Current concerns about child and adolescent mental health. Challenging articles of faith

Acting as advocates for the child

As practitioners we are aware of the urgent mental health needs of many of the children and young people who come to our attention. This means that we must assert the primacy of the needs of the child and young person and act as their advocates. This urgency requires first and foremost a more open and critical dialogue about how our psychotherapeutic practice can address these urgent needs. It follows that the development of new theory must emerge directly from clinical practice, experience and observation, rather than from imposing theory that adheres primarily to established orthodoxies. In this book an attempt is made to provide a fresh perspective of the rich field of psychodynamic understanding and how it can be applied to time- limited psychotherapy, not only with children and young people, but also with their parents and caregivers.

The new century has inevitably prompted a reassessment and re-evaluation of many of the accepted and traditional frameworks with respect to our understanding of the social, health, economic, political and environmental issues with which we are concerned. Psychoanalysis has not escaped this scrutiny. On the one hand, we may contend that the death of psychoanalysis is greatly exaggerated since so many psychoanalytic concepts are now integral to the web and waft of daily life as to be almost imperceptible as to their origins. On the other hand, psychoanalysis and its offshoot psychotherapy as a treatment mode have not fared so well, although the theoretical study of psychoanalysis continues to evoke interest within the academic realm. The fact that psychoanalytic or psychodynamic treatments are not generally in current favour is due at least in part to a cost-cutting economic climate. This has tended to elevate cognitive behavioural therapies as the apparently only evidenced-based cure-all, particularly as it has the advantage of being time-limited. However, there are a number of other reasons for the apparent marginalising of psychodynamic psychotherapy; the most predominant of which is the reluctance of its practitioners to fully engage with the changing social and emotional landscape in which they practise. This is a particularly critical factor for those psychotherapists who work with children, parents and families, where the issues of social change are at the tipping point, since it is within the family context and the rearing of the next generation that the demands and challenges for change are largely generated.

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