ABSTRACT
This chapter explores the consequences of the attempt to impose the contextual model upon one which, in the view, was effectively and efficiently serving the needs of the staff who worked in the service and the patients they cared for. In social care systems the context is all important. In the experience, if you get the context right then you optimise the treatment outcome and therapeutic potential. Although neo-liberal economic theory purports to promote equality through unfettered free enterprise, this is based upon a false premise. The psychotherapy service we developed over 25 years began as a small department with one consultant medical psychotherapist, helped by a small group of part-timers. The neo-liberal/managed care model (NPM) is based upon a cultural paradigm formed from a view promoting the primacy of the individual over social needs. In a social care service setting this is highlighted in the tensions between the management and clinical anxiety.
