Skills For Health Draft on Proposed National Occupational Standards (NOS) for Psychodynamic/Psychoanalytic Practitioners – A Response And Critique

Introductory Comments

The NOS draft relating to psychodynamic/psychoanalytic therapy represents a highly biased and particular view of what psychotherapy consists of. The covering note which accompanies the draft NOS states that the NOS are based on an appraisal of ‘manuals of dynamic therapies that have been used in research trials and which have been shown to be effective when applied’. However, there are simply no manuals of psychoanalysis as psychoanalysis is not a treatment that can be applied: rather, as all the major theorists of psychoanalysis have pointed out, it is something which is invented afresh in each case by the analysand and analyst. This is reflected in the fact that the list of manuals supplied by SfH contains no psychoanalytic texts, only those concerning other forms of therapy.

Psychoanalysis is based on transference and the idea that our conscious demands are moulded by unconscious desires and phantasies. The NOS place an inordinate emphasis on conscious aspects of an analysand’s demands and also on the idea of a clarity of communication between analyst and analysand, assumptions which are not accepted by the majority of theorists of psychoanalysis. Furthermore, the NOS are based around an idea of the ‘performance’ of the analyst, something which can only reinforce and even foster an alienation in the clinician if they feel that they have to distinguish their own activity from what their activity is supposed to be. This is in fact an alienation that many patients complain of and in fact seek psychoanalysis or psychotherapy to resolve. The above assumptions have shaped the NOS and are compatible with most forms of cognitive behavioural therapy but not with Freudian, Jungian, Kleinian or Lacanian psychoanalysis, or with most other forms of psychoanalytic practice that take place today in Britain and around the world.

There is one other general point which concerns all of the proposed NOS. Each section of the document starts with an explicit emphasis on the importance of respecting difference, yet Skills for Health have admitted that the group which has drafted this document has not been formed on a democratic basis. Representatives of the majority of psychoanalytic practitioners currently practising in this country have been excluded from the working party responsible for the draft despite written assurances that they would be included. There is thus an astonishing contradiction between the ethos which is supposedly at the core of the document and that which has in fact been operative in its construction. This point has to be recognised in order to grasp the essential problems in the draft NOS.