First Principles

Alessandra Lemma, Fellow of the British Psychoanalytic Society and Chartered Clinical Psychologist, is a Visiting Professor in the Psychoanalysis Unit, University College London and Consultant, Anna Freud National Centre for Children and Families. For 16 years she worked at the Tavistock Clinic where she was, at different stages, Head of Psychology and Professor of Psychological Therapies in conjunction with Essex University. She was a recipient of the 2022 Sigourney Award in recognition of her inventive theoretical and clinical contributions to understanding body modification practices, the impacts of technology on psychic functioning and transgender identities as well as for her efforts in developing and disseminating worldwide a brief psychoanalytic intervention for mood disorders.

Lemma's deeply reasoned and erudite advocacy for ethical self-discipline on the part of psychoanalysts eschews both stodgy moralizing and formulaic guidelines. Instead, she recommends the cultivation and sustenance of psychic space for truth, fairness, and respect for the patient's essential Otherness. Lemma's approach is characterized by a gentle iconoclasm that challenges us to leave the comfort of normative narratives, societal or psychoanalytic, while listening to our patients. Her oeuvre is wide-ranging, writing style elegant, and arguments convincing. The result is a book of rare literary luminosity, theoretical soundness, and clinical significance.

• Introduction 1: The unbearable silence of responsibility 2: Bioethical principles 3: A psychoanalytic principled approach 4: The ethics of listening 5: On getting it wrong 6: Apologies matter 7: Principles in action 8: Developing the ethical chóros Epilogue: A plea for a measure of irony