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3. Is psychotherapy a luxury?

Jeremy Holmes Karnac Books ePub

As we saw in the preceding chapter, one source of opposition to psychotherapy comes from those who hold it to be at best an unscientific form of treatment, and at worst simply an excuse for unscrupulous charlatans to exploit the misery or gullibility of their customers. We argued—against these and more measured criticisms—that psychotherapy is effective and, from the standpoint of scientific credibility, fares no worse than other kinds of psychological enquiry or psychiatric treatment.

We ended by looking briefly at whether psychotherapy is cost-effective. The studies we cited show that it can stand up well, even on its weakest ground—the areas of symptom alleviation and severe mental disorder. However, studies of cost-effectiveness require some assumptions of value—about the relative importance of potential goals. Once there is agreement about goals, the task is then to discover the most efficient method of achieving them. We believe that the strongest reason for seeking to expand psychotherapy is that it offers its beneficiaries something of vital importance which cannot be provided by other treatments or social interventions.

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9. Ethical codes and codes of practice in psychotherapy

Jeremy Holmes Karnac Books ePub

If, as we argued in the previous chapter, both simple appeal to therapists’ consciences and attempted direct control by legislation are unsatisfactory vehicles for minimizing incompetent or unconscionable conduct among therapists, the most obvious alternative is for some regulation from within the body of psychotherapists itself. The medical profession has attempted to regulate its own professional standards at least since the fourth century BC when the Hippocratic Oath was formulated. Since the Second World War, several codes of medical ethics have been published, most notably the 1947 International Code of Medical Ethics following the Geneva Declaration of the World Medical Association, amended by the 22nd World Medical Assembly held in Sydney, Australia, in 1968.

As psychotherapy has expanded, so ethical problems arising out of therapy have become one of the central issues for the nascent profession. Our discussions in the previous three chapters have shown how the therapist has special moral responsibilities, and inevitably faces tough moral dilemmas. There is therefore a need for considerable moral integrity among therapists.

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11. Epilogue: the future of psychotherapy

Jeremy Holmes Karnac Books ePub

Throughout this book we have returned repeatedly to the idea of autonomy. Autonomy, as we have characterized it, implies personal independence, emotional freedom, and the capacity to form satisfying relationships. Understood in this way, autonomy is one of the most valuable goals that psychotherapy can help its beneficiaries to achieve.

By focusing as we have on autonomy, we could perhaps be accused of neglecting other goals that embody the values of many psychotherapists. We have said little about the relation between psychotherapy’s emphasis on childhood experience and the Christian tradition of reverence for innocence and simplicity. We have touched only lightly on the role of imagination and play in psychotherapy, nor have we related these to the heritage of Romanticism. We have only glancingly referred to the Kleinian emphasis on renunciation, suffering, and deferment of pleasures, nor have we related these to the tradition of radical dissent within Lutheran and puritan Christianity. We have barely mentioned concepts such as non-attachment (Holmes, 1996) and enlightenment, or their secular equivalents which include irony and humour, where the influence of Eastern philosophy and religion has made its impact on psychotherapy. We have said nothing of the connections between Judaism and psychoanalysis.

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4. The unjust distribution of psychotherapy

Jeremy Holmes Karnac Books ePub

We argued in chapter three that psychotherapy addresses basic needs, and we suggested that its distribution should not be determined by the ability to pay for it. It is our belief that in this respect psychotherapy should be regarded, like basic health care and education, as something that should be equally available to people according to need. This follows from the Principle of Equal Respect.

This Principle is really about well-being or flourishing, and it states that people should not be disadvantaged on arbitrary grounds. Of course, natural differences, which from a moral point of view are arbitrary, mean that it is not possible for everyone to flourish equally. A person born with severe spina bifida may never be able to achieve a level of well-being that approaches that of the able-bodied. A child who dies of leukaemia will have less of a good life, no matter what we do to help, than someone who lives out a normal healthy life. The crucial point is that scarce essential services should not be distributed on an arbitrary basis. To distribute health care or education simply according to ability to pay is to do an injustice to those whose needs for the services are great, but whose financial resources are small.

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1. Taking psychotherapy seriously

Jeremy Holmes Karnac Books ePub

THE ANXIOUS WIDOW

A farmer’s wife in her 30s consulted her doctor, complaining of feelings of panic and doom. She was referred to a psychiatrist. He, a humane and well-trained professional, asked her several questions about her state of mind, satisfied himself that she was not hearing voices or deluded, and sent her back to her doctor with a diagnosis of “anxiety and depression”. He offered some helpful ideas about which brand of anti-depressant and tranquillizer might be most appropriate in her case. She did not take the drugs, but some months later her depression spontaneously lifted and things returned to normal.

Four years later, she was referred again, this time to a psychotherapist. Her husband had died a few months earlier, at the age of 48, from heart failure. She had been left to run the farm on her own with her 17-year-old adopted son, who was more interested in his motorbike than in helping his mother. She said that she had “coped” very well at first after her husband’s death and had “buried herself in the work of getting in the harvest”. But when winter came, she felt his absence fully for the first time, and her feelings of panic reappeared.

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