Oliver Burkeman’s article (Therapy Wars, The long read, 7 January) provides an excellent overview of the history and current debates within the psychological therapy world. Thankfully “the war” is ending and it is increasingly recognised that it is not a binary debate between cognitive behavioural therapy and psychoanalysis.

CBT is an effective intervention for some people at certain times in their lives, and proponents such as Richard Layard (Tony Blair’s “happiness tsar”) and Professor David Clark should be congratulated for ensuring its increasing availability within the NHS.

For others there is a need for someone to “hear their story”. When that person is a highly trained psychotherapist who can understand and help them understand the causes of their emotions and behaviours, the benefits can be considerable and long lasting, as the results of the Tavistock depression study suggest.

The psychoanalytic profession is working with our cognitive colleagues and other professionals in counselling, psychology, psychiatry and neuroscience. The evidence base is becoming clearer, and groundbreaking work with neuroscientists such as Professor Mark Solms in South Africa, has the potential to bring Freud’s often arcane language into the modern world. As “the war” draws to an end, what is becoming clearer is that different therapies have their place, and with informed choice (underpinned by growing research and evidence) it is time to get back on the couch.

Gary Fereday

Chief executive, British Psychoanalytic Council

• Oliver Burkeman doesn’t devote a single line to the more serious therapeutic issue of our times – the wholesale wastage of trained and experienced person-centred counsellors, many thousands of them, in the NHS, employment assistance programmes and elsewhere who have been culled in the cognitive-behavioural craze of the last decade. More than half of Britain’s counsellors have been trained in the humanistic PC (person-centred) school seeded by the eminent US psychotherapist Carl Rogers. Yet thousands of my humanistic-therapy colleagues, as is being widely reported these days by the British Association for Counselling and Psychotherapy, are unable to find work despite the fact our society is self-evidently falling apart around our ears, with people in more need of help than ever.

John Pepper

Lancaster

• Embedded within Oliver Burkeman’s excellent overview is a very distressing human story: of a young woman, Rachel, struggling with postnatal depression, being “treated” by a computerised programme, which leaves her feeling even more lonely and isolated, because she is denied a human relationship within which her pain and distress could be made sense of. And yet this is the logical conclusion of a government policy aimed at providing therapy on the cheap, in a one-size-fits-all approach, which affords little allowance for the diversity and complexity of human emotional pain.

Meanwhile, and not unconnected, NHS departments providing psychoanalytic therapy are being dismantled across the country. It is likely that in five years psychoanalytic therapy will have mostly disappeared from the NHS. For people like Rachel, that is a tragic situation.

Noel Hess

Consultant clinical psychologist in psychotherapy, St Pancras Hospital, London

• There is one important group of people who do benefit from CBT: the homeless. The extent and severity of psychological and mental health problems among rough sleepers and homeless people is becoming evident.Sixty per cent of residents of hostels in England have a diagnosable personality disorder, compared with about 10% in the general population. Also over-represented are histories of neglect, abuse and traumatic life events dating back to childhood and continuing through adult life.

Homeless people often self-medicate with drugs and alcohol, exhibit antisocial or aggressive behaviour and have long offending histories. This leads to exclusion, rough sleeping and ill health. Average life expectancy for male rough sleepers is 47 and for females, 43.

The development of psychologically informed services for homeless people helps staff work constructively with people with challenging behaviour, and improves outcomes for some extremely excluded and vulnerable people.

CBT and other therapies are not the answer to chronic homelessness but they can help people understand and manage their emotions. This means they will have more chance of finding and keeping accommodation and also of getting into mental and physical health services. It’s part of a pathway into recovery.

Helen Keats

Rough sleeping adviser, Shorwell, Isle of Wight

• Excellent piece by Oliver Burkeman on the ongoing battle for supremacy between psychoanalytic therapies and CBT. But what baffles and frustrates me, as a counselling student, is the blinkered factionalism that insists we have to have to choose which side we’re on. To me, for example, it seems blindingly obvious that learning to “challenge your inner critic” (CBT) is a good idea, but that any thoughtful person will also want to explore why they have an “inner critic”, and what its origins are (psychoanalytic).

Lindsay Camp

Bristol

• Oliver Burkeman’s reliable and up-to-the-minute survey of the psychotherapy scene leaves the sources of emotional suffering unexamined. Wrong thinking and infantile neurosis may well be sources of personal distress for some, but there is a growing realisation among therapists of all schools that experience of living in society has an exceptionally strong impact on the psyche. There is not so firm a boundary between the inner world and the outer world as we had assumed. Prejudice and discrimination, unbridled ambition and acquisitiveness, economic inequality, violence at home and abroad, even environmental despoliation – all these cause high degrees of anxiety and distress in citizens, whether therapy clients or not. It may be difficult to accept that these more-than-personal aspects of the human condition work on us in these ways – but what therapists hear from their clients bears it out.

What this means is that issues of emotional health and resilience should grab the attention of politicians and policymakers across the board. Every government policy has an emotional consequence – and in these days of austerity this is becoming more and more pronounced. And every government policy has an emotional root – perhaps our politics also needs some therapy.

Professor Andrew Samuels

University of Essex

• As a practising Jungian psychoanalyst, qualified in 1995, I would like to add this perspective to the views expressed: modern psychoanalysis, ie the treatment of emotional suffering through the medium of a reliable and benign relationship with another, has its roots in the simplest and most profound truth: a baby who has a mother who is emotionally available, loving and interested, has a better chance of growing up to be able to weather the storms of life without recourse to self-destructive (eg drug/alcohol dependency) responses.

In psychoanalysis, patients who have not been able to have this early natural relationship, have an opportunity to experience dependency and to grow through it, into emotional maturity and self-reliance. The human importance of the therapeutic benefit of a consistent reliable relationship is evident in schools, hospitals, day nurseries, care homes, GP surgeries and social work departments. Cost-cutting has meant that this vital therapeutic ingredient has almost disappeared in any recognised form, other than within the psychoanalytic consulting room.

Lest this sound too cosy, the findings of neuroscience are increasingly supporting this view and attachment theory research gives us information about the many ways in which disrupted early bonds cause life-long damage. Offering consistent support to distressed and alienated people is difficult, challenging and requires mental and emotional strength. Freud, Jung, all the psychoanalytic pioneers and every psychoanalyst since them, were and are ordinary humans with ordinary weaknesses and frailties, but the core of the psychoanalytic message remains supremely important and is ignored at our peril.

Anne Ashley

Purley, Surrey

• More letters on therapy: Where the power lies in the therapist-client relationship

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