[Mouse_]

http://news.bbc.co.uk/1/hi/health/7714848.stm

[searchingmysoul]

Interesting article.

The arguement about what makes therapy successful is a complex one. With managed care, the push for short and effective "evidenced based" therapies such as CBT is becoming the norm. However, when I have read literature, the single most indicator of "successful" therapy is the therapeutic relationship. Thoughts?

[sunrise]

Some of my comments on the article:

There was huge excitement last autumn when the health secretary, Alan Johnson, announced that £170m would be spent on talking therapies in England.

It sounds like they will only be supporting CBT, so I'm not sure what the other talking "therapies" are they refer to. I think a more diverse approach would indeed be helpful. One size does not fit all when it comes to therapy.

"I think this is a dream service. Patients can refer themselves and get access to quick treatment."

That indeed sounds very positive, but it would be even better if the ability to self refer was not limited to CBT therapists.

The service has a good record for getting unemployed people back to work

"They will speak to people, and help them get vocational plans."

But critics are nervous about therapy being linked with employment services."

Fascinating. So if a person has a mental health problem and needs psychotherapy, the only way they can get it is if they are unemployed?

"What you're witnessing is a coup, a power play by a community that has suddenly found itself on the brink of corralling an enormous amount of money.
"The CBT community has managed to sell to the government and its agencies a notion of research that is allegedly scientific.

Very interesting. I didn't realize the different branches of therapy had lobbying groups.

Policy director [of Mind, a leading mental health charity], Sophie Corlett, said: "The debate appears to have focussed on 'CBT good' or 'CBT bad' without any recognition that CBT is good for some people.

"There is a case for saying that CBT has been promoted above its usefulness.

"It's extremely useful for large numbers of people. Some people have assumed therefore that the evidence base is superior - but for some, it may be of no use at all.
"There needs to be recognition of different approaches for different people."

Amen.

I wonder how they can even mandate what the therapist does with his/her clients behind closed doors? If a client comes in, and CBT is not a good match, isn't the clinician ethically obligated to offer an alternative that will be helpful? Or at least refer to a broader based practitioner? And who would know even know that the therapist is not providing CBT to every single client? (Do they have hidden cameras?) Therapists in the U.S. are used to gaming the system to get insurance reimbursement for services. I wonder if UK therapists will be doing some similar gaming--saying they are doing exclusively CBT, but really doing what works best for the client.

However, when I have read literature, the single most indicator of "successful" therapy is the therapeutic relationship.

Yes, I have read that too, and a couple of my therapists have also mentioned it, most recently the family therapist I am seeing with my daughter. I have wondered that if this is true, then why is more effort not spent (when agencies are involved) on promoting a good match between therapist and client? Sure, the client often does this on their own--sometimes trying out a few therapists before finding a good match--but they don't always have that choice if they are receiving government services. Perhaps there could be a more systematic way to help with this, even for public health services. I know there are assessment tools that measure different aspects of the therapeutic alliance. Perhaps an assessment like this could be administered to the client after a defined number of sessions (say 3-6), and then the result given to the client. The results could be used to help the client decide to stay or move on, and to obtain a better match in the next effort. That is off the top of my head and has problems. But I have always wondered if the therapeutic relationship--the most successful predictor of therapy success--couldn't be used somehow to facilitate a good match.

Last year I took an interdisciplinary course on addiction and learned about a study where people addicted to alcohol were given one of three different types of psychotherapy. (One of them was an individual twelve-step based form of therapy, one was CBT, and I don't remember the third.) Efforts were made to not only match the client with the therapy modality best suited to them, but also to assess the therapeutic relationship after 6 sessions, and switch practitioners if the scores were low. It was a complicated study, and I can't remember if the best modality was assessed before the client entered therapy or after some defined period. This was the first time I had ever heard of this approach, but I think it could be used more. For example, in the UK, if therapeutic approaches likely to be effective for an individual could somehow be assessed (a 10 question instrument?) before therapy began, then the client could be assigned to a therapist with the appropriate therapeutic approach.

I love to discuss this stuff.

Thanks for the article, Mouse.

[RiverX]

Originally Posted by Mouse_

http://news.bbc.co.uk/1/hi/health/7714848.stm

Love the Christmas tree mouse! dont tell me you're that organised --- tree up already?! lol

I was getting distracted from the debate by working out who's hailing from these dark and rainy shores.


river

[sorrel]

Interesting.
I've always been in psychodynamic based therapy, as it works well for me.
I did however spend 6 months in counselling with a private CBT based psychologist, who was however open minded and pretty eclectic. In fact she advised referral to a Kleinian analyst, in the first session with her. I declined, because of my lack of knowledge at the time. But, looking back, I see how wise she was.
I'm lucky in that I have financial support for private therapy.
People that rely on NHS referrals have less freedom of choice.

[Mouse_]

Originally Posted by RiverX

Love the Christmas tree mouse! dont tell me you're that organised --- tree up already?! lol

I was getting distracted from the debate by working out who's hailing from these dark and rainy shores.


river

If I had my way it would be!!! LOL< I do have my first decoration though, hubby bought me a me2ubear dressed as santa

[Mouse_]

Originally Posted by sorrel

Interesting.
I've always been in psychodynamic based therapy, as it works well for me.
I did however spend 6 months in counselling with a private CBT based psychologist, who was however open minded and pretty eclectic. In fact she advised referral to a Kleinian analyst, in the first session with her. I declined, because of my lack of knowledge at the time. But, looking back, I see how wise she was.
I'm lucky in that I have financial support for private therapy.
People that rely on NHS referrals have less freedom of choice.

Much the same as my experience, CBT doesn't work for me.