A
Cognitive Behaviour Therapy and
Evidence Based Practice debate got sparked off on
Mandy's Lifeboat when part of the
UserWatch team, PatientGuard, posted a speech from :
Janet Low a Psychotherapist on YouTube over on that ally site.
We note the owner (or admin) of
MENTAL NURSE joined in after listening to Janet Low's thought provoking speech on the health UK politics and economics of the (in our words) strangely single choice (so far) CBT roll-out in mental health services across the UK ..
The owner of the MENTAL NURSE site though we think is very likely to be an NHS worker and partisan, so that is factor (public versus private ? ) we think should also be taken into account .
At UserWatch we care only about patients getting the best care and choices and that we feel should be based on
patients having economic power to portabilise their recovery and management packages away from the NHS if necessary .....Ofcourse a mental health Patient-Choice culture has never really been allowed its "gonads" in the State dominated UK - but there are plenty of NHS spirit gulag practices still around....
Here's how the debate is going over on the Lifeboat though and MENTAL NURSE would clearly like to take it to their site too ...Any takers in the User-community ? See debate below :
Blogger Zarathustra said...Wow, I think I managed to disagree with just about every word of Janet Low's speech there!
First off, she completely misrepresents evidence-based practice as being purely based on the hard sciences with no place for human values, but that's not true at all. EBP includes the use of research methods like ethnography, case studies or focus groups that do allow room for individual expression. EBP isn't about excluding human experience. It's simply about ensuring that before a clinician does something to a patient, there's some degree of evidence that it's liable to work.
I've seen a few critiques of CBT floating around the internet, and one thing I've noticed is that it nearly always seems to come from psychoanalysts, so it didn't surprise me when I googled Janet Low's name and it turns out she's a psychoanalyst too. Whenever I read any of these critiques, the subtext always seems to be, "Why are the government spending money on CBT when they should be spending money on psychoanalysis?"
I'll probably sound like a massively cynical old bugger by saying this, but my own opinion is that the reason psychoanalysts hurl such vitriol at Evidence-Based Practice is because there's very poor evidence that their hugely expensive remedy is likely to do any good, and there's even some evidence that it could do some harm to the client.
Janet Low's also got a bloody cheek for accusing the pro-CBT crowd of bringing money and economics into it, when psychoanalysis has nearly always been a luxury for the rich who have the time and money to spend 3 or 4 sessions a week in analysis for several years.
Don't get me wrong, I'm not saying that CBT can't be criticised. I'm just saying that I'm not inclined to hear it from psychoanalysts.
Wow, I really went off on one there. I need to learn to relax more. Maybe I should get some CBT/psychoanalysis*.
*delete as appropriate.
1/13/2008 12:54 PM
Blogger mandy lifeboats appeal said...I am sceptical about 'experts' in their field proclaiming to be experts about other people and their experiences. Okay, so they will have their learning and practises and views on what other people's experiences are but it is always better to hear things from the person who has received the service.
Would it be unfair of me to say that I think that a survival game is being played...as well as power games? I think maybe it would...but
I am sceptical about alot of what is going on in MH fields.
Where are these evidence bases that are being spoken about? Can I and others easily access them?
and I don't wish to poo poo any type of talking therapy...I just want to see some evidence that they help. Which may prove to be another red herring as organisations tamper with statistics to suit their purposes.
Bewildered of Bedfordshire
1/13/2008 2:59 PM
Blogger PatientGuard said...Zarathustra I think the problem is in Britain is a lack of Patient Choice of treatments being driven by patients having their own budgets. People like yourself can argue about approaches and their various values and applicability etc and even play within the field of what you call evidence but this does not touch the point about the patient culture getting out of the position where "experts" of any variety choose for them ...
I am a User and I dont like any approach that tells me or others it knows best when my experience over 30 years has watched the professionals slowly kill people off including some family and then more currently suggest (in the UK) that CBT thought controlling therapy is the way for logical processes of thinking to domimate circles of bad feelings that might be causing distress...
