Michael Fitzgerald – in conversation with Mary Montaut
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.
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