Training for the future
What kind of training would be most appropriate in time-limited psychotherapy for those child psychotherapists, child psychologists and other professionals who are committed to a psychodynamic approach in working with children, young people and their parents? The model of time-limited psychodynamic psychotherapy proposed in this book is essentially an integrated interactive one, in which the problem, its context and its solution is viewed as all one piece. This makes particular demands on the practitioner and also challenges contemporary approaches to child and adolescent mental health services, which are often fragmented or heavily focused on the individual to the exclusion of the context. Involving parents actively in the therapeutic work is a critical part of this training. Therefore, practitioners in time-limited psychodynamic psychotherapy need to be as proficient in working with parents and adults as they are with children and young people. The model of time-limited psychodynamic psychotherapy is not one that merely informs parents solely as onlookers, but has them engaged in their child’s therapy.
Training for time-limited psychodynamic psychotherapy is best considered within a framework that is concerned with developing best practice in the field and with the wide dissemination of this best practice within the professional community. Best practice in the context of time-limited psychotherapy is predicated on a refreshed and recalibrated conceptualisation of what is essentially constituted by a psychodynamic approach, particularly in work with children and young people. This means that training institutions need to move beyond representing one or other psychoanalytic pioneer of the past. Their primary task is to ensure that trainees have the best access to current knowledge and information, and are able thereby to hone a critical attitude to examining this information at the broadest level.
Training practitioners in time-limited psychodynamic psychotherapy entails working with and attending to the total field that surrounds the child and adolescent. Incorporating the total field enables us to assess and focus on identifying and promoting capacity. This does not imply that psychotherapists must abandon their core therapeutic task. However, they must be trained to be cognisant of the complexity of the dynamics that surround the child and young person, and how these not only inform, but also perpetuate the presenting problem. These complex dynamics are not static but will change over time.
Training practitioners to engage effectively where appropriate with the networks that surround the child and young person, has a threefold function. By widening the field of inquiry, this often leads to shortening the length of therapeutic involvement. Second, it creates a stance that links psychotherapy with advocacy, and provides necessary containment for the child and young person. Third, through the broadening of the therapeutic process, psychological mindedness is promoted in collaboration with other professionals and the community that surrounds the child.
Whilst it is important for practitioners to have a sound understanding of psychopathology, training in time-limited psychotherapy introduces an additional health and wellbeing dimension to therapeutic practice. The skill building required for this type of practice involves to some extent a reversal of conventional practice, so that the presenting symptom is not viewed as the problem but as the opportunity. Training in time-limited psychodynamic psychotherapy is further grounded in the acknowledgement of the inherent capacity within the child and young person, for growth and change.
It was stated at the outset, that acknowledging the value of the previous work and professional experience of trainees is important in promoting a more three-dimensional experience of training. Many of the psychotherapy training courses already exist at postgraduate level, where students come into these trainings often with a wealth of previous experience. It is this experience and exposure to a wide range of emotional and psychological problems of children and young people, that will be most helpful to the development of professional skills in time-limited psychotherapy, rather than solely their experience of long-term psychotherapy.
In addition to this, there is the need to expand the contact that trainees have with professionals from related disciplines in the course of their training. Understanding of the total field is enriched by learning about the wider social, organisational and cultural contexts of the children and parents who come into therapy. The need to create strategic links and alliances with other professionals is a vital part of this training process. These collaborative links are particularly important in trying to help children and adolescents with complex inter-generational problems, where no single practitioner or single treatment, is realistically going to create significant change.
This view resonates with psychoanalyst Otto Kernberg’s (2014) recommendations for innovation in psychoanalytic education. He makes the point that we need to be cognisant and inclusive of approaches and scholarship that lie on the boundary of our professional work. For Kernberg these include evolutionary and developmental psychology, experimental and social psychology, as well as sociology and cultural anthropology. Ultimately, connecting psychodynamic understanding within the wider field of scholarship in related fields will be the most effective way of ensuring its continued relevance in the context of mental health care.
Combining practice, training and research
Training in time-limited psychodynamic psychotherapy encourages the promotion of specialists in the field who can in turn disseminate information and skill building to further generations of psychotherapists. It lends itself particularly well to combining training with a variety of clinical research inquiries. These research inquiries necessarily open up a new field that is concerned with prevention and that examines the aetiology of emotional and psychological problems of children and young people within a broader relational and social context. Finally, a confluence of training and research that turns the lens onto the children and young people themselves, and gives them a voice, has the great potential to incorporate their contributions to inform the future development of time-limited psychodynamic psychotherapy.