Wednesday, 29 June 2011

NICE and psychotherapy ... part 2

Okay, back to the "NICE Under Scrutiny" document from UKCP....

The report from Roehampton also looks in some depth at NICE's use of research. In these days of "Evidence-based Practice", the so-called Gold Standard for research is the Randomized Controlled Trial, or RCT.
Now, there has been so much intelligent and scholarly analysis of RCTs, and their drawbacks when applied to psychotherapy, that the debate is now well and truly 'out there'. The fact that NICE continues to hold up RCTs as sacred - the 'only' research that can really be considered 'evidence' is frankly a bit crazy. In TA terms, we might think of this as a contamination. (This suggestion was made some time ago in the TA community - if I can find a reference, I will post it!)

Contamination though it may be, this is a vivid demonstration of how NICE is still steeped in the medical model and the machinery that goes with it. Politically, NICE is colluding with the over-sanctification of medicine and adding to the mystification (see my previous post around Radical Psychiatry). In basic terms, NICE is holding a hammer in its hand and looking at everything like it's a nail. (Hat-tip to Abraham Maslow).

NICE is practically and psychologically bound up with the economics and politics of the day, and unfortunately this translates into an unhealthy attachment to politically useful forms of 'evidence'.

Qualitative research, for instance, is much harder to sell to voters, and even harder to use if one wants to inform policy. But it is still a hugely valid and rich form of research in psychotherapy.


Thursday, 23 June 2011

Group Process, and the writing process

Thinking today about group dynamics - the structure and process of groups. I'm particularly interested in this in terms of healthcare services (the "multidisciplinary team".
The 2 or 3 journal articles has now become a small pile, and I can feel, perhaps, an article brewing.....

Although I enjoy writing, it's a bit of a painful process at times, and rather time-consuming. I tend to collect bits of stuff like a jackdaw and then start typing (surrounded by the stuff I've accumulated) until I'm finished. I haven't yet found a way of doing it little-by-little, which would probably be more practical (and less stressful).


Tuesday, 21 June 2011

NICE and psychotherapy ... part 1

This is the first of a few posts dedicated the the UKCP's document "Nice Under Scrutiny", published a few days ago. UKCP have commissioned an authoritative academic report into NICE's foray into the world of psychotherapy, and the resulting roll-out of CBT via the IAPT programme.

NICE is an organization steeped in the biomedical model, where a linear pathway is assumed to be the norm - diagnosis, treatment, cure. Symptoms, or pathology, is the major focus of attention; the patient is simply the carrier or presenting 'face' of the pathology that is to be treated.

The debate about the dangers of the biomedical view in mental health is not new... not by a long way. Back in the sixties, the Radical Psychiatry movement was making noises about the oppressive, alienating effects of psychiatric diagnosis. The 'manifesto' of the Radical Psychiatry movement, which was produced in 1969, still feels relevant today, and is worth a read.....

Today, as in 1969, the medical establishment (including NICE) are trying to shoehorn the emotional lives of real people into diagnostic boxes. They have picked on depression as seemingly the most prevalent 'condition', and of course Lord Layard has picked on it due to its perceived economic effects. But the obvious truth is that human emotionality cannot be distilled down into such narrow (and some might say arbitrary) criteria. As Irvin Yalom said, the medical model is a "wafer-thin barrier against uncertainty".

This is to say nothing of the interpersonal effects of diagnostic labelling, and the dehumanizing effect of psychiatric treatments upon patients.... see R.D. Laing, for a start! The bottom line is, you can't treat people's distress by trying to use a standardized approach.

I recently heard a tale of IAPT which sent shivers down my spine. A person had been referred to the IAPT service by their GP, due to multiple trauma including a recent bereavement. They were telephoned by an IAPT worker, who tried unsuccessfully to 'treat' her with the manualized CBT-style spiel. The person later told her (face-to-face, psychodynamic) counsellor that they needed to talk about their sadness and loss, not be told to 'make a list of negative thoughts you need to change, and have it ready next time I call you'. What kind of therapy is this?

The use of a treatment protocol is fine, in cases of actual organic illness. But treating, say, a strepto-throat-infection is so very different from treating sadness, fear, loss, anguish, or any other kind of mental or psychic pain. The 'pathology' can't be isolated, so the medical model falls over.

