seems to leave no stone uncovered... [this is] a work which should become a necessity for all counsellors, counselling psychologists, psychiatric nurses and psychotherapists... This is a book to which I will make reference time and time again, and one which will occupy a prominent place in my library' - Counselling, The Journal of the British Association for Counselling `An invaluable handbook for students of psychotherapy and a good reference for established therapists... I recommend that all therapists have a copy of this book on their shelf' - Psychology, Health & Medicine Assessment and referral skills are essential for counsellors and psychotherapists. Practitioners need to have an understanding of the clinical manifestations of severe emotional distress. They must, for example, be able to recognize when clients are a suicide risk or when they are suffering from a psychotic episode. This lively textbook provides a clear overview of the issues involved in our understanding of psychopathology and offers guidelines on appropriate interventions. Alessandra Lemma explores a range of key topics, covering how psychiatric diagnoses and classifications are arrived at, and the issues that can arise when working in conjunction with other mental health practitioners, such as psychiatrists. She addresses the needs of practitioners in relation to some of the more common forms of mental distress - depression, anxiety and eating problems - as well as some of the more controversial diagnoses, such as schizophrenia and `borderline personality disorder'. The book concludes with a discussion of alternatives to mainstream approaches, including those which seek to deconstruct the concept of psychopathology. Introduction to Psychopathology offers a framework for assessing clients which incorporates a broad range of models and approaches, and which takes into account psychological, social and biological factors. It will be an invaluable resource for students of counselling, counselling psychology, psychotherapy and clinical psychology.

Alessandra Lemma - Winner of the Levy-Goldfarb Award for Child Psychoanalysis! The Perversion of Loss is an edited collection of psychoanalytic papers written by clinicians in the field of trauma. The text offers a psychoanalytic perspective on trauma and its effects on psychic functioning. In particular, it draws on attachment theory to explain how trauma undermines psychic resilience both within individuals and also within broader communities and societies. This collection contextualizes external traumatic events and addresses both individual, internal responses as well as the impact of trauma on broader social relations.

In First Principles, Alessandra Lemma examines the centrality of applied ethics to psychoanalytic practice, The book focuses on the articulation of an accessible framework for developing and exercising an identifiable method - an ethical self-discipline - to support critical reflection on therapists' psychoanalytic work with patients and to help them to approach the resolution of ethical dilemmas. Integrating key concepts from the field of applied ethics, and bioethics specifically, Lemma re-interprets them for use within a psychoanalytic framework, articulating how we can understand psychoanalytically the concepts of beneficence, non-maleficence, autonomy, justice, and veracity and deploy these to guide clinical work. Using clinical examples, the book outlines a working model for how therapists can reflect on their practice, as well as devoting a chapter on how to teach ethics within psychoanalytic psychotherapy trainings and outlining a detailed curriculum for teaching ethics. This book is essential reading for psychoanalytic practitioners as well as clinical psychologists, psychiatrists, psychotherapists, counsellors, and psychoanalysts who work in the psychoanalytic tradition.

Dynamic Interpersonal Therapy (DIT) is a brief psychodynamic psychotherapy developed for the treatment of mood disorders. It is being rolled out as part of the Improving Access to Psychological Therapies (IAPT) initiative as the psychodynamic model for the treatment of depression.
This book is a user-friendly, practical guide for the implementation of a brief psychodynamic intervention in routine clinical practice as well as in research protocols. It sets out clearly the theoretical framework, as well as the rationale and strategies for applying DIT with patients presenting with mood disorders (depression and anxiety). Throughout, it is illustrated with detailed examples that help the reader to implement the approach in their practice.
The book will be required reading to support the national IAPT training initiative, as well as providing a resource for mental health professionals specialising in psychodynamic psychotherapy and wishing to work within a limited time frame.