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Medical psychotherapy: a specialty for now

  • Chris Mace (a1) and Kevin Healy (a2)
Summary

If many patients having multiple difficulties are to receive the integral and efficient psychotherapies they require, they need attention from psychiatrists who have specialised training in psychotherapy. This paper sets out the roles to which existing holders of the Certificate of Completion of Training have already moved to, as they work with patients, families, teams and organisations. The General Medical Council has recognised that the understanding of medical psychotherapists is also vital to the future clinical teaching of all psychiatric trainees. This paper summarises key components of the knowledge and roles of future specialists in medical psychotherapy. It recommends that the term ‘medical psychotherapy’ be used widely to clearly differentiate psychiatrists with this training and these responsibilities from non-medical psychotherapists.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Kevin Healy (kevin.healy@wlmht.nhs.uk)
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Declaration of interest

None.

Footnotes
References
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1 Postgraduate Medical Education and Training Board. The General and Specialist Medical Practice (Education, Training and Qualifications) Order 2003. Statutory Instruments 2003; 1250.
2 Bhugra, D, Jackson, R. Education and training. In 2006 Annual Review: 67. Royal College of Psychiatrists, 2006.
3 Royal College of Psychiatrists. Role of the Consultant Psychiatrist in Psychotherapy (College Report CR139). Royal College of Psychiatrists, 2006.
4 Mace, C, Rowland, N, Evans, C, Schroder, T, Halstead, J. Psychotherapy professionals in the UK: expansion and experiment. Eur J Psychother Counsel 2009; 11: 131–40.
5 Health Professions Council. Draft Standards of Proficiency for Counsellors and Psychotherapists. HPC, 2009.
6 Samuels, A. Therapy regulation. Times 2009; 12 December.
7 Gabbard, GO. Psychodynamic Psychiatry in Clinical Practice (4th edn). American Psychiatric Publishing, 2005.
8 Healy, K. Living with personality disorder. New Associations 2010; 3.
9 Johnston, J. Medical Psychotherapy: Specialist Handbook in Psychiatry. Oxford University Press, 2011 (in press).
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
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Medical psychotherapy: a specialty for now

  • Chris Mace (a1) and Kevin Healy (a2)
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eLetters

If not now, when...?

Jeremy a holmes, Visting Professor of Psychotherapy
17 August 2011

The contrast between the cover of this Month's The Psychiatrist and the content of its lead article (1) could hardly have been greater. On the outside: shocking depiction of a winged Freud in drag - women's bathing costume, high heels -- flanked by the sphinx. Inside: announcement of change of title from Consultant Psychotherapist to Consultant Medical Psychotherapist, buttressed by bland reassurance that 'the working role of medical psychotherapists has become more like that ofother consultant psychiatrists', warfare between different therapeutic modalities has ceased, and predictable pleas for greater recognition and investment in medical psychotherapy.

But, sadly, it's the cover that gets it right. Medical psychotherapyis a chimera trying awkwardly to reconcile two currently incompatible sets of values - medical instrumentalism and psychotherapeutic humanism. A change of name will do nothing to resolve Medical Psychotherapy's abiding dilemma: how to stay true to psychotherapeutic values without isolationism, or, claiming a spot in themainstream, undermining its case for a separate identity.

Rather, I would like to see Medical Psychotherapy accepting the full irony and challenge of its chimeral status: a 'hopeful monster' (2), ensuring on the one hand that psychiatry does not become increasingly confined to pharmacology and forensics, on the other that psychotherapistskeep sight of their prime task - contributing to the effective treatment of psychological illness.

But nature abhors a chimera. Cash-strapped chief executives are unlikely to fall in with Medical Psychotherapy's vague promises when they can get NICE-approved therapies delivered by bureaucracy-savvy Clinical Psychologists and Nurse Specialists at half the price.

Which brings us back to Mace and Healy's seemingly proud statement that Medical Psychotherapy is unique among the CCT-bearing specialties in being 'not descriptive of the types of patients seen'. But therein lies its great weakness. Despite today's name-change, the rose will smell as un-compelling until the Faculty of Medical Psychotherapy becomes the Faculty of Personality Disorders and Complex Cases. Then at last the unique skills of the Medical Psychotherapist really will be seen as indispensable, and Mace's legacy come to fruition. Yesterday's hopeful monster may yet become tomorrow's role-model: the psychotherapeutically sensitive psychiatrist..

1 Mace, C. & Healy, K. Medical psychotherapy: a speciality for now. The Psychiatrist (2011) 35, 301-304

2 Gould, S.J. (2002) The Structure of Evolutionary Theory. Harvard University Press: Cambridge MA

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Conflict of interest: None declared

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