Integrating feelings that are distressing or self defeating can lead to mourning and resolution if helped withing the bounds of feeling the feelings themselves and working with them to get to a point where they can be released properly ..The other side of this though is many Users are harmed again and again by choiceless nothingness of the current UK services and CBT is a one sided Top Down absence of choice so far so lets open up the field eh ?
CBT just a partial mechanism of some worth but extremely bad and superficial when applied to serious emotional trauma involving damage to feelings and damages to consciousness itself so that consciousness and even behaviour is warped by pain and past trauma or relational damages.. I have lived and been amongst psychotics and many others and most of them have some warping family lives or horrendous care rearing patterns full of contradiction and some powerful child abuse episodes...
Shefield University EBP Views1/13/2008 4:31 PM
Blogger Zarathustra said...Hi Mandy
Would it be unfair of me to say that I think that a survival game is being played...as well as power games?
Oh, absolutely. There's definitely partisanship between different schools of therapy.
Where are these evidence bases that are being spoken about? Can I and others easily access them?
The best place to start is by using the Google Scholar search engine at http://scholar.google.com - unfortunately you'll probably only be able to read the abstracts of research papers rather the full texts, but it should be able to give you some gist of what those papers are concluding. If you're enrolled on a university course, you should be able to acquire an Athens username and password that will enable you to read the papers in full.
Hi PatientGuard
I certainly agree with you that patients require access to a range of approaches rather than just one.
In my view, any type of psychiatric intervention (humanistic, cognitive-behavioural, pharmacological, psychosocial, psychodynamic etc) should be regarded as one of the various tools in a toolbox, and it's the role of a skilled clinician to work out - preferably collaboratively with the patient/client - which tool or (more likely) combination of tools will suit this particular client. Every client is different and what helps one will not necessarily help the other.
I'm not entirely pro-CBT and anti-psychoanalysis. I do tend to mostly use a combination of humanistic, CBT and psychosocial approaches, but I do also find certain psychoanalytic concepts - particularly attachment theory - to be clinically useful. However, I think it's rather telling that Janet Low chose to devote almost the entirety of that lecture to trashing CBT rather than making a coherent case for psychoanalysis.
1/13/2008 5:24 PM
Blogger mandy lifeboats appeal said...Dear Zarathustra
As someone diagnosed with Bipolar...a label that sort of fits some of the symptoms I have...and having had different psychological therapies (or whatever the correct term for them is) in the past...none of which really helped me alter anything..or feel better. in the long term - am wondering how effective any of them are.
One could argue that they were the wrong therapies or that my illness (personal make up etc) has not and will not respond to talking therapies. Sounds rather defeatest but being in the thick of some kind episode right now...I feel that I may not even able to get to counselling this week, let alone deal with anything that I take to that session and get some comfort, help whatever from it.
I guess it depends where a person is at, at any given time.
And maybe the structure of talking therapies (the routine and demands of it) are too much for me to fit within.
I am a very errratic person. So some days I can handle things, others getting out of bed is the achievement...
Why am I saying this?...because at times like this...I sense that there isn't anything that can help me except survival instinct and I hope that will sustain me through...particularly when I get impulses to do dangerous things to myself or I feel so worthless it would seem a relief to me and my loved ones if I was out of it.
Sorry to be so negative. I usually am a fighter and seeker of things that do help.
Today, I think it is all debates that are superseded (scuse spelling) by the reality of being in shite and having to try and wade on into the next five minutes..and so on.
But whatever my states..the debates should continue and hopefully they lead to understanding..information sharing and a bit of hope to those suffering.
Hmmmm
1/13/2008 5:54 PM
Blogger Zarathustra said...Hi Mandy
Sorry to hear that talking therapies don't seem to have helped you. Though that may not be entirely surprising given that your diagnosis is bipolar disorder.
I'm not saying that talking therapies can't necessarily be of use in bipolar disorder - they can help with certain things like developing coping strategies, avoiding stress, recognising relapse signatures and so on. However, with bipolar disorder the main focus of treatment is always going to be the medication.
