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Does psychoanalysis have a valuable place in modern mental health services? Yes

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e1211 (Published 20 February 2012) Cite this as: BMJ 2012;344:e1211

Re: Does psychoanalysis have a valuable place in modern mental health services? Yes

The recent debate1 regarding the value of psychoanalysis to modern mental health services should include consideration of the important contribution offered by group-analytic psychotherapy, or ‘group analysis’. Developed by Foulkes2 in the post WWII years, this form of treatment brings together two key disciplines: Freudian and post-Freudian psychoanalytic concepts, and, through the influence of eminent sociologist Elias3, an understanding of man’s inescapable identity as a social being.

In thinking about the individual patient as located within a social matrix, an enriched understanding and formulation of symptoms and strengths may be reached. Treatment offered in a carefully selected group setting not only makes use of the skills of the group analyst , or ‘conductor’, but also enables group members to reflect to each other useful insights and experiences in the here-and-now of the group sessions, which lead to ‘therapy of the group by the group.’

Group analysts work in many contexts in the NHS, in adult and child mental health services, and through an understanding of group behaviours and processes, can also offer valuable organisational consultancy in the NHS.

With regard to physical as well as emotional wellbeing, work such as Brown’s4 studies of psychosomatic illness highlights beneficial factors arising from group analytic treatment, including containment of painful emotions, improved communication, naming feelings and finding both the meaning of, and the ‘mentalisation’ of physical symptoms. Patients generally cope better with their illness as a result.

PostFoulkesian group analysis is very much alive : the ‘psyche and the social world ‘5 remain core preoccupations of its practitioners, and recent evidence from the Sheffield Systematic Review6 indicates this relatively cost-effective form of psychoanalytic treatment has much to offer the NHS.

1 Fonagy P, Lemma A. Does psychoanalysis have a place in modern mental health services?Yes. BMJ 2012;344:e1211(20th February.)
2 Foulkes SH. Therapeutic Group Analysis, London, Allen & Unwin,1964.
3 Elias N. The Civilising Process ,first British edn Oxford,Basil Blackwell,1978.
4 Brown D. ‘The psychosoma and the group’ in J Maratos(ed) Resonance and Reciprocity, selected papers by Dennis Brown, Routledge,2006.
5 Brown,D, Zinkin L (eds.) The Psyche and the Social World, Developments in Group-Analytic Theory Jessica Kingsley,2000.
6 Centre for Psychological Services Research, School of Health and Related Research,The University of Sheffield A Systematic Review of the Efficacy and Clinical Effectiveness of Group Analysis and Analytic/Dynamic Group Psychotherapy ,2009.

Competing interests: No competing interests

04 April 2012
Chris MacGregor
Consultant Psychiatrist
NHS Highland mental health services
New Craigs Hospital InvernessIV38NP
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