Council for Psychoanalysis and Jungian Analysis

The CPJA is a College of the UK Council for Psychotherapy. It has an individual membership of over 1800 practitioners and brings together 30 Organisational Members, most of which offer training courses. It is the largest organisation of psychodynamic, psychoanalytic and Jungian psychotherapists in the UK.

What kind of psychotherapy do CPJA members offer?

All members of the CPJA believe that unconscious processes shape our behaviour and our lives. Broadly speaking this means that we don’t know as much about ourselves as we think we do.

The unconscious is, as the word suggests, ‘un’-conscious but manifests in dreams, symptoms and patterns of behaviour. Often we know these patterns are damaging to our selves and others, but we feel powerless to change them. More positively, the unconscious is also a source of creativity and imagination.

Members of the CPJA work with people with a very wide range of concerns, such as depression, anxiety, sexual and relationship problems, conflicts at work or in education, and loss of a sense of meaning and purpose in life. However, it is not necessary to have a specific problem but simply desire to undertake a journey of discovery. Read more here.

Are you looking for a psychotherapist?

Our members work with children, adolescents, adults and older people, with people with disabilities, with couples, groups, and families. If you are looking for a psychotherapist, please use our find a therapist page.

CPJA members: for latest news, scroll down …

The Next CPJA Meeting on Saturday 16 July 2016

The next College meeting will take place from 12.00 on Saturday 16 July 2016 at Channing Hall, Upper Chapel, Norfolk Street, Sheffield S1 2JD.  This is very close to the station and can be located on

This will be the first ‘regional’ College meeting and all members of CPJA are invited to attend.  Lunch will be provided at 12.00 and the pre-meeting discussion will begin at 12.30.  Martin Pollecoff, the new Chair of UKCP, will be present so this will e a good opportunity for members to ask questions about issues of interest or concern.

If you wish to attend please email to reserve a place.


” THE GUARDIAN ” 16 / 22 MAY IS MENTAL HEALTH WEEK ( see blog below from a GP published on 16th MAY )

GPs like me can’t help mental health patients in 10 minutes – it’s cruel
When I refer people with severe depression, who are sometimes suicidal, they can wait up to six weeks for therapy
There are 10 times more people suffering with major depression compared to 1945
There are 10 times more people suffering with major depression compared to 1945 Photograph: Alamy
J Ratnarajan

The word compassion in all Latin derived languages combines the prefix, with (com) and the root, to bear or suffering (passio). For a doctor and all health professionals this is a given prerequisite. We suffer with our patients. It is the essential penance we shoulder in return for the wondrous joy of helping those in need.

I am a GP, and as such I act as one of the gatekeepers to the health service. People of any age and problem can walk through our door. Wherever possible we either treat or reassure. If not then we direct the patient to another NHS service for help.

In general practice we see a large number of patients in need. Few people more so than those struggling with mental health problems. There are 10 times more people suffering with major depression compared to 1945. It is utterly heartbreaking to see a depressed person who is struggling, only to reply to them: “Sorry, but the counselling you need is at least a six-week wait”. To this patient, six weeks is 42 days (and nights), 1,008 hours, 60,480 minutes or 3.63 million seconds.

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These seconds are not ordinary seconds. Life feels like constantly walking in oversized wellies through knee-high wet mud. It is backbreaking, emotionally draining, gloomy and painful. As their GP, I have to condemn my patient to at least 3.63 million seconds of further torture without hope. I feel so helpless and cruel.

This horribly familiar feeling was evident with a recent patient of mine. He was a gentle young man who had cared for his mother and watched her slowly die. Nine months after her demise, the strain of tending to her and the suffocating pain of loss had taken its toll. He came to me quivering in desperation, not for happiness, but for temporary relief. I listened and told him no one could replace his mum. I listened and told him he was a good man. I listened and told him I could never fully understand what he is going through, but I’ll try. I told him I am here to help. After a few appointments a trust was built. I advised him that counselling could help him find peace, he agreed.

Between appointments a birthday and mother’s day came cruelly to remind him of a lost vision of the future. He returned having taken three steps back. He also told me that the waiting time for counselling was six weeks – 1,008 hours wondering “What is the point in this suffering?”.

