Background to psychotherapy
Psychotherapy is unique amongst the
subspecialties in psychiatry in not being defined by a patient
population in terms of age or diagnosis. I think this embodies the
integral relationship psychotherapy has with all of psychiatry; it
permeates all of the subspecialties in the form of the relationship
with the patient that is the foundation of all psychiatric
practice.
A psychiatrist who decides to train
as a psychotherapist will leave mainstream psychiatry but will be
required to remain engaged with it. The psychiatrist needs the
psychotherapist and the psychotherapist needs the psychiatrist. The
medical psychotherapist informs and helps to develop psychiatry to
help to make it the discipline it aspires to be, integrating
biological, psychological and social perspectives on an equal
footing.
The medical psychotherapist brings
their medical and psychiatric training as a foundation for an
approach to psychotherapy which is informed by working with the
body, with risk, with responsibility and with colleagues.
All psychotherapy involves sitting
in a room with a person or people in mental pain and psychological
confusion, conflict and distress and trying to make sense of what
is going on. There are many different models of therapy to suit all
sorts of personality, some structured, problem solving and logical;
others more intuitive and exploratory and suited to those prepared
to wait for thoughts and understanding to emerge. It is possible to
work with individuals or with couples, families, groups,
therapeutic communities or with organisations therapeutically.
An interest in teaching, training
and research will be essential for a doctor wanting to become a
psychotherapist as these functions are fundamental, in different
measures, for all medical psychotherapists. A curiosity about the
mind and a doubt that we have arrived at a satisfactory
understanding of the mind will be an enormous asset in a profession
which is constantly changing but which contains diverse and
passionate advocacy for widely different ways of understanding the
problems of being human.
Improving access is the shibboleth
of psychotherapy and access to psychotherapy can only be improved
by attracting doctors with an open mind into psychotherapy.
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Personal perspective
I think of psychotherapy as a craft
which combines art and science. At the risk of this being sent to
Pseuds Corner in Private Eye, psychotherapy is the poetry to the
prose of psychiatry. Without psychotherapy, psychiatry would be
very impoverished. Psychotherapy was why I came into
psychiatry.
I chose to train as a
psychoanalytic psychotherapist because it suits my perception
that people are universally similar and infinitely different
from one another. In medical school I first encountered
psychotherapy in family therapy in a child and adolescent unit
where I spent an elective. It has taken me some years to realise
that I chose this elective because I was interested in exploring my
own origins and family which is what drew me towards
psychotherapy.
I have been working as a consultant
psychiatrist in psychotherapy for twelve years in a busy and
thriving psychotherapy service in Leeds and I do not stop feeling
that it is a privilege to be in the position of listening to my
patients’ stories. However, I do not want to ignore the darker side
of the work because people seeking psychotherapy are in mental pain
and trauma and destructiveness in human relationships are a
leitmotif of my day.
Many forms of therapy now exist and
compete with one another for the prize of being the most effective,
but what all therapies have in common is the interest in the value
of using the mind to attempt to understand and help another
mind.
Despite the competition between
therapies, therapists in whatever model recognise what it takes to
become a good therapist. If I was asked what makes a good
therapist, working in whatever model of therapy, I would say that
it is a person willing to reflect on themselves. This is what we
hope for our patients, that they might be able to reflect on
themselves, to come to be able to reflect on their own minds, to
develop a mind of their own, and the therapist has to be able to
model this in their willingness to reflect on themselves.
At the heart of psychotherapeutic
practise is the creation and the development of a space to think.
There are many demands in life which internally and externally
threaten the space to think and reflect on the self.
My cartoon of the ‘Do Do Bird’
shows a rather beleaguered bird attacked by multiple competing
demands and my caption the ‘Do Do Bird became extinct because it
had no space to think’ captures a central concern that a space to
think is not a luxury, it is crucial to the survival of the species
known as a psychiatrist.
Dr James Johnston
Consultant Psychiatrist in
Psychotherapy, Leeds
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Page updated on 8
December 2010