What’s the good of therapy?

*            Switch focus from theoretical models or therapy in general to specific settings;



*         Primary care / GP surgery

*         Business & occupational

*      Occupational health, HRM; eg. The Post Office

*         Military

*         Conditions (eg. Panic disorder)



*            One possible response to ethical and practical criticisms of therapy





                         So far have looked at efficacy and effectiveness



*            Considering specific settings broadens this to look at the benefits from more than the
client viewpoint.



*            It is also appropriate in the UK where responses to distress and disturbance are more
likely to be publicly or organisationally funded and focused on certain client groups / disorders /
settings than the traditional individual practitioner / private client model that is implicit in
much literature.



*            Material on specific settings also responds to critics of therapy (which often take a
much broader view than whether it 'works' or not) by looking at real-life applications.

                                     Business model in the NHS

*           Purchaser / provider distinction



*           Services commissioned and funded to meet new needs, apply new capabilities, respond to
new agendas



*        Eg. New focus on social anxiety



*           Means clinical psychologists have to be competent, active, academics and  researchers

                                                     Organisational  settings 1: Military / defence

*            Military – ‘can do’ philosophy thriving on risk, the dignity of risk and the
excitement of risk. Individuals pushed and may grow, autonomy given up for the benefit of the group
in return for group support and protection - the psychodynamics of the military family



*            The soldiers dilemma: accept risk or  feel a failure - grief and loss, guilt and shame



*            Evacuation syndrome; if kept in the social role of soldier (not  patient) and not
evacuated beyond rear area, comradeship, self respect, sense of belonging are retained.



*            Proximity / immediacy / simplicity / expectancy



*      Palmer 2002 in Feltham What’s the good of counselling and psychotherapy?

                               Employee assistance programmes (EAPs)



*            Post Office EAP study (Cooper & Sadri 1991)



*         Significant benefits anxiety, absences, depression, down; self esteem up – but not to
typical level.



*         Implies that investment in recruitment comes first



*            Benefits to organisations? US studies have mixed results but some strong cost-benefit
outcomes



*            Little UK evidence, results suggest both parties may benefit.



*            Altruistic and organisational motives



                                Counselling in primary health care

*            Substantial growth – but is it evidence-based?



*            Some evidence of reduced medication, GP appointments



*            NICE – if no RCT evidence of benefit, no funding. Fine in what Cochrane (1999) calls
cure conditions (heart disease, cancers) , fraught with problems in care conditions.



*            Important to establish evidence with counselling to differentiate from the margins of
acceptable practice



*            Clinical audit procedures such as CORE may help