In primary care we only have 10-minute appointments. This does no justice to the complexity of issues surrounding a person’s depression. We need the help of other counselling and secondary care services. To shelve people’s misery in this kind of environment does so much damage. A loss of faith in those you came to in desperation is a disaster for patients with mental health problems.

I worked as a junior doctor in psychiatry and spoke frequently with patients who had attempted suicide. I always wondered when we could have intervened to convince them that life is better than death. Unfortunately I’ve come to realise that the deck is stacked against them and us. There were 6,233 people over the age of 15 that killed themselves in 2013 (252 more than 2012). Despite this, Jeremy Hunt and company continue to whittle the bones of our NHS.

Each time I need to tell someone they have to wait for treatment, it feels like one of those moments I should never forget. You try to leave your patients at work, but you can’t. A thought for them will corner you at any time. The frustration of knowing we could help them. The anger of knowing that the professions’ call for proper funding is being ignored, again. The sadness of knowing the utter tragedy that befalls under treated mental health problems. These are today’s truths that leave you drained. Leaving you unable to care for your loved ones properly. They patiently sympathise, while never fully understanding.

Seeing how the NHS handles attempted child suicide scares me
Read more
I rather naively became a doctor because I wanted to help people. An opportunity for me to provide some good back into this world. It is a fading truth that I have to keep trying to remind myself of these days. Compassion is the burden I willingly suffer each day. For how long? Well, that depends on the shelter this government provides.

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A Climate Psychology Alliance Conference: ” The Psychology of Climate Action – New Perspectives on Leadership ” November 19th

Save the date for a Climate Psychology Alliance conference

The Psychology of Climate Action – New Perspectives on Leadership
Saturday 19th November 2016
Holloway Resource Centre, 356 Holloway Road, London N7 6PA

The aim of the event is to:

Clarify the contribution and links between key elements in climate leadership
Open up for discussion the psychological and psycho-social dynamics which enable/ impede effective climate action

Caroline Lucas MP – Professor Paul Hoggett – Professor Andrew Samuels – Sally Weintrobe – Richard Black – Cate Lamb
+ Workshops
Further details see

GAP with The Wigmore Hall present The Vera von de Heydt Public Lecture Series- June 4th

G.A.P. in collaboration with the Wigmore Hall

Cavatina: The Inner Life of Ensemble

Saturday 4th June 2.00 – 4.00 pm

Wigmore Hall
36 Wigmore Street, London W1U 2BP

In this unique lecture-recital, Professor Paul Robertson, leader of the renowned Medici String Quartet, offers his perspective on the inner workings and emotional dynamics of ensemble playing.

Paul shares his experiences of the pressures, the struggles, the spiritual costs and rewards of a music ensemble. In conversation with Tia Kuchmy, Jungian analyst and musician, Paul answers questions about how a string quartet comes into being, rehearses and forges its joint interpretative decisions. Playing in an ensemble is a metaphor for life itself and illustrates the tension between outer and inner reality. Paul describes the striving and intense emotional ambivalence the players experience within the music, and occasionally between themselves. In what will almost certainly be their very last appearance together, the Medici String Quartet perform Beethoven’s Cavatina as a tribute to their and their previous colleagues’ musical life as an ensemble.Professor Paul Robertson founded the Medici Quartet forty-five years ago. During this time, he has been visiting Professor in Music and Medicine to the Peninsula Medical School, Visiting Fellow of Green, Templeton College, Oxford, a Fellow of the RSA and Associate of the Royal Society of Medicine. His work exploring the neurological and scientific basis of music reached a wide audience with the Channel 4 television series Music and the Mind. More recently, his award-winning Radio 4 programme Hearing Ragas explored his time in coma and close relationship with the composer Sir John Tavener. Paul’s book Soundscapes of the Soul will be published by Faber & Faber in Autumn 2016.

Tia Kuchmy is a Jungian analyst with IGAP, London. Originally trained as a musician, she has a special interest in linking the insights of C.G. Jung with archetypal dynamics in the realm of music, and has given talks in Jungian circles on a variety of topics, including the music of Michael Tippett, Bartok’s Bluebeard’s Castle, and Wagner’s Parsifal.

