NEWS , ANALYSIS , OPINION FOR THE PSYCHOANALYTIC COMMUNITY ISSUE 4 AUTUMN 2010 Should Psychoanalytic ‘In Treatment’: The HPC on psychoanalysis Psychotherapy writing fitness to be in the NOW 2010 from life practise 2 Science Museum? 4 7 8 NHS, impacting on every corner of relationships with local commissioners. mental health care. The highly respected Individual practitioners will increasingly Kings Fund, which generally supports need to group themselves into larger Gearing the need for reform, has warned that the practices to compete effectively in the scale and speed of the current reforms is market place; the BPC will be looking at likely to distract attention from the need ways we can help build expertise across to maintain quality and avoid cutting the sector in various forms of social up to meet services. enterprise. How can our profession respond to these Finally, the scale of these challenges huge changes? How do we help make highlights more dramatically than ever challenges it possible for psychological therapy the incapacitating fragmentation of the services to be organised along the lines psychoanalytic and psychodynamic recommended by the We Need to Talk community. Many of our organisations coalition? And how can we help ensure have begun to sense just how weak they ahead that large numbers of high-calibre are by operating in this isolated manner. psychoanalytic and psychodynamic The need to move from this broad By Malcolm Allen anyone concerned about the shape of such practitioners are not lost to the system in perception to a position of purposeful services in the future. The report reveals the years ahead? strategic action is of course another that only eight percent of those surveyed matter. Our ability to bring our various S THE GOVERNMENT had a full choice in the therapy they The key to all this is partnership. The organisations together into a disciplined announces, in its received, but that people offered a full BPC has been working hard to help build and determined force for change is one of Spending Review, an choice of therapy were five times more alliances in support of the progressive the biggest challenges we now face. expansion of access to likely to be helped back to work than platform set out in the We Need to Talk psychologicalA therapies, a hard-hitting those who weren’t. Also, people who had a document, especially around patient report from mental health charity Mind choice of therapies were three times more choice. The coalition that produced the We must sail sometimes with the wind and highlights the key challenges that such likely to be happy with their treatment document is an excellent example of this sometimes against it – but sail we must and services now face. than those who wanted a choice but did in practice, and there are signs that the not drift, nor lie at anchor not get it. Government is listening. In a related Oliver Wendell Holmes First, the Spending Review. Compared initiative, the chief executives of BPC, to other departmental budgets, the NHS These results also sit interestingly with UKCP and BACP have written a joint settlement is as good as it could be with the National IAPT Data Review of the letter arguing that the next phase of Malcolm Allen is CEO of the BPC an increase of 0.1% a year ‘in real terms’. first IAPT roll-out sites by North East IAPT roll-out must not simply replicate However, the ‘real’ figures are based on Public Health Observatory. The review the CBT-dominated estimates of general inflation – the GDF found, for example, that the median first phase. It is now an deflator, and the NHS inflation rate has number of sessions for low-intensity urgent priority for the historically been higher than this. This interventions was just two and for high- professional bodies to relatively slender increase (the NHS intensity interventions it was only three. sink their differences has been getting average increases of This compares with NICE guidance that on a range of issues to nearly 7% a year from 2000) will soon be recommends at least six sessions for most focus on building a co- swallowed up by things like pay increases, low intensity interventions and up to ordinated campaign the increase in VAT, and meeting the twenty sessions for some high-intensity to defend and improve costs of the structural re-organisation interventions. counselling and announced in the White Paper Equity psychotherapy services and Excellence: Liberating the NHS The Mind report also makes clear that throughout the UK. (on one estimate between £2–3 billion). IAPT services have been more successful Together with increasing demands from where they have been well integrated Coalitions at a a rising and ageing population, the NHS with other broader psychological national level will now faces an unprecedented level of therapy provision. However, in spite of be meaningless challenge. DH guidance to the contrary, Mind’s without building research has shown that IAPT money corresponding This is the context in which the has sometimes been used to replace other alliances at a local Government announced an expansion of psychological therapy services. The report and regional level access to psychological therapies. At the states that ‘this simply replaces, not – where the real time of writing, the amount of additional improves, the provision of psychological decisions on funding funding had not been confirmed – the therapies.’ This also means that many and commissioning original DH bid was for around £140 existing therapists and counsellors will be made. This is million. But it is without question a (especially those based within GP a difficult challenge remarkable achievement, owed in part to surgeries) are losing their jobs, impacting for all of us, but again the determined lobbying of Lord Layard, adversely on the knowledge base and the professional bodies but also to the campaign of the We Need relationship networks of these services. may be able to take a To Talk coalition (of which BPC is a lead in facilitating and member). Delivering all types of psychological supporting this sort of therapies services, including IAPT, will local activity. The coalition has recently published We now be taking place within the context need to talk: getting the right therapy of the move towards GP commissioning Psychodynamic at the right time, drawing on a report together with the implementation of the practitioners in from Mind. Mind’s report is based on £20bn quality, improvement, productivity particular will need to a survey of 527 users of IAPT services and prevention (QIPP) programme. It get smarter and more and its conclusions are far-reaching for will be a tumultuous time for the whole organised in building 2 NEW ASSOCIATIONS ISSUE 4 AUTUMN 2 0 1 0 NEW ASSOCIATIONS ISSUE 4 AUTUMN 2 0 1 0 Opinion Should psychoanalysis be in the Science Museum? An article in a recent issue of New Scientist, by philosopher Mario Bunge (opposite page), questioned the appropriateness of the Science Museum giving space to psychoanalysis. Mary Target and an impressive roll-call of international colleagues responded in the 30 October edition; this is the for the effectiveness of psychoanalytically- scientific journals (e.g. The Journal of the longer, more comprehensive version of their letter. based treatments. Recent literature American Medical Association, Science, reviews and meta-analyses of scientific The Archives of General Psychiatry, studies of psychotherapy outcome The American Journal of Psychiatry, Dear Editor, scientific journals, and that clinical (for example the series of papers by American Psychologist). We run twice- Re: ‘Should Psychoanalysis be in the trials have not attempted to examine Leichsenring and colleagues) have found yearly, free research summer schools to Science Museum?’, New Scientist 2.10.2010, the effectiveness of psychoanalytic that effect sizes – a quantitative measure offer consultation, training and ongoing pp 22-23 psychotherapy, or that we are ‘foreign of treatment benefit – for psychoanalytic mentoring to psychoanalysts and others to the scientific community’. A cursory psychotherapy in randomized controlled wishing to engage in research of the e were very literature search would have provided trials are comparable to those for other kind Professor Bunge has been missing. disappointed by citations and abstracts of hundreds of therapies that are promoted as evidence Many early participants are now well- Professor Bunge’s psychoanalytic research articles published based. The majority of trials have offered established psychoanalytic researchers. intemperate and in mainstream scientific journals. strong evidence of the effectiveness Although we would love to do more, this Wunscientific contribution to the debate on Masling’s series on ‘Empirical Studies of psychoanalytic therapies, others level of scientific contribution compares the scientific status of psychoanalysis. of Psychoanalytic Theories’ alone spans have found stronger evidence for other very well with that in other clinical This is an important issue which 10 volumes and includes 389 pages of therapies for specific conditions; the professions. sometimes receives far more sophisticated references. point is that psychoanalytic therapy has consideration. We would have welcomed a for a considerable period been tested in We believe readers of this New Scientist well-informed critique from a philosopher We readily accept that some specific the same stringent way as have other debate will be reassured to know of science of the stature of Professor developmental or psychopathological approaches. that psychoanalytic researchers are Bunge, and regret that he did not take this propositions put forward by Freud would undertaking productive, cutting edge opportunity to address the issues seriously. not fare well in empirical testing, and that studies guided by psychoanalytic some details of his theories are probably ‘Psychoanalysts ideas, at world-leading universities, Far from being a discipline that incorrect or outdated. This is true of most have been testing and helping younger colleagues to do has ‘remained basically stagnant’, bodies of knowledge evolving over 120 so.