Our expert says:
Some further thoughts, there have never ever been good grounds for recommending or providing psych-analytical services, as, after all these years, there is still no good evidence that this extremely expensive means of treament has any reliable benefits in any conditon whatever. I consider analysts as working in a similar category of work to call-girls --- for a hefty fee, they provide at most and at best some marginally intelligent conversation.
If one believes that evidence-based therapeutic choices are preferable, then there is never an occasion when analytic methods can be chosen, as the evidence is simply not there. For CBT, and some of its variants, there is suficient evidence to proceed, for the time being, by considering such methods to be reasonably likely to be beneficial. It is more fruitful for unhappy people to play video-games than to see a psychoanalyst.
I think you are exaggerating the limitations imposed by technology distributon. Much could be done, if the govt were actually serious about encouraging it, to greatly increase access ; but it is already far more readily available to ANY SA citizen, tan psychotherapy ; and enormously more easily and cheaply available than analytic therapy ( could you send me a list of psychoanalysts practising in the townships and rural areas ? It wouldn't take up much space, would it ? )
I think better linguistic training would b benefical for all therapists, and ahree that it is particularly useful in this form of work. For instance, anecdotally, not long back we received a long and rambling message from someone, which hadly asked any clear question. But it was clear from linguistic and other internal clues ( including it's having been posted at 3am ) that the sender was in a marked manic phase, and needing re-adjustment of medication, as indeed proved to be the case.
I agree that there are far larger ethical problems routinely ignored by the Health Professions Councl, which deserve their attention long before they consider whether referral patterns in cybertherapy and cyber-advice might raise problems. I know of cases of doctors who were markedly demented, constantly drunk, and involved in massive medical aid fraud, all of whom were ignored by the Council, while it worried about the correct dimensions for a brass plate placed outside a therapist's offices.
I would worry about the settng of standards for such cyber-services, on the basis of so much bad experience of the self-serving nature of the standards that get set. Maybe it'd be better in the hands of PSYSSA ( if they also involved a few relevant psychiatrists ! ) tan in the highly unrepresenative hands of the Health Professions Council. It'd be tragic if the HPC messed up this field as they have messed up the issue of Continuing Professional Education, turning it from a genuinely educational idea into a license to print money for crtain individuals and organizations, to charge exorbitantly for sub-standard "educational" exercises, wih no relevant quality control, and not a shred of evidence that complaince with the regulations in any way improves quality of patient care, or that non-compliance in any way related to poor quality of care.
I'm not sure that cyberservices in mental health particularly encourages the existing keenness for instant gratification, except by comparison with secialist services, where patients are routinely asked to wait months for an appointment. What we provide is hardly instant gratification. We provide an opportunity for people to ask questions and seek advice whenever they feel able to make that step forwards ( often after "lurking" on the Forum for a while, to gain confidence in the system ) and to receive a reasonably prompt response. But wat maters is the nature of the response. WHere they receive information, questions, and suggestions for further consideration, thought, testing, and challenging, it's not instant gratification, but an early start of seeking solutions in a manner more likely to be successful than alternatives.
I don't post my phone number here, for obvious reasons, but if you contact my colleagues at the Health24 offices, such as Mari, she'll be able to give you my number, knowing that I have authorized this in advance.
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