While watching a powerpoint presentation on a study day at the Oxford Cognitive Therapy Centre some years ago, I took exception to a cartoon which appeared on a particular slide showing a grey haired old man sitting beside a woman who was prostrate on a couch. Quite predictably, the caption read something like ‘So, Mrs Jones, tell me about your mother.’ This outmoded view of psychoanalytic psychotherapy, I pointed out to the room, is both misleading and frankly patronising given the fact that psychoanalytic practitioners play a crucial part in diverse, multidisciplinary NHS teams up and down the country. Psychoanalytic insights are rightly valued greatly in these and in many other contexts.
Reciprocally, most psychoanalytic psychotherapists recognise that only such a caricatured analyst would disregard the accrued therapeutic knowledge and skill that exists beyond the limits of the psychoanalytic field. Psychoanalysis as a tradition is not very good at letting go tired or burdensome ideas, or so I would argue; but it is nonetheless a broad church which lends itself to incorporating new learning. This is surely what we all want, what any trained professional wants. If not, we risk complacency; we risk becoming of little use to our patients. Other people’s ideas encourage in us a process of revision, of clarification and of illumination by which, ultimately, we are reminded at the very least of the value of what we already know and do. As Doris Lessing once put it, when learning new things, we might ‘suddenly understand something [we’ve] understood all [our] life, but in a new way [my italics]’.
In June 2003, I qualified as a UKCP psychoanalytic psychotherapist. For most of the intervening time, I have worked within the NHS as well as in private practice. Like most NHS professionals, I have attended many CPD events since qualifying, reflecting both my areas of interest as a therapist and the needs and priorities of the different NHS departments within which I have worked. Thus, whilst my core psychoanalytic training, coupled with a five year training therapy, form the root – the trunk, even – of my psychotherapeutic practice, they together are not the whole tree.
Having been employed in multidisciplinary teams since qualifying, each with its own characteristic therapeutic culture, each with its own idiosyncratic exchange of therapeutic ideas, I have absorbed – though not uncritically – different elements of clinical practice, reflecting a range of psychotherapeutic philosophies and prepositions. The result is that I am highly eclectic (I distinguish eclecticism from an integrative approach here) as a therapist. The simple truth is that, having learned from and alongside not only psychotherapists, but also psychologists, psychiatrists, counsellors, occupational therapists, physiotherapists and yoga teachers, to name but a few, a more than cursory knowledge of different therapeutic modalities and a proficiency in delivering them has become central to the way I work.
This is inevitably about evidence, something which is absolutely inescapable, certainly when working in a medical context as I have done for a number of years. In truth, I remain somewhat reassured by the fact that psychoanalytic psychotherapy is not so easily dredged for data when compared with more DSM- led, more data-friendly therapeutic models. That said, research into psychoanalytic psychotherapy is proving beneficial in some areas. (This is very well presented, for instance, on the BPC website – bpc.org.uk – in a paper entitled: Psychoanalytic psychotherapy: what’s the evidence?.) But, it remains the case that to be psychoanalytically trained when working in some clinical spaces means having to change and to adapt. (Reciprocally, of course, some contemporary cognitive and behavioural therapies do in fact make great use of psychoanalytic insights. This is true, for instance, of Cognitive-Analytic Therapy, of Schema-Focused Therapy and, more recently, of Compassion-Focused Therapy.)
In 2018, however, I realised – quite abruptly – that this eclecticism was potentially a very serious problem for me. During the process of CPJA reaccreditation in that year, I became very worried that my professional development was at risk of being judged inconsistent with UKCP registration and at odds with the practice of psychoanalysis. I was informed that the final judgement on my practice as a psychotherapist would be down to a skilled and experienced peer, someone charged by the UKCP with making a decision in my case.
But based on what? The guidance issued by the UKCP made clear the need for therapists to show evidence of professional development in a way that reflects the underpinning assumptions of psychoanalytic practice. My CPD folder now included a post-graduate qualification from the Centre for Mindfulness Research and Practice at Bangor University, extensive specialist medical and psychological training in the management of pain, many hours study and practice in third-wave cognitive and behavioural therapies (particularly acceptance and commitment therapy and mindfulness-based cognitive therapy) and extensive trauma work. Much of this I have done at my own expense and through internationally recognised training bodies. I felt the warning was clear, nonetheless: it had been suggested to me that my assessor was a ‘conservative’ who was not in favour of therapists developing ‘away’ from a particular classical view of psychoanalysis. By following the evidence – and, by extension, bringing psychoanalytic insights into new areas of clinical practice – I was afraid I had for all intents and purposes committed a kind of apostasy.
With help, I was able to shape my track record to reflect more of what was wanted from the process. Not lies, just different points of emphasis. And having survived it, ultimately without too much strife, I came away fully reaccredited. What stuck, however, was a sense that I had had to justify myself for developing as a professional in the real world. It also concerned me that the UKCP seemed blind to this issue, something that would surely be bound to become a problem for other psychoanalytic psychotherapists: at least, those who don’t live in Hampstead or Crouch End, who don’t see patients five times a week and who resist being caricatured.