A New Deal for dynamic psychotherapies: The psychoanalyst as a street-level bureaucrat

Author/s Jeremy Clarke
Publishing Year 2024 Issue 2024/2
Language Italian Pages 52 P. 199-250 File size 632 KB
DOI 10.3280/PU2024-002002
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In the UK in 2007 a national experiment was initiated with the aim of tackling “Britain’s biggest social problem”: depression. Improving Access to Psychological Therapies (IAPT) was devised as the solution. A universal free-to-access talking therapies program would make avail¬able evi-dence-based treatment to all patients with depression and anxiety disorders. NICE (National Insti-tute for Health and Care Excellence), the body that decides on what is cost-effective, said cogni-tive-behavior therapy (CBT), not medication, should be its first line offer. The starting gun was fired. The promise from IAPT was 3-fold: to scale up access to CBT rapidly; to achieve recovery targets that would reduce the prevalence of depression and anxiety disorders over time; and – most ambitious of all – to ensure the Treasury would see a return on its investment by reducing the economic burden from depression. People who were on invalidity benefits due to depression would be supported back into employment. It was a New Deal for depression, as well as for CBT. But did it work? A decade and a half on with IAPT, are we in any posi¬tion to give an an-swer? It is attempted to draw lessons about “what worked”, and what didn’t, to ask ourselves a question: are we – those of us in the applied psychoanalytic community – willing to garner what can be learned from IAPT to advocate a New Deal for evidence-based psychoanalysis? Faced with challenges from unemployment and widening inequalities, against a backdrop where global economic recovery must heed the existential threats from climate change and warfare, to say noth-ing of the scale of loss and grief for those already impacted by bereavement due to the pandemic, the need for such deal could not be more urgent.

Keywords: Improving Access to Psychological Therapies (IAPT); Dynamic Interpersonal Therapy (DIT); Evidence-based psychoanalysis; Street-level bureaucrats; Universal psychotherapy

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