Response to the paper by Betty Joseph: ‘Thinking about a playroom’

In this classic paper, Betty Joseph talks about the setting in our work – how we hold the physical, as well as the human, aspects of it. The paper outlines the importance of freedom in the therapist’s mind – the freedom to think about what is going on in ourselves, as well as in the children we see. I will start with a few words about my professional context, before moving on to my personal experience of the paper. I have been in private practice as a child and adolescent psychotherapist in the Republic of Ireland for almost four years. This is a part of the world that is very different to the world I grew up in, in Bulgaria, and also different from London where I trained at the Tavistock. I struggled with finding my way in a new country, in a community where child and adolescent psychotherapy is not known and recognised in the same way as it is in UK. I missed the professional and personal networks I had established. However, over time, I began to see that the existing gaps in the system (in particular, regarding work with younger children), the overload of the public health services, and the lack of enough private professionals prepared to see complex cases, all meant that what I had to offer as a child and adolescent psychotherapist was valued and in demand. I work primarily in ‘The Natural Clinic’ in Cork (Figure 1). I also have a space one day per week in a small clinic in Clonakilty (West Cork) called ‘Clonakilty Natural Therapies’ (Figure 2). Both clinics strive to provide a holistic and non-intrusive approach to human health, offering a space for a wide range of non-medical therapists to practice (including psychotherapists and psychologists, physiotherapists, acupuncture therapists, etc). In this cultural context, psychotherapy does not have a very long tradition or an established position in its own right. It is mostly recognised in the community as a ‘member’ of the natural therapies’ family. In both clinics I am the only practitioner for the moment who sees younger children. I am very grateful to have my colleagues’ tolerance and support of my work. The difference between working in a city context (Cork City) and a small town in the countryside (Clonakilty) continues to interest and challenge me. In the city there is diversity of patient groups in terms of different social and cultural backgrounds, and an ever dynamic and increasing interest in psychotherapy. In the countryside setting I have the unique chance to hear the stories of patients and families I would have never come close to before. However, there is also a much stronger sense of fragility in the small town setting related to a stigma about ‘being seen’.