Wednesday, October 25, 2017

Psychotherapy and critical psychiatry need to cooperate

I've posted verbatim a copy of the talk I gave recently to the Council for Psychoanalysis and Jungian Analysis, a college of the UK Council for Psychotherapy (see powerpoint slides). Part of the aim of the talk was to challenge the rhetoric about Improving Access to Psychological Therapies (IAPT), particularly from its two main protagonists, David Clark and Richard Layard (as I have done in previous posts, eg. Wider measures of IAPT outcomes needed). Saying that IAPT is a 'marvellous treatment' has to stop. Unrealistic claims about the effectiveness of psychotherapy are a 'perversion of care', to use Rosemary Rizq phrase (see previous post).

Critical psychiatry and psychotherapy need to work together to change the dominant technological paradigm in modern mental health services (see previous post). This technological paradigm includes psychological therapy if it is applied in a mechanistic way. As in the position statement from the Division of Clinical Psychology of the British Psychological Society, we need to give up the disease model of mental disorder (see another previous post).

3 comments:

cobweb said...

Duncan - thank you for posting your very honest talk - it would be interesting to know what response you received? Was there any acknowledgement that there is problem? I would like to add that there are some who are actually promoting the theory of psychodynamic psychotherapy but admitting that all the while are not practicing what they preach - whether it is referred to as eclectic or simply that they use any combination of what works or that they rely on the good fit between therapist and client - in fact there is no choice in the NHS. Recipients of therapy have been recruited to bolster certain theories,it has not been equitable or of good quality. You touch on the funding issue - it is not entirely cynical t see how pseudo science has been employed to back psychotherapy to the extent of creating another diagnostic manual which apes the offensive psychiatric diagnostic manual. there is a massive problem whereby clients own authentic accounts are not published independently - reported accounts by therapists have no validity or verification especially when relying on 'vignettes' which are a mish mash of fiction as imagined by the therapist and parts taken from real experiences of peoples' lives. Any 'narrative' can be concocted to suit the aims of the practitioner and the theory being promoted. Psychoanalysists have played a political game in order to survive but one that has taken the practice further and further away from the relationship being paramount..the funding is in setting up projects mainly to oversee and influence the lives of others in a way which disempowers when it is the structure of society which creates their problems and it is there the funding is needed. As you say true psychodynamic therapy is practiced mainly in the private sphere- with people from the same social group. How ethical is it for public funds to be used for training in the NHS using NHS users to 'prctice' on until qualified when most then go into private practice? It is surprising by the way that you make no mention of the work that has been done, with massive amounts of funding by Peter Fonagay and the team at UCL - they have projects at Tavistock and Anna Freud Centre. have usefulcontacts with politicians which disadvantage other projects which are more innovative and not based on biopsychiatry or set up to benefit practioners and theorists more than people who want the sort of help they themselves find useful.

Anuj Agarwal said...

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cobweb said...

Duncan deserves the praise - he is one of the few psychologists/psychiatrists who run open access blogging for debate - maybe more could be encouraged to contribute? Did the Rxisk blog or the David Healy blog make it on your list? This is a campaign being run to highlight adverse effects of psychiatric dlong term rugs, especially SSRI's ; to try to find a cure for what are so far irreversible effects and with the added intention of the findings of this research making psychiatric drugs safer; also prioritising the rights of people to give properly informed consent if they choose to use them and importantly to have their feedback about experiences of adverse effects recorded Best wishes to you and your team.