Pegasus Child and Adolescent Psychotherapy:
the Story of our Development
I was delighted to be asked by Helen Edwards for an article in the Oxford Psychotherapy Bulletin about Pegasus. She suggested writing on the theme of transitions in our growing and changing organisation. Pegasus has been in a continuous period of growth and transition. We agreed I would write a narrative of what it was in my experience that led us to begin meeting, what it has been like to develop a service, the challenges and rewards of undertaking PCT funded work, and ways in which we need to extend ourselves.
So I’ll begin with a bit of autobiography. Having worked in the Croydon Mental Health Service with inpatients and outpatients and knowing I wished to do an analytic training, I studied social work at the London School of Economics where the Mental Health Course had just changed to the Diploma in Social Work Studies. It remained heavily influenced towards mental health and I was fortunate in having two psychiatric placements and a tutor (Irma Elkan) from the Anna Freud Centre. My placement at the Child Guidance Training Centre (at the Tavistock Centre) whetted my appetite for analytic work with children. The team was led by John Bolland who had been Medical Director of the Anna Freud Centre.
I was then appointed as a psychiatric social worker at the Kingsbury Child Guidance Centre. Our director was a child psychoanalyst and there was a rich team of child psychotherapists from the different training schools. The clinic was run by the Education Department of Brent and there was very open access to children and their families from the local area. While there I completed my analytic training in work with adults and started training in child analysis.
On the basis of these experiences I assumed similar services would be available in most areas. When I came to Oxford over 30 years ago, I learned about the national centre of excellence at the Park Hospital with inpatient facilities especially for organic disorders but it didn’t offer child psychotherapy. In terms of local services, I was welcomed by Mercy Heatley who ran a service out of Northern House. I found the imbalance in use of resources troubling.
As NHS funding became available for training child psychotherapists, an anomaly arose whereby increasing numbers of child psychotherapists were trained but those qualifying were not matched by posts. As the CAMHS service developed in the context of restricted resources, children being seen had to meet certain thresholds of disturbance. Not only were there few child psychotherapists in the service, but children with the kinds of problems we had seen at the Child Guidance Training Centre and at Kingsbury often did not meet these thresholds.
It became apparent that there were numerous children in need of psychotherapy and numerous child psychotherapists who were able to offer therapy but without established posts.
The seeds of Pegasus were sown early in 2000. A number of child psychotherapists had met to consider the lack of posts and as convenor of the British Psychoanalytic Council (BPC) for this region, I wrote on their behalf to Julie Waldron, Chief Executive of the Oxfordshire Mental Health Trust, to raise our concerns and letting her know a group was meeting to consider how child psychotherapy could be made available. She asked Mike Hobbs to call a meeting which he did and a number of us attended. Things have moved on and circumstances have changed and the service for children is now very different from what it as over a decade ago.
Having had an exploratory meeting with the Trust, the seeds for developing a service for children outside the Trust lay dormant. Partly this was because the energies of the regional BPC group including my own went into cooperating with the Isis Centre Action Group in sustained efforts to keep the Isis Centre open. The campaign required a huge degree of commitment over two attempts to close it. The importance of keeping open such a unique NHS provision for adults took first call on energies.
In terms of work with children, the seeds sown earlier began to come to life about 5 years ago when child psychotherapists began to meet regularly and gradually Pegasus came into being. We soon established links with PCAMHS with a view to seeing children whom they considered unsuitable for their six session model or children who needed further help after their six sessions. By and large they needed to be from families who could afford private fees.
Soon we were asked to take on several children who had suffered sexual abuse and these would be funded by the PCT. We established a 12 month contract with weekly therapy for the children and monthly consultations for parents with another child psychotherapist. We have also taken on children from Northamptonshire Social Services and from Southend Borough Council for children placed in Berkshire. These latter two are placed in separate children’s homes. The court had ordered intensive three-times-weekly sessions following recommendations from Inspiring Childhood that they should be seen intensively by ACP registered therapists. We have a very constructive relationship with the relevant PCT who follow their progress with interest having agreed a minimum of eighteen months intensive therapy.
It will be apparent that in our five year history we have achieved some but by no means all of our objectives. We do provide a service to children and their families from the private sector and from time to time we have been able to see children with public funding. However it is patently obvious that we have only scratched the surface of helping to bring about increased understanding that many behavioural problems, educational difficulties, psychosomatic illnesses, emotional and relationship problems may be the result of unrecognised underlying anxiety. Referrals to Pegasus often come because a member of the family knows of the benefits of psychotherapy rather than from other professionals. There is much work to be done and this brings me to Pegasus’ educational objective.
We co-sponsored a study day with Margot Waddell and have organised talks on abuse with Meira Likierman, internet pornography with John Woods, and exploration of the child’s inner world through the film “Spirit of the Beehive” presented by Andrea Sabbadini.
It has been an immensely satisfying undertaking. One of the most satisfying aspects has been working with such a strong and supportive group. They are highly motivated and have proved an energetic, committed and effective team. It is interesting that several members of the group work in the public sector and do not themselves see children privately; in my view their participation is one of our strengths. We meet quarterly on a Saturday morning for business followed by a clinical discussion with our consultant in the afternoon. Up to now we have consulted a child psychiatrist on an “as needed” basis and we are currently exploring forming a more ongoing relationship. We are also discussing broadening our experience of doing court reports. As we have seen from the experience of Inspiring Childhood, this may be a way of obtaining funding for therapy where resources are otherwise limited.
To learn more about Inspiring Childhood visit www.inspiringchildhood.com
From An Article for OPS Bulletin about Pegasus Child and Adolescent Psychotherapy
by Lawrence Brown, October, 2011