Doctorate Psychotherapy - Additional Information

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Further Information about the structure of the Doctorate

Taught Courses

The syllabus for the teaching programme, according to year group, is described in detail below. Reading lists and detailed structure of specific seminar courses are provided before the relevant term.

1st CLINICAL YEAR

Advanced Psychoanalytic Theory (45 hours 30 seminars 1.5 hrs)

Aims

This component aims to offer you an overview of psychoanalytic thinking through the critical comparative survey of the historical evolution of psychoanalytic frameworks of thought starting with Freud and the application of these concepts to disorders of childhood and adolescents.

Objectives

In chronological order, central topics covered will be narcissism and the self, object relations, transference-counter transference, therapeutic alliance, defence and resistance and psychic structure. This course is co-ordinated by one teacher with some of the modules taught by guest lecturers.

Child Development and Disturbance (45 hours 30 seminars 1.5 hrs)

Aims

This component offers an in depth review of classical and contemporary psychoanalytic descriptions and understanding of development from infancy to adolescence. This will give you the means to further your psychodynamic understanding of the main disturbances as well as normal development in chronological sequence.

Objectives

Topics will include: psychosexual aspects of development, separation and individuation in early childhood, latency and adolescence, emotional disorders, personality disorders, pervasive developmental disorders and developmental disturbance. The range of specific age related symptomatology will be covered. Topics include: sleeping and feeding difficulties in early childhood, enuresis, encopresis, learning difficulties, adoption, abuse, school phobia, adolescent suicide, drug taking, anorexia and breakdown. Reading is based on both key theoretical papers and classical and contemporary clinical papers. Throughout, reading is related to treatment issues.

Introduction to the Technique of Child Psychotherapy. (67.5 hrs 45 seminars 1.5hrs)

This group of seminars is divided into 2 parts.

Part A

(45 hours 30 seminars 1.5 hrs)

Aims

These seminars will prepare you for starting treatment cases focusing on key technical issues.

Objectives

Topics on technique covered are: the framework of treatment including setting, attendance etc, the therapeutic relationship including the treatment alliance, resistance, fantasies and transference and counter-transference., use of the therapist as a developmental object, modes of expression including play and interpretation and intervention.

Part B

15 fortnightly seminars. 5 per term in modules.

Aims

These modules aim to familiarise you with the various procedures in undertaking diagnostic work and to enable you to make psychoanalytically based diagnostic formulations.

Objectives

You will learn about referrals and social history taking . 4 seminars, on taking a psychosocial history, 1 on psychological testing,5 seminars on diagnostic interviewing of children. 5 seminars on The Diagnostic Profile.

Observational Methods in Clinical Work. (22 hrs 15 seminars 1.5hrs)

Aims

This course concerns observational methodology in clinical work. The course will help you to integrate these experiences in a theoretical context as well as refining your techniques of observation.

Objectives

You will spend one hour per fortnight during term time observing interpersonal interactions between a mother and infant and other family members in the family setting. Following on from the weekly observational visits made to this family in the pre-clinical course you will be able to discuss your observations and hear those of other trainees.

Research Methodology (Fortnightly 1 hour seminars)

Aims

To broaden your knowledge base about current psychoanalytical and developmental psychology research.

Objectives

To explore relevant research methodology issues within the context of current research and to revise and refresh trainees statistical knowledge and computing skills including common statistical procedures and use of the SPSS package. The seminar leader will also be available for individual consultation.

2ND AND 3RD CLINICAL YEAR

Core Programme: Clinical Technique in Treating Childhood Disturbance

(45 hours per year over two years).

Aims

This component will focus on the psychodynamic understanding and treatment of common disturbances of childhood and adolescence.

Objectives

All common disorders relevant to child and adolescent psychotherapy will be covered. You will bring case material for discussion. elaboration and further understanding of topics covered in the first clinical year (see above) in the light of current treatment cases. In addition, special topics related to technical problems will be covered such as brief non-intensive interventions and termination.

