Clinical Psychologists’ Usage and Experiences of Psychoanalysis and Psychoanalytically-Informed Approaches Within the NHS

Background

Psychoanalytic approaches have decreased in use as a therapy in the UK. After an initial growth in Britain post World War One, the subsequent emphasis on using empirically supported treatments resulted in cognitive and behavioural approaches being prioritized. Neoliberalism and austerity measures have led to an emphasis on short-term, low cost treatments, and the further marginalization of psychoanalytic approaches. There is no research exploring its use within clinical psychology in the NHS, despite increased research supporting its utility and a policy emphasis on patient choice.

Aims

This research will aim to explore how clinical psychologists use the psychoanalytic approach within the NHS and their experience of the approach.

Methods

A mixed methods approach was used. A quantitative online survey of clinical psychologists working within the NHS in the UK (N=189) collected demographic data as well as information about modalities used and their services, clients and training characteristics. An interview was used to explore the experiences of clinical psychologists of using the psychoanalytic approach
within the NHS.

Results

It was found that a higher percentage of participants (18%) used the psychoanalytic approach than expected from previous research. A greater majority used CBT and third wave approaches. Most participants using psychoanalytic approaches worked with adults with severe and enduring difficulties in secondary care settings. From the interviews, participants spoke about having little space and practical time to use psychoanalytic approaches within services. Participants spoke about how the approach was useful to provide space for clinicians and clients to reflect and build a therapeutic
relationship. However, some participants expressed concern that it could be regarded as elitist and inaccessible to some client groups. There was debate about the future of psychoanalytic approaches within the NHS.

Conclusions

Some clinical psychologists use psychoanalytic approaches in practice and find it useful, although there are service barriers that constrain its use within the NHS that should be addressed. Strengths and limitations of the study are discussed and recommendations made for future research.