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OPINION

‘So how do you feel about that?’

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New research has found psychotherapy delivered by nurses to be clinically effective, but is it feasible?

Research last week revealed that nurses could be well positioned to offer patients psychotherapy. The study at Durham University found that, with only five days of training, mental health nurses could deliver “clinically effective behavioural activation to people with long-standing depression”.

My first reaction was surprise. Only five days of training and their treatment was clinically effective? Really? Maybe it was the hole in my pocket from having invested copious amounts to train as a counsellor in my spare time that had me bitter. But even after giving it more thought, I was still undecided.

“Nurses to offer psychotherapy: good or not so good?”

So, as many who cannot make up their own minds, I decided to consult two friends who practiced psychotherapy about theirs. It turns out they had quite opposing views.

Friend A believed that the more counselling on offer, the better. And I do agree. Especially as fewer than 10% of people with depression have access to psychological treatment.

He said that research has shown little difference between the quality of care given by experienced and less experienced counsellors. It wasn’t the experience that was the issue, it was the time spent with the patient that really changed things. Apparently, offering counselling for five years or more was the most important thing related to better outcomes for the patients.

 So that begs the question, will nurses have enough time to invest with patients? And if they don’t, could it do more harm than good?

Friend B was more of this opinion. That nurses offering psychotherapy could be helpful but not if it was a short-term fix. If nurses could only offer limited numbers of sessions, would they ever get to the root of the depression?

Friend B also believed that nurses may be more inclined to fix things, and take control, rather than nondirectionally help someone to come to their own conclusions. So nurses may not actually be suited to therapy. And as nurses are you interested in giving therapy? Do you feel that counselling would be a positive or negative development of your role?

I’m still not sure, but the main thing to me seems to be time. The more time spent with patients with depression, the better. And it doesn’t matter too much whether the time is spent with an expert counsellor or an expert nurse.

What do you think?

  • 2 Comments

Readers' comments (2)

  • My understanding was that the nurses in the study were trained to deliver the specific CBT intervention of Behavioural Activation, which certainly can be effective when delivered over a brief series of short contacts.
    This is quite different from counselling and not designed to 'get to the root' of the depression, but to enable clients to make changes and move forward.

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  • On the premise that a talk with a friend, nurse, doctor or other without specialist training as a psychotherapist can act as psychotherapy, this could be a helpful adjuvant to existing psychotherapies for patients suffering from general dysphoria but depressions are a complex group of disorders which nobody yet fully understood, and those with a deep seated and serious affective disorder such as depression or a bipolar disorder need the choice of support from an experienced clinical psychotherapist who has undergone years of specialist training.

    Training for such short term therapies would need to be rigorous to eliminate problems such as those mentioned in the article which may do more harm than good for the patient.

    There is also a danger that patients who present for treatment may have other underlying DSM-IV Axis I and Axis II disorders which have not been diagnosed and may only become apparent during treatment as symptoms may only be triggered by a major life event, such as personality disorders, and notably borderline personality disorder which is extremely difficult to treat and lack of familiarity with this disorder and inadequate responses from the therapist through lack of understanding lead to extreme frustration in the patient. For this reason, individuals with this disorder have a tendency to go from one treatment facility to another in a frustrated attempt to get the treatment they require. Their complex needs are often little understood, even by healthcare professionals, which also leads to frustration and often very bruised egos in therapists and for this reason they are often labelled as a group of patients with a disorder that is untreatable. This also involves the important issues of transference and countertransferance, which may apply to any patients and their therapist which this new group of 'therapists' are not going to learn about and gain experience in, in a few hours training.

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