Musings on the Faculty of Psychotherapy Annual Residential Meeting at the Moller Centre, Cambridge 22-23 April 2010.

08May10

The unconscious parallel worlds of fellow tragic princes, Hamlet and Oedipus; the master painter’s empathic awareness that enables admirers to experience other people minds; Mozart’s operatic homage to Don Giovanni’s guilt driven manic narcissism… so far, so psychotherapy. All must be well then for psychotherapists from the Royal College of Psychiatrists to be taking two days out from busy clinical commitments to appreciate the insights of the geniuses of the creative arts.

In their work with the emotionally vulnerable, these psychiatrist therapists are readily familiar with having to hold and contain doubt. Increasingly though they’re needing those same qualities in regard to their own existence. While their trade is fundamentally concerned with their patient’s internal world, external factors like pressure for demonstrably effective results and departments threatened with closure have become increasingly important. Thus as both country and Faculty face imminent elections and with uncertainty about whether the next government’s cuts will be bad or worse, the members of psychiatry’s Cinderella service are gathered for their annual conference in Cambridge. Here they will network, learn and possibly dare to dream, though later during a presentation on night terrors we see that for some, even sleep offers little respite.

Ahead of the conference, discussion in the Faculty’s newsletter centred on their proposed rebranding as medical psychotherapists, to more accurately reflect their core work and breadth of training. The thinking is that as management is tempted to rely on less-costly psychologists and counsellors to perform the limited therapy work that is offered, emphasising their medical credentials would demonstrate the  importance and value of their experience and expertise.

Thus I’m interested to hear more because of my interest in psychotherapy that has run alongside my general training in psychiatry. I’d often been skeptically curious about ‘therapy’ before medical school, but 20 years later, my recent diploma course in psychoanalytic psychotherapy at the Tavistock Clinic opened a world of challenging and at times, compelling ideas. Only a week earlier I submitted my dissertation comparing psychiatric and psychoanalytic approaches to Freud’s melancholia or what we psychiatrists call severe depression. Both approaches have their strengths but only psychoanalysis offers an understanding that could be applied even after the patient is ‘well’.

One of the most crucial writers in my reading was the psychoanalytically trained psychiatrist, Richard Lucas. Among the psychoanalytic approaches to psychiatry that he described was Freud’s pioneering description of the relentless and sadistic nature of melancholia. Here, Lucas advocated for more than just ordinary empathy and encouraged therapists to tune into what he termed the Psychotic Wavelength. In this eponymously titled, post-humous book, he also highlighted Freud’s call for psychiatry’s greater awareness of psychoanalysis, a role Lucas fulfilled in his own work as an NHS psychiatrist. Fittingly a memorial conference in London is planned for a few weeks later that many here will also attend.

Further crossover between the two disciplines was shown in the opening presentation by Paul Fletcher, a psychiatrist and professor of Health Neuroscience, who suggested that an exaggeration of our natural tendency to make predictive errors offered an explanation for the development of delusional beliefs. Later Kevin Healy, clinical director of the Cassel Hospital, one of the few remaining psychotherapeutically oriented in-patient units, presented a similarly grounded in science account of the body’s dynamic relationship with the brain. Both are subject to traumas and carry living records of their experiences, though some brains may be more effected by stress due to their development in utero and their genetic predisposition towards attachment.

The final presentation returned to the arts but of a more grim, gritty kind using clips from the UK gang culture film, Bullet Boy. Here Don Campbell, a forensic analyst from the the Portman clinic, drew attention to how relationships based on indebtedeness, as often occur in gangs or families, can limit personal development that becomes entranced by it’s own narcissistic wounds.

The next day, I accompanied one of my previous psychiatric supervisors to an immigration detention centre where he does assessments on Saturday mornings. As a trained analyst, he had also supervised my first year-long psychoanalytic psychotherapy case. Amusingly among the permanent clutter that remains on the backseat of his vintage BMW was the latest copy of Mojo with Angus Young on its cover. Like the perennial school boy of AC/DC, Giuseppe Spoto had no time for fanciful academic diversions. What mattered was the basics of his clinical duties and when due to changes in the terms of his work commitments he no longer had time to offer psychotherapy supervision to psychiatry trainees as he had done myself, he had felt unsupported by the Faculty.

When I had asked around during the conference about why there wasn’t as much emphasis on the practical issues involved, it was suggested that these had been addressed somewhat last year. But maybe that wasn’t all that was missing as was made explicit when the problems with the running of the scheduled small group explorations was raised. Was it all down to the quality of the refreshments provided by the Moller Centre, with glass coned building that proclaimed it was designed to inspire? Perhaps the anxieties of a wounded faculty savaged by cuts and facing the loss to retirement of two of its admired leaders were not so invisible.

Overall the conference was enjoyable with high quality engaging presentations and I was welcomed by a number of the senior members. I was also pleased to have met some former colleagues, two doctors I’d previously met (but unknown to each other) at a friend’s wedding and a staff grade from Leicester, who shared a mutual respect for my first two psychiatry trainers whilst at medical school. I left with a broader scope of the evidence for psychotherapy around me though not necessarily any more sure whether there was a future for me in psychoanalytically orientated psychiatry.

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2 Responses to “Musings on the Faculty of Psychotherapy Annual Residential Meeting at the Moller Centre, Cambridge 22-23 April 2010.”

  1. 1 Graham

    Great piece, Greg. Really enjoyed reading it. Also, I went to the Richard Lucas memorial event on Saturday and was quite inspired by the talks. I’m not very optimistic about the provision of services for psychoanalytic psychotherapy but feeling more sure of my attempts to try and incorporate some of these understandings into my own practice. My main enemy is time though, and perhaps my lack of formal training, but maybe a little can go a long way?

    • Thanks Graham, would like to have been there. Do read his book, I have a copy out here with me. Yes I think the knowledge does help and helps against feeling helpless.


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