Fitness to Practise What? The Destruction of Psychotherapy in 21st Century Britain

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Over the last few years, since the NICE guidelines in relation to mental health and psychological therapies have gained in influence, I have often pondered how it was that clinical psychologists, many of them seemingly intelligent and thoughtful people, have colluded with the absurdity of the medical model on which the guidelines are based. They are, after all, by their own words of their mission statement, guidelines for the treatment of ‘specific diseases’ within the NHS. However, once again it is possible to see the underlying benefit financially and in status. Those who claim to provide NICE approved ‘treatments’ for psychological ‘diseases’ do indeed often appear to charge very high fees. There is money and status to be made in marketing ‘treatments’. Compare the fees that tend to be charged for CBT with those for psychodynamic or person-centred counselling – even though the latter may have involved considerably more training and personal demands. Counsellors do not usually market their services as treatments for diseases – but practitioners of CBT can claim they are offering NICE-approved treatments for anxiety, depression, and other diseases.

The medical model of emotional distress becomes even more iniquitous when applied in court. I am thinking particularly of family courts. Psychiatrists and psychologists are drawn into pontificating on the ‘diagnoses’ and ‘prognoses’ of a mother, for example, in the context of moves to have her child taken for adoption against her wishes. One hears commonly of concepts such as ‘borderline personality disorder’[2] or ‘munchausen’s by proxy’ being bandied about – these being used (misused) as predictive markers of the mother’s future behaviour. Thus, in the discourse of the court room it may be stated that a person has a diagnosis of ‘blah blah’ – as if this were closely analogous to some real medical condition. Unfortunately, the impact on that mother and her child may be all too real.

It is not difficult to see the absurdly inappropriate nature of the disease model adopted by NICE when the circumstances of real clients are addressed. Consider the following common example. A single mother, living in a council flat in a tower block, is subject to abuse by neighbours who play loud music all night, along with harassment by drug users outside. She is anxious and depressed, seeing no easy solution to her life’s difficulties. The NICE guidelines would recommend her ‘disease’ be treated with either a Selective Serotonin Reuptake Inhibitor (SSRI antidepressant) or with Cognitive Behaviour Therapy. These alternative treatments are presented as if within a similar category of phenomena. Thus the guideline on anxiety states:

“Any of the following interventions should be offered
Psychological therapy [CBT]; pharmacological therapy [SSRI], or if an SSRI is unsuitable or there is no improvement, imipramine or clomipramine may be considered; self-help bibliotherapy [based on CBT].” [abbreviated text]