Esther12
Senior Member
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I'd just been sent a link to this free copy: http://www.lefnet.hu/resources/userfiles/file/Rihmer/Nutt -Psychotherapy.pdf
Uncritical positive regard? Issues
in the efficacy and safety of
psychotherapy
David J. Nutt
Psychopharmacology Unit, University of Bristol, Bristol, UK.
Michael Sharpe
School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh, UK
I thought this was a decent paper... although a bit scary that it was being written in 2008.
They look at side-effects like increased risk of suicide, but they don't look at side effects in terms of altering people's beliefs and preferences in ways that are not well understood and that patient have not given prior consent for, which seems like a serious danger with the medicalisation of people's minds and possibly false claims of expertise. Also - they don't talk about the possible social adverse affects that can come from this medicalisation. I know that it's harder to measure outcomes for these sorts of things... but that doesn't mean that they should be assumed to be unimportant.
They talk about the fact that even CBT for anxiety seems to have a poor evidence base compared to what would be expected for a new drug being brought to market, and the low levels of adverse effects which are taken seriously for drug treatments.
It isn't a paper with fascinating new ideas, but I thought I would post a link to it anyway, as it mentioned many of the things which other people here have complained about.
This is their conclusion:
Uncritical positive regard? Issues
in the efficacy and safety of
psychotherapy
David J. Nutt
Psychopharmacology Unit, University of Bristol, Bristol, UK.
Michael Sharpe
School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh, UK
I thought this was a decent paper... although a bit scary that it was being written in 2008.
They look at side-effects like increased risk of suicide, but they don't look at side effects in terms of altering people's beliefs and preferences in ways that are not well understood and that patient have not given prior consent for, which seems like a serious danger with the medicalisation of people's minds and possibly false claims of expertise. Also - they don't talk about the possible social adverse affects that can come from this medicalisation. I know that it's harder to measure outcomes for these sorts of things... but that doesn't mean that they should be assumed to be unimportant.
They talk about the fact that even CBT for anxiety seems to have a poor evidence base compared to what would be expected for a new drug being brought to market, and the low levels of adverse effects which are taken seriously for drug treatments.
It isn't a paper with fascinating new ideas, but I thought I would post a link to it anyway, as it mentioned many of the things which other people here have complained about.
This is their conclusion:
Can the safety of psychotherapy
be improved?
Taken together, it is clear that psychotherapy is not necessarily
always the benign yet efficacious therapy that seems to be generally
assumed. Patients should be made aware of the risks as well as the
benefits especially now we have a government initiative to improve
psychotherapy provision on the NHS. Recently the UK regulators
have amended the “yellow card” scheme for drug adverse effects so
that patients can use them (CSM 2004). Perhaps a similar scheme
should be introduced to require therapists, and allow patients, to
report problems with psychotherapy – a “pink card” perhaps?
It would seem appropriate that in the UK this be provided by the
new Medicines and Healthcare Regulatory Authority (MHRA),
which runs the drug adverse effect monitoring schemes.
In addition, therapists need to commit to performance and prac-
tise standards and agree to be monitored or audited in terms of
these. A psychotherapy standards agency might be required to per-
form these monitoring processes or it could be could be carried out
as part of professional audit of clinical teams depending on the
independence of the practitioners. Only therapists with appropriate
training and monitoring should be allowed to practice and if work-
ing in the NHS they should be required to only use treatments of
proven efficacy. But before all this and before rolling out psy-
chotherapy in place of drug treatment, proper controlled assess-
ments of efficacy and of safety need to be carried out.