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Working in the NHS as a child and adolescent psychotherapist, in the context of cost-cutting and austerity-led public services, can often feel a thankless task. CAMHS clinicians, it seems, are asked to perform miracles on the scale of Jesus in the parable of the ‘five loaves and two fish’, multiplying the scarce ‘bread and fish’ despite the lack of resources. This has particularly been the case during the years of the pandemic.
As UK child and adolescent psychotherapists working within chronically underfunded public services, our dilemma is stark: do we overstretch ourselves and offer more and more, trying and failing to magically multiply the resource that exists? Or do we adhere to rigid boundaries, sticking to the required hours and patients per day and reserving traditional child psychotherapy for a limited few? Despite our best intentions, we are often pulled into offering more than we can manage, feeling, regardless, that it’s still not enough. The worst case scenario for child psychotherapists working in this context is burnout, or a decision to leave the health service altogether.
In a cost-cutting public sector, an obvious answer to the existing problems is to offer time-limited therapy to children and young people. Yet traditionally child and adolescent psychotherapy has been linked, for better or worse, to longer-term treatments. Even the recently manualised short term psychoanalytic psychotherapy (STPP) (Goodyer et al., 2017) studied as part of the IMPACT randomised controlled trial (RCT) offers 28 sessions, which depressingly, may still remain beyond what CAMHS teams can comfortably manage.
With these dilemmas in mind, and in the spirit of exploring options rather than despairing, I recently turned to a book by Ruth Schmidt Neven, published in 2016. This short book on time-limited psychodynamic psychotherapy for children and adolescents takes a distinct approach on these issues, engaging with the broad landscape in which we work, rather than offering a man