Fitness to practise what? The destruction of psychotherapy in 21 st Century Britain

1. Fitness to practise what?The destruction of psychotherapy in 21st Century Britain Phil Mollon PhD Psychoanalyst & Clinical Psychologist

2. Freud: Psychoanalysis is not a quasi-medical activity. • The question of lay analysis [1926] • The psychoanalyst as ‘secular pastoral worker’.

3. Are psychotherapists ‘health professionals’? • Do Lacanians provide health-care treatments for ICD10 diagnostic conditions? • Was Erich Fromm a ‘health care practitioner’?

4. Depth psychologyvs Surface Psychology • Exploration of the psychic depths. • Psychoanalysis is inherently subversive of the psychological, political, and cultural ‘establishment’.

5. The tyranny of the left hemisphere • The ordered and structured imposition of band-aids of rationality and positive thinking • Combined with ‘feel the fear and do it anyway’. • [Not true of sophisticated Beckian cognitive therapy and schema therapy].

6. Financial drivers • Thought and attitude can be shaped by economic forces. • It is possible to make money from NICE.

7. Harmful consequences of the medical model • Misleading applications in the court room • Are our clients suffering from ‘specific diseases’? • Medical model diagnostic thinking forecloses enquiry – homogenises the individual into a ‘disease’ for which a standardised ‘treatment’ is ‘prescribed’.

8. Anxiety and depression may be ‘treated’ with drugs – but this does not mean they are ‘diseases’ • A single woman living in a council flat, suffering persecution by drug dealing neighbours who play loud music through the night, combined with verbal abuse and threats of violence – harassment by drug users – mugging by ‘hoodies’. • This person suffers with anxiety and depression. Does she have a medical ‘disease’, for which NICE can indicate the appropriate pharmacological or psychological treatment?

9. Interpersonal Psychotherapy [IPT] • Originally designed as a plausible control condition for use in psychotherapy research • A manualisation of supportive psychotherapy • In the NIMH study of depression it was found to be helpful, along with CBT. • So NICE recommends either CBT or IPT !

10. Psychiatric diagnoses are not scientifically valid • Psychiatric diagnoses are not ‘specific diseases’ • Co-morbidity is very high • Essentially different expressions of stress and outcomes of psychodynamic conflict • Dr Colin Ross: ‘patients’ collectively have a good legal case for class action on grounds of malpractice against the psychiatry profession

11. The external authority of NICE • The psychotherapist’s stance of respectful and empathic enquiry is replaced by the external authority of NICE. • An ‘empirically validated protocol’ is prescribed for a specific diagnostic category [all ‘patients’ seen within the NHS must have one] • Creative adaptation to the individual is proscribed!

12. Medical model as ‘category error’ • A medical person will ‘diagnose’ and ‘treat’ specific ‘diseases’ and provide indications of ‘prognosis’, as well as prescribing medicines in their correct dosages. • A ‘secular pastoral worker’ does none of these.

13. Ethics at the heart of psychotherapy • Nothing is more important than the truthful and ethical stance at the heart of the psychotherapeutic encounter. • But this is not reducible to a tick box list of do’s and don’ts. • Integrity: the therapist’s behaviour is congruent with his/her values, knowledge, intuition, and emotion.