– The Child and Adolescent
 Analytical Psychotherapy Course

Michael Fitzgerald – in conversation with Mary

This article outlines the new training course in 
Analytical Psychotherapy at UCD (St. Vincent’s). (See
 Winter issue of Inside Out for course details.)

When I came back to this country in 1981, I was involved in setting up a two year
 training course in analytical psychotherapy and since then I have had the opportunity
 to train a large percentage of the people who are working in the field. I felt free then 
to reduce my input into adult analytical psychotherapy and to move on to child 
psychotherapy where I saw there was a need not being met. With a few others, I set
up the Child and Adolescent Analytical Psychotherapy Course which has been 
running for about six months and is going very well. It contains the usual components
- a theoretical input and the personal psychotherapy which is mandatory in all 
analytical psychotherapy courses. The first principle is to know thyself. People must 
work out whatever kind of blind spots they may have or there may be certain kinds of
 patients they cannot get on with because of their own personal experiences in
 childhood. Their personal analytical psychotherapy must be completely separate from 
the course, with no reporting back on the content of the personal psychotherapy to 
any course organiser. This is different from analytical psychotherapy courses in other
 countries, but to me it is a contradiction in terms to include assessment of personal
 analytical psychotherapy as part of training.

One of the distinctive features of the Child Analytical Psychotherapy Course is
 that we have Baby Observation Seminars. All students have to meet a mother before
 she delivers her baby and to stay with her for a couple of years, visiting her once a
 week and recording the mother-child interaction. Actually, I believe this should be
 part of all psychotherapeutic training because almost all psychotherapy is about the 
child – most of the time we are working with the child within the individual. By baby
 observation, the students can pick up the nuances between the mother and the child 
during feeding and bathing and so on. They can pick up the mother’s mental state
 and how this affects the baby, a lot of pre-oedipal material. During the last ten or
 fifteen years, the British school of psychoanalysis has become much more interested 
in the pre-oedipal period; we see the crucial importance of these early years and so 
the Baby Observation Seminars tune the students in to all of this. Of course, they find 
it immensely enjoyable. People might think they are intruding on the mothers by
 coming for an hour a week for a couple of years, but I have found the exact opposite: 
the mothers find it immensely supportive and look forward to visits. I found that the
 days when there were any problems were when I could not come for some reason or
 another. So I believe that all psychotherapists, I don’t care what persuasion, should 
include this in their training. It is very simple to set up and inexpensive. All the 
observations are discussed in a weekly seminar, which is a distinctive feature of the
 Child and Adolescent Analytical Psychotherapy Course.

Constitutional Differences

Just one other thing about this course: I felt that there was too much emphasis in
 this country on family therapy, even though I am a great fan of family therapy. It was 
the first form of therapy that I used and I still practice family therapy nearly every 
day. And yet it somehow neglected the individual child and its intrapsychic processes, 
the stresses, conflicts and guilt. Family therapy is often very good in the assessment 
stage, but sometimes we need to take a child out for individual psychotherapy because 
not all problems are caused by family stresses. We are now aware about constitutional
 temperamental differences which are probably linked to genetic factors and these can 
have a big impact on the development of symptoms and psychopathology. These are 
individual factors, you can’t blame the environment for them. These difficult 
temperamental children of course get the environment to react in a hostile way 
towards them so that there are secondary environmental stresses. This aspect had 
been neglected for about twenty years, that children’s experiences varied according to 
their constitutional make-up. So a mother might be perfectly well able to rear a
 perfectly healthy child who was malleable and easy and temperamentally good, but
 totally fail with another sibling in the same family who was temperamentally difficult
 and unmalleable.

Getting Ourselves Together

There has been a great increase in interest in psychotherapy and training. I don’t 
think we can ignore the Irish Standing Conference on Psychotherapy which is being 
proposed – it is going to be important. There is an urgent need for people working in 
the various types of therapy to get together because the Dutch are trying to get the
 EC to legislate in an extremely narrow way, making it legal only for psychiatrists,
 psychologists and social workers to be therapists. I was alarmed when I learned that
 and it made me realise that we must get together here. For the last ten years I have 
been involved in training ‘non-core’ professional therapists and we should not now be 
forced to go this very narrow way, abandoning them. The Department of Health will
 be more supportive to us if they see that we have got ourselves together as a group. I 
hope that people will come together under this threat. It is more dangerous than
 people realise. In Europe, they are paying high-powered lobbyists to advise them. We
 must get ourselves together in a group of Analytic, Humanistic, Family and
 Behavioural therapists.

I would like to see the various types of therapists all working together in a group,
 with a doctor or psychiatrist included. This would be best, I think, because there are e
certain conditions which need medical attention. A headache may be mostly psychosomatic but it could also be a brain tumour. So could a tic in a child. And some 
psychosomatic problems need some medical intervention. If we could work in a 
group, and reduce the schism between the professions, then this would benefit the
 patients. We ought to put clients first and send them where they are best suited. In 
the past, the professions have put themselves first the unspoken economic factor. It
 reminds me of when forceps first came out for delivering babies: doctors had different 
forceps which they kept secret. A doctor would have a forcep which he had developed
 and which would help mothers, but he kept this secret and did not let any other 
doctors know about it. We should be sharing the knowledge for the benefit of 
humanity. We have to set up an independent psychotherapy profession with very
 definite high standards. The public deserve this. The developments in this area in 
Ireland in recent years have been very hopeful.

Dr. Michael Fitzgerald, MB MRC Psych., Psychoanalyst, Member of
 International Psychoanalytical Association, is Co-Director of the MSc in 
Analytical Psychotherapy at UCD. He is also Consultant Child Psychiatrist 
at the Ballyfermot Child and Family Centre