ABSTRACT
A recently appointed high-up official in a Mental Health Trust had courteously set up a meeting with me in pursuit of his conscientious wish to understand more of the services provided within his new responsibilities. He naturally wanted to know of what psychotherapy consisted. He displayed a genuine curiosity, a wish to learn and to place the psychotherapy business alongside his previous experience of other businesses. He had worked in industry and he wanted to make a parallel between the activity of the psychotherapist and his own experience of giving career advice to junior staff in his previous executive positions. At the same time, he displayed a characteristic fear: people could get an excess of advice and support and might grow to rely too much upon it. He feared that receiving psychotherapy might become an indulgence; it might create a risky dependence. He also displayed a belief that there could be something unhealthy about talking a lot about feelings. In saying such things he revealed all that characterises a very English attitude towards the subject. In many ways it is surprising that someone accepting a position in a Mental Health Trust in the United Kingdom at the present time would be comfortable with his own attitude. The field of psychodynamic psychotherapy owes a great deal to the British school of psychoanalytic thinking. It is also true that the subject, as a professional practice, is now undergoing a veritable explosion in the numbers of psychotherapists within Britain. The recently established register of psychotherapists demonstrates how many organisations are currently developing standards of practice and are training psychotherapists. At one time such trainings were almost exclusive to London (with one training each in Aberdeen and Edinburgh). Now psychotherapy courses are available in many centres throughout Britain, with, for the first time, an evolution of university-based diplomas and masters degrees in the subject. There is an even more marked development in the more ‘sanitised’, apparently cheaper form of talking treatments which are encompassed by the concepts and practices of counselling. In my discussion with this senior executive, I chose not to confront the inconsistency in his attitude and side-stepped the issues. I talked of the particular psychiatric conditions that interest me and for which ‘psychological treatments’ alone are the only ones that have been shown to work. (These are, specifically, the so-called eating disorders, especially those associated with self-starvation, which have been shown to be singularly unresponsive to pharmacological therapies, and for which effective residential treatments are expensive and scarce; see Dare et al. 1995). My response was tactical and I failed to talk with him about the origins of his beliefs about what is for me my life’s work. Of course, his views are indeed common and representative and have an important place in
any understanding of the phenomenon of psychotherapy. The common attitude to psychotherapy includes two persistent myths.
