Article review – Peter Fonagy on psychotherapy in the NHS

In: Article Reviews, Individual psychotherapy, Latest News

Article review – Peter Fonagy on psychotherapy in the NHS

I am reading Martin Pollecoff”s interview of Peter Fonagy in the Psychotherapist, the magazine of the United Kingdom Council for Psychotherapy, of which I am a member, and find myself resonating with Pollecoff’s concern that “in IAPT (increasing access to psychological Therapies) you have people who have been through a year’s training with no therapy of their own. I am concern about the political shift between the therapist and the client. It’s a model in which the expert, who is OK, is treating the poor client.There is something wrong there for me”.In my view, Peter Fonagy is absolutely right to point out that the medical model has failed in the provision of adequate mental health services to a broad public, and that the IAPT initiative is a way to   Address this failure. But I don’t feel that in this interview he answers the interviewers’s questions with total clarity. Fonagy says that the psychoanalytical model is the best way to understand how the mind works and how a person can heal. He also describes three essential elements in psychotherapy (the working alliance, mentalisation and compassion). In my experience of practising psychotherapy in London, all three elements are totally contingent upon the relationship between the patient and therapist, and I feel it can only be beneficial to the patient if the practitioner has experienced these elements in a relationship with a confirmed practitioner for a significant amount of time.

Fonagy says “you have to be robust”, and in my view this comes as a result of the practitioner having tested out the solidity and healing potential of a working alliance, not as a result of a short one year training. Generally, it is my experience that the patients who come to see me at my London practices will only ever go as far as I have been myself. If there is something that I cannot negotiate within myself, then  it follows that I cannot help my patient negotiate this corner for themselves. Fonagy has gone through intensive analysis himself, and I am surprised to see that he remains quite vague when discussing the essential aspect of practitioner therapy with Pollecoff.

By: Cedric

Four elemental questions for therapeutic psychology: a personal view

In: Article Reviews, Individual psychotherapy, Latest News

In this article, David Zigmond, who is a GP, Psychiatrist and psychotherapist, gives us four fundamental questions to ponder when we see patients for psychotherapy. Zigmond is concerned that the medical model, prevalent in the NHS, does not equip us with the mindset that is necessary for an authentic encounter.

He proposes four fundamental questions for therapists, which “escape subsumption to prepackaged, designatory psychologies”, and are, in his experience, “primal to any likely successful engagement”.

1. What is it like to be this person, to have lived their life?
2. What is the meaning and experience, for them, of this kind of distress?
3. What is the meaning and experience, for them, of me, now?
4. What do I need to understand of their needs that theyvpossibly cannot yet express, or even think about?

Zigmond describes these questions as “naive”, in that they assume very little. Indeed, by asking ourselves these questions as practitioners we are necessarily led to discard accepted theories and conventional perceptions so that we can form an understanding of the person’s presenting needs based on our experience of them, of ourselves as we are in relationship with them, with empathy, curiosity and openness.

The term “naive” is quite important here and I find myself drawn to it. As a psychotherapist and counsellor in London I have, like my colleagues, undergone years of therapy, supervison and training, and I know still that my learning has only begun. Psychotherapist D.W. Winnicott prefaced his book “playing and reality” with the following words: “to my patients, who have paid to teach me”.

It is tempting for many to adopt a top-down approach to psychotherapy for depression, relationship problems or problems such as anxiety. By this, I mean that the practitioner concerns themselves with acquiring an understanding of the symptoms that each condition presents and developing an approach whereby they can track progress in treatment according to criteria of functioning that may have nothing to do with the person, but that are instead taken from a group-level view.

While the latter approach is necessary in driving some areas of research and monitoring outcomes in institutional settings, the former needs adopting in every encounter. By doing this, the practitioner has the better chance of not only fulfilling their role in an institution, but also to meet the person who is suffering as an equal and give them a chance to be understood more fully and more immediately.

Nature versus nurture – more grist to the mill

In: Article Reviews, Individual psychotherapy, Short articles (<500 words)

This recent article by the Guardian, “Why do identical twins end up leading such different lives?” adds yet more weight to the argument that even though our genes may predispose us to certain traits, and therefore give us strengths and vulnerabilities, our epigenetic makeup, i.e., the pattern by which certain genes are expressed or not through of our interactions with the world, will make a huge contribution to the building of our personality.

Continue reading “Nature versus nurture – more grist to the mill”

By: Cedric Tags: , , , ,