n e w s , a n a l y s i s , o p i n i o n f o r t h e psychoanalytic c o m m u n i t y i s s u e 4 AUTUMN 2010

Should Psychoanalytic ‘In Treatment’: The HPC on psychoanalysis Psychotherapy writing fitness to be in the NOW 2010 from life practise 2 Science Museum? 4 7 8 NHS, impacting on every corner of relationships with local commissioners. mental health care. The highly respected Individual practitioners will increasingly Kings Fund, which generally supports need to group themselves into larger Gearing the need for reform, has warned that the practices to compete effectively in the scale and speed of the current reforms is market place; the BPC will be looking at likely to distract attention from the need ways we can help build expertise across to maintain quality and avoid cutting the sector in various forms of social up to meet services. enterprise.

How can our profession respond to these Finally, the scale of these challenges huge changes? How do we help make highlights more dramatically than ever challenges it possible for psychological therapy the incapacitating fragmentation of the services to be organised along the lines psychoanalytic and psychodynamic recommended by the We Need to Talk community. Many of our organisations coalition? And how can we help ensure have begun to sense just how weak they ahead that large numbers of high-calibre are by operating in this isolated manner. psychoanalytic and psychodynamic The need to move from this broad By Malcolm Allen anyone concerned about the shape of such practitioners are not lost to the system in perception to a position of purposeful services in the future. The report reveals the years ahead? strategic action is of course another that only eight percent of those surveyed matter. Our ability to bring our various s the government had a full choice in the therapy they The key to all this is partnership. The organisations together into a disciplined announces, in its received, but that people offered a full BPC has been working hard to help build and determined force for change is one of Spending Review, an choice of therapy were five times more alliances in support of the progressive the biggest challenges we now face. expansion of access to likely to be helped back to work than platform set out in the We Need to Talk psychologicalA therapies, a hard-hitting those who weren’t. Also, people who had a document, especially around patient report from mental health charity Mind choice of therapies were three times more choice. The coalition that produced the We must sail sometimes with the wind and highlights the key challenges that such likely to be happy with their treatment document is an excellent example of this sometimes against it – but sail we must and services now face. than those who wanted a choice but did in practice, and there are signs that the not drift, nor lie at anchor not get it. Government is listening. In a related oliver Wendell Holmes First, the Spending Review. Compared initiative, the chief executives of BPC, to other departmental budgets, the NHS These results also sit interestingly with UKCP and BACP have written a joint settlement is as good as it could be with the National IAPT Data Review of the letter arguing that the next phase of Malcolm Allen is CEO of the BPC an increase of 0.1% a year ‘in real terms’. first IAPT roll-out sites by North East IAPT roll-out must not simply replicate However, the ‘real’ figures are based on Public Health Observatory. The review the CBT-dominated estimates of general inflation – the GDF found, for example, that the median first phase. It is now an deflator, and the NHS inflation rate has number of sessions for low-intensity urgent priority for the historically been higher than this. This interventions was just two and for high- professional bodies to relatively slender increase (the NHS intensity interventions it was only three. sink their differences has been getting average increases of This compares with NICE guidance that on a range of issues to nearly 7% a year from 2000) will soon be recommends at least six sessions for most focus on building a co- swallowed up by things like pay increases, low intensity interventions and up to ordinated campaign the increase in VAT, and meeting the twenty sessions for some high-intensity to defend and improve costs of the structural re-organisation interventions. counselling and announced in the White Paper Equity psychotherapy services and Excellence: Liberating the NHS The Mind report also makes clear that throughout the UK. (on one estimate between £2–3 billion). IAPT services have been more successful Together with increasing demands from where they have been well integrated Coalitions at a a rising and ageing population, the NHS with other broader psychological national level will now faces an unprecedented level of therapy provision. However, in spite of be meaningless challenge. DH guidance to the contrary, Mind’s without building research has shown that IAPT money corresponding This is the context in which the has sometimes been used to replace other alliances at a local Government announced an expansion of psychological therapy services. The report and regional level access to psychological therapies. At the states that ‘this simply replaces, not – where the real time of writing, the amount of additional improves, the provision of psychological decisions on funding funding had not been confirmed – the therapies.’ This also means that many and commissioning original DH bid was for around £140 existing therapists and counsellors will be made. This is million. But it is without question a (especially those based within GP a difficult challenge remarkable achievement, owed in part to surgeries) are losing their jobs, impacting for all of us, but again the determined lobbying of Lord Layard, adversely on the knowledge base and the professional bodies but also to the campaign of the We Need relationship networks of these services. may be able to take a To Talk coalition (of which BPC is a lead in facilitating and member). Delivering all types of psychological supporting this sort of therapies services, including IAPT, will local activity. The coalition has recently published We now be taking place within the context need to talk: getting the right therapy of the move towards GP commissioning Psychodynamic at the right time, drawing on a report together with the implementation of the practitioners in from Mind. Mind’s report is based on £20bn quality, improvement, productivity particular will need to a survey of 527 users of IAPT services and prevention (QIPP) programme. It get smarter and more and its conclusions are far-reaching for will be a tumultuous time for the whole organised in building 2 NEW ASSOCIATIONS ISSUE 4 AUTUMN 2 0 1 0 NEW ASSOCIATIONS ISSUE 4 AUTUMN 2 0 1 0

Opinion Should psychoanalysis be in the Science Museum?

An article in a recent issue of New Scientist, by philosopher Mario Bunge (opposite page), questioned the appropriateness of the Science Museum giving space to psychoanalysis. Mary Target and an impressive roll-call of international colleagues responded in the 30 October edition; this is the for the effectiveness of psychoanalytically- scientific journals (e.g. The Journal of the longer, more comprehensive version of their letter. based treatments. Recent literature American Medical Association, Science, reviews and meta-analyses of scientific The Archives of General Psychiatry, studies of psychotherapy outcome The American Journal of Psychiatry, Dear Editor, scientific journals, and that clinical (for example the series of papers by American Psychologist). We run twice- Re: ‘Should Psychoanalysis be in the trials have not attempted to examine Leichsenring and colleagues) have found yearly, free research summer schools to Science Museum?’, New Scientist 2.10.2010, the effectiveness of psychoanalytic that effect sizes – a quantitative measure offer consultation, training and ongoing pp 22-23 psychotherapy, or that we are ‘foreign of treatment benefit – for psychoanalytic mentoring to psychoanalysts and others to the scientific community’. A cursory psychotherapy in randomized controlled wishing to engage in research of the e were very literature search would have provided trials are comparable to those for other kind Professor Bunge has been missing. disappointed by citations and abstracts of hundreds of therapies that are promoted as evidence Many early participants are now well- Professor Bunge’s psychoanalytic research articles published based. The majority of trials have offered established psychoanalytic researchers. intemperate and in mainstream scientific journals. strong evidence of the effectiveness Although we would love to do more, this Wunscientific contribution to the debate on Masling’s series on ‘Empirical Studies of psychoanalytic therapies, others level of scientific contribution compares the scientific status of psychoanalysis. of Psychoanalytic Theories’ alone spans have found stronger evidence for other very well with that in other clinical This is an important issue which 10 volumes and includes 389 pages of therapies for specific conditions; the professions. sometimes receives far more sophisticated references. point is that psychoanalytic therapy has consideration. We would have welcomed a for a considerable period been tested in We believe readers of this New Scientist well-informed critique from a philosopher We readily accept that some specific the same stringent way as have other debate will be reassured to know of science of the stature of Professor developmental or psychopathological approaches. that psychoanalytic researchers are Bunge, and regret that he did not take this propositions put forward by Freud would undertaking productive, cutting edge opportunity to address the issues seriously. not fare well in empirical testing, and that studies guided by psychoanalytic some details of his theories are probably ‘Psychoanalysts ideas, at world-leading universities, Far from being a discipline that incorrect or outdated. This is true of most have been testing and helping younger colleagues to do has ‘remained basically stagnant’, bodies of knowledge evolving over 120 so. We also believe that readers would psychoanalysis has creatively developed, years, and would certainly be expected of the outcomes of expect contributors to their debates to producing (as well as the most profound any science. Contemporary psychoanalysis psychoanalytic be informed as to the facts. We fully clinical theory) substantial research is not reducible to the study of the work agree that scientific progress requires contributions of interest to other fields. of Freud, any more than contemporary therapies for a willingness to seek and learn from Many basic psychoanalytic propositions physics stops with the study of Newton, decades.’ evidence, and in this spirit we respectfully have been widely accepted. Examples or biology with Darwin. However, like offer a factual context in case the include the impact of early childhood other scientific frameworks built on We are entirely bemused by Professor entertaining jibes of Professor Bunge relationships on adult personality fundamental insights into underlying Bunge’s assertion that the original studies might be mistaken for reality. (e.g. the explosive growth of scientific reality, the basic psychoanalytic in Shedler’s meta-analysis did not have attachment research and theory), assumptions of a dynamic unconscious, control groups, which a glance through Yours etc empirical demonstration in academic actively shaping conscious experience, the article (American Psychologist, vol psychology of the impact of unconscious self-image and relations with others, have Professors Mary Target PhD, Peter Fonagy 65, p 98) would have disproved. (We thoughts and feelings on behaviour proved creative and convincing across PhD, Anthony Bateman MD, Peter Hobson do not claim, however, that patients (e.g. the study of unconscious prejudice), many disciplines. There is welcome MD, University College London in psychoanalytic therapy have been Professor Falk Leichsenring DSc among many others. Neurobiologist Nobel convergence, for example, with trends , University of studied in double-blind trials; it is Giessen Prize-winner Eric Kandel MD sees the in current cognitive, social and affective difficult to imagine adult patients in a Professors Sidney Blatt MD and Linda Mayes brightest future for psychiatry in a joining neuroscience, being explored intensively MD, Yale University talking treatment being oblivious of what of psychoanalysis and neuroscience. by researchers in neuropsychoanalysis, Professors Otto Kernberg MD, Robert treatment they were receiving.) Professor Bunge’s claim of scientific which bridges these disciplines at a high Michels MD, Barbara Milrod MD, Joseph irrelevance is untrue, and he goes on level. Schachter MD, Stephen Roose MD, David The 74 signatories of this letter have Olds, MD, Frank Yeomans MD PhD, Richard to make a series of statements which raised many millions of pounds from C Friedman MD, Monica Carsky PhD, Weill completely part company with the easily Psychoanalysts have been testing the Medical College of Cornell University & competitive public research funding available evidence. outcomes of psychoanalytic therapies for Columbia University Center for Psychoanalytic decades, using randomized controlled to undertake just the kind of research Training and Research Professor Bunge advocates. We have Professor Mark Solms PhD We are reluctant to accuse a distinguished trials and systematic follow-up studies, , University of Cape adopted respected, mainstream Town colleague of poor scholarship, but cannot as Professor Bunge urges us to. Active methodologies despite the challenges Professor Jonathan Shedler PhD, University of let pass the bizarre assertions that academic researchers will form a minority Colorado of doing so in this area, and published laboratory science has been absent from of any clinical profession, but a committed Professor Marianne Leuzinger-Bohleber PhD, systematic, empirical psychoanalytic psychoanalysis throughout its existence, international band of psychoanalysts have Sigmund Freud Institut & University of Kassel research in first rank, peer-reviewed that we have not submitted papers to accepted the challenge to test the evidence NEW ASSOCIATIONS ISSUE 4 AUTUMN 2 0 1 0 3

