Reflections

I read with interest This Life by Helen Waddell (19 September), and
agree with her that a range of therapeutic options for people with
particular mental health needs should be available alongside
prescription drugs where appropriate. While I recognise the
experiences Helen describes, I want to offer an alternative
assessment of services I had when I required medication and therapy
for clinical depression.

My alternative assessment may be due to a number of factors: that I
accessed services in the mid 1980s; or that I had contact with a
different group of professionals. My GP agreed to refer me to the
clinical psychologist as well as prescribing anti-depressants.
Although I had to wait for therapy, I didn’t feel as if I had been
abandoned to my symptoms, which didn’t get worse while I was
waiting.

The clinical psychologist, who was a talented and caring woman,
assessed me and eventually we engaged in a productive
client-centred relationship. Although she didn’t always give me
what I thought I needed (in terms of access to her) she always
listened to me and offered me what Helen seems to have been denied:
talking therapy over an extended period of time. Unlike Helen, I
believe my drugs did work – they alleviated distressing symptoms
when I was in crisis, while therapy helped me to cope.

Since then I have continued to manage my mental health and gone to
a range of therapeutic groups, which I’ve paid to attend. I have
also trained as a psychodrama psychotherapist – every year I run a
therapy group for residents from a rehabilitation project who have
misused drugs or alcohol and who are unlikely to have psychotherapy
in the normal run of things. My experiences of helping those
residents to access other therapeutic services have shown me how
hard that is. Without such services it is difficult for people to
continue the work they’ve started.

As Helen argues, choice is crucial if people are to use services
that meet their specific needs. Without some sense of choice and
voice, people requiring services are unlikely to feel empowered by
systems or staff. There is always the thorny question of
negotiating when client and staff assessments of what is needed
differ, but the bigger issue, from my perspective, is the rise to
dominance of particular therapeutic approaches, often due to
attempts to offer services in organisations where budgets are
limited and need endless.

The standardisation of therapy makes it less effective, yet the
rise of “protocol therapy”, which is rooted in the “managed care
movement” and grounded in spurious notions of “evidence-based”
effectiveness, dominates therapeutic service delivery. Until that
changes, people will continue to have the sort of experiences Helen
described rather than those I had.

Annie Huntington is a lecturer in the directorate of social
work at the University of Salford.