The Princess of Wales is in hot water for some remarks she made while visiting the Open Door charity in Birkenhead, which helps teenagers with their mental health problems through arts and dance. She is reported to have said: ‘Talking therapies don’t work for some people, they’re not for everybody. It’s so important to have a range of therapies.’ Her remarks have naturally been interpreted as being a veiled swipe at her estranged brother-in-law and his use of psychotherapists. I’m not sure whether it is more po-faced to do that or take her at face value, but she does have an interesting point if she’s not thinking about her privacy-loving family author.
As with all areas of mental illness treatment, talking therapies still don’t have enough research behind them to indicate which ones work best. They don’t also get enough funding for patients to access them. The most popular ones are part of the NHS Improving Access to Psychological Therapies programme, which is aimed at anxiety and depression. The NHS isn’t meeting its targets on IAPT, with a shortfall of 474,790 people from the 2020–21 target of 1.6 million. But those therapies, such as cognitive behavioural therapy, only work for certain conditions. It is much more difficult for anyone with conditions such as bipolar disorder to get the therapy they need, and for the length of time they need it.
Then, there is the fact that the world of therapy is a nightmare to navigate, even when someone is in a good mental state. There is no statutory regulator of counselling in the UK, and instead there are a number of organisations to which therapists can be accredited – though of course that’s not a sign of quality. Therapy is intensely personal and even ‘good’ practitioners can find certain patients struggle to form a bond with them, and therefore don’t open up. In some cases, it might just be because the therapist and client don’t get on. In others, it’s because talking is really difficult for a person with a buried childhood trauma that might be manifesting itself in addiction, for instance. Some therapies, used on the wrong patient, can be deeply inappropriate and make dealing with their trauma much harder.
The ‘talking therapies don’t work for some people’ line came when the Princess asked one of the boys helped by the charity if the music workshop he was attending had ‘helped with your personal lives’. His response was: ‘Producing music and letting out what you’re feeling is better than saying it in a clinical atmosphere. I can put it into words. That was tough to explain.’
The problem at the moment is that clinicians don’t always know which therapy, talking or otherwise, might work best for each patient. There are protocols within the NHS for this and for antidepressants, but they are quite clunky. Some researchers are developing a model called the Personalised Advantage Index which will list the likely impact of treatment options for each patient using the data that already exists. That will allow a doctor to decide whether talking therapy is going to work for someone, and then what sort of talking therapy might be best.
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