Tuesday, 5 July 2011

NICE and psychotherapy ... part 3

In this final instalment, I'd like to look at the conclusions drawn by the UKCP/Roehampton report on NICE's apparent attachment to CBT.

As we've already seen, NICE favours the RCT as the 'gold standard' of Evidence. So what's the problem with that? Well firstly, the RCT has been examined and discussed by academics who conclude that it may well NOT be the most useful methodology as far as psychotherapy is concerned. Secondly - although NICE acknowledges that other forms of research method exist - it seems to ignore them! (In TA terms, we might think of this as discounting on an organizational or political level).

So far, the bulk of Evidence that NICE has recognized comes from the CBT community. No surprise, since the methodology is very fitting to a modernist paradigm. But it is a world away from what the UKCP's document describes as "Therapy as dialogue". Other forms of therapy (particularly those which are longer-term, more analytical etc) are ill-suited to these trials - indeed, most practitioners of these modalities would shy away from RCTs (on well-thought-out ethical and theoretical grounds). There has been a sea-change in TA and other therapy communities recently, towards a more relational (and therefore postmodern) ethos. NICE and the RCT aren't geared up for this kind of approach - so inevitably, they stick with what they know.

The result, then, is that NICE has favoured CBT - by virtue of its use of a particular research method - and then blinkered itself to other methodologies and modalities. Politically, NICE's endorsement of a Quick, Cost-Effective and Evidence-Based approach fell right into the hands of a government who wanted to squeeze the welfare/mental health budget.

The economist Layard was looking at the budget and saw CBT as a way of saving money, by reducing the number of mental health welfare claimants. The government jumped onto this bandwagon, and sadly, so did the media - spreading the contamination, confusion, and mystification. As I've mentioned before, the constant use in the media of the catchprase "Psychological treatment such as CBT" is nothing short of product placement.
The public are misinformed about therapy as a whole; we have worked so hard to change this - but now the perception is being further warped, this time with the collaboration of some segments of the therapy community itself.

The NICE-CBT-IAPT collusion is damaging in so many ways - not least in the suggestion that the nation can be made Happier - by (in the words of Oliver James) "spreading a thin layer of CBT across the country".


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