Distinguished Professor Mardi Horowitz MD; Extract from ‘Should psychoanalysis Professor George Silberschatz PhD University be in the Science Museum?’, New Letters to the Editor of California Scientist, 2 October 2010 Professors Ayelet Barkai MD, Raymond Levy PsyD, Harvard University and Medical School A request Statutory regulation Professors Helmut Thomä MD, Horst Kächele …Psychoanalysis is a bogus science MD PhD, University of Ulm because its practitioners do not do Jeremy Holmes proposes ‘ironic Distinguished Professor Paul L. Wachtel scientific research. When the field Dear colleague, detachment’ as the sound attitude to take PhD; Professors Diana Diamond PhD, Eric turned 100, a group of psychoanalysts A. Fertuck Ph.D., Elliot Jurist, PhD, City towards state regulation (Letters, New admitted this gap and endeavoured to We are writing to ask your readers if University of New York Associations, Issue 3, Summer 2010). I’m fill it. They claimed to have performed they have any books that they would be Professors Christopher Perry MD, Daniel able to donate to Kids Company’s new not so sure that this is psychologically Frank PhD, Martin Drapeau PhD, McGill the first experiment showing that appropriate or politically effective. An University patients benefited from their treatment. library. We are developing training for aristocratic, Olympian and disdainful Professor Kenneth N. Levy PhD, Pennsylvania Regrettably, they did not include a control all our volunteers and are committed to State University attitude may erroneously lead BPC group and did not entertain the possibility educating people in creative relational Professors Stephan Hau PhD, Andrzej registrants to conclude that HPC of placebo effects. Hence, their claim approaches to personal, social and Werbart PhD, Stockholm University emotional development. We would be regulation won’t bother them very much. Professor Anna Buchheim PhD, University of remains untested (IJPA, vol 81, p513). Innsbruck very grateful for any donations of books To the contrary, as I know from my job Professor Jeremy Safran PhD, New School for More recently, a meta-analysis published that could help to resource our new Social Research, New York as Chair of UKCP, wherein I get to see all in American Psychologist (vol 65, p98) library towards this aim. Professor Stijn Vanheule PhD, Reitske the papers, there are compelling reasons purported to support the claim that Meganck PhD, Mattias Desmet PhD, Ghent We are particularly interested in books why BPC registrants need to start to take University … psychodynamic therapy is effective. an active, informed, critical, conscious Professors Geoff Goodman PhD, Marvin However, once again, the original studies on the therapeutic relationship, child attitude towards what is happening in our Hurvich PhD, Philip S. Wong PhD, Long Island did not involve control groups… development, attachment theory, inter- University cultural issues, arts therapies, social work profession. Professors Eve Caligor MD, Lewis Aron PhD, This does not mean their hypotheses have and anything concerned with the well- Richard Lasky PhD, New York University being of children and young people. For example, if there are no changes to School of Medicine never been put to the test. True, they HPC’s Fitness to Practise system then Professors Morris Eagle PhD, Joel are so vague that they are hard to test something grotesquely inadequate for Weinberger PhD, Adelphi University and some of them are, by Freud’s own We are interested in receiving books from Professor Nancy McWilliams PhD, Rutgers our work will be imposed on us – public, admission, irrefutable. Still, most of the every orientation in psychotherapeutic University adversarial, legalistic. Or, to mention testable ones have been soundly refuted. or counselling approaches including: Professor Michael Stuart Garfinkle, PhD, psychoanalytic/psychodynamic, family/ another conundrum, if BACP’s view Mount Sinai School of Medicine that there is no difference between Professor Allan Abbass, MD, Dalhousie As for therapeutic efficacy, little is known systemic, cognitive/behavioural, psychotherapy and counselling prevails, University because psychoanalysts do not perform humanistic, person centred and Professor Joseph Masling PhD, State our hard-won standing as a profession double-blind clinical trials or follow-up integrative-humanistic perspectives. University of New York at Buffalo will be undermined. And, to my mind, studies. Professor Golan Shahar PhD, Ben-Gurion Please contact Nikki Finning on 020 7202 there is something far too ‘detached’ about University bystanding with regard to the very low Professor Adela Leibovich de Duarte PhD, Psychoanalysis is a pseudoscience. Its 2700 or [email protected] for standards HPC regulation depends upon. Buenos Aires University concepts are woolly and untestable yet further information about how to donate Professor John Auerbach PhD , East are regarded as unassailable axioms. As a books that are so desperately needed Tennessee State University Furthermore, I don’t think BPC members result of such dogmatism, psychoanalysis to start to educate a new generation of Professor Henning Schauenburg MD, people to support children and young can stay ‘ironic’ over matters closer to University of Heidelberg has remained basically stagnant for more home. What is BPC going to do about its Professor Dorothea Huber MD PhD, University than a century… people. of Munich registrants who don’t want to register Professor Stephen Soldz PhD, Boston with HPC, even if they are as immature Mario Bunge is a philosopher at McGill With thanks, Graduate School of Psychoanalysis and rebellious as Jeremy and Julian University in Montreal Nikki Finning Professor Phebe Cramer PhD, Bronfman Kids Company Lousada think they are? Can they stay in Science Center BPC or will they have to go? Does BPC Professor Bethany Brand PhD, Towson The full article appears at want them to go? University www.newscientist.com/article/ Professors Louis Diguer PhD, Karin Ensink mg20827806.200-should-psychoanalysis- PhD, Stéphane Sabourin PhD, Universite Make no mistake about it, if you don’t be-in-the-science-museum.html Laval, Quebec plan to register with HPC, you can call Professor Clara Lopez-Moreno, Universidad del Salvador yourself a psychoanalyst or a Jungian Dr Alessandra Lemma PhD, Visiting Professor, analyst and, provided you stay within a Essex University high standard ethical framework, practise Dr Saskia de Maat PhD, Mentrum Institute for with a clear conscience – and not be Mental Health, Amsterdam interfered with by the state. This may Dr Patrick Luyten PhD, University of Leuven Dr Margaret R. Zellner PhD, The Rockefeller be one way to promote the core values of University, President and Chair, The psychoanalysis. Neuropsychoanalysis Foundation Dr Mary Beth Cresci PhD, President, Division All of this needs to be opened up by the of Psychoanalysis, American Psychological BPC leadership in dialogue with ‘we, the Association William H. Gottdiener PhD, Director, Addiction registrants’. What is going to happen if Studies Program, John Jay College of Criminal the leadership cannot truly recommend Justice HPC? Dr David Taylor, Clinical Director of the Tavistock’s Randomised Controlled Trial of Andrew Samuels psychoanalytic psychotherapy in the treatment of chronic and refractory depression Society of Analytical Psychology Dr Sherwood Waldron MD, Chair, Psychoanalytic Research Consortium Dr Paolo Migone MD, Editor, Psicoterapia e Scienze Umane Dr Henriette Löffler-Stastka MD, Medical University of Vienna 4 NEW ASSOCIATIONS ISSUE 4 AUTUMN 2 0 1 0 NEW ASSOCIATIONS ISSUE 4 AUTUMN 2 0 1 0

Meeting the challenge of complexity together

his conference was and had a vision that if we could quality of what we all know is so vital discussion there was agreement that a refreshing, and it manage to really work together and in essence about psychological therapies. variety of fears have led to neglect of strengthened in me the collaborate across all the orientations that I’m investing in visions of a future where sexuality within the training curriculum desire for collaboration comprise the fields of psychoanalysis, we can make that contribution that could and that this is a significant problem. Tacross traditional borders and boundaries psychotherapy, arts-based approaches and make a real difference to a society that so The example of the Columbia model. that have failed historically to generate counselling, we could perhaps be able desperately needs what we have kept to with its broad base and inclusion of recent the creativity and relatedness we need to to evidence more effectively in a myriad ourselves for far too long. papers, generated enthusiastic interest survive the professional challenges of the of ways what depth psychologies and from trainees and trainers – although modern world. Whilst I am profoundly relational methodologies have to offer our Jocelyne Quennell is a Clinical Director it was noted that the caution exercised informed by and passionate about modern world in every area of our human at Kids Company, a UKCP Fellow and in teaching the course later rather psychoanalysis and analytical psychology, development, social and cultural life. former Principal of the Institute for Arts in than earlier in the training might be I chose to study, qualify and teach in the Therapy and Education. misplaced… field of Integrative-Humanistic Psychotherapy for ideological reasons ‘The search My response to this session led me to related to issues concerning race and reflect on what I, as a psychiatrist and for truths so s a psychiatrist specialising culture, sexuality, gender, disability, age cognitive behavioural psychotherapist in cognitive behavioural and religion. It would seem that the BPC characteristic want from psychoanalytic psychotherapy. psychotherapy I enjoyed are moving forward in all these areas, My conclusion is that the challenging of our field attending your conference seeking to redress the problems that have questions asked by your discipline i n the continues.’ onA behalf of my colleague Dr Bernard perhaps held it back for years. face of complexity are profoundly helpful, Ratigan. even in situations when explanations The breakout session chaired by Helen The choice of awards was moving and generated from your theory lack face I had feared I would feel an outsider Morgan with presentations by Kamaldeep communicative, in particular the homage validity for me. and the material seem foreign. It was Bhui and Frank Lowe was particularly given to Camila Batmanghelidjh from therefore a pleasant surprise to find enthralling, and we probably needed six Mary Target. I have participated in my attention fully engaged during the months of intensive work in the group to Camila’s vision and struggle to apply ‘My experience opening session. The content of the papers think through the processes and issues psychoanalytic thinking and principles spoke directly to my own interests and the was of a visitor raised, such is the hunger to address these to practice in working with children and emerging issues of concern were ones with long-repressed concerns. How wonderful young people, and I know how much she made welcome on which I could identify. My experience was that Frank chairs a weekly group at deserved this tribute, which she received not of a foreigner in a strange land but of a neighbouring the Tavistock Clinic reflecting on these on behalf of Kids Company and the a visitor made welcome on a neighbouring themes. children. island.’ island. The debate between Peter Fonagy and The British Psychoanalytic Council is In the evening it was a great honour to I was surprised to see a breakout Peter Tyrer brought into sharp focus apparently in a period of renaissance accept on Bernard’s behalf an award in session entitled ‘Is there a drift away the inter-cultural issues between the and this is most heartening. I have recognition of his outstanding leadership. from teaching about sexuality in different philosophical underpinnings for been subject to periods of deep despair This felt apposite and moving within the psychoanalytic training? What part research methodologies. There is so much about our field in recent years with the context of the day. Bernard’s pioneering should the subject play in the training to think about for everyone who has the CBT hegemony and the anti-regulation work alongside colleagues from other curriculum?’ I had assumed that a motivation and interest to engage with movement, and was much in need of an disciplines in delivering effective HIV detailed understanding of sexuality and participate in the development of event that could lift my spirits. services is a particularly fine example of is fundamental to the practice of research, including qualitative approaches how psychoanalysis can play a leading psychoanalysis, and that this subject and randomised control trials, as well as From mythology Pandora’s story tells role in ‘meeting the challenge of would therefore occupy a prominent the inevitable conflicts between them that whilst evil, sickness, misery and complexity together’. place within the curriculum. During with reference to both practical and pain exist, they can only be tolerated the session we heard a frank account ethical concerns. It would seem that the and survived by the presence of hope. Richard Fox, Nottingham Psychotherapy of the bruising experiences of voicing search for truths so characteristic of our My personal and professional vocation Unit psychoanalytic theories within complex field continues, whether it be narrative, has always been endured by working and political arenas. We also heard a detailed existential, theoretical, transcendent or suffering in the midst of that hope, and description of the recently developed empirically scientific. if we can make these kinds of quantum leaps evidenced by the BPC, perhaps we course on ‘Sexuality and the Clinical Situation’ in the psychoanalytic training In particular I was inspired by Jean could discover that we have everything at Columbia University. In the ensuing Knox’s call for practitioner research, to work towards together to reveal the NEW ASSOCIATIONS ISSUE 4 AUTUMN 2 0 1 0 5

