Challenging articles of faith
The pursuit of a refreshed vision for psychodynamic therapy for children and young people, whilst acknowledging the contribution of long-established psychoanalytic theory and practice, nevertheless necessitates a critical examination of this theory and practice and its historical biases. Psychotherapy trainings together with many other areas of professional endeavour that prepare students for practice, pay tribute to the works and wisdom of their founders. As the sociologist
Thomas Scheff (2003) explains, each culture (from which the scientific community is not immune) generates and reflects a variety of assumptions that are never fully declared or critically discussed, thus contributing to the maintenance of the status quo. These ruling assumptions are understood as ‘tropes’ which in turn give rise to a variety of linguistic and mental routines. Within child psychotherapy training as well as adult psychoanalytic training, similar sacrosanct doctrines prevail in which there is an adherence to the theories and life works of many remarkable and innovative pioneers who have made enormous contributions to our understanding of human psychology. The problem however is, that there is a serious risk that these theories, so illuminating in their time, have now become embedded and repeated as articles of faith in the various training schools. This has the potential to create an environment in which it is difficult to examine these theories critically in the light of changing circumstances, as well as for new ideas and theory to flourish.
The various embedded articles of faith also make it difficult to overturn rigid views about how psychotherapy for children should be practised. We find that what was original and innovative in the work of the pioneers of psychoanalysis with adults and children, has in some cases stagnated into doctrine. For example, the ‘true gold’ of child psychotherapy is almost always construed as long-term psychotherapy, sometimes over years. The further justification is that only long-term psychotherapy enables the full panoply of psychopathology to unfold. This leads us to question whether whilst we may as practitioners be fascinated by the complexity of the psychopathology; does this actually ensure that the patient gets better? In this regard, the researcher and psychotherapist Jonathan Shedler (2010) who has championed the contribution of psychodynamic psychotherapy, refers to what he describes as the preoccupation with style over content in the therapeutic discourse with respect to endlessly debating what ‘really’ constitutes psychotherapeutic treatment. For example, whether it is frequency of sessions or lying on the couch. In this regard Shedler reminds us that ‘psychoanalysis is an interpersonal process not an anatomical position’ (Shedler, 2010, p.9). In his examination of the scientific evidence to support the efficacy of psychodynamic psychotherapy (2010), Shedler makes the point that the earlier resistance to disseminate this evidence in contemporary research circles, is connected at least in part in the United States, to past ‘psychoanalytic arrogance and authority’ of the hierarchical exclusive medical establishment. This has played a part in creating a negative view of psychodynamic thinking amongst many mental health professionals who have gone on instead to embrace the promise of cognitive behavioural therapies. Psychoanalyst Otto Kernberg
(2014) goes further in his critical assessment of what he describes as the ‘underlying authoritarian structure of psychoanalytic education’ which he states has infantilised candidates, whilst creating a self-protective isolation from ideas that present alternative views and positions.