"Who benefits from Psychotherapy? "

About: Nottinghamshire Healthcare NHS Foundation Trust / Adult mental health (inpatient)

(as the patient),

Last year I was seen by psychotherapists at Nottinghamshire Healthcare. I didnt want to see therapists in this trust as it is the trust I work for.

My details are now on the trust computer information system for all my colleagues to access. I am open about my mental health problems, but feel it should be my decision who at work I tell, not for colleagues to come across, they certainly shouldnt be able to access my address and other details, but they can.

The therapists were only really animated when they were asking me about how my work affected my mental health, which isnt my main concern.

The therapists I saw were really uncomfortable when I wanted to talk about my homosexuality. My sexuality has impacted on my mental health, and I wanted to talk about it. The therapists reaction was one of disgust and this made me feel worse about myself.

I thought the therapist was very manipulative. When I said I was discharging myself they made further appointments for me which I attended against my better judgement although they did not have anything constructive to say.

After seeing the psychotherapists I became more depressed and anxious, it has taken me about a year to get over the experience.

A lot of money is spent on psychotherapists, and the waiting lists are huge, I wonder who benefits.

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Response from Involvement Team , Involvement & Experience, Nottinghamshire Healthcare NHS Trust

We are very sorry to hear that your experience has been so negative. We as a Trust and in all psychological therapies within the organisation do not discriminate on sexuality and would regard any possibly homophobic reaction as a matter of very serious concern.

We can never refer to details of individual cases and we hope that you will voice your concerns informally or via a formal complaint by contacting the Service Liaison department on 0115 993 4542.

Your question about who benefits from psychotherapies, and there are many different forms of psychotherapy, is an excellent but a complex one. I have passed this question on to Professor Chris Evans who is Clinical Director for Psychological Therapies in Local Services in the Trust who will post a reply next week that will give some information and pointers to more work on the subject.

Thank you for bringing this to our attention.

Update posted by pans (the patient)

I have no intention of making a complaint as I do not believe that the trust's complaints process would be impartial or confidential.

I notice that there is no comment on how my details are held on the computer system against my wishes which causes me ongoing distress.

Response from Involvement Team , Involvement & Experience, Nottinghamshire Healthcare NHS Trust

Dr Chris Evan's has followed up your question. As you have raised a query in your latest posting around personal information, this is something that will be need to be followed up. Thank you for your response.

“Who benefits from psychotherapy?” is a really vital question but incredibly hard to answer in a satisfying and honest way. One simple answer some of us can give is “I did” and I can say that having had two periods of analytic therapy, one in a group and one individual. However, it’s easy to say that after the event but even then it’s hard to explain exactly what benefits you got. For me I’m sure I’m happier, easier to live with and more productive but how that happened is hard to explain and it’s impossible to deny the sceptic’s view that I’d have changed that much anyway.

One problem is that there are many different forms of psychotherapy: you can have therapy without another person: bibliotherapy in which you use a book, computer delivered therapy, self-therapy; you can have “individual therapy”, i.e. with one other person, you can have group, couple and family therapy, even multiple couple and multiple family group therapies. The therapy can be based on a wide range of theories. These include analytic/dynamic, humanistic, family/systemic, cognitive and behavioural theories and there are many varieties within each of those and also ways of combining some of them. Some researchers and therapists argue that all the theories we currently have are hopelessly incomplete and less important than the relationship that develops, often idiosyncratically, between the client and therapist.

There is an enormous amount of research evidence and research into the question started in the 1930s. Sadly there are no utterly clear answers yet though it’s clear that many therapies help many people and there’s some evidence that some therapies are best for particular problems or diagnoses though diagnosis doesn’t generally seem to be very important. There’s also some evidence that some people do better with some therapies than with others and some reason to believe that some therapies have complex change patterns with things often getting worse before getting better and getting a bit worse again at termination but then showing a continuing improvement that goes on long after the therapy ends (“sleeper effects”). In all, predicting who will do best with what remains very difficult and perhaps always will.

This probably seems a very frustrating answer but it’s an honest one and I believe it to be an accurate reflection of the enormously complex research literature as we have it now. I’m happy to try to give more detail or to try to answer questions about particular forms of therapy (individual, group, family etc.) or theories. I’m on leave for the next two weeks so response will be at least that slow.