Tickets priced £15/£10 are available from the Wigmore Hall
(The Wigmore Hall have a special rate of £5 for the under 35s)

CPD Accredited

For further details please contact the Wigmore Hall or 020 7935 2141

G.A.P. Administrator
0118 922 2993
4 Ennerdale Road
Reading RG2 7HH
The Guild of Analytical Psychologists
is a company registered in England number 3252741
Registered office: 4 Ennerdale Road, Reading, Berks RG2 7HH
Registered Charity number 1058818

ADAM PHILLIPS ” Talking about Clinical Work ” run by THE SITE Sept 28th

‘Talking about clinical work’
Wednesday 28th September 7.30pm
8th Oct 2016 Working with couples Haya Oakley
12th Nov 2016 The impact of suicide Paul Gurney
21st Jan 2017 The responsible
supervisor Jim O’Neill
4th Feb 2017 Psychoanalysis & Truth Angela Kreeger
8th April 2017 Working with psychosis Dorothée Bonnigal-Katz
6th May 2017 Psychoanalysis & class Barry Watt
10th June 2017 Working with drug &
alcohol addiction Eric Harper
October Gallery
24 Old Gloucester Street
London WC1N 3AL
£50.00 per workshop
£40.00 each if you book
3 or more workshops
For more info, visit
To book, email siteenquiries20

WMIP Summer Conference ” On the Language of Analysis : the words we work with that work on us ” JULY 2 nd

WMIP Summer Conference
On the language of analysis:
The words we work with that work on us
2 July 2016
9.30 for 10.00 am – 4.00 pm
Edgbaston Quaker Meeting House, St James Road, Birmingham, B15 1JP
Speakers: Birgit Heuer and Josephine Evetts-Secker
In any ‘talking therapy’ words are not only the medium but also the message. Language is
symbolic, creating powerful communications both conscious and unconscious. But how
often do we reflect on the underlying layers of the language we use with and about our
patients? What are the deeper resonances of meaning and connection revealed by our
language as used in the consulting room and shared in analytical writing?
The WMIP summer conference presents two papers by two experienced analytical
psychotherapists, with space for questions, discussion and reflection.
Birgit Heuer: Sanatology: Towards a Language of Health and
Birgit Heuer’s analysis of the language used in multiple case-histories reveals an
underlying negativism, a kind of linguistic pathology that is just as much in need of healing
as the patient. Her fascinating critical study calls for a ‘sanatological’ rather than
‘pathological’ approach and has practical implications for today’s psychotherapists.
Josephine Evetts-Secker: At Home in the Language of the Soul
Josephine Evetts-Secker’s paper delves deep into the underlying resonance of the
‘linguistic scraps’ with which psychotherapists work. She demonstrates that paying close
attention to the word means going beyond its image, to feel its invisible effects within us
and between us, discovering a shared language of the soul.
Booking & Event Information
• WMIP Members £75 / Early bird £65; WMIP Trainees £40 / Early bird £30
• Non-members £80 / Early bird £70
• For early bird discounts, book by 27 May. No refunds after 17th June.
• Booking form available on-line at
• Completed booking form along with a cheque made payable to WMIP should be sent
to: The Administrator, WMIP, Nairn House, 1174 Stratford Road, Hall Green,
Birmingham, B28 8QA.
• Coffee, tea, biscuits and sandwich lunch provided.
Venue: Edgbaston Quaker Meeting House, St. James Road, Edgbaston, B15 1JP
Five Ways train station and on-street parking nearby
0121 455 7888
Birgit Heuer: Sanatology: Towards a Language of Health and
Psychoanalysis offers profound theories of human transformation and healing. However, indepth
study of the language employed in case histories suggests that such theories do not
sufficiently translate into the consulting-room. Textual analysis of case material reveals
implicit attitudes in the analyst that are remarkably similar to those diagnosed in patients.
This paper presents my research into clinical case-histories. My approach is based in the
critical philosophy of 20th century thinkers such as Habermas, Kuhn and Polanyi, who
describe the existence of a paradigmatic dimension that underlies any organised scientific
activity, yet ordinarily remains un-reflected.
The paradigmatic dimension of contemporary psychoanalysis indicated by my research
appears negativistic and itself in need of attention and healing. To this end, I offer a
sanatological outlook, which involves rethinking our relational sensibilities and using
different words to express them.
Dr Birgit Heuer is a Jungian Analyst of the British Psychotherapy Foundation, with a
previous training in body-oriented psychotherapy. She has been in private practice for the
past thirty-four years. She served on the BAP training committee and worked as clinical
supervisor at Kingston University. She teaches on several Jungian-analytic trainings, at
Birkbeck College, University of London, and at the Centre for Psychoanalytic Studies,
University of Essex. She has published and lectured on the body in analysis, on the theme
of forgiveness and on clinical paradigm.
Josephine Evetts-Secker: At Home in the Language of the Soul
On a London street, Erasmus is said to have picked up and carefully examined a scrap of
printed paper that had blown on his path. Writing was precious. The word was still highly
charged. Our culture is less attentive, so often crying out “nothing but words!” and
demanding action instead. In this paper / in my work, I retrieve and value lexical
‘scraps’, attend to the working particles of language, seeing energy and intention active in
psyche’s grammar and heeding James Hillman’s call to restore an “angelogy of words”. We
can do this by acknowledging invisible syntactic, as well as imagistic, values in our soulspeech.
Josephine Evetts-Secker graduated from the University of London and went on to teach
English literature at the University of Calgary. In 1988 she completed training at the CG
Jung Institute, Zurich, practicing privately in Canada before returning to Britain in 1997.
She has served on the council of the IGAP training programme (London) and is currently
President of AGAP. She teaches regularly for ISAP (Zurich) and has lectured for Jung
societies in Canada and USA. She has published poetry, articles, lectures and book
chapters, and edited collections of fairytales for Barefoot Books. ‘At Home in the
Language of the Soul’ (Spring Journal Books, 2011) was written in conjunction with the
Zurich Jung Lecture Series. She is an ordained priest in the Anglican Church and continues
her Jungian practice whilst serving as curate in the Mulgrave parishes, north of Whitby.
Venue: Edgbaston Quaker Meeting House, St. James Road, Edgbaston, B15 1JP



