Mental health professionals are calling for further resources to enable the development of a broad range of psychological services, writes Sylvia Thompson
'Psychotherapy keeps people out of hospital." So said Prof Alan Carr, director of the doctoral training programme in clinical psychology at University College Dublin (UCD) recently.
Presenting a review of the effectiveness of psychotherapy, Prof Carr also called for a fully funded national psychotherapy service. "Psychotherapy is an effective treatment for an extensive range of psychological problems associated with physical illness and major life stresses in both adults and children," he said.
Last week the British government committed to developing comprehensive psychological therapy services throughout the country. In contrast, people here continue to have very little access to such services within the public mental health services.
Clinical psychologists, clinical nurse specialists, social workers and counsellors are currently among those who offer limited therapy services for problems such as anxiety or depression related to recent events such as loss or financial difficulties.
According to Dr Brion Sweeney, consultant psychiatrist and chairman of the Irish Council for Psychotherapy, a broader approach needs to be developed whereby people who would benefit from longer term psychotherapy for deeply entrenched psychological problems - would have access to trained psychotherapists. Such problems could include sexual abuse in childhood and other early life traumatic experiences.
"There needs to be more access to therapy for everyone which needs to be funded by the HSE. Meanwhile, what centres like ours is doing is plugging the gap," says Aileen Tierney, chief executive officer of the Clanwilliam Institute in Dublin.
The Clanwilliam Institute which has been running for 25 years was one of the first to offer psychotherapy to couples and individuals in the State.
During that time, Tierney says that the psychotherapeutic relationship has changed from one in which the psychotherapist is the expert to one in which the psychotherapist is the facilitator helping the client to reflect on their difficulties and find new ways of thinking.
This shift towards the client as expert is also part of the Government's 2006 mental health policy, A Vision for Change which stresses the role of advocacy and the inclusion of mental health service users in the development and training of health professionals.
Martin Rogan, assistant national director with responsibility for mental health in the HSE acknowledges that there is a growing need for more psychological therapies. "We wouldn't see this as a standalone psychotherapy service but we do see the need for various forms of psychological therapies at primary care level and within the mental health services."
"People now want to be more engaged with their recovery process," adds Rogan. "But if you consider that up to 10 per cent of our population is now not from Ireland, we also have to consider other forms of therapy such as art therapy and we need to develop staff with skills who can run family therapy groups and therapy for groups of people with similar experiences."
Support groups such as Aware, Grow, the Irish Advocacy Network and Schizophrenia Ireland have all highlighted the need for more access to psychotherapy within the mental health services.
Often such groups are also interested in accessing psychotherapy outside the traditional boundaries of the mental health services. "More and more people are seeking meaning in their lives and we are seeing men speaking out about the emotional issues in their lives as much as women," says Tierney.
"In the early days, it was mostly women who made the referrals. Fathers are also talking about their role as a father as much as women are."
Tierney says that many people come for psychotherapy at transitional points in their lives such as the early stage of relationships, parenting, when children are leaving home and facing retirement.
Meanwhile, while those who can pay for private psychotherapy will continue to do so, some experts are concerned that the current emphasis on evidence-based therapies will push psychotherapy out to the margins of the public health services.
Prof Paul Verhaeghe, head of the Department for Psychoanalysis and Counselling Psychology at the University of Ghent, Belgium is one of these. "The rise of protocol-based treatments makes psychotherapy much less efficient and will reinforce pharmacological approaches [to mental health problems]," he said at a recent conference in Dublin City University.
Prof Verhaeghe also argues that since current cultural values gives people the idea that they should receive everything without a personal effort, psychotherapy will be less effective. "Guilt has become an obscene word and if something goes wrong, the cause has to be looked for in some external agency," he explains.
On a more profound level, Verhaeghe suggests that new symptoms of panic, aggression and promiscuity are appearing in psychotherapy. Worryingly, he says the aim of these symptoms is purely one of "acting out or getting rid of inner tension without any hidden meaning". But, psychotherapists are trained to look for meaning and therein lies the dilemma. So, ironically, as more and more people with mental health problems begin to seek out psychotherapy to help them with their problems, some experts are beginning to say that the current forms of psychotherapy will no longer be equipped to help them.
Instead, the challenge will be to find new forms of psychological dialogue in which therapist and client can find ways to deal with these inner tensions.
More and more people are seeking meaning in their lives and we are seeing men speaking out about the emotional issues in their lives as much as women