Containment lost: the challenge to child psychotherapists posed by modern CAMHS

The paper is an examination of some emotional challenges facing child psychotherapists working in modern CAMHS following the introduction of the NHS internal market for commissioning and providing services. Its introduction has brought the loss of organisational containment for all CAMHS clinicians. The meaninglessness in work reported by clinicians is a clue to this loss. This loss is especially difficult for child psychotherapists because of their particular investment in the apprehension of meaning in symptoms and other presentations by patients. The paper proposes that meaninglessness is itself a clue to the ascendancy of what Freud called the death instinct, and that this is inherent within the internal market model. Because service design and delivery is predicated upon it, the internal market model structurally determines that clinicians are bound to senior management in a way that leaves child psychotherapists open to professional life-threatening dynamics associated with the death instinct. The ?K (Bion) world of CAMHS is thus deathly, leaving child psychotherapists vulnerable to self-destruction. We have lost a workplace in which our approach flourished conferring on us the identity of a discipline structurally favoured, because of the help we provided through this approach to patient and clinic work. This loss of identity brings the dangers of containment lost. This situation leaves child psychotherapists emotionally vulnerable and is akin to Satan’s loss in Milton’s Paradise Lost.     

Rediscovering Meaning

The present crisis of the Western countries involves not just the world of politics, finance, and the economy, but also the ecosystem balance, the world of the values on which the model of social organization and economic development is based. The crisis is therefore systemic, epoch-making, and overcoming it will require radical changes, above all in the way we think, in our scale of values, and therefore our culture. On the other hand, for decades the world—in particular the West—has been experiencing a cultural sea-change that is challenging many of the pillars of society that have stood for centuries. The young people of today and their use of technological social networks to develop non-profit initiatives for social change may create a more positive future while maintaining our human values.     

CRISIS OF BRAIN AND SELF

Abstract. Neuroscientific evidence requires a monistic understanding of brain/mind. Truly appropriating what this means confronts us with the vulnerability of the human condition. Ca-muss absurd and Tillich's despair are extreme expressions of a similar confrontation. This crisis demands a type of courage that is consistent with scientific truth and does not undermine the spiritual dimension of life. That dimension is not a separate substance but the process by which brain/mind meaningfully wrestles with its crisis through aesthetic symbols, religious faith, and ethical affirmation. The validity of these activities does not depend upon human autonomy but instead upon the fact that they exist. Furthermore, they constitute the self, which Dennett calls a "center of narrative gravity."