n the breakout session on orthodoxy, rather than by a more curious is currently ongoing within the BPC, ‘What I liked complex interdependencies and questioning state of mind. though it was recognized that there the question for the group was: will be challenges. Justin Richardson most was the What are the relationships There was comment from the audience on reminded us that the American open engagement betweenI the individual, the family, and the theme of authority in the professional Psychoanalytic Association had issued its society as they impact on mental health relationship, as well as lively discussion on own position statement in 19991, and he in the need for and models of therapeutic intervention? paying attention to intrapsychic processes, described the long and difficult battle in The two speakers approached the topic in while at the same time being in the real the US to remove homosexuality from change within very different ways. world of people who live in partnerships the Diagnostic and Statistical Manual of the analytic and families and need to talk about these Mental Disorders (DSM) – successfully Susanna Abse, who is the Chief Executive aspects of their outside lives within the achieved in 1986. He explained how once community.’ of the Tavistock Centre for Couple therapeutic relationship. this had happened, further changes in Relationships, addressed the issue of how theory, practice and attitudes followed. psychoanalytic thinking can engage with There was not sufficient time to take the larger political process. She drew further the ideas about relational social There was some anxiety about the pace attention to the ways in which poverty policy that were proposed, for example of change. Several participants felt that ‘I had difficulty in and deprivation are linked to children’s the economic arguments of invest to save more time was needed to take on board choosing which well-being, with Britain being at the schemes like early years interventions the changes in practice and attitudes bottom of the Unicef list on well-being in which could lead to fewer families being which were being discussed. However, breakout sessions children. referred to CAMHS. there was a strong feeling from others to attend – I was that people had had long enough to Most of the audience worked Beverley Tydeman is chair of the adjust and that change was needed spoilt for choice!’ predominantly with individuals. She Association of Child Psychotherapists. now. The facilitators reflected their made us all think about relational issues concern about a delicate balance between and how to engage couples, parents and making and sustaining progress, whilst families to think about intergenerational he session on simultaneously engaging with those transmission of ways of relating. She Homosexuality – moving who might still view homosexuality as ‘I enjoyed pointed out that parents getting on on attracted a high level of pathology and developmental derailment. listening to well together is important to children’s interest. Participants very As the session closed, many said how well-being. When parents have become Tmuch welcomed the chance to explore the much they welcomed the chance for people talking estranged and separated and there are subject of homosexuality, and it was discussion and their wish to contribute about frontline high levels of conflict, children can get encouraging that the discussion was to the continuation of this dialogue. The caught up in terror and upset at the thoughtful and wide ranging. There was a facilitators were pleased to announce that services… they extent of the adult aggression. From the sense of agreement that homosexuality alongside the various strands of work all managed floor one of the participants linked this remains one of the most problematic areas underway in this area, the next PP Now aspect to what had been mentioned in the within psychoanalysis, all too often Conference for 2011 will be on the subject to engender morning session by Vamik Volkan about inadequately understood, theoretically of homosexuality, and preparations for exciting links the history of enduring conflicts between inflexible and, at worst, attacking and this are currently well underway. nations, and how difficult it is to break pathologising. However, rather than the between practice negative patterns of relating. She spoke discussion being a chance to complain, about the aims of treatment, including the participants genuinely grappled with Leezah Hertzmann is a clinical lecturer and models of containment of more destructive aspects their own professional and personal at the Tavistock Centre for Couple thinking and of relating, helping the individuals and challenges in this area and voiced many Relationships. the couple achieve a more realistic view constructive ideas about how progress of making a of themselves and their partner. She drew might be made. 1. American Psychiatric Association: Position difference.’ attention to the family as the most potent statement on psychiatric treatment and sexual agent of social change. orientation. American Journal of Psychiatry ‘Participants 1999; 156:1131 The next presenter was Jean Knox, genuinely a Training Analyst for the Society of ‘The conference Analytical Psychology and a Training grappled with Therapist for the British Association of their own had a good overall Psychotherapists. She approached the format with an question from an attachment perspective. professional Her focus was the interpersonal, relational and personal excellent opening context of the psychotherapeutic and plenary.’ mother-child relationships. She made challenges.’ the case that the achievement of a secure sense of self-agency lies at the heart of any Amongst the ideas articulated there was successful psychotherapy, and she used consensus about the need for wider and developmental research, neurobiology more inclusive curricula on sexuality in ‘The stimulating and the use of language and metaphor as psychoanalytic trainings. Participants important aspects of communicative style. expressed concern about the difficulty topic of of finding both analysts and supervisors applications in She proposed that an analyst’s who had experience of or were open to interpretations can become a form of thinking about homosexuality in a non- “tough” settings coercive communication, in the same pathologising yet rigorous way. They was what I way as negative attributions by a mother also voiced concerns about the negative become an integral part of a child’s sense and intrusive manner in which some enjoyed the most.’ of self – interpretations of the negative candidates for training are questioned transference can be like this – deeply about their sexuality. Others spoke of alienating. Her preferred style is one of the need for the BPC to issue a position co-constructing a narrative using the statement to formally declare a non- interpersonal agency of both analyst and pathologizing view of homosexuality, and patient, rather than having a specific that attempts to alter a patient’s sexual theory being imposed. She warned orientation are unethical. Participants against therapists who are driven by were pleased to hear that work on this 6 NEW ASSOCIATIONS ISSUE 4 AUTUMN 2 0 1 0 NEW ASSOCIATIONS ISSUE 4 AUTUMN 2 0 1 0

largest in the UK outside London. He has Institute of Psychoanalysis in 2011; and made significant academic contributions The Philosophy and Methods of Clinical within his areas of clinical interest. Research in Psychoanalysis and Child Psychotherapy, to be published by Karnac Following retirement from full time in 2011. NHS work he has continued his active contribution as a psychoanalytic psychotherapist and as an independent scholar. His interests are in the contested Award for Innovative space between psychoanalysis, religious Excellence belief, the (homo-)sexualities and the arts. His academic investigation of otherness This award celebrates a striking example has recently focussed on splitting within of ground-breaking work. The innovative the representation of Jews and Judaism in nature of the work can be in terms of Northern European early renaissance art. clinical practice, research, or socially His studies are supported by the Woolf inclusive practice, such as working with Institute (University of Cambridge) and Awards sections of the community who may earlier this year he presented a paper at traditionally find access to therapeutic IARPP in San Francisco. The Professor of The Psychoanalytic Psychotherapy NOW conference once again featured an treatment difficult. awards ceremony to celebrate achievement in the psychoanalytic community. Art History at Harvard University (who worked as Peter Gay’s research assistant This year we presented four awards. The award was presented to whilst writing Freud’s biography) has Camila Batmanghelidjh expressed regret at not having had such a and Kids Company Early Career in California, was reportedly the most simple idea himself. Achievement Award interesting presentation of the Conference. Camila Batmanghelidjh, the founder Bernard is currently working on a and director of Kids Company, has been Two years ago Nick became Head of This award recognises an outstanding larger series of papers and a book on a psychotherapist for more than twenty the AFC Programme for Children and contribution to advancing psychoanalytic psychoanalytic approaches to the seven years. In her early twenties Camila Young People. His development of diverse knowledge or practice from someone sacraments. founded her first charity, The Place To clinical, research and training projects in the early stages of their career as Be, which is now a national organisation has been extraordinary. He quickly a psychoanalytic or psychodynamic reaching thousands of children. In her turned deficit into strong surplus, on a practitioner, normally within seven years Psychoanalysis and early thirties, Camila founded Kids budget over £1 million. He has a gift for from qualification. Culture Award Company in six converted railway arches facilitative management and creative in London. During the first few months, collaborations, helping others attract new The award was presented to the team spent time integrating with funding above £370,000. This is an award to someone outside the Nicholas Midgley profession for a special contribution to the local young people, who tested their the understanding of psychoanalytic or resilience and commitment with the Nick was the first Anna Freud Centre psychodynamic work through culture (in challenging behaviour that had given child psychotherapy trainee to complete Award for Outstanding its widest sense). The award this year was them the label ‘hard to reach’. a Professional Doctorate, in 2003, his Professional for a lifetime contribution to intellectual outstanding doctoral research being Leadership culture. For thirteen years Kids Company has published shortly afterwards. He is survived largely due to the support of now a leading researcher of UK child This award recognises a significant The award was presented to charitable trusts, businesses and many psychotherapy, co-author of a landmark contribution to developing the position Michael Rustin wonderful individuals. It has often review of its outcome literature, and and/or influence of psychoanalytic / been a ‘hand to mouth’ existence for the key process researcher on the highly psychodynamic psychotherapy in the Michael Rustin was nominated for organisation and Camila has kept united important IMPACT study of adolescent wider world. this award to acknowledge his lifetime a staff team who accept that the future depression. The enthusiasm of child achievements as one of the leaders in the is always uncertain. On two occasions psychotherapists about joining this RCT The award was presented to field of psychoanalytic interdisciplinary she has re-mortgaged her flat to see Kids reflects a sea-change to which Nick has Bernard Ratigan studies. He has had a deep involvement in Company through its lack of funding. To greatly contributed. He has held most psychoanalysis for his entire professional date, she and the team have raised £50m positions related to child psychotherapy Bernard Ratigan has worked in the field career. In his role as Professor of Sociology since Kids Company began in 1996. research, as well as other positions of of psychotherapy since the 1970s. In his at the University of East London he authority and trust in UK psychoanalytic early career he was responsible for setting developed a department that has In April 2008 Kids Company was awarded psychotherapy organizations and journal up one of the first student counselling become internationally renowned for its government funding of £12.7 million over boards. services within the UK at Loughborough psychoanalytic engagement. He developed three years through the Department for University. In 1988 he was appointed with the academic link between UEL and Children, Schools and Families, to fund In addition to over 20 book chapters and Department of Health approval to work the Tavistock (where he is visiting its work with the 400 most disturbed peer-review articles (Routledge/JCP at the Nottingham Psychotherapy Unit professor) and has inspired generations young people over the age of 14. Research Essay Prize, 2005; Anna Freud as a consultant grade psychotherapist. of students, through lectures, seminars Foundation Prize, 2007), Nick has taught During his career he was influential and supervision of a very large number of Camila has created a unique and on many psychotherapy training courses in establishing the place of adult doctoral theses. He was made an Associate pioneering approach in delivering services and supervised 50 research dissertations. psychoanalytic psychotherapy within Member of the British Psychoanalytical to vulnerable children. She has always He was director of professional doctorate NHS mental health services. He played Society (an honour given to only a focused the organisation’s activities on studies at Essex until 2007, where a particularly active role in establishing handful of people) where he is Chair the needs of the most vulnerable client he established a clinical doctorate in psychotherapy in the curriculum for a of the Applied Section, the only person group without making compromises in psychoanalytic psychotherapy for the SAP, range of health professionals, and was ever to chair a committee of the British order to hit current trends or government Tavistock and LCP; he then helped the instrumental in the development of Psychoanalytical Society/Institute of priorities. BAP establish their Birkbeck doctorate the South Trent Training (full time Psychoanalysis who is not a psychoanalyst. in child psychotherapy. His UCL/AFC NHS provincial UKCP training). He postgraduate psychoanalytic theory has been tireless in his advocacy of His books include The Good Society and teaching consistently gets excellent psychoanalytically informed services for the Inner World (Verso, 1991), and Reason feedback, inspiring young people to minority groups with high levels of need. and Unreason: Psychoanalysis, Science, train as clinicians and researchers. He He was instrumental in establishing HIV Politics (Continuum, 2001). Two further regularly lectures internationally; a psychotherapy within Nottingham GU books are in press: a jointly-authored book recent presentation, at the major Society services and developing the Nottingham (with Margaret Rustin), Reading Klein, for Psychotherapy Research conference Gender Identity Clinic, which is now the to be published by Routledge and the NEW ASSOCIATIONS ISSUE 4 AUTUMN 2 0 1 0 7