Research Methodology (1 hour fortnightly seminars)

Aims

To enable you to apply your knowledge base about current psychoanalytical and developmental psychology research in the light of your developing proposals for your projects.

Objectives

The specific course content for years 2 and 3 will be determined on your research projects.

Modular Theoretical Programme

(20 courses. Each module usually consists of 5 seminars of 1.5 hrs. Modules marked with an asterisk are four seminars.) There will be 20 specialist courses offered of which students have to do at least 8 per year. The 20 modules are to be offered in 2 blocks of seminars every alternate year. An extra module (21) will be run according to trainees needs and specialist intererests.

Overall Aims

The specialist courses are designed to further and deepen trainees understanding of psychoanalytic knowledge as applied to specific disorders. An integrally related aim is to promote the development of clinical sensitivity with reference (where applicable) to the particular therapeutic contexts in which future professional work will be carried out.

Objectives

The above aims will be met through small group teaching led by staff who are experienced clinicians and recognised experts in the particular field. You will be expected to actively participate by drawing on your relevant clinical and observational experiences.

BLOCK A

Severe Personality Disorder

Aims

You will cover the spectrum of severe disturbances using a psychoanalytic framework and where appropriate integrating this with relevant current research findings. Focus on the clinical presentation of the severe disorders will be enable you to diagnose the different disorders and to consider the appropriate clinical techniques for this group of children.

Objectives

Critical evaluation of the ways in which severe personality organisation has been conceptualised in the relevant literature. Differentiating the disorders. These issues will illustrated through clinical case studies

i.) Borderline and Atypical Children

ii.) Pervasive Developmental Disorders including Autistic and Psychotic conditions.

Adult Psychopathology

Aims

This course introduces you to the spectrum of disorders in adults. A nosological view is integrated with the aim of enabling you to apply this knowledge when working with families where a disorder is present in a parent and to reflect on the impact on the development of the child.

Objectives

The specific objectives of each module are listed below.

Modules

iii.)Psychosis and Neurosis in Adulthood.

Diagnosing psychotic states of mind. Range and severity of psychotic illness. Psychotic processes from a psychodynamic point of view. Differentiation of psychosis and neurosis. Neurotic syndromes. Biopsychosocial aetiology of psychiatric disorder.

iv.) Personality Disorders of Adulthood including Narcissistic and Borderline Personality Disorders

Clinical presentation of narcissistic and borderline personality disorders. Awareness of therapeutic treatment issues when working with such parents.

v.) Sexual Deviations in Childhood and Adulthood

The prevalent developmental, familial and emotional influences in sexual deviation. Clinical presentation in children and adults. Manifestation in the transference and counter transference. Technical treatment issues.

vi.) Disorders of Conduct and Delinquency

Aims

You will be able to understand the disorder from a psychodynamic point of view with a view to increasing your awareness and sensitivity to the types of psychological and emotional functioning encountered in this population and the implications for treatment.

Objectives

Case material is used.

vii.) Child Psychiatric Nosology - US, European and Psychodynamic Diagnostic Systems

Aims

This seminar is to familiarise you with the ways in which different nosological systems conceptualise disorders. The aim is to encourage flexibility of understanding with a view to enabling you to work with other professionals in NHS multi disciplinary teams and to develop awareness of current, commonly employed formulations.

viii.) Physical Illness with Psychological Origins and Psychological Aspects of Disease

Aims

To critically explore and examine the concept of ‘psychosomatic. You will consider developmental issues in relation to physical illness as well as the psychological impact of illness.

Objectives

Issues encountered in working in hospital and out patient settings. Clinical material is used as illustrations of the impact of illness on development.

ix.) Thinking, Dreaming and Symbolisation

Aims

This seminar will further your understanding of the unconscious psychodynamic processes underlying and manifested in thinking, dreaming and symbolisation.