As I'm sure you're more than aware, the meds are something of a blunt instrument. They work haphazardly, and often with unpleasant side-effects. Even so, it's hard to imagine any successful intervention for bipolar that doesn't rely heavily on medication. The idea of using a talking therapy to get someone out of a cycling mood disorder strikes me as - to paraphrase Jonathan Swift - an attempt to reason someone out of something they were never reasoned into in the first place.
1/13/2008 7:48 PM
Blogger mandy lifeboats appeal said...Thanks for the posting, Zarathustra...Can I call you Z because I am having to double check my spelling and even then getting it wrong?
I think I agree with you in my situation. I wouldn't dream of speaking on behalf of anyone else with Bipolar diagnosis. Cos individuals, and their circumstances, are as big a part of the person as the illness...if not bigger. Hard one to judge that.
I always go into counselling on a bit of a high. The relief of thinking something positive could happen. And then I get this anxty thing...where I acknowledge that I am unstable and therefore seeking some kind of answer (more something construcitve) to that seems like climbing Everest without a rope.
Also, I would say, people with MH issues with family histories of MH issues (and then other tragedies that have impacted on their lives) are going to need more than a bit of a chat, with some positive reinforcement, to make things easier to maintain, thereafter.
I do think with Bipolar....the severe end of that spectum...the emphasis from services is about medication. I don't diss it, when it works, and I hear others saying Lithium saved their lives or the meds they are now on make things much better. I get all jealous then because I can't tolerate most medications. Be they shrinky or for other physical ailments. But I am glad when I hear about people who have found meds that really help. It is always nice to hear good news stories.
I guess my consultant thought he'd let me try more counselling because he thinks I need somethign positive to cling on to. And when in assertive mode, I can be pretty persuasive. Maybe that is a bipolar trait...or maybe just my bolshy side coming out.
I understand that when most things have been tried, there are some professionals who will offer something in the absence of anything else that is of use (or services that once helped that have now disappeared). For that I thank them. But I feel more so that what is needed is better on going support. And that costs money and who gives a shit about a bipolar who isn't able to sustain work with any level of consistency?
Not deliberately playing victim.But trying to seek something real that makes sense and won't make me iller.
Not sure about other bipolars but I spend most of my time evaluating and re-evualting things to see what I can improve or how better to maintain what I have.
Right now, I guess the best thing would be to accept where I am...and seek little comforts that help ease me through the day.
Chocolate is an ever faithfull friend. lols
Thanks again for sharing your thoughts.
:>)
1/13/2008 8:46 PM
Blogger Zarathustra said...Yup. Chocolate is good. :)
I've done some more critiquing of Janet Low's audio lecture over on Mental Nurse.
Z
1/13/2008 9:09 PM
Blogger PatientGuard said...I am not sure Janet Low was knocking the nature of evidence in itself for instance, or even CBT completely. She clearly concerned about a lack of depth though . I listened to her speech again and she was trying to get beneath the politics and top notch crowd like Layard, that had Top Down arranged CBT as the roll out that was economically , politically and managerially suitable in the current Top Down new labour work driven climate too where the NHS establishment "knows best" and frankly hijacks Users Voices with DWP stripes on its arms
The worst part about where your argument leads Zara....is you cannot quantify whether or not patient choice might be cheaper if we allowed it in this country ..
Yet I recall in the 1990's there was a case (known to me) of someone getting a therapy supply privately using an extra contractual referral mechanism via the GP fundholder to exercise "Choice" and the costs were less than half of what a local Trust could supply . The figures were obtained for 3 costed hours of group therapy from a local Trust and 3 hours privately and there was astonishing difference of something like £180 (for the NHS 3 hours) and the equivalent of £45 (3 hours for a quality service privately)
The present patch em up and get em back to work CBT philsophy is prevalent in Britain and its frankly seen as partly anti-patient in some parts of the user-community because already CBT (cases known to me and others ) has been misapplied and though I welcome a more eclectic understanding I really wonder why those who claim to be therapists in the NHS dont have some therapy themselves (I dont know many that do) and thus become enabled to more acutely see the contrary institutional even managerially neurotic ways that patients become invalidated and socially re-erased by the NHS's so called help ...
..
1/13/2008 9:36 PM
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