he even sort of looked like a turtle in his Justin with impeccable handwritten notes shell. And when our psychiatric advisor, in the margins, detailing more precise or ‘In Treatment’: Justin Richardson, read the script, he correct ways that Paul could respond to pointed out to me exactly how and why the patient – he’d show me where Paul Oliver as the overweight child of a messy was missing an interpretation, where divorce would identify with the turtle – Paul was saying too much, where he was writing from life why wouldn’t he see an image of himself saying too little. And in virtually every in a slow-moving animal that carries its case, he did this so gracefully, it was By Keith Bunin house on its back? incredibly easy for me to rewrite Justin’s interpretations into my dialogue, to figure Now seems like a very good time to talk out how to put his thoughts into Paul’s about Justin’s specific contributions to the mouth. he first time I went to see made sense: while many scenes on most show as our psychiatric advisor. Warren a psychiatrist, I was eight television shows last no more than ninety was very committed to making sure that Now, as I said, there were a lot of years old. My parents sent seconds, every episode of In Treatment Paul was as good a therapist as possible. times when we sacrificed the truth of me to take an IQ test to see is a conversation that lasts almost thirty He knew that on many occasions the show psychotherapy for the sake of pacing, Tif I would qualify for the gifted and uninterrupted minutes. would have to sacrifice verisimilitude for drama, and suspense. When people talented program at my new elementary drama, but whenever possible he wanted asked me if In Treatment was a truthful school. I had a lot of fun taking the test – One other unusual thing about the show the show to give a positive and accurate depiction of therapy, I always said it I was one of those rare kids who liked is its structure, which comes from the representation of psychotherapy. was probably a little closer to an actual taking standardized tests – they always original Israeli version of the series. therapy session than your average seemed like a game to me. A year later, I There are five episodes per week: for the When we were all in the writers’ room, TV courtroom drama is to an actual went to see a psychiatrist for the second first four episodes, we follow Dr Paul plotting out the season ahead, we would courtroom – but not by much. We looked time. This time it wasn’t any fun at all. I Weston with four different patients – talk to Justin about each of our characters, at Paul’s sessions as a crucible where was having a rough time in school, and an and on the fifth day, we see Paul with and he would comment on them, giving drama could happen – sometimes a especially tough experience with my his own therapist. Therefore, Warren us his essential diagnosis of their neuroses boxing ring where Paul and his patients teacher, who yelled a lot. I was a really hired five writers and assigned each of and their psychological issues. All the would circle each other, and sometimes sensitive kid, and one day after my teacher us our own patient. We would create our writers would look forward to the days a safe harbour where the patients would had screamed at me, I came home from own characters, based on the template when Justin would come and visit with find a way to be completely vulnerable school, wrote a note to my mother that of the Israeli series, and we’d have true us: it was a time when we could all and open with him. was a little suicidal, and then climbed out ownership over those characters for the discuss the psychology of our characters in my window and sat on my roof, thinking entire season. Warren would work with detail, away from the daily pressures and For me, I was always looking for a way about jumping. all of us to make sure that the journey of deadlines of television writing. to be truthful to the nine-year-old boy I Paul’s character was consistent and strong. used to be, who sat in the therapist’s office, Of course our roof wasn’t that high, and It was also a way for the writers, who terrified and frightened and completely if I’d jumped I probably just would’ve Because of my own experiences in therapy had all been therapeutic patients, to alone. And I also wanted to figure out how broken my leg. I was mostly hoping that as a child, I was determined to make get a sense of what it was like to live to inhabit the skin of the doctor who was my mother would climb up to the roof Oliver’s story as true-to-life as possible. I on the other side of the couch, to get sitting across from me, trying very hard and stop me, but my language was a wanted to make sure that his story didn’t an understanding of the theory and to reach me. little vague, so my mother didn’t really become melodramatic or heightened – I practice that goes into being a good understand what the note meant, and wanted to be true to my own experience psychotherapist. And even more than that, when she didn’t come upstairs for a while, of therapy as a child – how difficult and it was a way for us to see the interesting Keith Bunin is a writer on Season 2 I just climbed down off the roof and came slow a process it can be for both therapist congruencies and divergences of the (‘Oliver’). Keith’s latest screenwriting work back inside. and patient, and how enormously all- writing profession and the therapeutic includes Which brings me to you for the encompassing the problems of a child can profession – the different ways in which Oscar nominated director Susanne Bier. But understandably, at this point, my feel, how hard getting through a week or both jobs are about striving to get to the He is currently writing a film for Michel parents decided that I should see a even a day can seem when you’re ten years bottom of the ocean of human behaviour. Gondry and a television pilot for HBO. psychiatrist. The psychiatrist they chose old. seemed to me at the time to be just It was when we submitted our first drafts Season 2 is soon to be released in the UK on as gruff and hostile as my teacher, so As a freelance playwright and that Justin would really earn his keep. I DVD. when he asked me, ‘Why do you think screenwriter, I write most of my early would receive my first drafts back from you’re here?’ I burst into tears and kept drafts alone in my room. So it was such crying for the whole session. Finally my a huge change to work together with a parents decided to talk to the psychiatrist room of incredibly talented writers, and themselves, while I sat in the waiting it was especially gratifying to be able to room and read Great Expectations. All of bounce ideas off each other, to help solve which is to say that I had a fairly intense each other’s problems. and difficult experience in therapy when I was a kid. For instance, early on, while we were talking about Oliver, one of the other The good news about being a writer writers suggested that he have a school is that even your most traumatic and assignment that would somehow carry painful experiences can be turned into over across the weeks he came to see Paul. profit-making enterprises. So when in the A second writer suggested that Oliver fall of 2008 I was hired to write the story have to take care of an animal, and a of Oliver, a preadolescent boy in therapy, third writer suggested that the animal for the television series In Treatment, it be a turtle. I immediately knew this was was kind of nice to know that I’d finally a great idea, and wrote the turtle into be able to put my experience to good use. the script. So when it came time to shoot, we had a professional turtle and a turtle Between its first and second seasons, the wrangler on the set. show had moved production from Los Angeles to New York, and an almost This kind of communal creativity kept entirely new group of writers had playing out, even outside the writer’s been hired. Warren Leight, the new room. When our costume designer read executive producer and showrunner, the script, he instinctively understood was a playwright as well, and filled that Oliver identified with the turtle, and the staff with other playwrights. It dressed him in a green shell jacket, so 8 NEW ASSOCIATIONS ISSUE 4 AUTUMN 2 0 1 0 NEW ASSOCIATIONS ISSUE 4 AUTUMN 2 0 1 0

Regulation, accountability and fitness to practise

By Anna van der Gaag

Anna van der Gaag, Chair of the Health Professions Council HPC is going to stand at your elbow and always be at least one person who is from (HPC), reflects on the regulators’ role in considering allegations say you must do this or that. Their concern the same profession as the practitioner. We about practitioners and what this might mean for psychotherapists is public protection.’ refer to these individuals as our ‘partners’ and counsellors, and discusses her thoughts on how this links to wider and they provide the expertise we need We aim to be as ‘light touch’ as possible to make decisions in a number of key developments in accountability across the professions. in making sure those standards are areas, including assessing education and met, respecting registrants’ personal training programmes and international he role of a professional standards and ‘boundaries’ and ensuring responsibility and freedom and only applications for registration. If we were to regulator in considering they are adhered to, and ensuring that intervening when we need to. regulate psychotherapists and counsellors, allegations about registered individuals are free to exercise their own we would recruit new partners across the professionals is arguably its judgement, free of unnecessary external different modalities to undertake this Tmost pivotal one. I thought it might be interference. As a professional regulator, What is the fitness to practise work for us. useful to begin by reflecting on one of the we want to ensure that we regulate in a process? wider societal shifts that underlies why we way that strikes the right balance here – If a panel finds that a registrant’s fitness have such systems in place in the UK. safeguarding the public whilst respecting These principles apply equally to our to practise is ‘impaired’ (negatively the freedoms and rights of practitioners to process of considering allegations about affected), it has a range of different The last few decades have seen an increase provide services to the public. professionals on our Register. options available to it. This includes in public appetite for accountability placing conditions on a registrant’s amongst those who occupy positions of Our fitness to practise process is the way practise, suspending them from the trust and provide services to the public ‘The era of in which we can consider allegations Register and, in the most serious of cases, – whether they be a dentist, priest or “unquestioning” about someone on our Register (called a striking them off the Register. politician (O’Neill, 2002). This has ‘registrant’). If we receive an allegation arisen, at least in part, from changes in trust in we first consider whether it relates to society’s expectations and perceptions professionals ‘fitness to practise’. We only deal with HPC’s approach to justice of professionals. Improved access to allegations which are about the fitness information and specialist knowledge, has passed.’ to practise of a registrant – i.e. a matter The fitness to practise process is a key way greater public confidence, as well as which might raise concerns about a in which we protect the public. However, political and media interest in well- registrant’s competence, behaviour or the process is not designed to punish but documented failures in public services, Underlying principles health and their ability to practise safely to decide whether a registrant’s fitness for example, have certainly played a and effectively. to practise is ‘impaired’ and what action, part. The era of ‘unquestioning’ trust So how does HPC strive to strike this if any at all, is necessary to protect the in professionals has passed and no one balance? The process involves a number of stages. public. To help demonstrate what this who provides services to the public is At the first stage we gather information means practically, panels are advised to untouched by this social change. Our approach is clearly and explicitly from any relevant parties and invite the consider each of the ‘sanctions’ they have based on mutual trust. Those on our registrant who has been complained available in turn and apply the minimum Richard Smith (2007) has argued that Register have personal responsibility for about to respond. All the information sanction necessary for public protection the ‘quality and safety’ movement is one their own practice and continue to make is then considered in private by a panel – for example, to place conditions on a part of this change within society – an their own decisions about therapy together which decides whether the complaint is registrant’s registration if appropriate example of a social movement driven with their clients, free of any day-to-day something we should look into further at a and consistent with public protection to imbue professionals with more self- interference from the regulator. public hearing. rather than removing a practitioner from reflection, a desire to drive up standards practise. In this sense our approach to and a commitment to continuous The standards we set are not prescriptive, The panels at every stage are made up of justice is aimed at being rehabilitative and improvement. Professional regulation but instead overarching, enabling professional and lay people and there will restorative rather than retributive. is part of that – created to enhance standards for safe and effective protection for the public by setting practice, developed via consultation standards and holding those regulated to with professionals, their representative those standards. But it is only one part organisations and the public. For example, of a much broader quality and safety we do not and would not prescribe matrix in the UK – which includes what should happen during each service regulators, professional bodies, therapy session, and we recognise that the ombudsmen services, voluntary professionals on our Register might meet sector organisations, user groups as well our standards in a variety of different as individual practitioners who share the ways, depending upon, for example, their desire to provide high quality services to professional background, their personal the public. preference, and the needs of individual clients. As Val Huet, Chief Executive of One of the tensions in any regulatory the British Association of Art Therapists or legal system is between setting commented in the February 2010 edition of New Associations: ‘Nobody from the NEW ASSOCIATIONS ISSUE 4 AUTUMN 2 0 1 0 9

