This audit is relevant in psychotherapy services and considers re-referrals after the patient had received 20 sessions of psychodynamic psychotherapy.
Psychodynamic psychotherapy is one of the more commonly offered talking treatments in the National Health Service (NHS). It is usually offered on a once-weekly basis, with sessions lasting 50 minutes. The duration of treatment can range from 10 sessions or fewer (for brief therapies) to 6 months or less (moderate-length therapies) or 1 year or more (longer-term treatment).
Organising and Delivering Psychological Therapies (Department of Health, 2004) remains the most relevant publication for psychotherapy service delivery in secondary care. It also gives some direction on measuring service delivery. Two of its recommended action points for specialised mental health services are:
ᐅ contribute to the debate about the best performance indicators for psychological therapies – waiting times for psychology and psychotherapy assessment are the most promising
ᐅ extend the use of outcome measures across all aspects of psychological therapy service provision.
These action points can be extrapolated to standards that might apply to those individuals who have already been through the cycle of: assessment, referral, waiting list, therapy (a ‘dose’ of 20 sessions) and re-referral after unsuccessful treatment. These individuals will add to the burden of administering a waiting list, as they will have already been assessed and treated by a therapist within the department within the time limits set by the commissioners. Repeating such a process is frustrating for the patient and therapist alike, especially if the difficulty revolves around the treatment length having been too short for it to have been effective in promoting lasting psychological health, despite the treatment modality having been correctly selected and administered. If such individuals can be identified, for example through the application of the outcome measures routinely used in some departments (Clinical Outcomes in Routine Evaluation or CORE system of tools and patient satisfaction questionnaires – see http:// www.coreims.co.uk and Barkham et al, 2001), or by outcome measures resulting from clinical governance work, including the present audit, then this gives scope for the delivery of psychological therapies to be tailored to these individuals, to promote lasting psychological recovery.