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Norris is to be commended for producing a stimulating and wide-ranging analysis of the acute challenges faced by contemporary child psychotherapists working within the NHS. The picture painted is bleak. Child psychotherapists find themselves in the straightest of straitjackets: operating in a restrictive climate with limited freedom of movement and thought, working within destructively competitive systems where coherence, collaboration and meaningful connection frequently break down under the weight of the emotional strain placed upon them. Norris also points out the cruel irony of a system that invests heavily in producing highly skilled clinicians, which it is then unable to make effective use of. With respect to the latter, it is not hard to see why child psychotherapists may feel extremely aggrieved and troubled by the circumstances they find themselves in, especially in the face of a mental health crisis among children and young people.
In his paper, Norris expresses deep frustration and confusion about why we, as a profession, are constantly overlooked and pushed aside. In his analysis, the fault predominately lies with the system. There is certainly truth in Norris’ assessment, but with his analysis there is a danger of locating all of the problems outside of the profession, and in doing so, greatly diminishing any agency we have to address the very real challenges we face. With the frustrations of being overlooked in mind, I would like to look at two aspects of Norris’ paper. The first is his discussion and considerations about working with complexity and the second is his commentary on treatment outcomes and the evidence base for child psychotherapy.
In his analysis, Norris highlights the problematic nature of applying the medical model to the treatment of mental ill-health. Not only does it offer an unhelpfully simplistic notion of the relationship between the cause/presenting problem and treatment, but what is pe