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The early 1970's saw the beginning of a major investment by the National Health Service in specialist psychotherapy which continues to this day. The expansion was marked by a document from the Royal College of Psychiatrists (1975) which recommended staffing norms for psychotherapy services (now nationally half achieved) and the formal recognition of the medical speciality by the DHSS in 1978. Much of the expansion has taken place in the provinces; its local form has been powerfully influenced by the conceptual affiliations of the new consultants, the presence or absence of established services in the private sector and the relative affluence of the local Health Authority. Generally, the new services have been able to set their own norms and establish innovative patterns of training and staffing. This paper documents what has been achieved in the southern half of one provincial Health Region. In addition, some of the guiding principles, problems and present solutions are presented.
The Nottingham NHS service was initiated in 1974 with my appointment. For five years I was the only appointed consultant medical psychotherapist in the Trent Region. Now there are companion units in Leicester , Derby (Nassol Constantopoulis , ) and Lincoln ; a second consultant (Patricia Slack) was appointed in Nottingham in 1987. The Nottingham Psychotherapy Unit has nine full-time and five part-time members of staff drawn from all the mental health care professions and each working as a psychotherapist. It has the accolade of having a fully accredited senior registrarship in psychotherapy, provides a wide range of trainings and clinical services and contributes to the three year plus certifcated South Trent Training in Dynamic Psychotherapy for career psychotherapists that is collaboratively provided by the four units. A consultant in behavioural psychotherapy (Alan King) was appointed in 1981 in Leicester.
In the beginning outside the NHS,