PSYCHOTHERAPY IN NEW ZEALAND

Press, Volume XCV, Issue 28252, 13 April 1957, Page 6

PSYCHOTHERAPY IN NEW ZEALAND

Poverty Of Psychiatric

Facilities

PLEA FOR DIVERSION OF MONEY SPENT ON DRUGS

[By an Otago Medical School n

A LL psychotherapy, as we see it today in the English-speaking countries at least, has strong roots in the pioneering of Freud and in the science of psychoanalysis which sprang up from it. However, it is neither practicable nor, fortunately, necessary for most psychotherapy to be of the order of unabridged psychoanalysis. Shorter modifications have been introduced together with many new methods. In the bare outline which is all that space permits, it is impossible to do justice to the variety, ingenuity, and liveliness of contemporary psychotherapeutic techniques, and to indicate more than scantily the training of the professional personnel referred to.

Individual psychotherapy in-| eludes a variety of treatments, some very specialised and timeconsuming. some easily practised by the family doctor, some only suitable for certain cases in highly organised mental hospitals. Psychoanalysis in the proper sense involves an hour's session, four or five days a week, over a period of months or years, and consequently its cost is prohibitive. For practical purposes, it is not available to the ordinary oerson here, but in Britain, the National Health Service pays for or subsidises it in some general hospital clinics and for some patients in mental hospitals. More commonly there, the psychiatric departments (which all sizeable hospitals

possess) offer systematic psychotherapy, not amounting to psychoanalysis, once or twice weekly. Long waiting lists are the rule because, as we have seen, psychological ill-health is exceedingly common and trained staff in short supply still. Self-Understanding

Psychotherapy aims, by discussing the past and present, the analysis of dreams, and perhaps other approaches, to overcome maladjustments by giving corrective emotional experience and not by tendering advice. The psychotherapist is not a counsellor —the patient will have encountered much well-meant advice already. Instead he seeks to promote more efficiency for coping with life by promoting enhanced self-understanding. Intensive psychotherapy is the field of the specialist. Such a specialist may be a medically qualified psychiatrist who, apart from training in the mental hospital -field, has also had further experience in psychoanalytic methods and usually been psychoanalysed himself, or else he may be a university-fledged psychologist with similar additional training in psychoanalysis, who works under medical supervision. For psychiatrists and psychologists in New Zealand there is as yet no publicly financed training of this kind in psychotherapy. A tiny handful of professional persons have obtained it on their own initiative overseas, and nonmedical psychologists in the Justice Department are making commendable efforts to render themselves proficient for psychotherapeutic work in prisons. Smaller scale psychotherapy is. of course, no monopoly of psychiatry. In London and elsewhere, certain analytic clinics run courses to impart their methods to family doctors, and in America medical men are increasingly submitting themselves for psychoanalysis with the aim of improving their competence to manage the everpresent psychological problems of general practice. The psychiatric team always includes the psychiatric social worker (a very rare creature here), who among other functions, supplies certain varieties of psychotherapy, not only to patients but to others involved in their difficulties. Group Psychotherapy Psychotherapy with groups and communities traces its origins to the 1920’5, when inspired educators, such as Susan. Isaacs in England and August Aichom in Austria, began to apply the insights of psychoanalysis to normal children at school and to juvenile delinquents. Experiments in the British Army in the last war gave it an immense impetus and since then it flourishes over a continually growing territory so that only a few of its uses can be listed here. First, in a fashion reminiscent of psychoanalysis, several patients may meet in a group for regular sessions with a therapist, and this may sometimes be supplemented with regular but less frequent inidvidual sessions too. The method may also serve as a valuable form of support for husbands, wives, and parents of patients who are undergoing more intensive psychiatric treatment Then, there is the technique known as psychodrama, in which the members of the group present a theatrical re-enactment of some person’s life story and troubles, and discuss its nature and its ' solution with the psychiatric team. 1 Such performances can be an enormous stimulus to thought and to self-examination.

It is in mental hospitals, special schools, prisons, and for the rehabilitation of unemployables, alcoholics, and people who have not regained social confidence after a breakdown, that group methods contain particular possibilities. For example, people who have apparently become derelict and apathetic with the years in mental hospitals occasionally may improve surprisingly with placement in a small and supervised group, and may come to take part in simple work and pleasures in the institution. In psychiatric social clubs, patients can retain a link with the clinic, employ psychodrama spontaneously to help themselves, obtain individual psycnotherapy sessions when needed, and practise overcoming difficulties and inhibitions in a sympathetic setting. Child psychiatry is now a specialty within a specialty, but its methods are essentially those ©f the adult department. There are some differences—nsvchotherarrv

-|is almost the only treatment com- , monly used, and the child, even - more than the adult patient, is r unlikely to be treated in isolation ■ from the family. It seems pointr less at this stage to relate any details of psychotherapeutic r methods with children since, apart , from Dimedin, there is not a r single child psychiatry clinic in 1 the whole country. In so far as . help is available at all for malt adjusted children, it comes at i present from interested practi--1 tioners, child specialists, and - school doctors, and from the 1 psychological services and child i welfare division of the Education t Department, which is not, prims arily, an organisation connected s with health.

What is to be Done? It will be evident to the reader that the Hospital Boards’ Association, by pinpointing the absence of psychotherapy in our health services, has drawn attention to the poverty of psychiatric facilities in general for the community. Outside the mental hospitals.

which deal with only a fraction of the problems of psychological illness, this very rich country completely fails to provide for one of its largest public health problems. The Mental Hygiene Division’s mental hospitals themselves are understaffed, often with a ratio of one doctor to hundreds of patients, and it is futile to expect them usefully to man psychiatric departments in urban general hospitals. Such departments supplying a full-time general service for both adults and children, and staffed by teams with experience of modern psychotherapy, are the first need. For a start, personnel would have to be recruited overseas and trained tljere, but in time, as they multiplied, training here would grow feasible. By their influence on medicine, education, and other social institutions, ser-

vices developed on these lines would be preventive as well as curative, they would save public money and reduce the cost of disease in the long run. I can already hear the politician's and the plain man’s objection to the capital expenditure involved. In 1955-56, the nation’s

drug bill exceeded £4m, an increase of £lm over the previous year’s bill. This article has a simple theme—could not some of this money be better spent for the nation’s health to develop the services suggested here?