Education And Debate

Controversies in Management Psychotherapy - a luxury the NHS cannot afford? More expensive not to treat

BMJ 1994; 309 doi: (Published 22 October 1994) Cite this as: BMJ 1994;309:1070
  1. J Holmes
  1. Northern Devon Healthcare Trust, Barnstaple, Devon EX31 4RT

    Psychotherapy is “the systematic use of a relationship between therapist and patient - as opposed to physical or social methods - to produce changes in cognition, feelings and behaviour.”1 Psychotherapy, or perhaps more usefully “the psychotherapies,” is a generic term covering a spectrum of treatments that can be grouped under four main headings: analytic therapy, cognitive behavioural therapy, systemic (or family) therapy, and creative therapies such as psychodrama and art therapy. Each of these can be brief or long term and delivered to individuals, couples, or families and groups. I shall consider the case for the psychotherapies under three main headings: empirical, economic, and ethical.

    Controversy about the empirical evidence for the value of psychotherapy continues, although the debate has moved on considerably since Eysenck's ill fated attempt to discredit it in the 1950s. Meta-analysis has provided overwhelming evidence for the usefulness of psychotherapy, which produces “effect sizes” of around 0.8-1.0.2 This means that the average patient having psychotherapy does better than 85% of control subjects. This kind of outcome …

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