A new deal for dynamic psychotherapies: The psychoanalyst as street-level bureaucrat

Abstract

In the UK in 2007 a national experiment was initiated with the aim of tackling “Britain's Biggest Social Problem”—Depression. Improving Access to Psychological Therapies (IAPT) was devised as the solution. A universal free-to-access talking therapies program would make available evidence-based treatment to all adults with depression. NICE (National Institute for Health and Care Excellence), the body that decides on what is cost-effective, said CBT, not antidepressants, should be its first line offer. The starting gun was fired. The promise from IAPT was 3-fold: to scale up access to CBT rapidly; to achieve recovery targets that would reduce the prevalence of depression over time; and—most ambitious of all—to ensure the Treasury would see a return on its investment by reducing the economic burden from depression. People who were on invalidity benefits due to depression would be supported back into employment. It was a New Deal for depression. As well as for CBT. But did it work? A decade and a half on with IAPT, are we in any position to give an answer? This paper will seek to draw lessons about “What Worked”, and what didn't, to ask ourselves a question: are we—those of us in the applied psychoanalytic community—willing to garner what can be learned from IAPT to advocate a new deal for evidence-based psychoanalysis? Faced with challenges from unemployment and widening inequalities, against a backdrop where global economic recovery must heed the existential threats from climate change and ongoing warfare, to say nothing of the scale of loss and grief for those already impacted by bereavement due to the pandemic, the need for some such deal could not be more urgent.