“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.”
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.”