IGA Foundation Courses aim to familiarise students with the principles of Group Analysis through a range of lectures/seminars, workshops and experiential group work.

A combination of theoretical and experiential learning encourages participants to gain a more informed general understanding of how groups operate. IGA Foundation Courses offer a wonderful opportunity for both personal and professional development.

Please click on the links below to learn more about IGA Foundation Courses across the UK and to book your place.


IGA Open Days / Evenings offer an opportunity to find out more about the various training courses we provide. Course convenors and teaching staff will present the range of courses on offer and will be available to answer your questions about the Institute and our trainings.

Please see below for time and dates or visit our website for more information.LONDON
Friday 27th May, 6 pm- 8 pm
Saturday 25th June, 2 pm – 5 pm
Friday 29th July, 6 pm – 8 pm
Friday 9th Sept, 6 pm – 8 pm

Book online here

Book here

Saturday 25th June,
10 am – 3 pm

Contact: Pat Briskham

Please click on the links below for further information
Friday 1st July


To book this course go to

Promoting Attachment and Inclusion


Saturday 4 June and Sunday 5 June 2016
Saturday 18 June and Sunday 19 June 2016


Seminars will include the following themes
Introductions – our relationship to attachment theory
Attachment theory in context
Separation, loss and mourning
Patterns of attachment and their internal representation
Secure • Dismissing • Preoccupied • Unresolved/ disorganised • Not classifiable
Evaluating adult attachment states of mind
Internal working models
Reflective functioning
Clinical work will consider the role of mourning, narrative, mutuality and recognition, affective attunement and cycles of rupture and repair in the therapeutic process.

