Finding new clinical pathways in the changing world of district child psychotherapy

This paper discusses the changing working environment of child psychotherap ists in the public sector in the UK whose responsibility is to play a part in providing a general service to a focal community. It suggests they opera te with a kind of dual citizenship, owing allegiance both to the psychoanal ytic community and to the public sector. Transitions between one and the ot her are demanding, requiring careful thought and management. This has becom e more demanding because of changes occuring within the public sector as a whole and within multi-disciplinary multi-approach child and adolescent men tal health teams. The nature of these changes is outlined. It is suggested that their cumulative effect is radical and irreversible and that, if distr ict child psychotherapy is to be sustained, it will need to adapt to them i n ways that are understood by and are acceptable to both the psychoanalytic and the public-sector communities. Hard thinking will be needed to carry f orward into the next fifty years the achievements of district child psychot herapy in the UK in its first fifty years.