Psychotherapy Faculty (RCPsych) Newsletter ~ Spring 2012
The current crisis of Medical Psychotherapy provides an opportunity to review the identity and functions of the specialty. With Psychotherapy services closing, jobs disappearing and training waning or merging with other Psychiatric specialties we Medical Psychotherapists need to go back to basics, think what defines us, and think what, if any, are the niches we can occupy in the new professional world that is emerging.
While acknowledging that singling out any particular feature as the core of our specialty is necessarily controversial, I would propose that what defines us is our capacity to think and to promote thought in others. The thought we contribute with is not just an operational one to solve particular problems, but awareness of ourselves and others, of subjective experiences and interactions, of the bigger picture beyond short term statistics and diagnoses. As I see it, our function is to transcend the medical scientificism and to rescue the value and dignity of the human being. Thus, we would mirror the reaction of the Romantics against the Enlightenment but, learning from experience, without repeating the same mistakes. The thinking capacity we contribute leads to the development of the individual patient, institutions and society at large.
We might consider two main areas of work for Medical Psychotherapy: the ivory tower and the depths of the forest. By ivory tower I refer to specific Psychotherapy services where we can flourish on our own, revel in our own jargon and develop very sophisticated theories. This is the cradle of our professional identity and the source of our distinctive approach. Personality disorder services constitute one step into the woods but can keep its core of deep subjective thought among similarly minded professionals. By the depths of the forest I refer to the role of the psychotherapist who abandons a team of like-minded colleagues and reaches out to other professionals who use different epistemological approaches, frequently the scientificist medical establishment. This is our approach to Liaison Psychiatry, in which we not only help to solve clinical cases, but promote changes in the way professionals think and institutions function.
A particularly interesting field for Liaison Psychiatry is that of Primary Care. The recent changes in the funding system of the NHS make the communication between Primary Care and Psychiatric Services essential. Also patient care would significantly improve by a better understanding of mental health by GPs. I am currently working with five Primary Care surgeries covering a population of over 100,000 people in Spain. There I am having the opportunity to run Balint groups, brief psychotherapy groups with patients with common mental health disorders and doing co-therapy with Primary Care practitioners.
Unfortunately, Psychiatrists tend to show little interest for Primary Care. This could be observed in the thematic conference “Mental Health and Family Medicine Working Together”, jointly organized by the World Psychiatric Association (WPA) and the World Organization of Family Doctors (WONCA), which was held in Granada (Spain) in February 2012. Most of the attendants to this conference were GPs from all over the world but few Psychiatrists participated.
The joint conference of the Psychotherapy Faculty and the Royal College of General Practitioners in April 2012 might constitute a rerun of the above mentioned experience but with some differences. The mood in Britain might be different to that of the world at large and, especially, Medical Psychotherapists might show a different sensibility to that of General Psychiatry.
The resistances to leave the ivory tower restrict both our job opportunities and our ability to influence different professional fields. Now that many of the specialist psychotherapy services are being closed, this might be our drive to explore other areas rather than perish professionally. In this diaspora, we also need to put in place support structures that sustain us away from our natural workplace, namely wide support networks or central hubs where we can return to our roots, as I do regularly having trained in the UK.
In summary, we are living a time with great dangers and opportunities. Our creativity and flexibility will determine the future both for our individual careers and for our profession and the approach it entails. I hope we make the right choices.
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