“I was surprised how this course touched on all areas of my life… for me it has been the missing piece of the jigsaw I have been looking for and brings together many things…”

Seminar Leader

Orit Badouk Epstein is an Attachment based Psychoanalytic psychotherapist (UKCP registered) and a supervisor working in private practice. She works relationally with individuals, couples and parents. Orit has a particular interest and passion for working with individuals who have experienced extreme abuse and trauma displaying symptoms of dissociation. Orit is a trustee for the Clinic of Dissociative Studies. She is co- author of the book “Ritual Abuse and Mind Control: the Manipulation of Attachment Needs” (Karnac Books) and co-editor of the recently published book ‘Terror within & without’. She is the associate editor for Journal Attachment New Direction and on the editorial board of the ESTD (European Society for Trauma and Dissociation) where she regularly writes articles and film and book reviews. Orit regularly teaches the Attachment Theory in Clinical Practice short course.

Course Details:
Saturday 4 June and Sunday 5 June 2016
Saturday 18 June and Sunday 19 June 2016

10.00am until 4.00pm

£540 Organisations
£480 Individuals

The Bowlby Centre
1 Highbury Crescent, London N5 1RN

Seminar leader:
Orit Badouk Epstein

If you would like to book this course please visit or contact Carol Tobin at


Forthcoming Mental Health CPD Conferences
-May , June July 2016

Healthcare Conferences UK series of mental health events focus on a number of topics helping those working in mental health or with mental health service users have an increased understanding of the service user experience and look at issues such as capacity and consent, co-morbidity and psychological therapies.

Our mental health events enable you to share best practice and have been designed to bring together comprehensive knowledge sharing and seek clarity through discussion with expert speakers and colleagues working in the same specialism.


A 20% discount* is currently available for the events below
Quote ref: hcuk20mht when booking online

Improving Services & Outcomes for People who Self Harm
Friday 13 May 2016, Hallam Conference Centre, London

Improving Mental Health Services for Men
Thursday 19 May 2016, Hallam Conference Centre, London

Improving Mental Health Support for Asylum Seekers and Refugees
Wednesday 8 June 2016, ICO Conference Centre, London

Improving Mental Health Services for Young Adults: Supporting the Transition to Adulthood
Tuesday 21 June 2016, Hallam Conference Centre, London

Investigation of Deaths in Mental Health & Learning Disabilities Services
Wednesday 22 June 2016, Hallam Conference Centre, London

Improving Mental Health Crisis Care: Maintaining Momentum
Wednesday 22 June 2016, ICO Conference Centre, London

Mental Health, Ill Health & Personality Disorder
Thursday 23 June 2016, ICO Conference Centre, London

Improving Physical Health for People with Mental Health Conditions
Tuesday 5 July 2016, Hallam Conference Centre, London

Psychological Therapies for Severe Mental Illness
Tuesday 5 July 2016, ICO Conference Centre, London

Eating Disorders: Developing a Gold Standard Service
Wednesday 6 July 2016, Manchester Conference Centre, Manchester

For a Full List of our Mental Health Conferences & Masterclasses Visit:

We hold training in-house for groups of up to 25 tailored to suit the needs of your organisation and staff. For a cost-effective quote contact us on 01932 429933 or email
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*Terms and conditions. Offer only applies to bookings on the above conference and is not available to commercial organisations. Discounts are not valid in conjunction with any other offer from Healthcare Conferences UK or the HC-UK Conferences group (including the credit card discount) and are for new bookings only, we are unable to offer refunds on booked places. Bookings are subject to payments made, strictly 30 days from date of invoice.

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Rozsika Parker Essay Competition

Details of the winning essays are given here.

CPJA Members are invited to consider submitting an essay – the deadline is 17 October 2016 and more information regarding submissions are available here.



