I am reading Martin Pollecoff”s interview of Peter Fonagy in the Psychotherapist, the magazine of the United Kingdom Council for Psychotherapy, of which I am a member
, and find myself resonating with Pollecoff’s concern that “in IAPT (increasing access to psychological Therapies) you have people who have been through a year’s training with no therapy of their own. I am concern about the political shift between the therapist and the client. It’s a model in which the expert, who is OK, is treating the poor client.There is something wrong there for me”.In my view, Peter Fonagy is absolutely right to point out that the medical model has failed in the provision of adequate mental health services to a broad public, and that the IAPT initiative is a way to Address this failure. But I don’t feel that in this interview he answers the interviewers’s questions with total clarity. Fonagy says that the psychoanalytical model is the best way to understand how the mind works and how a person can heal. He also describes three essential elements in psychotherapy (the working alliance, mentalisation and compassion). In my experience of practising psychotherapy in London
, all three elements are totally contingent upon the relationship between the patient and therapist, and I feel it can only be beneficial to the patient if the practitioner has experienced these elements in a relationship with a confirmed practitioner for a significant amount of time.
Fonagy says “you have to be robust”, and in my view this comes as a result of the practitioner having tested out the solidity and healing potential of a working alliance, not as a result of a short one year training. Generally, it is my experience that the patients who come to see me at my London practices will only ever go as far as I have been myself. If there is something that I cannot negotiate within myself, then it follows that I cannot help my patient negotiate this corner for themselves. Fonagy has gone through intensive analysis himself, and I am surprised to see that he remains quite vague when discussing the essential aspect of practitioner therapy with Pollecoff.