Transparency, openness and Creating an environment in which Therapists have emphasised to me the profession we regulate, we change and sensitivity the public and professionals alike feel importance of ensuring that the system learn from their particular experience, confident and secure in raising concerns of fitness to practise can take account and we acknowledge their expertise. If Our purpose is to protect the public, and about practitioners is certainly an ongoing of this particular and often highly we were to regulate psychotherapists and because of this we need to make sure that challenge for organisations involved in charged therapeutic environment, counsellors, individuals with knowledge our process is as open and accessible as considering complaints. There are often recognising, for example, the potential of the discipline and the range of possible, so that members of the public, anecdotal reports in many professions for negative transference as a feature of approaches within it would be involved at and members of the profession, can feel about the reluctance of professionals to the therapeutic process. I believe that the every stage of the process, ensuring that confident enough to raise concerns with report their concerns. In our experience system of regulation delivered by HPC is those with relevant expertise are involved us. Where an allegation is considered at regulation can be constructive because able to do this because it does rely on those in the decision making process. We have a hearing, we adhere to the ‘open justice practitioners and the public alike can with knowledge of the profession to make recently reviewed one set of our standards, principle’ used throughout the UK, which raise their concerns with an independent judgements. the standards of proficiency, in light of means in general that our hearings are organisation with the necessary ‘legal concerns about some of the content and held in public. It is important for any framework’ to follow up concerns and Our fitness to practise process is about terminology, and are currently consulting regulator to avoid the criticisms often take action where necessary to protect the deciding whether a professional remains on the revised standards. levelled in the past – that of decisions public. fit to practise. Sometimes a client might being taken ‘behind closed doors’, solely be dissatisfied about their therapy or Similarly, we have heard feedback from in the interest of the profession and at the their therapist, for example, because psychotherapists and counsellors about the expense of the protection of clients. What might this mean for they didn’t find that the therapy met use of mediation to resolve disagreements psychotherapists and counsellors? their expectations. We have to consider between practitioners and clients and We know, however, that this is part of the complaints we receive individually, heard arguments that there are some the difficult balance between ensuring Many psychotherapists and counsellors but we only need to take action where disputes between therapist and client that that the public can have confidence in have discussed with me the complex a practitioner’s fitness to practise might may be more amenable to more informal regulation and in the regulated professions nature of their work with individuals. be impaired and where we need to take means of resolution. We are currently whilst avoiding the perception of a Depending on their approach to practice, action to protect other members of the doing some work to look at how such ‘naming and shaming’ approach. We can they explain this in different language, public. To illustrate the kinds of cases approaches are applied. This review will and do conduct all or part of hearings in but one of the common themes that we deal with, the fitness to practise of a inform our decisions about if or whether private where appropriate to do so: for comes across is that therapy almost always therapist who engages in sexual activity such approaches might be appropriate in example, to enable a vulnerable witness involves risk – and some argue that any with a client during therapy sessions the future. to give evidence, or to protect the private kind of ‘talking therapy’ is inherently is very likely to be ‘impaired’. In this life of the registrant. Panels are able to risky. People who come for therapy can be example most fellow therapists and make a public and a private decision at the ‘damaged’ by events and circumstances, members of the public would reasonably Summary conclusion of a hearing to further protect vulnerable, abused, experiencing a wide conclude that this was not appropriate the private lives of those involved. We range of emotions, including anger, as behaviour by the therapist. I have sought to situate the HPC fitness also need to be sensitive to the needs of well as searching for greater levels of to practise process within the wider clients who might be attending a hearing, insight and understanding. The risk move towards accountability in society, and we have a dedicated system of witness therefore of misinterpretation, retaliation, ‘One of the illustrating how the process we follow support to help them through the process. or disappointment is often high, and the common themes balances public protection with the rights therapist enters into therapy with a degree and freedoms of practitioners. I think it is important to acknowledge the of awareness that the client may or may is that therapy wider public protection value of knowing not derive benefit, and may or may not almost always Our work on revising our standards of about the outcome of a hearing – making find the experience of therapy to be a proficiency and exploring mediation clear what the profession and the public positive one. Indeed, some will undergo involves risk.’ processes illustrates our commitment to considers to be unacceptable behaviour, therapy that becomes difficult, painful, continuous improvement and we look allowing the opportunity therefore for the confusing and challenging; though in the The standards we use are designed to forward to continuing to work with our profession to demonstrate to the public its majority of cases the outcome will leave enable us to make informed decisions stakeholders to improve the way we work. commitment to high standards. the person feeling that therapy has been a which are focused on fitness to practise rewarding and strengthening experience. and public protection. With each new Anna van der Gaag is Chair of the Health Professions Council. She is a research speech and language therapist and Honorary Research Fellow in the Faculty of Medicine, University of Glasgow.

References

HPC Fitness to Practise Annual Report 2009 www.hpc-uk.org/publications

HPC’s Approach to Justice and Impairment Council papers, March 25 2010, Enclosure 9.

Onora O’Neill (2002) A Question of Trust. BBC Reith Lectures

Smith, R (2007) Learning from social movements Keynote at the International Forum on Quality and Safety in Healthcare Barcelona, 2007. http://barcelona.bmj.com/plenary-2/

Follow the progress of the HPC’s Professional Liaison Group at www.hpc-uk.org/aboutus/ professionalliaisongroups/ psychotherapistscounsellors/ 10 NEW ASSOCIATIONS ISSUE 4 AUTUMN 2 0 1 0 NEW ASSOCIATIONS ISSUE 4 AUTUMN 2 0 1 0

News In Brief

We Still Need to Talk BPC approves new trainings

The We Need to Talk coalition, headed The BPC has just accredited two WPF by Mind, has launched the next phase of Therapy psychodynamic trainings. its campaign, calling for ‘a full range of Graduates of the Postgraduate Diploma evidence-based psychological therapies in Psychodynamic Theory and Practice to all who need them within 28 days of and the twice-weekly Psychodynamic requesting a referral.’ Psychotherapy qualification will become members of the Foundation for Representatives of the WNTT coalition Psychotherapy and Counselling. met on 28 October with Paul Burstow MP, minister for care services, to present their The Exeter University training in report. They welcomed the government’s Psychodynamic Psychotherapy has commitment to psychological therapies also been approved. This training has and their promise of additional funding. four centres for clinical work in the £70 million is confirmed for this year. geographical catchment area of Exeter, Plymouth, North Devon and Cornwall. The minister, who had been instrumental in securing the continuation of The BPC is delighted to welcome the funding for talking therapies under the graduates of these trainings. Comprehensive Spending Review, said the intention is still to roll out the IAPT programme nationwide. They also intend BPC Trainees’ Association news to pass the baton of leadership in mental health strategy to ‘society’, that is, to the Following the success in May of the private and third sectors. ‘Making Contact’ conference, the nascent BPC Trainees’ Association is discussing The report, We need to talk: Getting the a trainee event for next year and beyond. right therapy at the right time, can be Anyone with ideas for a theme for the downloaded from: www.mind.org.uk/ conference should contact Lee Smith, campaigns_and_issues/we_need_to_talk association Chair (lee.smith@ukonline. co.uk). With a mind to engaging more trainees from all areas of the country Peter Fonagy wins award there is support for holding future Trainee conferences outside London Peter Fonagy has been annouced as one of hosted by one (or more) of the out-of- the four recipients for the 2010 Sigourney London BPC accredited trainings. Award. The conference is just one way to include The Sigourney Award is named for Mary trainees in the life of the new Association. S. Sigourney, whose will established a Current activity is focusing around Trust for the purpose of recognizing how to ‘make contact’ with member past achievements by individuals institutions and their trainees. At the and organisations whose significant recent PP NOW conference flyers we contributions have generated new interest made available about the Association, and activity in psychoanalysis and related inviting people to get in touch. The disciplines. Nominees are evaluated on Trainees’ area of the BPC website is one the basis of their work during the ten way of doing this. Login details can be years proceeding the year of the award. obtained from the BPC office (mail@ The other recipients this year are Franco psychoanalytic-council.org). It is hoped Borgogno (Italy), Jean-Michel Quinodoz that a broad definition of ‘trainee’, to (Switzerland), and Rolf Sandell (Sweden). include those in their first year or so after qualification, will not deter those within Peter and his fellow award recipients are sight of qualification from getting and due to receive their awards at the January remaining involved. 2011 APsaA meeting in New York. We are delighted by the inclusion of two trainees, Gearoid Fitzgerald and Alan A Dangerous Method Colam, in the BPC working party on homosexuality. This invitation signifies David Cronenberg’s new filmA Dangerous the value the wider organisation places Method, described as ‘a look at how the on the trainee voice, and in addition to intense relationship between Carl Jung the two places with voting rights on the (Michael Fassbender) and Sigmund Council of the BPC, is another important Freud (Viggo Mortensen) gives birth to development. It is hoped that there will psychoanalysis’, has completed shooting be trainee participation in the Future and is scheduled for release toward the Strategies working party, something that end of 2011. The film also stars Keira was enthusiastically discussed at the most Knightley as Sabina Spielrein. recent Trainees’ Association meeting.

