‘I just can’t give you the time of day’

This is a potted summary  of an Editorial in this month’s British Journal of Psychiatry,  by Consultant Psychiatrist, Dr Martin Deahl, reflecting on his 38-year career, as he nears retirement. But the same could be said by psychological therapy practitioners. He makes the point that really listening is a necessary ingredient in any psychotherapeutic intervention. Pre-NHS Talking Therapies/IAPT this was taken as axiomatic by all mental health professionals, but it was quickly abandoned by the Service. Drew et al’s (2021) and Faija et al’s (2022) studies have evaluated transcripts of  treatment sessions and discovered a machine-like process, were priority is given to client’s completion of psychometric tests, which do not inform treatment. Whichever direction one looks, it is difficult to escape the conclusion that mental health clients have been seriously failed. 

NHS Talking Therapies has improved access to psychological therapies but without the therapist being present in any meaningful way. Only a significant minority of clients attend two or more treatment sessions, investing time and energy in the therapeutic enterprise. Most are appreciative of the therapist’s efforts and do not want to believe that they have wasted their energies. But few believe that they are either back to their old-self post-treatment or functioning at their best ever. There is a conspiracy of silence about treatment not being personalised. Client’s are kept in the dark that they are missing out. 

Recently I met a lady who had had a very bad car accident, she underwent a telephone assessment with NHS Talking Therapies and signed up for a 6 session group programme for PTSD. There were 20 people in the group and discussion of personal traumas was forbidden. When I asked her about her experience she said it was ‘helpful’ but there was no real-world change in her functioning. She said that she was given a trauma related psychometric test at the beginning and end. Her score improved and they suggested, on this basis,  that she didn’t really need to come back for individual therapy but could if she wished. She didn’t take up the option. Her treatment has been a con:

  • she did not know that there is no empirical evidence that a 6 week group programme for PTSD is evidence-based.
  • Nor did she know that she was given a treatment for something she might not have.
  • She was deprived of informed consent. 

There is a pandemic of presenteeism amongst psychological therapists with many unaware that they are carriers, passing their ‘best practice’ on to others.

Dr Mike Scott