Questions of supply and demand in dynamic psychotherapy

Abstract

Out-patient psychotherapy resources are severely limited in the face of a considerable mental health problem in the community. A review is made of the literature pertinent to the attempt to estimate the number of patients who receive, or might benefit from receiving, dynamic psychotherapy in the National Health Service. Among the many variables involved, problems of definition and the interests and opinions of general practitioners and hospital psychiatrists are prominent. Implications for the planning of psychotherapy training and service programmes are discussed.

Aspects of the patient intake process in a psychotherapy clinic

“…Furthermore, the rate of referrals was no higher the following year, suggesting that psychiatrists at the Centre communicated to referring agencies their anticipatory anxiety of being 'swamped ' if psychotherapy were to be made readily available. This may be partly a 'spill-over ' phenomenon from other areas of the National Health Service which have been overwhelmed when offering services, and seems to be consistent with the overall impression that only a very small proportion of the population who suffer emotional disturbance receives specialist psychotherapy (see Tyson & Reder, 1979). Also, there is evidence that a considerable need for psychotherapy services exists among minority groups (Kiev, 1965), and establishing the Centre in an area of London in which minority groups predominate, especially West Indians, led many of the staff to expect large numbers of them to apply.…”

“…General practitioners clearly preferred to specify individual psychotherapy for the patients they sent, and these patients constituted approximately 65 per cent of all patients referred for this form of treatment (Table 2). Just as certain general practitioners develop an inclination to utilize this resource for their patients (Tyson & Reder, 1979), so may other individuals in various referring agencies. Therefore, monitoring changes in level and quality of referrals may afford the specialist clinic an opportunity to anticipate changes in demand for services and perhaps to influence them as well (as for example through educational liaison seminars with referring agencies).…”