The R&D sub-committee was formed in 1996, following the Strategic Review of Psychotherapy services carried out by the Department of Health See: Parry, G. & Richardson, A. (1996) NHS Psychotherapy Services in England: Review of Strategic Policy. London: MHSE Department of Health. The review highlighted the absence of empirical evidence for the effectiveness of psychoanalytic psychotherapy, a point underscored in the clinical guidelines developed by NICE that prioritise evidence from randomised controlled trials.
The APP does not have resources to sponsor RCT studies, but it has invested in practice based research and in research dissemination by gathering together what evidence does exist, and ensuring policy makers and key NHS decision-making bodies are aware of this evidence.
Up until 2006, during the first phase of work, Marco Chiesa led an important project comparing outcomes from a number of NHS psychoanalytic psychotherapy services (presented at the AGM in 2006). See: Chiesa, M., Bateman, A., Fonagy, P. & Mace, C. (2009) Psychiatric morbidity and treatment pathway outcomes of patients presenting to specialist psychodynamic psychotherapy services: Results from a multi-centre study, Psychology and Psychotherapy 82: 83-98. One finding from undertaking this project was the generally poor level of routine outcome monitoring by psychoanalytic psychotherapy services that further exposes their vulnerability in a competitive commissioning climate.
From 2006 the work has been led by Jeremy Clarke, primarily with the aim of ensuring psychoanalytic psychotherapy is seen as an evidence-based therapy. Following the 2009 review of the Depression guidance by NICE, a new evidence-based version of brief dynamic therapy was developed for IAPT. See: Lemma, A. Target, M. & Fonagy, P. (2011) Brief Dynamic Interpersonal Therapy: a clinician’s guide OUP. Funding has been secured for a pilot RCT for this therapy, and the trial is due to get underway during 2012. The IAPT programme itself is now expanding into new areas (children and young people; serious mental illness; older people; long-term conditions and medically unexplained symptoms). A number of experienced psychoanalytic psychotherapists are placed in national advisory positions in these new work streams (Peter Fonagy; Alex Stirzaker and Anthony Bateman; Sandra Evans and Andrew Balfour; Brian Rock, respectively) to ensure we are in a position to secure opportunities for further expansion of psychoanalytic psychotherapy provision.
What is now very clear for the future of psychoanalytic psychotherapy is the strategic importance of being recommended in NICE guidelines. This remains a major challenge and requires, in all probability, collaborative efforts with other NHS disciplines (e.g. CBT) and internationally with other psychoanalytic research teams, testing new evidence-based models. At the same time, other forms of research, including practice-based evidence, can still make an important contribution to securing the future for psychoanalytic psychotherapy, and both the IAPT (Improving Access to Psychological Therapies) and NAPT (National Audit of Psychological Therapies) initiatives offer ways for psychoanalytic clinicians to engage with building the evidence base by routinely and systematically documenting their own outcomes.
See: Clarke, J. & Barkham, M., (2009) Evidence de rigeur: the shape of evidence in psychological therapies and the modern practitioner as teleoanalyst Clinical Psychology Forum 202 7-13
The Research lead is a member of the Executive Council and is responsible for organizing the Annual Phil Richardson Memorial Lecture that is given following the AGM, and published in the APP Journal. There is a limited amount of funding available as ‘seed corn grants’ for small-scale research projects. Details on how to apply for these are available from the office.
Jeremy Clarke, Research Lead