CPJA Discussion Statement: Parameters of Practice/2

We need to address the question ‘what is it we do?’ (and what is it we try not to do). Because it may be unclear, and therefore requires redefinition. This short paper seeks to delineate core principles of psychoanalytic practice, based in a reliable theoretical model that has evolved over time.
Essentially, it is a concrete restatement of our ‘flag statement’ (revised 2012) that in simple but meaningful terms may be listed as a series of principles of practice as follows:
• Rhythm (translation: key arrangements around time, frequency, and regularity, typically longer than shorter, based in an understanding concerning, among other factors, infant development);
• Regression (trans: also concerning time and the importance of early or past experience ,including as re-experienced, possibly re-enacted, in the therapy setting);
• The Unconscious (trans: mental operations , perhaps determining behaviour, not immediately apparent, the meaning of which may be accessed through language, dream and symbol);
• Setting/Frame (trans: the therapeutic space, involving the above, as well as, crucially, attention to boundary and abstinence, as far as possible intellectually, and certainly physically);
• Language and Thought ( trans: the epistemophiliac impulse, aka the desire to know – and fear knowing – as investigated, facilitated and understood , quintessentially, via language and speech);
• Interpersonal Relationship ( trans: the inter-subjective relationship/s between therapist and client, often involving multiple objects of a transferential and countertransferential nature, that may come to be identified and recognised by means of insight and interpretation);
• Supervision ( trans: therapist normally has recourse to the ‘3rd position’ of supervision, wherein there is located some authority of the model, in addition to managing this position internally).

It therefore follows, as distinguishing features of p-a practice, that normally or typically, we do not advise, and try to be judicious in our use of creativity. We are also cautious about, if not actually prohibit, forms of acting-in, which may include touch, extra-sessional contact, or excessive dosages of expertise, sermonising or prescriptions. We may utilise short-term dynamic approaches, but we do not consciously adapt our approach by wandering into territories best occupied by other modalities. We try not to succumb to pressures for a ‘quick-fix’, or be seduced by the fantastic, whether ‘new idea’ or latest toy.
This statement is really a reprise, in edited form, of my thinking of twenty years ago,* which was what many jobbing analytic therapists thought anyway, and what most should be thinking now! Some things do not need to change, for the sake of change. Notwithstanding my claimed adherence to the above rubric, over 25years I have become, subject to client or pathology, relatively more flexible, responsive and creative in my personal style. But, I suggest, it is within, not beyond the pale

DISCUSSION PAPER (1) PRESENTED TO THE CPJA ON NOVEMBER 28TH by ALAN LIDMILA ( Executive Committee Member of CPJA and member of The Hallam Institute of Psychotherapy )

Paradigms of Practice/1


By way of introduction, let me tell you a short tale. Twenty-five years ago today, a few of us were trying to get all the band to play.. So, in this actual venue, a meeting was held, probably long forgotten, with the title: ‘The Making of Analytic Psychotherapy – Varying Perspectives’. H.W (a fellow-conspirator at the time)and I were invited to contribute and my offering was entitled :’ The Emperors Clothes – looking again at analytic paradigms’ At the time, we barbarians spoke for the fringe, unsanctified analytic tribes, those unblessed by metropolitan hegemonic holy waters.
There has always been a debate as to what properly constitutes psychoanalytic practice. In alliance with elements of The Guild, AGIP & other ‘liberal’ organisations, we were trying to widen, indeed diversify the range of organised p-a practice in what were pre-UKCP days, in a field that was very exclusively organised in ritual, incestuous obeisance around The Institute. Hence the sub-title on that day. It is a longer tale, but one not only for the archive: history, like food, repeats.

Now, looking for an apposite phrase in very different times I consider plus ca change , plus c’est la meme chose but, things are not quite the same, even if the comment underscores what is often ironic about apparently progressive change, and signifies the importance of history, taking a ‘ long view’ regarding a current zeitgeist, or any uncritical conformity to the flavour of the day..
At that time, as now, sub-texts,politics, are at play. Then, the ‘radical’ tendency was to widen the net, extend the brief, allow in some of the Barbarians from the outer encampments (not a wholly altruistic move, as this would in turn strengthen a power base, assist economic imperatives, in squabbling London town houses).Yet change is ironic, and dialectic, and often unintended; my comments today suggest other consequences in psychotherapy culture ,and in turn a response that is now, necessarily, more ‘tradical’ than radical !

