In the United States and Britain, with resonances in other Western countries, a full-scale war has broken out regarding emotional distress and illness: how we talk about it, whether we try to measure it or not, and - crucially - what we do about it. Behind this war over ownership of the soul lies culture's profound ambivalence regarding psychotherapy and counselling. Many societies have opted for what they believe to be a quick and effective form of therapy, Cognitive Behaviour Therapy (CBT) which, proponents say, has been scientifically measured to have proven effects in relation to suffers of anxiety and depression.
But if you read my last sentence again, you will see just below its surface the main grounds upon which the war is being fought. Are there really separate diseases called anxiety and depression? No-one in the field seriously believes that, hence to coinage 'co-morbidity'. And whether or not you can measure either the illness or the cure is such a hot topic that it will be keeping university philosophy of science departments busy for years. Is there such a thing as an 'effective' therapy? Don't people keep coming back?
Recently, a further front opened up in connection with the proposed Diagnostic and Statistical Manual of the American Psychiatric Association. Many established professional bodies are concerned that there is going to be an over-easy pathologisation of what are really ordinary - if difficult and painful - human experiences such as grief. If the draft DSM doesn't get changed, then the psychiatrists will win the war.
But will they actually win? The stock-in-trade of psychiatry is drug treatments and, recently, a series of books and scholarly papers have appeared (notably "Irwin Kirsch's The Emperor's New Drugs: Exploding the Antidepressant Myth") that cast doubt on the reliability of the research that seem to support such treatments. Kirsch's point is that the methodology that underpins such research - randomised controlled trials (RCTs) - is liable to many kinds of distortion. For example, if a patient is given a placebo with a mild irritant in it, she/he will assume they have been given the actual drug being trialled (all drugs have side-effects, don't they?) and Hey Presto! they get better.
In Britain, there is great interest now in discussing the pros and cons of RCTs because they are used to ration therapy on the National Health Service (NHS). Well-established approaches, such as humanistic and integrative, family systemic and psychodynamic are vanishing from the NHS. But it is too easy to dismiss RCTs as totally useless when it comes to therapy, though, for many fully-trained psychotherapists and counsellors, that is what they believe to be the case.
Things are happening on the political front.
My own organisation, the United Kingdom Council for Psychotherapy (UKCP), is performing a useful leadership function in trying to get all the warring powers to sit round a table together. It is early days, but the UKCP is hoping that a 'both-and' approach to research methodology will mean that patients and clients in Britain will be able to get the fullest possible range of effective psychotherapies on the NHS.
In addition to the professional and academic challenge and dialogue mounted by UKCP, as the lead professional body for psychotherapy in the UK, a new campaign promoted by the Alliance for Counselling and Psychotherapy (a pressure group drawing support from across the field) is calling for an independent review of the non-RCT evidence for the efficacy of psychotherapy and counselling.
There is masses of such evidence, but the government agency that draws up guidelines for treatments on the NHS does not recognise the methodologies that underpin this research. At times, this National Institute for Healthcare Excellence (NICE) does seem to have been captured by the proponents of RCTs and - due to the way in which it has been researched via RCTs - CBT. The Department of Healh claims that NCE is beyond its control which has left many observers gobsmacked.
The Alliance has launched a petition that has attracted over 4,000 signatures in a short space of time, including many proponents of CBT who clearly want to put the formation of a balanced approach to therapy ahead of their own sectional interests. This is the largest expression of public dissent by psychotherapists and counsellors who have, traditionally been rather reticent.
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