Britain on the couch: Head for therapy?
Tuesday 02 June 1998
But what if you do not happen to know me or someone like me? Whether considering which therapy or which therapist, you would effectively be taking pot luck in a matter of potentially enormous importance.
When John Major won the 1992 election he spoke of a property owning democracy in which wealth would be "cascading down the generations". Tony Blair has the opportunity to ensure that the wealth that cascades down the generations is psychological insight, not the fees of estate agents: he could transform the disgraceful shambles that is the organisation of therapy in Britain today.
The blame falls four-square on the shoulders of the last government. Despite numerous requests by the various therapy training bodies for legislation, the Department of Health has repeatedly refused to become involved on the grounds that it is a privatised industry that must be left to Market Forces.
The result is an unregulated mishmash in which anybody can still set up as a therapist and fleece the public of their money, or even worse - and that is just the completely untrained therapists. There are more than 70 bodies who train a huge variety of kinds, some of whom should not be allowed to so designate themselves. If astrologers wish to practice astrology, then good luck to them, but it should be illegal to pass themselves off as therapists.
It is imperative that the government sets up a body to define and regulate therapists. In assessing them it should apply the same standards as it does to psychotropic prescription drugs for mental illnesses: approving only those therapies that have been proven through scientifically conducted research to be more effective than no treatment.
Some therapies, such as many psychodynamic (the tradition started by Freud) and cognitive ones, have already been tested in this way. A committee of suitable experts could decide which other therapies are based on theories and methods worth testing at all - it would be a waste of money to test the astrological varieties, for example.
On top of this, an independent body should be created to deal with potential breaches of ethics. No patient should begin treatment without knowing the telephone number and address of this body and without a detailed professional curriculum vitae of their therapist, complete with a leaflet agreed by the training body explaining the basic theory behind the treatment and its typical practices.
On top of all that, there is a great deal the Department of Health could be doing to ensure that well-trained therapists are available throughout the country. Having established which therapies are worthwhile, it should support and nurture them, ending the hand-to-mouth existence which means that some trainings are a great deal more rigorous than others.
While posts for therapists are gradually becoming more common within the National Health Service there are still far too few to meet the demand. For the minority of patients who can afford private treatment this is no problem but for the majority there is an urgent need for this kind of treatment to be made available.
A new book, Counselling and Psychotherapy in Primary Health Care by Jan Wiener and Mannie Sher (Macmillan, pounds 11.99), explains how this could be achieved and why it is needed. Only 31 per cent of General Practitioner practices offer any kind of counselling provision. Of those that do, 28 per cent of the counsellors have no formal qualification.
At present, the mental health field is dominated by specialist doctors, called psychiatrists. I am far from being hostile to the prescription of drugs for mental illnesses. Furthermore, I fully recognise the nightmarish difficulties facing psychiatrists (some of my best friends...) who have to treat the severely mentally ill. They work extremely long hours and are increasingly required to mop up the effects of social problems that are not their province - like violence and the fallout from domestic and marital disputes.
But first and foremost, psychiatrists are doctors who have had a further training in the administration of chemicals and electricity for changing the physical state of brains. While many of them are wise and sensible, some know little about basic psychology and child development and some are actively hostile to it.
It is such people, for the most part, who advise the Department of Health on how best to spend taxpayer's money in improving mental health and, not surprisingly, their advice is driven by their training and professional loyalties. Yet it is only an accident of history that created their dominance over the field and it may be that the Government should reconsider its extent. Surely this is exactly the kind of reallocation of resources within existing budgets that the present government is committed to - psychiatrists cost a great deal more than most therapists.
Such changes in the world of therapy would help to break the cycles of emotional deprivation and abuse which scar so many lives. Truly, those who forget the past are condemned to repeat it and this dictum applies to all of us: probably without a single exception, all of us need to carry out an inventory of how our childhoods and genes have effected us. Doing so, albeit briefly in many cases, with a neutral stranger who is suitably qualified is the best way - friends and relatives can only help to a limited degree.
An excellent summary of the full package of changes that are needed was recently published (Relative Values by Ed Straw, Demos, pounds 4.95). Particularly important for long-term do preventative change are its recommendations for more relationship counselling for disharmonious couples and much greater status for full-time parents.
We can only hope that Ed Straw's report is compulsory reading for all the men and women who sit with his brother in the cabinet.
Oliver James' book 'Britain on The Couch - Why We're Unhappier Compared With 1950 Despite Being Richer' is published by Century
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