Sally Beeken, Trainee, NEAPP NEW ASSOCIATIONS ISSUE 4 AUTUMN 2 0 1 0 11

patients and their families seemed to be in every town (clouds already sweeping in left to fall into during and after diagnosis. over the horizon, note, with the word ‘clinic’ For a year I undertook a psychodynamic not ‘service’, services cost money), better Living with observation of a dementia assessment unit support for carers, better education and to track the patient pathway. This enabled training for staff, and so on. me to come closer to both patient and staff experience. I understood more about my But the societal clouds have been gathering dementia colleagues’ experience of diagnosis and the with a vengeance, and by the time readers see way in which the process of obtaining and this article the Spending Review will have receiving a diagnosis can, in and of itself, be a been announced. When slash and burn cuts By Rachael Davenhill traumatic experience on top of the trauma of kick in, it is the most vulnerable who suffer. If ‘I know now that my biggest difficulty was not her illness itself, not our the actual illness.1 I began to see people with you are old, have dementia and have no strong pre-existing relationship, not even my limited time, but the fact that I knew early onset dementia and their families, often advocate, and even if you do, then you are 2 nothing about dementia.... The district nurse from her GP practice didn’t therapists or counsellors who knew of my in the land of the most vulnerable. Which interest in the area. In their allowing me to is why, if it is not to be plus ca change plus mention the word, didn’t mention diagnosis, didn’t mention memory clinics work with them, I came to develop a flexible c’est la meme chose, it is precisely now and or drugs for dementia, or the Alzheimer’s Society or support groups or respite but rigorously framed psychoanalytically in the coming months that as many voices care...The hardest thing for me was, and still is, that I was unable to provide informed therapeutic programme supporting as possible from the world of psychoanalysis her with a decent quality of life, at a time when she was utterly dependent people through the process of diagnosis and and psychoanalytic psychotherapy are on those around her to do so – and when, moreover, that quality of life was providing room to digest and work with the needed more than ever to ensure that basic possible, if I and others had known what we did not know. I don’t blame outcome afterwards. services for people with dementia and myself. I don’t even feel guilty, just terribly sad, that what was possible did those who support them are preserved, and not happen for her, and that she had some truly awful experiences which psychotherapeutic provision for people with need not have happened.’ ‘The first year dementia is pursued. We need to develop and Rosemary Clark, ‘State of Grace’, Telling Tales About Dementia’ use our combined and unremitting powers is extremely of persuasion in engaging with government, with funding bodies and with each other to he despair expressed so cogently at work in organisations who care for them precious and ensure that the case for psychotherapeutic as by Rosemary Clark, a which, if left untended, can wreak havoc on there is no time well as drug and information-based support in psychotherapist who looked after the provision of safe, containing practice for dementia care is not forgotten. her mother with dementia, will be patients, families and staff. to lose.’ Ishared by many who have cared or will care for a relative, friend or colleague with For people with early onset dementia, What I have learned, more than anything, is Rachael Davenhill is Director of Age dementia. A recent survey indicated that it is and their spouses and family members, a that the first year post diagnosis is extremely Matters and Fellow of the Institute of dementia, not cancer, stroke or heart attack, meaningful quality of life can be expected precious and there is no time to lose. A great Psychoanalysis. Age Matters is a clinical, that is now top of the list in terms of the and sustained for quite some period of time deal of rewarding work can be undertaken in training and consultation service, offering illness people fear getting the most. In mental if only we can know what is known, as terms of individual psychotherapy for people workshops, courses, and clinical supervision. health services, old age has always been Rosemary Clark so accurately points out. And with dementia who wish to think about their Contact details: www.agematters.org.uk; marginalised in terms of funding, and there is a lot that is known about improving experience whilst they can. The awareness of [email protected] dementia has always been on the margins of the quality of life for people with dementia knowing that the capacity for self-awareness old age – the Cinderella of the Cinderella and those involved in their care once we start will diminish provides a clear focus for time services. to engage with the actual work itself. limited treatment. Similarly there is a strong 1. For experience based evidence see Dartington, A. & Pratt, R., My unfaithful evidence base showing that support for carers brain – a journey into Alzheimer’s Disease, There is a double jeopardy regarding is essential in reducing carer depression and Chapter 16 dementia in terms of both the loss of mind ‘Psychoanalytic enabling people to continue over a long period and the association dementia has with old concepts provide of time to continue caring for a relative, or 2. For research evidence see Davenhill, R., ‘No age. Whilst dementia has been described make a decision about residential care if that truce with the furies: issues of containment in as a ‘semi-psychotic state’ (Kitwood, 1990), a strong armoury becomes necessary. Couples psychotherapy the provision of care for people with dementia and there have been no shortages of for workers in and working in consultation with families and those who care for them’, Chapter 12, psychoanalysts working and innovating in the as and when needed are similarly crucial and Balfour, A., ‘Facts, phenomenology, and area of psychosis, I could count on the fingers dementia.’ components of an integrated dementia psychoanalytic contributions to dementia of each hand the number of colleagues from programme. It seems to me, and certainly to care’, Chapter 13 in: Looking into Later Life: a psychoanalytic approach to depression and our profession who are currently working I developed the Age Matters Dementia people with dementia and relatives coming dementia in old age (2007, Ed. Davenhill, R., directly in the area of dementia. Perhaps we Assessment, Psychotherapy and Counselling for consultation, that every moment of the Tavistock Series, Karnac). are not immune as a profession to veering Service in direct response to the experience I time there is can be used to the full if there away from an area that can arouse such acute had some years ago when I drew a complete is a receptive mind to think, yes, about anxiety, for at the heart of the dementing blank after being approached by a senior death (after all dementia is a progressive process is loss of awareness of self and other, colleague wanting to know if I could find illness, with all the pain and work of loss and the loss of mind, the very tools of our trade. psychotherapeutic support for a colleague mourning that is required), but also about life, Whilst psychoanalysis in its pure form has with early onset dementia. Despite knowing tackling life and how to continue living life traditionally had little to say about dementia, all the old age services in the area, and with dementia. psychoanalysis in its applied form has drawing on all my professional contacts, I everything to say in terms of its contemporary was unable to find anything within the NHS The danger with the word dementia is exactly relevance to dementia care, with recent years at that time. I was deeply shocked by what the same as the ‘Big C’ in cancer care twenty heralding an enormous increase in academic I discovered and this experience was one of years ago in terms of the taboo surrounding and applied papers from colleagues drawing many which gave me a window into the lived the illness and the projections of anxiety, on psychoanalytic theory (Sinason,1992; experience of people diagnosed with dementia hopelessness and deadly inertia into an Davenhill, Balfour, Rustin,1998; Waddell, and those who cared for them in terms of illness that has the capacity to be managed 2000; Davenhill,2007; Morton, 2007; Evans, the absence of a thoughtful, well-grounded and funded far more effectively. In 2009 the 2008; Malloy, 2009; Ng, 2009). Psychoanalytic psychotherapeutic programme which could National Dementia Strategy was launched in concepts provide a very strong armoury provide the necessary space and time to digest a flurry of publicity: ‘Dementia now has its for workers in the field of dementia in the implications of the illness. place in the sun and we have the opportunity terms of articulating the processes of to put the focused attention of the system splitting, fragmentation, denial, projective I thought of Hanna Segal’s paper on silence on dementia’ (NHS Chief Executive, day of identification which are at the bedrock of any being the real crime. I wanted to find out launch). Wonderful aims there were and are: therapeutic work, along with the unconscious more, wanted to learn more about the raising public awareness about dementia, transference-countertransference dynamics processes involved in the gaping abyss tackling prejudice, setting up memory clinics 12 NEW ASSOCIATIONS ISSUE 4 AUTUMN 2 0 1 0 NEW ASSOCIATIONS ISSUE 4 AUTUMN 2 0 1 0

to shame, and shame-related emotions paranoid and depressive positions. He like embarrassment, humiliation and also places emphasis on how men can feel guilt. As a consequence, all the softer, disrespected with an accompanying deep A cure for caring empathic feelings or expressions sense of injustice if their contribution or of vulnerability or weakness normally status is questioned (real or otherwise), associated with ‘feminine’ character traits how they may react to the birth of must be defended against to keep control children, and how reactive, defensive masculinity? of potency. He posits a phallocentic world mechanisms like hyper-masculinity, in which men dominate and oppress perversion and dramatic acting out are women. Violence and abuse are used to used to ward off anxiety and depression. By Ian Simpson maintain control and as a defence against Nowhere is this so apparent as in work a feared intimacy which will return with men who are sexually perverse. The them to a shameful and anxiety-laden link between perversion and shame is a Review of Is There A Cure For Masculinity? by Adam E. Jukes. state where vulnerability, impotence and major issue for many of the men Jukes Free Association Books, London, 2010 castration anxiety (symbolic and real) has seen for psychotherapy. He provides threaten their sense of self. Men must clinical examples of this and extends the separate from their mothers to become definition of perverse sexual behaviour his is a book about the anxieties and anxieties about loss, either men, but this not only involves a deep to include the use of pornography for darker sides of masculinity. already suffered or feared. These anxieties fear of women but also of intimacy or masturbation. This is a much more It is the third book Adam arise during the separation/individuation dependency upon the other, including inclusive definition and he links it to Jukes has written on the phase of development and reach their male shame and its causes. Perversion, subjectT of men and masculinity and it is apogee during the onset of the phallic as he sees it, is a defence certainly the most accessible. He brings phase, the beginning of the construction against serious mental distress. his many years of experience working of phallic narcissism. Masculinity is However, its expression also with men and his customary enthusiasm, constructed out of phallic narcissistic leads to powerful feelings of energy and audacity to the work. Although defences against an underlying basic fault shame as it occurs if we fail to the examples offered are from his clinical deriving from the loss of and separation live up to an ideal of behaviour experience of working mainly with from the maternal and primary object and we have set ourselves. Jukes abusive, violent men, the book is also an it is formed in the crisis of the Oedipal argues that men defend attempt to understand ‘normal complex. against the fear of intimacy by masculinity’. ‘….masculinity is not a crisis, but indulging in perverse sexual rather that masculinity is effectively a behaviour (of whatever degree) Differing from his previous books Why state of crisis, or a crisis management and this inevitably leads to Men Hate Women and Men Who Batter strategy, by virtue of its being effectively shameful feelings. The vast Women, it not only focuses on the genesis constructed on a structural fault.’ (p.27) consumption of pornography of male violence towards women, it on the internet certainly seems also has much to say on male violence The significance of the Oedipal drama to point to a largely hidden, (and the insecurity lying behind it) in is that it elevates and affirms the secretive, onanistic (shameful) its own right. He takes as his starting significance of the penis in the emerging male agenda which has now point the belief that any theory of male male psyche. It comes to symbolize all become culturally normative. individuation necessarily involves a deep that masculinity is and should be. The narcissistic wound which results in an relationship between the structural fault Whenever men are threatened inescapable fear of dependency upon and the penis is what defines this book with a shaming or humiliating women and a terrible rage at the original and the many expressions of masculinity experience most will escalate maternal ‘betrayal’. Men must, in the Jukes meets in his clinical practice. The their defences and will become development of masculinity and male combination of a desire for the mother and determinedly more masculine, individuation, of necessity reject the a fear of the retaliating father is focussed with all the potentially m/other to become separate individuals. around the penis. Examples abound of destructive or self-destructive They must also defend themselves against what men are prepared to do in order to behaviours outlined above. the ‘feminine’ and distance themselves pre-empt symbolic castration or regain other men. The narcissistic wound is so Jukes asks, ‘Is there a cure?’ He believes from intimacy with women for the their masculine status, providing evidence painful and threatening to his sense of there is, and gives examples of strategies original betrayal, by maintaining power of the significance of shame in male self and to autonomy that the male infant he has found successful in his work and control over them. The defensive psychology and the lengths to which men must not only armour himself against with men. Some resolution is possible structure which is created applies, by will go to avoid the evidence of shame and dependent relationships in the future, but if men are willing to acknowledge and extension, to other men as well, albeit in public humiliation. This feared collapse he also needs to punish all women for this accept their vulnerability and fallibility, a different form, essentially through the into failed phallic narcissism which is original betrayal. The roots of misogyny allow themselves to trust that they can stereotypical male traits of aggression, profoundly connected to the more basic are located in the male infant’s separation be held and their fears contained by rivalry, competitiveness and the narcissistic wound evokes the experience trauma. In this world, real intimacy with and with others. Individual and group acquisition of status and power. of being unlovable and intrinsically a woman (and by extension with other psychotherapy offers the context for this, damaged or unworthy. As Jukes says, men) is no longer viable. Only its shadows as do educational programmes which The loss of primary attachment and ‘The penis is a rather insignificant piece and substitutes, sex or male rivalry and explore masculinity and its effects. If men the vulnerability and shame associated of flesh, although it supports a mighty competitiveness are available and these can move outwards as opposed to inwards, with this must be defended against at weight.’(p.40) are inevitably cursed by a desire which share rather than hide, there is some hope all costs. As masculinity is predicated on sees women as little more than objects that shame and guilt can be dissolved a basic fault which is the consequence Jukes brings together attachment and to use and control and where men are and integrated. Perhaps we cannot ‘cure’ of loss, it leads to attachment and classical analytic theory to elaborate and constantly reduced to attempts to measure masculinity any more than we can ‘cure’ commitment problems and to profound elucidate his position, with examples their potency against other men. depression or anxiety but in working separation issues. These, of course, will be of pathological ‘hyper-masculinity’, through the difficulties they present us compounded by actual lived experiences to highlight his concept of ‘normal The book moves through the various with we can learn to deal with them of abusive or neglectful parenting and masculinity’. The central tenet in his stages in the development of masculinity, better and minimise their disabling and by cultural and social conditioning. This view of the development of masculinity linking theory with examples from destructive potential. goes some way to answering the question and individual male autonomy is that the author’s clinical practice. Male raised by his earlier books as to why some of a rigid adherence to a defensive, destructive and self-destructive behaviours Ian Simpson works at the Psychotherapy men are more prone to violence and abuse detached maleness, an inward-looking are explored and examined, with a Service, St Thomas’ Hospital, London. than others. All men have the propensity desperate search for self-control and particularly novel and inspired chapter but this is defined by their personal containment. Men typically have great on sulking, which he argues should be Is There A Cure For Masculinity? (2010, experience. Jukes understands masculinity difficulties with feelings and intimacy. recognised as a clinical condition located £14.95) is published by Free Association to be a set of defences against attachment This is because of the way they respond in the transitional stage between the Books, www.fabooks.com NEW ASSOCIATIONS ISSUE 4 AUTUMN 2 0 1 0 13

