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Number 9: Winter 2013

Trauma and the Ghost Dance of Psychoanalytic Practice

Brid Greally

Currently, there is an increasing interest in trauma. As well as an extensive academic literature, there are new clinical trainings and the emergency services now employ trauma counsellors as part of their ‘Employment Assistance Programmes’. It would seem that the increasing popularity of the signifier ‘trauma’ is an attempt to grapple with extreme mental suffering, so it is curious that, at the same time, the provision of psychoanalytic practice in the public sector is in decline. In a press release, jointly published by the United Kingdom Council for Psychotherapy and the British Psychotherapy Council  in June 2013, it is claimed that 65% of psychoanalytic services within the public sector have been lost. The National Institute for Clinical Health and Excellence (NICE) guidelines which regulate the provision of health care across the National Health Service were issued in 2005.  These restrict the provision of psychotherapy to those which can provide positivistic evidence-based practice.   Protests from the psychoanalytic community have been muted except for a few exceptions, such as the Alliance for Counselling and Psychotherapy. In December 2012, the Alliance website described, in catastrophic language, the loss of psychoanalytic practice in the public sector. It described the situation thus: ‘the decimation of primary care counselling, the destruction of the National Health Service psychotherapy departments, by the growth of the scandalously insufficient Improving Access to Psychological Therapies Project, [and] by the unwarranted dominance of Cognitive Behaviour Therapy’ (Alliance 2012). Others seem to enthusiastically embrace the opportunity, for instance Fonagy, Target & Lemma (2011) claim to develop new practices which are both psychoanalytic and congruent with the NICE guidelines. Others, still, claim to combine psychodynamic therapy and cognitive behavioural therapies (Brumley, Northcut, Rovinelli & Heller 1998). Whilst the position of psychoanalysis has always been precarious, I wish to raise the question as to whether the current interest in trauma is linked or in some way symptomatic of the rise of positivism and the demise of psychoanalytic practice.