The determination of NICE to push ahead in this way, and the onward rumbling of IAPT, seems to represent an unwillingness to accept that psychotherapy is different.


Sunday, 19 June 2011

Goodbye to Brian Haw

A brief pause to pay tribute to Brian Haw, veteran anti-war protester who famously camped out in Parliament Square and conducted a 24/7 protest for almost a decade.

Why devote a post to Mr Haw, on a blog about 'therapy thinking'?

In the words of Radical Psychiatry, oppression of people and the mystification of it results in alienation.

Brian Haw's UK was a country where people were alienated from their government. A country alienated from other countries. Why? Because of the decisions to go to war, and oppress nations abroad; decisions shrouded in mystification that generations to come won't understand.

I reckon history will judge Brian Haw to be a hero of peace and free speech. I also consider him a wonderful example of "Speaking Truth To Power".


Thursday, 16 June 2011

NICE, CBT and IAPT finally get a critical review

UKCP (The United Kingdom Council for Psychotherapy) are publishing an academic report that they commissioned some time ago.

I'll be blogging some more about the findings of the report over the next couple of weeks, and exploring some of the important points that are made.

Having given the report a once-over, I am really encouraged that a highly-respected academic team have brought their weight to the issues. Finally, we can begin to debunk some of the mystification, economics and politics behind the NICE/IAPT/CBT set-up.


Tuesday, 14 June 2011

Men's Health Week: 13-19 June 2011

I'm all in favour of "Men's Health Week"...

In the psychosexual field, I am always working with men who want or need to talk about their bodies. Commonly, it's getting past the initial hurdles of embarrassment and shame that prove difficult. After that, most guys find a sense of relief and support in being able to open up and talk.

I admit, because of the work I do, I tend to be quite pushy with men I meet, young and old. If they're young, I will usually find an opportunity to talk about examining one's testicles. If they're not-so-young, I will ask about their prostate and encourage them to visit their GP for a "well man" check.

So, my good wishes to Men's Health Week. And let the "meat and two veg" jokes begin. (One way around the embarrassment is humour.....)


Tuesday, 7 June 2011

Joe Glenton and "The Choice" (Radio 4)

I listened with interest today to Joe Glenton being interviewed by Michael Buerk.

Former Lance Corporal Joe was an objector to the war in Afghanistan. He also suffered from PTSD symptoms following his deployment, which were inadequately addressed by the military. As a result, he took the decision to go AWOL, and returned to the UK later to face court-martial and a spell in military prison.

Joe explains that his main driver was his ethical objection to the war. It's also plain that the army's response to his PTSD was derisory. This brings to mind the classic military approach - as on the battlefield, they patch 'em up and send 'em out again. Only with psychological wounds, the treatment is much more difficult (emotional) so it's best avoided (or at best, medicated away). But the theory is the same. We don't want emotionally needy (literate) people in the ranks; we don't want politically aware (thinking) people, either. The job is to go and follow orders, and maybe get shot at. So people like Joe find an unwelcoming home in the military.

Classically, the military life can be seen as a massive Parental system. Its heirarchy and ethos greatly favour a non-emotional, closed-off approach to the world, because "it's the job". The recruits (moved into a Child role) are taught to suppress their feelings, and emotions are devalued culturally. If this comes into conflict with the truth of one's core self, then a problem is inevitable. I've also seen problems arising in relationships between forces-people and their non-forces partners, because the emotional toolkit needed to nurture a healthy relationship with that person isn't available.

It seems to me that Joe was (is) a thinking, feeling human being. Looking for a thinking, feeling response from the institution that is the military, small wonder he felt like he was talking a different language. What followed was the sense of disappointment and frustration that comes to us all, when we experience a need that isn't met by an unresponsive 'other'.


Wednesday, 1 June 2011

End-of-life care - a human right

I'm feeling encouraged today to see that GPs in the UK are recognizing the need for good, respectful palliative and end-of-life care.
I have worked in end-of-life care for some time, as part of my wider practice. I have seen that the wishes and desires of people nearing their death must be recognized and attended to, as far as possible. It helps maintain their humanity right to the end, and helps to give their life meaning.