children may find themselves living with We work with couples to provide them On The Frontline distant relatives who are unable to act with space and encourage them to as parental substitutes, and who are in verbalise their thoughts and feelings in some cases unkind to, or neglectful of, the a holding environment. With the help children in their care; or they may live in of the therapist they can think through ‘Therapy is like children’s homes or with foster families. the origin of their difficulties and In many of these situations, young consider how migration and trauma have refugees or children of refugees may feel compounded this. We can also provide a mother feeding isolated, alone and unloved, feeling they help for the family as a whole. The have no one they can talk to about their therapeutic approach we use can help all difficulties. the members of the family to see how and why they may project their feelings of the child’ Some of our young clients may be persecution on to those around them. overwhelmed by fearful recollections of By Aida Alayarian and Lennox Thomas traumatic experiences, often expressed in a variety of unconscious, non-verbal ways. ‘Sometimes it These can evoke strong negative feelings is easier to talk The Refugee Therapy Centre helps refugees and asylum seekers deal in the people around them, particularly with their psychological difficulties by providing specialist counselling, those charged with their educational and with a stranger.’ psychotherapy and support. social care. Sometimes trauma in young children can ‘incubate’ until it finds Bilingual Support Outreach / expression in the teenage years. Community Development Workers he refugee therapy difficulties upon entering a host country, (CDWs) offer confidential help and Centre (RTC) was including adjusting to a new environment, We primarily use a psychodynamic or support with understanding and getting established in 1999, in language barriers, uncertain citizenship psychoanalytic approach in our assessment to know services available in the new response to the growing and material poverty. As a result, the and treatment. Working through their environment; accessing services such Tneed for a therapeutic service in the inner worlds of many young refugees experiences in a safe and supportive as health, education for children, and community that would respect and work are populated by experiences of abuse environment offers children insight into English or computer courses for adults, with the cultural and linguistic needs of and horror that often bear little or no their problems and provides them with a as well as finding work or volunteering refugees and asylum seekers. Our central resemblance to their present situations space for their own sense-making, helping opportunities. They can also provide purpose is to help refugees and asylum here. This can prevent them from them to verbalise feelings which they a ‘listening ear’. CDWs can therefore seekers to feel empowered to deal with settling and integrating into their new may have feared or suppressed through act as a filter for people who need some their psychological difficulties. The Centre environment, which then leads to new aggressive or harmful behaviour. One supportive therapy but have first made an delivers a culturally and linguistically anxiety, depression and stress. Some young person told us, ‘Sometimes it is approach for practical help. appropriate intercultural therapeutic act out their distress with parents and easier to talk with a stranger, to tell your service in 21 languages that addresses the teachers with aggressive and violent feelings openly without fearing. Therapy The CDWs developed the Parenting gap in service provision for refugees and behaviour, whilst others become helps me to understand a situation, to find Workshop in January 2010, working with asylum seekers. We offer individual, withdrawn or may develop eating a way to pass the problem. It makes me refugee and asylum seeker parents who couple, family and group therapy, giving disorders. Poor concentration and memory feel not alone.’ are finding the parenting role challenging priority to children, young people and impairment are also common reactions. in their new society. After a successful their families and to those who have been We also offer group therapy. Nadia, a pilot, the Community Development in the UK for less than ten years. We hope member of a women’s group at the Centre, Project has now set up a series of monthly to help them regain a sense of meaning ‘Some feel said: ‘Therapy is like a mother feeding the workshops for parents. They have also and improvement in the quality of life, rejected by their child. Initially when I joined the group, initiated an Open Surgery with our local after the considerable trauma they have it was strange, but now it feels like going MP and patron Jeremy Corbyn, MP. endured. own people and to a loving family home. Therapy has country.’ been a strong source of support for me, Even fully qualified and experienced It is important to understand the range which has also helped me to even talk professional psychologists, of effects of trauma from an intercultural about my jealousy and envy.’ While each psychotherapists, psychiatrists and The young people with whom we work perspective in order to distinguish refugee’s experience is unique, there are counsellors come for fortnightly have been subjected to various forms between different types of trauma, such as some issues common to particular groups. supervision sessions at the Centre. and levels of stress, such as the stress and interpersonal or violation of human rights This not only includes those coming from Working with people who have been fear of war, whilst others have witnessed by a state authority. This external trauma the same environment who speak the refugees and asylum seekers requires appalling atrocities against members in adult life can mask developmental same language, but also commonalities understanding of life events which may of their families or community. Young problems, perhaps accrued earlier. We are among people who have experienced be painfully difficult to tolerate, may refugees and children of refugees often also careful of the level of interpretation identical persecution in different cultures seem strange, unfamiliar, and unbearable. adjust to new host cultures and languages and the pacing of the treatment to ensure and communities. In a mixed language/ It is a relief, to experienced as well as less more quickly, and are therefore often used a better outcome. Most of the Centre’s ethnicity group this can be a positive experienced staff, to be able to recount as mediators by adults in the family who staff have a refugee or immigrant unifying factor. what they have heard, consider how they may not be able to fulfil their parental background and bring with them a might have responded, get over the pain responsibilities. As a result, young people wealth of linguistic, cultural and shared These experiences may have involved and shock, and have the support they need may develop psychological difficulties, knowledge and experiences. Patients can political or state violence, persecution, in order to face the task with renewed and the trauma that their parents have choose to receive support in English or in imprisonment, torture, domestic, family confidence. experienced may be transmitted to them their own language. Some people prefer abuse or rape. In some cultures, women due to parental suffering and the effect not to see a therapist from their own face blame for being raped, and are scared of role reversal. Some children make the cultural background because of feelings of to speak out for fear of being ostracised Aida Alayarian is Clinical Director of the journey to this country alone, and may mistrust, guilt, shame or embarrassment and rejected; many women bear the RTC, and Lennox Thomas is a supervisor. not know what has happened to the rest of about what has happened to them; it may secrecy as a heavy burden. Men are also www.refugeetherapy.org.uk their family and whether or not they are also be due to the intensity of feelings of raped and, having had the courage to alive. Some have lost one or both parents; pain when talking in their own language. disclose this in therapy, struggle with the Resilience, Suffering and Creativity: The others have lost their entire families. Some Some simply do not want to have contact difficulties of seeing this as personal and Work of the Refugee Therapy Centre (Karnac) have themselves been arrested, and even with professionals from their own emasculating or as a political act. Our provides information on the work of the tortured or raped. Though each has had a background because they feel rejected by supportive groups provide an environment Refugee Therapy Centre and the specific unique experience, all of these individuals their own people and country. in which participants can feel the relief approach used to support refugees and asylum have had to deal with displacement from and support of genuine human contact, seekers who have endured unimaginable their homes and familiar environments Refugee and asylum-seeking young breaking the ring of isolation. losses, displacement and violation of their and have had their normal life routines people may encounter a range of new basic human rights. severely disrupted. Unaccompanied 14 NEW ASSOCIATIONS ISSUE 4 AUTUMN 2 0 1 0 NEW ASSOCIATIONS ISSUE 4 AUTUMN 2 0 1 0

