NHS provision of psychotherapy

Most mental health-care services are organized around particular clinical problems and/or patient groups; only departments of psychotherapy are based on a particular form of treatment. This somewhat 'special' status has extended to the type of psychotherapy offered, which, until recently, was mainly psychodynamic, carrying considerable prestige and exerting a strong influence on psychiatric education and training.

Recent years have seen a reaction against psychodynamic psychotherapy, however. Prospective, randomized, controlled trials have not generally shown superiority of this treatment over comparison conditions, such as waiting-list controls. In contrast, brief, structured psychotherapies of the cognitive and cognitive-behavioural types do appear more effective than control conditions. Trends are therefore toward increased use of, and funding for, the latter types. It seems reasonable that health-care resources should be focused on treatments that have been shown to be effective ('evidence-based medicine'), especially considering the greater cost of long courses of dynamic therapy. However, part of this movement may represent another swing in the history of psychiatry of the biological/psychological pendulum; too marked a shift away from the fascinating, if 'unscientific', notions of psychodynamic psychotherapy may in the future be seen as counterproductive.

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