A new report shows a large rise in suicide attempts among people who claim the main out-of-work disability benefit. The research, reported by Disability News Service (DNS), draws on NHS data and covers the period between 2007 and 2014. It indicates that in 2007 – a year before the introduction of the much-criticised work capability assessment (WCA) used to determine who is awarded Employment Support Allowance – 21 per cent of incapacity benefit (IB) claimants (as the main out of work disability benefit was then called) told researchers they had attempted suicide at some point in their lives. The following year, IB began to be replaced by ESA, with eligibility tested by the WCA. By 2014 more than 43 per cent of claimants were saying they had attempted suicide.

DNS also reports that the ‘strongest evidence until now that there was a link between the WCA and an increase in mental distress came in November 2015, when public health experts from the Universities of Liverpool and Oxford showed in a study that, for every 10,000 IB claimants in England who were reassessed for ESA between 2010 and 2013, there were an additional six suicides, 2,700 cases of self-reported mental health problems, and an increase of more than 7,000 in the number of anti-depressants prescribed.’

This article by Oliver Burkeman takes a thorough look at the evidence base for psychoanalytic-based therapies compared to cognitive behavioural therapy. Given the increasing media chatter about an impending robotics revolution, some of his coverage evokes the (worrying) thought of the potential role for robots in some kind of future mental health provision. Burkeman cites a patient’s comments on the alienation and isolation she was left with when a computer programme all too unconvincingly announced its sympathy: ‘… “I don’t think anything has ever made me feel as lonely and isolated as having a computer program ask me how I felt on a scale of one to five, and – after I’d clicked the sad emoticon on the screen – telling me it was ‘sorry to hear that’ in a prerecorded voice,” Rachel recalled.’

‘Rachel’ goes on to suggest that completing CBT worksheets under a human therapist’s guidance wasn’t much better: ‘… “With postnatal depression,” she said, “you’ve gone from a situation in which you’ve been working, earning your own money, doing interesting things – and suddenly you’re at home on your own, mostly covered in sick, with no adult to talk to.” What she needed, she sees now, was real connection: that fundamental if hard-to-express sense of being held in the mind of another person, even if only for a short period each week.’

Burkeman uses data to argue that psychoanalytic therapies, long derided by their critics as too time and money intensive, are longer lasting in their effects: ‘Ask how people are doing as soon as their treatment ends, and CBT looks convincing. Return months or years later, though, and the benefits have often faded, while the effects of psychoanalytic therapies remain, or have even increased…’

Online comments to the article object that Burkeman’s analysis is too harsh and generalising, and insist that CBT, delivered by adequately trained therapists, can be effective – and it’s an argument worth thinking about. But central to Burkeman’s argument is the very question: what is the point of therapy? CBT and psychoanalytic approaches have different ends in mind to an important extent. These different ends shape the structures of the therapy and alter the subjective experience.

Burkeman puts it: ‘CBT’s implied promise is that there’s a relatively simple, step-by-step way to gain mastery over suffering. But perhaps there’s more to be gained from acknowledging how little control – over our lives, our emotions, and other people’s actions – we really have?’. He ponders: ‘what should count as a successful outcome anyway?’ Psychoanalysis argues that ‘there’s more to a meaningful life than being symptom-free. In principle, you might even end a course of psychoanalysis sadder – though wiser, more conscious of your previously unconscious responses, and living in a more engaged way – and still deem the experience a success.’

 

This Guardian article makes the case – one not often aired in the mainstream media – for a much wider availability of psychoanalysis. The writer draws on her personal experience argues that while psychoanalysis (or therapies based on it) is not for everyone ‘anyone who thinks introspection is the same as solipsism, or pictures a world in which many more people undergo psychotherapy as a self-indulgent, Beverly Hills nightmare, is wrong. A country in which reflection and curiosity about oneself is encouraged would be a wiser, kinder place.’ She also provides a link to yet more recent evidence on the effectiveness of psychodynamic therapy.

It is often assumed that there is little quantitative evidence for the effectiveness of psychoanalytic psychotherapy. On the one hand, NHS provision is geared around alternatives, particularly towards cognitive behavioural therapy (CBT) and medication. It is argued that the evidence base for these is strong, and their relative availability – compared with psychodynamic (therapies based on psychoanalytic principles) therapy – within the NHS lends support to this idea. Indeed when ‘talking therapies’ are referred to it is often CBT that is meant – as is the case in this report. Even some psychodynamic psychotherapists themselves assume that, while they know from the evidence of their own work that psychoanalytic therapy can be very effective, it is not ‘measurable’ in the way something such as CBT is.

However, this article by Jonathan Shedler analyses multiple research studies to show that plentiful evidence does exist for the effectiveness of psychoanalytic psychotherapy. He argues that much of this research is not publicised (and questions why this is so) and the reports of the research are often so technically written that it is difficult even for other researchers to interpret the data – but it does exist.

Shedler argues that this data firmly refutes the ‘belief in some quarters that psychodynamic concepts and treatments lack empirical support or that scientific evidence shows that other forms of treatment are more effective’. This is a belief, he argues, which ‘appears to have taken on a life of its own’ – and yet it is not evidence-based. Far from it, he says, as the effects of psychodynamic therapies are often longer lasting and deeper. He also argues that evidence indicates that, often unacknowledged, psychodynamic elements in CBT that contribute to its effectiveness.

Jonathan Shedler’s article, ‘The Efficacy of Psychodynamic Psychotherapy’, can be found in American Psychology, 2010, vol 65. A link to a summary of it is here.

Research by the umbrella psychotherapy professional network UKCP found a massive increase in anxiety and depression among out of work people in recent years. The time period considered in the research overlaps with changes in government policy on unemployment benefits – including the introduction of harsher sanctions for those who fail to comply with an often complex and demanding benefits framework. It is this link between increases in psychological distress among unemployed people and current benefit policy that has led UKCP to call on government to suspend the sanctions regime and review the impact of its welfare policies on mental health. UKCP is also calling for greater resources to mental health services.

Further details on the research and UKCP’s proposals can be found here:
rise in psychological distress among unemployed people