21 November 2010 4 December 2010 5 February 2011 Diary Walking with Freud Narcissism: A Troubled Way Of Self-Analysis Then and Now: BBC Radio 3, Music Matters, 9:30pm Relating From Jung’s ‘Red Book’ to the Countertransference Speakers: David Matthews, 23 Magdalen Street, London SE1 NOVEMBER Friends Meeting House, Anthony Cantle Speaker: Pat MacDonald 91-93 Hartington Grove, Cambridge Ongoing www.bbc.co.uk/bbcthree/ Contact: 020 7378 2050, Psychoanalysis: [email protected] Speaker: George Bright The Unconscious in Everyday Life 24 November 2010 Contact: 020 7435 7696, Science Museum, London SW7 The Cambridge Scientists and 4 December 2010 [email protected] www.beyondthecouch.org.uk Psychoanalysis in the 1920s Leadership and Narcissism Institute of Psychoanalysis, London W9 LCP, 32 Leighton Road, London NW5 11 & 25 February 2011 12 November 2010 Speaker: John Forrester Speaker: Michael Brearley Imagery and The Unconscious Observation, Reflection and Contact: 020 7563 5016, Contact: LCP, 020 7482 2002 October Gallery, 24 Old Gloucester Street, containment: A psychodynamic www.beyondthecouch.org.uk www.lcp-psychotherapy.org.uk London WC1N approach to work with parents and Speaker: Tessa Adams children under five 26 November 2010 4 December 2010 Contact: www.the-site.org.uk Centre for Emotional Development, Chinese Heart & Soul: Encountering Change: Gender and Sexuality 18a Clermont Road, Brighton BN1 the Chinese Psyche Speaker: Louise Emanuel BAP, 37 Mapesbury Avenue, London NW2 IGA, 1 Daleham Gardens, London NW3 12 February 2011 Contact: 01273 561511, Speakers: Heyong Shen, Gao Lan, Speakers: Barbara Lloyd, Cherry Potter Hmmm! A Time of Political Upheaval [email protected] Hester Solomon www.groupanalysis.org/imissite/events/ 120 Belsize Lane, London, NW3 Contact: 020 8452 9823, events_summary.asp Speaker: Malcolm Rushton 13 November 2010 www.bap-psychotherapy.org Contact: 020 7419 8896, Men in the Consulting Room 10-12 December 2010 [email protected] 23 Magdalen Street, London SE1 26-27 November 2010 What is Specific About Speaker: Brid Greally Brain Mapping Psychoanalysis Today Contact: 020 7378 2054, Brunei Gallery, Thornaugh Street, Christopher Ingold Building, UCL 12 February 2011 [email protected] London WC1 Various speakers Sexual Compulsivity and the Paraphilias Speakers: Daniel Glaser, Liz Hall, http://www.ucl.ac.uk/psychoanalysis/ 23 Magdalen Street, London SE1 13 November 2010 Ruth Lanius, Jean Knox, Nuri Gene-Cos, events/events.htm Why the mainstream needs Speaker: Thaddeus Birchard Dan Siegel its margins: The function of the Contact: 020 7378 2050, Contact: www.confer.uk.com/brain- JANUARY marginalised in psyche and society [email protected] mapping.html CPS, University of Essex, Colchester 15 January 2010 Speakers: Simon Clarke, Colin Samson, Object Relations Theory and 27 November 2010 23 February 2011 Christianity Karl Figlio, Jeffrey Murer, Eamonn Money Makes the World Go Round: Can Psychoanalysis be a Science? Carrabine, Tim Dartington, Joan Busfield, Or Does It? Marino Conference Centre, Dublin 9 Institute of Psychoanalysis, London W9 Aaron Balick Friends Meeting House, 91-93 Hartington Speaker: Chris McKenna Speakers: Mary Target, Jim Hopkins, Contact: 01206 873640, Grove, Cambridge Contact: www.confer.uk.com/dublin4.htm Michael Lacewing [email protected] Speaker: Jan Wiener Contact: 020 7563 5016, 16 January 2010 Contact: 020 7435 7696, www.beyondthecouch.org.uk 17 November 2010 Developing Identity [email protected] Bringing the Team Together Science Museum’s Dana Centre, 165 26 February 2011 Science Museum’s Dana Centre, 27 November 2010 Queen’s Gate, London SW7 Religion and Spirituality 165 Queen’s Gate, London, SW7 Internet Pornography: Speakers: Elizabeth Bradley, SAP, 1 Daleham Gardens, London NW3 Speakers: Michael Brearley, Working with client proccupation Robin Anderson, David Morgan Speaker: Margaret Clark Leon Kleimberg 23 Magdalen Street, London SE1 Contact: www.beyondthecouch.org.uk Contact: 020 7419 8896, Contact: 020 7942 4040, Speaker: Jenny Riddell [email protected] [email protected], Contact: 020 7378 2054, 22 January 2010 www.beyondthecouch.org.uk [email protected] Winnicott: An introduction to his work and ideas MARCH 19 November 2010 30 November 2010 23 Magdalen Street, London SE1 The Experience of Psychoanalysis 2 March 2011 Fidelity Speaker: Stephen Crawford Satisfying Mother Lauderdale House, London N6 The School of Life, 70 Marchmont Street, Contact: 020 7378 2054, Speakers: Robin Anderson, Angela Joyce, [email protected] SAP, 1 Daleham Gardens, London NW3 London WC1N Speaker: Mary Anne O’Donovan Josh Cohen, Elizabeth Wolf Speaker: Christopher Clulow Contact: 020 7563 5016, 29 January 2010 Contact: 020 7419 8896, Contact: www.theschooloflife.com/ [email protected] www.beyondthecouch.org.uk Psychotherapy/Fidelity Winning At All Costs: A psychological exploration of sporting greatness 20 November 2010 SAP, 1 Daleham Gardens, London NW3 5 March 2011 DECEMBER The Ego and the Superego Speaker: Ian Williamson Dreams and Archetypes 73 Fortune Green Road, London NW6 Contact: 020 7419 8896, SAP, 1 Daleham Gardens, London NW3 Speaker: Bernard Barnett 2-3 December 2010 Psychological Therapies in the NHS: [email protected] Speaker: George Bright, Valerie Roach (Squiggle Foundation) Science, Practice and Policy Contact: 020 7419 8896, Contact: 07534 422 117, Savoy Place, London WC2R 29 January 2010 [email protected] [email protected] Contact: 020 8541 1399, Enduring Pain, Enduring Spirit [email protected] Friends Meeting House, 43 St Giles, 8 March 2011 20 November 2010 Transference and Psychic Reality: Hide and Seek: Thinking about Psychic Oxford Identification and primitive imagos Skin whilst working with psychotic and 4 December 2010 Speaker: Lauren Kaye narcissistic states of mind Listening to Voices, Hearing a Contact: 020 7435 7696, G16, Birkbeck College, London WC1 Friends Meeting House, Oxford OX1 Person [email protected] 1.30pm to 3pm Speaker: Martin Schmidt Avenue House, 17 East End Road, Speaker: Gregorio Kohon Contact: 020 7435 7696, Finchley, London N3 FEBRUARY Contact: [email protected] [email protected] Speaker: Roger Bacon 9 March 2011 Contact: Vicky Raingold, 07534422117, 4 February 2011 21 November 2010 [email protected] The Horror in Dreams Thinking About Time and Ageing Screening conditions: Blind Love Science Museum’s Dana Centre, Institute of Psychoanalysis, London W9 (Juraj Lehotsky, 2008) 165 Queen’s Gate, London SW7 Speakers: David Bell, Danielle Quinodoz, ICA London Speakers: Donald Campbell, Anne-Marie Sandler Speakers: Andrea Sabbadini, Rosine Perelberg Contact: 020 7563 5016, Irma Brenman Pick www.beyondthecouch.org.uk Contact: [email protected] www.beyondthecouch.org.uk NEW ASSOCIATIONS ISSUE 4 AUTUMN 2 0 1 0 15

Grayson Perry Review In Praise of Shadows 2005 Psychoanalysis: Glassed ceramic The unconscious in everyday life Picture credit: Collection of Victoria and Warren Miro, London ‘Museums exhibit objects,’ writes Nicola Abel-Hirsch in the catalogue to this exhibition at the Science Museum. ‘The practice of psychoanalysis This pot is inspired by Hans Christian involves few such material objects. There is the couch on which people Andersen’s fairytale The Shadow, a being analysed lie, and child psychoanalysis makes use of toy figures of sinister story of a man whose shadow first people and animals, but beyond this, there is little. The curator of this leaves him and then returns to haunt him. exhibition, Caterina Albano, has chosen not to do this, but to link objects Psychoanalytically, the shadow in the story and ideas in a different way to illustrate the theme of the unconscious in represents an alter ego or a disowned part of the self. Perry evokes the dark and everyday life.’ Peter Silverton interprets. hallucinatory narrative and with it the ghostly images of the mind. The effect is heightened Human skin with various tattoos through the glittering effects of light on the Psychoanalysis, a slight return And there are art works. One is directly France, 1850–1920 pearl glassing on the pot surface. sexual. Of course it is. It’s by Tim Noble Picture credit: Science Museum To Exhibition Road on a Friday and Sue Webster – YBAs, famous for afternoon, in mid-October. their rubbish pieces (description, not Part of the collection belonging to a French judgment). There is an electronic piece. military surgeon, that Henry Wellcome I was invited so I went – to a preview of Of course there is. It’s Arnold Dreyblatt’s acquired in 1929, these tattoos exemplify a a show at the Science Museum. Entitled The Wunderblock – a tablet screen which long standing and cross-cultural body practice, Psychoanalysis: The Unconscious In displays a paper of Freud’s which compared still in vogue today. The psychoanalytical Everyday Life, it is small, tenderly the way memory works to the child’s toy valences of tattooing are multiple suggesting curated and intelligent. known, in German, as a Wunderblock. In complex relations between interiority and English, a mystic writing pad – you write exteriority, body and self, desire and loss, It’s just off the main entrance, up a flight on it, you see what you’ve written, you lift displaying and displacement. of steps. The light is low – giving a sense the wax sheet you’ve written and it’s all of the couch and the consulting room. A gone. On Dreyblatt’s the text is electronic, fine and private place. speeding and drifting past, constantly rearranging and re-emphasising itself. The show’s title gives little indication Unfortunately, it’s the one thing in of the contents or approach, though. It the show which isn’t well described or is, in fact, a collection of objects which explained. exemplify and dramatise psychoanalytic thought and concepts. So there is There is also a gorgeous Grayson Perry stuff from Freud’s room – predictable pot – his wife is, of course, an analytically in essence but given depth by the inclined therapist. There is a ‘Cabinet of accompanying exploration of their wish fulfilment’ – votives and pieces of significance by psychoanalyst David tattooed skin from the Science Museum’s Bell. own collection. (You can imagine the justifying explanation by the curator who He was scurrying around the show at the collected them, can’t you. Come on, he or Tim Noble and Sue Webster preview, explaining things and herding she would have said, there’s bound to be Bloody Haemorrhaging Narcissus people the way he does. He is also a a show someday when we’ll need a few 2009 wonderful speaker, a true believer whose ancient small carved penises and hands. Picture credit: Courtesy of the artists and views of psychoanalysis – as the central Trust me, there will.) Gagosian Gallery, London organising subject of human thought, effectively – are made acceptable – if not What’s most intriguing about the show, I The work stems from a residency of the true or entirely believable – by his wit guess, is its concreteness. Psychoanalysis artists at the Freud Museum in London and and eloquence. is the most cerebral – or, perhaps, most revisits self-portraiture in the light of the mental – of disciplines. It’s about words – Joseph Kosuth Narcissus complex. The silhouette shadows Other stuff in the show includes toys – as silences and gesture, too, but mostly words. ‘O.&A./F!D! (To I.K. and G.F.)’ of the profiles of the artists intercept a silicon used to analyse children, by Margaret This show gives it, I suppose, body. 1987 sculpture composed of interlacing casts of Lowenfeld and Betty Joseph. Basic Picture credit: Courtesy of Sigmund Freud Noble’s penis and Webster’s hand: the shadow idea: children aren’t capable of talking Museum, Vienna of the self born out of wounded libido. coherently about their inner life – ie via Peter Silverton is a journalist blogging at free association – so analyst gets them http://petersilverton.blogspot.com Created for the Freud Museum in Vienna, to play with toys and then analyse the ‘O.&A./F!D! (To I.K. and G.F.)’ merges text deeper meaning of their play. – a page from Freud’s The Interpretation Until 15 April 2011 of Dreams – and images – a photograph of There are also drawings made by www.beyondthecouch.org.uk the entrance of the museum, Freud’s former Melanie Klein’s young boy patient house. The result of this ‘condensation’ is Richard. Pictures of Spitfires and both intriguing and disquieting, inviting us Messerschmidts shooting and burning – to look beyond appearances searching for it was war time. There are Winnicott’s associations and meanings. squiggle pictures. Basic idea: analyst draws squiggly line on paper, child extends it, analyst explains meaning of child’s squiggle. (Put like that, it can sound daft. But I’m not sure it is. In fact, I’m sure it’s not. If we can’t find meaning and emotion in the shape and rhythm of a line, we would never visit art galleries and Picasso would have been out of work straight away.) 16 NEW ASSOCIATIONS ISSUE 4 AUTUMN 2 0 1 0

NPSA Research Study Group London, 2010 NA Neuropsychoanalysis in London

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