To briefly explain this shift. Now, we inhabit, in wider culture as it impinges on psychotherapy culture, different, but not necessarily progressively better times. Leaving aside the problematic ‘regulatory mind’, we almost over-subscribe to values of ‘inclusivity and diversity’, which may have undesirable consequences as far as a homogenous, clearly differentiated psychoanalytic model is concerned. Ironically, the old guard, zealous keepers of the flame, upped sticks to form a higher temple elsewhere, leaving a vacuum, fertile for doubters, to ‘develop’, deconstruct, or maybe dismantle the integrity of the model – a model already under external threat in Nice Times. (I note tendencies, by the way, not conspiracies!).

The confidence in the model seems to have wavered for some, who as a result, have experimented, with techniques, derived from other models. This is not necessarily ‘adapt and survive’, any more than any crisis is nuclear – it is more like anxiety, or at worst panic. There are two interacting factors:
Adaptive responses to external pressures in form of NICE, IAPT, contractions in NHS and trainings, coincident with a translation of the ideology of diversity into shifts in practice technique, so as to resemble a more mixed portfolio, some more strings to the practitioner bow, because, well, we need to reflect and embrace diversity, rather than anything that whiffs of exclusiveness, elitism, even specialism. I am suggesting there is evidence of muddled, if well-meaning thinking, which has contributed to doing a disservice to a confidently held psychoanalytic paradigm. Thanks.

Open Dialogue: The radical new treatment having life-changing effects on people’s mental health


Suzanne Chapman found herself talking about events she had bottled up for decades .

“If it wasn’t for Open Dialogue I wouldn’t be here now. This time last year, I was suicidal. I had totally lost faith in the mental-health services; I felt I’d been put in the ‘too difficult’ box.”

Suzanne Chapman has been in and out of the mental-health system since attempting suicide twice in her early twenties. Now 49, she’s had every treatment for depression and bipolar disorder: medication, therapy, ECT. For long periods of her life, the drugs worked.

But three years ago, she hit her worst crisis: a bout of depression that made her unable to function. “On Christmas Day, my daughter gave me a potato to peel and I just stared at it. I had no idea what to do with it. I had no strength; I would just lie on the settee or shuffle about the house. I wasn’t coherent, I wasn’t sleeping, I’d lost three stone. I felt so dark, so alone, so worthless.” None of the drugs that had helped in the past made much difference. Suzanne had to give up her job as an administrator and her husband, Simon, a police officer, took three months off to look after her. The couple have two daughters, aged 27 and 25, and a two-year-old granddaughter.

By the time Suzanne was offered an experimental treatment called Open Dialogue last October, she was desperate. It’s a pioneering approach that enables patients and their families to develop their own route to recovery. After just three sessions, Suzanne’s husband noticed a “miraculous” improvement; he now says, “I’ve got my wife back.” Suzanne accepts that she will never be free of depression, but says it’s now firmly under control.

Open Dialogue is currently being piloted in four NHS trusts. It could revolutionise mental-health care in the UK, according to its champions, who include Suzanne’s psychiatrist, Russell Razzaque. The North East London Foundation Trust, where he works, has just given the go-ahead for an Open Dialogue-based service for patients referred from anywhere in the country, starting next May.

Open Dialogue is primarily for people who are suffering a mental-health crisis such as suicide or psychosis – 1.8 million of them in the UK last year. They badly need help: a damning report from the Care Quality Commission in June found that the current system is struggling to cope with mental-health crises, with 42 per cent of patients not getting the help they need. A campaign launched last month calls for an increase in funding for mental-health services and parity with physical health.

The Open Dialogue approach was first developed in Finland in the 1980s, which at the time had one of the worst incidences of schizophrenia in Europe. There are now well-established services in Berlin and New York, where state investment in four respite centres that practise Open Dialogue has been doubled to $100m (£66m). Services are also springing up in Italy, Poland and Scandinavia.

What’s most impressive about Open Dialogue is its success with even the most intractable mental illnesses, where current systems of care too often fail, or offer only short-term respite. Results over the past 30 years from Finland sound impressive: 74 per cent of patients experiencing psychosis are back at work within two years, compared with just 9 per cent in the UK. Crucially, relapse rates are far lower than here: after an average of two years’ treatment, most patients don’t need to come back – ever. Here, a mental-health diagnosis can feel like a life sentence.

