“You regularly comment on the benefit of
psychotherapy for certain problems and my son has been going through a
difficult time recently. However, after reading Fay Weldon’s new book and
hearing her debate publicly at Central Hall Westminster on therapy as a curse
with Anthony Clare I am not so sure. There has been a lot of bad publicity
about Freud recently and about children and adults under therapy having words
put in their mouth. There is also little outcome research.”
Ms D.R.
It is always difficult when something we are
interested in and consider we might need is under attack for being dangerous or
useless (often both at the same time!) Sometimes the criticism and concerns are
accurate and helpful but sometimes the concerns reflect a deeper personal or
social malaise. When we lose energy, pleasure and creativity due to emotional
difficulties it is not surprising that we should feel vulnerable at the thought
of entrusting our most intimate hopes and fears to another human being. The rather
old hierarchic term of “under the doctor” seems to have recently extended
itself unhelpfully into the realms of public discussion about psychotherapy
implying a lack of reciprocity rather than a collaborative enterprise entered
with a trained professional. Worries of being “under” can link with fears of
being fed words from the person on top’s agenda- something that is less likely
to happen with a trained professional.
Dilys Daws, first Chair of the Child
Psychotherapy Trust is adamant that “Child psychotherapists do not put words
into children’s mouths. They are expert at listening to children and
facilitating their communication. Highly trained largely NHS professionals they
usually have a first degree and a first profession such as social work, psychology,
or medicine followed by a four-year clinical training which includes their own
psychoanalysis. This enables them to separate their own emotions and problems
from those of the children they work with.”
The centrality of psychoanalysis for other trainings
is rarely adequately acknowledged. Vice Chair of the Portman Clinic,
psychoanalyst & child psychotherapist Sira Dermen is concerned by this. “At
the Central Hall debate Anthony Clare was for something called “psychotherapy”
and against analysis when the informing structure of most psychotherapy
trainings comes from psychoanalysis. In that debate I could not recognise my
own profession from either speaker although such distortions were more
disheartening to hear from a psychiatrist who was supposed to be a
psychotherapist.”
However psychiatrists have only recently
received some basic mandatory psychotherapy training. Dr Jonathon Pedder, past
Chairman of the Psychotherapy Section of the Royal College of Psychiatrists,
has worked for years to help achieve this. “It is now recommended that all
psychiatrists should have experience in dynamic, cognitive, behavioural, group,
family and marital therapy. Personal therapy, however, is not part of general
psychiatric training but would be for higher psychiatric training.”
However, whilst health service professionals
who add on a basic psychotherapy training do at least share a professional code
of ethics and practise there are a plethora of “trainings” with no such minimal
base. Anybody can put an ad in a paper saying they are a therapist. Indeed, it
is a shocking societal reflection of our ambivalence about mental pain that
this is possible. Both major organisations – the UKCP and BCP – are concerned.
Sometimes, as Ms DR, comments lack of outcome
research is blamed for the ambivalence to talking treatments. Dr Jane Milton of
King’s College Hospital has been collecting and reviewing the considerable body
of outcome research now available on behalf of the APP. “Behaviour therapy with
its brief symptom-orientated treatments lends itself more easily to a
controlled trial model compared with the lengthy psychoanalytic psychotherapy
of ill individuals where there are logistic and ethical problems in terms of
controls. However, good quality controlled trials have emerged”.
However, Veteran MP and lawmaker Leo Abse had
clear views on the nature of social ambivalence. “Every year I find a new book,
a book which attacks Freud as a human being and as a searcher of the depths of
the human soul. He is described as a fake, as an adulterer and still they
gather round like gnats around an elephant, because, of course, however they
assail him, the fundamental truths that are painful and difficult to accept
show nevertheless the most extraordinary insight. Men and women are revealed in
all their tragedy and their potential for creativity. Despite all the clamour
of the critics he continues to influence generation after generation”.
Ms L.S and her son, in considering treatment,
should carefully check the nature of the therapist’s training and registration
(with the BCP and UKCP) as well as their emotional response to the person
concerned. As a voluntary prospective patient, as a collaborator in a major
endeavour, adults bears some responsibility for the nature of their choice.
For Sira Dermen, the most hopeful aspect of
the Central Hall meeting was that patients in the audience, unswayed by
brilliant oratory, were able to take that responsibility and say how
life-saving their treatment was. Similarly Dr Pedder comments “Psychotherapy is
what patients are demanding more and more as psychiatry moves out of hospitals
into the community. Patients expect to be listened to rather than sedated with
what the Prince of Wales referred to as the “chemical cosh” at the anniversary
meeting of the Royal College of Psychiatrists.”