On the Abandonment of Psychotherapy, An Introduction -I-

In a response to Prof. Laura Dilley’s “thread on some of the problems with the diagnostic approach to mental conditions posed in the DSM (Diagnostic and Statistical Manual of Mental Disorders)” I commented that “the problem was created with the abandonment of individualised psychotherapy and the dawn of chemical psychiatry and behavioural psychology. Psychotherapy has become entrenched in Freudian/Jungian philosophy, while people needed immediate help. Shortcuts were arbitrarily created.”

I am acutely aware about the limitations of “twitter science”, however, I have found twitter to be, probably the best practice ground for channelling one’s Asperger’s/Dyslexia short-time memory nightmares into the holy grail of Orwell’s third of his “Six rules for writing”:

Continuing my line of thought, I wrote: “given its exponentially growing negative effects on the subsequent abandonment of individualism for the ephemeral short-term results of mass therapies, this has become my interest area. Foulkes (Fuchs) was concerned that the drive for results is causing a drift to shallowness” also that “I’ve been involved shortly with group analysis, and experientially understood probably the precise period, motives and failures of this abandonment.”

I’ll leave my readers the choice of being curious about the multiple aspect born necessities which led to the development by Foulkes and others of a group approach to psychoanalysis, mentioning nevertheless his genuine, time and history proven ‘concern’.

In the 2^nd edition of his and Anthony’s “Group Psychotherapy – The Psychoanalytic Approach” (S. H. Foulkes and E. J. Anthony, Penguin Books, 1957/…/1973) he wrote:

“The present writers stand firmly on the ground of classical psychoanalysis whilst many other workers appeared to have been trained within the schools which, for short, one might call neo-Freudian. All these neo-analytic schools are not so much distinguished by what they have added to or developed from Freud’s work, but by what they have left out or distorted.”

It becomes worth noticing that the timing of these thoughts coincides with what I consider to be a major drift from the fundamental depths of psychoanalysis onto the one sidedness of behaviourism.

Unfortunately, the psychoanalytical school isn’t without fault as for the causes of this drift; the intrinsic danger of every ground-breaking idea is its enticing sea-siren song, luring the inquisitive mind into its never-ending intricacies. The truth is however, that besides what Foulkes mentioned in his rather bitter observation about neo-Freudianism as omissive distortions, I see as an equally pernicious development stagnation in the purely theoretical results of such endless philosophical dissections.

I firmly believe that one of the main influences of this abandonment of the individual for the group, and of psychoanalytical psychotherapy for behaviourism has been and still is, the mercantile, cost driven approach to healthcare.

The main difference between psychoanalytical psychotherapy and the behaviourist cognitive approach is the paradigm shift from intellectual individualism to mental collectivism, where an individual’s value is irrelevant if the social expectations of the almighty profit dictate otherwise.

Returning to my initial point about the quick results driven therapeutic shortcuts, I have found a rather disturbing effort to justify in a rather politically correct, nonconfrontational way the professional life-support dependent existence, of apparently well evidence-based reasons to reconsider and restore psychodynamic psychotherapy back to its history proven fertile-root role, and further into the mainstream of better available psychiatric and mental health care provisions.

While working in 2015 on one of my forensic mental health degree assignments, I have discovered a document by Jessica Yakeley, Director of the Portman Clinic and Director of Medical Education, Vice Chair of the Royal College of Psychiatrists Psychotherapy Faculty, Research Lead for the British Psychoanalytic Council, and Peter Hobson, Emeritus Professor of Developmental Psychopathology, University of London. To my surprise, the document which at the time was last updated in 2013, stated the following:

“In discussions over the evidence base, it is important to be positioned appropriately.   One of the reasons CBT evidence has had such political sway, is that research on this approach has been applied to diagnostic groups that correspond with those considered by NICE. Psychodynamic psychotherapists question the validity of these nosological categories […]”

In 2018 however, for reasons I do not wish to critically guess at the moment, Yakeley updated the document, amongst others with a “disclaimer”, stating that:

“We also advise caution in discussions comparing, or claiming superiority for, psychodynamic psychotherapy with other psychotherapies, especially CBT. Not only does CBT have a much larger evidence base than psychodynamic psychotherapy in terms of the sheer number of studies, but there is little evidence that any one therapeutic modality is superior to any other.”

She finishes however the same paragraph with the following, emphatic “key message” which clarifies a maybe different view, which again I do not wish to critically analyse:

“The key message, therefore, is that the available evidence demonstrates that the efficacy of psychodynamic psychotherapy is not inferior to, but is, on the contrary, as good as, that of other psychological treatments, including CBT, and moreover the benefits of psychodynamic psychotherapy may be long lasting and extend beyond symptom remission.”

A conclusion to this introductory critique to the causes and effects of what has been incipiently identified as an “abandonment”, must take into account -as previously mentioned- that “I’ve been involved shortly with group analysis, and experientially understood probably the precise period, motives and failures of this abandonment.” Having briefly touched some of the “periods and motives” part, brings back traumatic memories of my short-lived involvement in group analysis, which I have painfully experienced due to an utter failure to have relevantly included from its inception, consideration of individuals on the autism spectrum, for whom a different neurological development is an intrinsic barrier to participating in any “group” designed therapies. However, for the sakes of academic and scientific integrity, it must be mentioned that the 1950s period when group analysis was developing, coincides with the period when autism understanding, and research barely made it through the horrors of WW2, with ripples sadly alive to this they, especially in regard of Hans Asperger and his unclear involvement in Nazi war crimes.

What I believe to have understood, is that the emerging necessity of therapeutic skills and methods which could be applied in a shorter span of time to larger social groups, has overshadowed the concept of the individual as key component of any group. Even worse, it has caused an unwarranted departure of autism research, from individual uniqueness to socially interconnectible, representative groups. Unfortunately, this has damaged the very core of individual functionality, by stripping it from its biological and psychological autonomy, forced ultimately to become a simple asset of a hive-minded social construct.

If therefore, autism and mental health research have any chances of reaching out, they must return to where everything begins, to the individual as the undividable core of human existence.

[Rev.] Romulus Campan LTh (Hons), FDScMH (Forensic), CertEd, QTS,
PgCert Religion, Spirituality & Mental Health,
PgCert Special Psychopedagogy,
PgCert Autism & Asperger’s
Chair, Disability & Neurodivergence Staff Network – BSMHFT