Some Thoughts on the Creation of the Child Psychotherapist's Role in a Major Teaching Hospital

In a letter to his brothers, John Keats wrote about the quality he felt went into forming a “man of achievement”, especially a man of literature such as Shakespeare. This quality Keats defined as “Negative capability, that is when man is capable of being in uncertainties, mysteries, doubts, without any irritable reaching after fact & reason” (1817).

While Keats was attempting to struggle with the definition of an important quality in the creative process, his concept of “negative capability” is also useful in other areas. The capacity to bear the mystery of the unknown, to tolerate and use constructively the sense of vulnerability and helplessness which the unknown arouses, seems to be an essential ingredient in our psychoanalytic work. Two of our primary tasks as analysts and therapists are the discovering of a person's internal world, with the phantasies, thoughts, and wishes which motivate him, as well as the forces which counteract these; and the understanding of that world's relationship to the external world. Through these explorations within the therapeutic setting we attempt to bring about enough of a dynamic change for the person to leave behind the conflicts and anxieties, often arising from the earliest years of life, which impede development. The therapeutic journey is usually a long and arduous one, demanding, amongst many things, the capacity to bear the anxiety of not knowing quite where it is leading. Often, when with a patient, it is tempting to resort to a “reaching after fact and reason”, to mould what the patient gives us into a model with which we can feel more comfortable rather than to listen and hear and wait for understanding.

When I was asked to become the first Child Psychotherapist in the history of St. Bartholomew's Hospital, my enthusiasm for the task helped to carry me through the initial stages of the challenge which lay ahead. However, it very soon became apparent that much more than enthusiasm would be necessary in this London teachin