Open Dialogue’s key principles are: people are seen within 24 hours of becoming unwell; and all meetings with the psychiatric team are held at home, or wherever the patient finds most helpful. Significant others in the patient’s life – family members, or trained peer-support workers – are engaged in meetings from the word go.

What service users appreciate most is that they always see the same people. Annie Jeffrey, whose son took his own life last year after suffering from psychosis for five years, and relapsing several times, explains why this is so important: “Many service users say they feel like a parcel passed from one team to another: community services, in-patient services, crisis teams, psychiatric liaison… The number of times I went to meetings with my son to see a team of people we’d never seen before and we would never see again. How are you supposed to start talking to someone you don’t know? My son just felt that he wasn’t listened to.”

What also sets Open Dialogue apart from standard treatment is that discussion about patients takes place in front of them, in what are called “reflections” between members of the team; this adds to the sense of control.

For Suzanne, this was a turning point. After just a couple of sessions, she found herself talking about traumatic events and emotions she’d kept bottled up for 30 years. She explains: “The ‘reflection’ gives you a different perspective and makes you see how other people view your situation. In the past, I was always frightened that what I said would be judged. I was so afraid of talking about my past, and how dark I actually felt, for fear they’d call an ambulance to take me away. So I went into denial.

“Open Dialogue is totally different to any kind of therapy I’ve had before. At first, I didn’t know what to expect, but it helped that the psychiatrist and nurse were on my territory. I could always ask them to leave.”

Open Dialogue is not anti-medication. Treatment, from drugs to different kinds of therapy, is agreed by everyone at the meeting. Suzanne currently takes a mood stabiliser plus diazepam if her anxiety gets overwhelming. But whereas the mainstay of standard treatment is usually medication, the mainstay of Open Dialogue is talking. Dr Razzaque explains: “In normal treatment you explore what has led to the crisis, but then the response is usually to prescribe medication. Whereas with Open Dialogue the service user takes the driving seat in understanding what are the factors that have led them to be the way they are. That’s a very healing thing.”

It’s not immediately obvious what it is about Open Dialogue that makes people open up. Clearly, seeing the same team builds trust. Longer sessions help, too. In the early days, Suzanne met Dr Razzaque three times a week, and meetings lasted as long as three hours, whereas in the old system, appointments with her psychiatrist were 15 minutes to an hour. Therapy sessions were limited to six or eight – not enough to establish trust, she says.

But there’s something else which encourages patients to open up: mindfulness. Every member of the team, from psychiatrists to support workers, practises it. Dr Razzaque explains: “This is not about teaching service users mindfulness. This is about clinicians practising mindfulness themselves. It’s very stressful to be in meetings where we really give patients the space to explore their emotional difficulties. So clinicians need some emotional training themselves – such as mindfulness – to enable them to facilitate that environment.”

Annie Jeffrey, who started training to be an Open Dialogue support worker after her son’s death, agrees: “I’ve found it very hard to listen to people being very emotional because you always want to make people feel all right, don’t you? But you learn to sit with that, instead of trying to shut all that emotion down. And service users say how helpful that is.”

But surely the big stumbling block is that 90-minute meetings several times a week are totally unrealistic for our cash-strapped, overstretched mental-health services. In some areas, doctors are struggling to meet National Institute for Health and Care Excellence standards of seeing patients within 14 days, never mind 24 hours.

Critics also stress the need for more robust evidence before ploughing precious NHS funds into expanding an experimental service. Evaluation will inevitably take time. A multi-centre research trial conducted by University College London will publish its results in 2020.

Dr Razzaque insists that Open Dialogue doesn’t have to place an extra burden on staff. He also argues that in the long term, it won’t cost more than previous initiatives to improve mental-health services, such as training swathes of cognitive behavioural therapists. This is partly because of the low relapse rates: once patients have been discharged, the majority don’t need to use services again. Dr Razzaque adds: “The frequency of meetings is the same as it would be normally in the initial period: over two years, meetings average out at just one a month; over five years, it’s once every two months. Putting intensive, highly focused support in that early time of crisis enables people long term to graduate from services altogether.”