Friday, 1 May 2009

One More Session To Go

Today was my penultimate psychotherapy session. It was difficult; in fact, it was very difficult. I know that I am not ready for it to end, but end it must because that is the way of things on the NHS. There is never enough of what is needed.

As a former manager myself (though not in the NHS) I am well aware of the necessity of management of some kind, but I wonder how much more could be done for the patients' benefit if the multiple levels of management and the ridiculous amount of paperwork, results tables, protocols, and sundry other government and management requirements were to disappear overnight.

Mental health has always been a poor relation. It is not glamorous, nor is it seen as being of significant importance to this country. Yet the fact is that approximately 25% of the population will suffer with mental health problems at some time in their life, and a significant proportion of the population is unable to work because of mental health problems means that is should be seen as important. It is likely that the proportions will rise over the next couple of years because of the global financial crisis which has resulted in so many losing their jobs and the uncertainty that so many others feel.

As with everything else, this government has promised to do something about mental health provisions and yet their solution is far in the future and a least cost option. There is much evidence to show that psychotherapy can do much to make a change to the lives of those with mental health problems, particularly depression. But it is necessary to ensure that the right sort of therapy is provided for those that need it; and it needs to be available from the start, not when the situation has become so bad that the sufferer cannot work and their life has fallen apart. The government plans for there to be 10,000 therapists offering CBT in the next few years, but the Layard Report which brought about this decision by the government actually said that 30,000 were needed and that was before the financial crisis which is likely to increase the number of those needing help.

And CBT is not the global panacea that many seem to think it is. I am sure that it does help some people, but what is not widely reported is the number of people who are made well for a few months but then regress and have to rejoin the waiting lists for treatment of some kind. There is no point in offering a treatment that encourages people to change their thinking about the here and now if it is the long-distant past that is the root cause of their problems.

I know that I have been lucky. I have been receiving psychodynamic psychotherapy for a year now and it has made a significant difference to me. I have started to regain some of my self-confidence, and my weekly appointments have meant that there has been a little bit of routine in my life which has helped me get some structure in my life. But I know that there is still much work to be done to deal with the problems that led to me becoming ill. I need to understand how things that happened to me long ago and of which I had no conscious knowledge can be put behind me and I need to be helped to move on with my life. However, that is not going to happen because next week I will be saying goodbye to my therapist and I will be left on my own. I am being abandoned. Not because I am 'cured' but because the resources are not there to help those who need help.

1 comment:

cbtish said...

Treatment that merely encourages people to change their thinking about the here and now is not CBT. Real CBT addresses root causes directly and efficiently. That was the whole point of A.T. Beck's discoveries that led to CBT being invented.

It is very sad that much of the "CBT" being provided by the NHS is phoney. I agree with you that its effects, if any, are often temporary.

On the other hand, psychodynamic therapy is generally far too slow (and therefore costly) to cope with the volume of demand. And there are incompetent psychodynamic therapists too, who can treat patients for years and years without any benefit at all.

Having experienced psychodynamic therapy, you possibly see your problems as much more complex than they really are. You might find that when you finally leave therapy you gradually find a new equilibrium.

If not, don't dismiss CBT. When done properly it can certainly help to put right things that went wrong long ago.