BLOCK B

x.) Children and the Law

Aims

This seminar is aimed at increasing your knowledge and understanding of the legal framework within which you will be called upon to apply and communicate your understanding of children’s emotional development.

Objectives

Topics will include The Children's Act, Fostering and Adoption and writing Court Reports. Consideration will be given to the Child Psychotherapist’s role in a multi disciplinary team assessment of a case.

xi.) Diagnosis and Treatment of Maltreatment and Abuse

Aims

To focus on the main issues when diagnosing and working with abused children.

Objectives

Consideration of the developmental impact of physical and sexual abuse on the child's emotional functioning. The effects on the different professionals working with a case involving child abuse. Diagnostic signs indicating the possibility of abuse. Technical issues in diagnosing and treating abuse.

xii.) Working with Families

Aims

The aim of this seminar is to enable to familiarise yourself with systemic thinking as applied in therapeutic work involving the family.

Objectives

To include video material and/or a visit to a family therapy centre such as The Marlborough Family Centre.

xiii). Advanced Freud Studies

Aims

Re-visiting Freud. This course is based on key theoretical papers by Freud in chronological sequence outlining the development of his theories.

Objectives

The seminar covers Freud’s main models of the mind from early instinct theory and the topographical model through to later structural theory. Development of Freud’s thought on intrapsychic agencies, unconscious processes and conflicts.

xiv.) Consultancy in Child Psychotherapy (Liaison Work, Multidisciplinary Work and Formal Interactions with Public Agencies);

Aims

To focus on the specific professional role and contribution of the Child Psychotherapist in relation to Social Workers, Teachers and other allied professionals.

Objectives

Managing and working with cases as a team member. Consulting to professionals through offering expertise on the child’s development and functioning. Communicating a view on the child’s best interests and emotional needs. Writing reports for other professionals.

xv). Sexual Development in Girls (Female Sexuality)

Aims

A historic overview of the psychoanalytic formulations on female psychosexual development.

Objectives

This seminar will draw on key texts including contemporary writings and will evaluate the modifications to earlier theories

xvi.) Dyadic Therapy with Mothers and Infants

Aims

Long and short term clinical interventions with mothers and infants.

Objectives

Contemporary therapeutic practice (Parent Infant Project at the AFC) Modification and application of psychoanalytic thinking to dyadic therapy. Accompanying reading based on the work of current child developmentalists such as, D.Stern, C.Trevarthen and other specialist psychotherapeutic practitioners and researchers.

xvii.) Advanced Seminars on the Work of Klein and Post-Kleinian Psychoanalysts

Aims

Further building on key Kleinian concepts.

Objectives

Reading and discussion of key texts on projective identification and the Kleinian framework for understanding the transference and counter transference.

xviii.) Emotional Development and its Clinical Implications

Aims

Overview of psychoanalytic theory of emotional development.

Objectives

Key Freudian case histories and current case histories are evaluated and considered in the light of clinical technique.

xix.) Structure and Management of the NHS

Aims

Overview of the structure and management of the NHS.

Objectives

To familiarise trainees with the NHS context as a preparation for future

employment.

xx.) Training for Being a Supervisor

Aims

Preparation for the role of being a supervisor.

Objectives

Supervising trainees. Helping a trainee starting a treatment case. Holding trainees anxiety. Encouraging trainees to consider the transference and counter transference treatment issues in an appropriate way. Supervising trainees working in multi disciplinary settings re case management whilst remaining focused on the internal world of the child. Management of high risk cases. Working towards clinical independence. Supervising allied professionals.

xxi.) Writing Clinical Research Papers.

Aims

This module will help you in structuring clinical and research papers.

Objectives

You will consider writing for various academic and research purposes and publications. Use of clinical material and confidentiality issues.

xxii) Requested Topics

Topics requested by trainees.

A range of topics can be requested e.g. Bion, working with parents, advanced seminars on Kleinian or Contemporary Freudians etc.

