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The place of psychotherapy in modern psychiatric practice

  • Chess Denman

Summary

This article makes a case for training and developing psychotherapeutically competent consultant general psychiatrists. It describes what such psychiatrists should know and suggests that they should be able to prescribe psychotherapy rationally and assess its outcome. They should be able to deliver some psychological treatments themselves but, more importantly, they should be competent to apply psychotherapeutic knowledge and emotional literacy skills to their routine clinical practice. Possible CPD experiences are suggested to increase the competencies of existing consultant general psychiatrists.

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Copyright

Corresponding author

Dr Chess Denman, Complex Cases Service, Springbank Ward, Fulbourn Hospital, Cambridge CB21 5EF, UK. Email: chess.denman@cpft.nhs.uk

Footnotes

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See pp. 240–242, this issue.

Declaration of Interest

None.

Footnotes

References

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BJPsych Advances
  • ISSN: 1355-5146
  • EISSN: 1472-1481
  • URL: /core/journals/bjpsych-advances
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The place of psychotherapy in modern psychiatric practice

  • Chess Denman
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eLetters

Adverse effects of psychotherapy

Ben Green, Professor/Consultant Psychiatrist
09 September 2011

This paper's presentation of the adverse effects of psychotherapy wasnovel and welcome. The topic is under-researched in comparison to the wealth of data on the side effects of medication. However the list of adverse effects presented here is not complete and although I am a frequent advocate of psychotherapy for patients I would venture to suggestthree very important adverse effects: inappropriate or missed diagnoses, psychological dependence and withdrawal, and finally boundary violations leading to sexual abuse or financial manipulation.

Sexual boundary violations during therapy crop up regularly at regulatory body hearings for psychiatrists, psychologists, psychiatric nurses and mental health social workers. Adjustment disorders, PTSD and relationship breakdowns ensue for the victims and these surely are an unwanted and major adverse effects of psychotherapy.

Being launched into therapy without a correct diagnosis is dangerous.As psychiatrists we may all have come across patients with organic illness(e.g. hyperthyroidism) having months of anxiety therapy when all they required was the correct investigations and management.

Similarly we will all have encountered self-funding psychotherapy patients whose 'time-limited' therapy has elongated into an unlimited assault on their time and pockets. They have become psychologically dependent on their therapists and their therapists have become financiallydependent on them in some kind of symbiosis.

I would suggest that therapists have a duty to advise about the potential adverse effects of psychotherapy at the start of therapy just asdoctors have a duty to advise patients about the side effects of the drugsthey prescribe. This is an example of seeking informed consent. Being openabout such adverse effects at the start of therapy and discussing their features may hopefully prevent their development.

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Conflict of interest: None declared

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