Clinical Components

The programme requires three intensive psychotherapeutic treatments, a minimum of six non-intensive treatments and a minimum of two parent guidance cases. All psychotherapeutic treatments and parent work cases are supervised individually. Supervisors are chosen from the an approved list. Assessment of clinical competence will be based on reports from supervisors and feedback to the Training Committee.

Trainees are required to write two reports on their clinical work for presentation at a Scientific Meeting at the Centre. At least one of these should be on an intensive case.

Over the four years of the programme clinical attachments will also include

a) three social histories
b) three diagnostic assessments including comprehensive psychoanalytic formulations

c) three less detailed assessments

Trainees will have a comprehensive experience across age groups, genders and a variety of psychological problems. Trainees will gain experience in a range of psychodynamic methods of investigation and treatment paying particular attention to methods of clinical investigation which will advance understanding of psychological difficulties in a variety of common problem areas.

Clinical Research Requirements

Formal research will be a component of supervised clinical work both with children and with parents.

Original contributions to clinical understanding will be emphasised for the trainee in all clinical attachments. The trainees’ research work with specific clients and in specific settings will be separately assessed. The methods of research most commonly applied in this context will be participant observation in family and day care settings or process recording of individual interventions.

Over the course of the training trainees are expected to present two observation research reports based on:

a) family interactions specifically mother/infant interactions

b) Either the interaction of 2-3 year old children and their caregivers in a group setting or 3-5 year old children in a daycare setting. These papers should evidence originality as per the doctorate regulations either by the discovery of new facts and/or by the exercise of independent critical power.

Observation research reports will be presented at a Scientific Meeting at the Anna Freud Centre

On completion of all taught courses, clinical and observation research requirements, trainees will work on their major research project in the fourth year of the course. The major research project will represent investigative work, the results of which can be judged to contribute a substantial contribution to knowledge. The candidate should be able to demonstrate in what respect her or his work appears to advance knowledge or practice in child and adolescent psychotherapy. The overall length of this report will be a minimum of 25,000 words.

Doctorate in Child and Adolescent Psychoanalytic Psychotherapy Examinations

The examination of the Doctorate in Child and Adolescent Psychoanalytic Psychotherapy will be based on the thesis as outlined in the regulations. The conditions for entering the examination include satisfying the Board of Examiners in terms of a) theoretical knowledge b) clinical competence.

Assessment of theoretical knowledge will be based on extended essays submitted at appropriate times as part of assessed course work or unseen written examinations at the end of the year.

Examination of clinical competence will be made by supervisors in each clinical setting. These supervisors are appointed by the Training Committee of The Anna Freud Centre in accordance with the procedures laid down by the Association of Child Psychotherapists.

The Doctoral Thesis

The doctoral thesis will consist of a portfolio comprising:

a) A clinical section consisting of the detailed presentation of four pieces of clinical work At least one of the case reports should be on an intensive treatment. The others may be on non-intensive or parent work interventions. In reporting each of these interventions the candidate is required to give evidence of originality, normally through exercising independent critical power.

b) The second part of the thesis will normally include an observational component based on observations of family interactions or children in a group setting.

c) The major research component will normally include either the collection of new information or critical treatment of an important major concept relevant to the theory or practice of child and adolescent psychotherapy.

The presentation of all three components will be presented in a vive voce examination where candidates are obliged to demonstrate in what respect their work appears to advance knowledge or practice in child and adolescent psychotherapy. The thesis will be an integrated presentation of work undertaken during the programme and must demonstrate that the candidate has acquired skills in the original use of clinical knowledge as well as research methodology in exploratory, descriptive and confirmatory research. The research must include investigative work, the results of which can be judged to make a substantial contribution to knowledge. In order to be awarded a doctorate the candidate must satisfy examiners (internal and external) on their capacity to use psychoanalytic theory as applied to clinical work in an original way.