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I must risk annoying the reader: this is the second of a pair of books which need to be thought of as one. The first, also published in 1996, is called The Broad-Spectrum Psychotherapist (Bramley 1996), and the two were clearly planned, and perhaps written, as a pair.
Wyn Bramley also risks annoying at least this reader by putting in each title an expression, ‘Broad-Spectrum Psychotherapy’, that initially has a meaning for her alone. The premise behind the expression is that five times a week psychoanalysis without time limit, with selected patients, is important and valuable. It is, however, sometimes thought of as the paradigm, the best, against which other kinds of psychologically based treatments are measured; and when we carry out one of these we often tend to think that what we are doing is second or third best.
More is taken to mean better and less to mean worse. At the end of this chain is the therapist, often working in the public sector, where the amount of time available for any patient is limited often to one session a week for a duration which is also measured in weeks. Many therapists also work in GP practices where the work is time limited, with the range of patients and the problems they bring very broad. Not only this, but the patients are not closely selected for suitability. If you do this kind of work the patients you get to work with are those who walk through the door, and one part of the challenge is to find, and to find quickly, something valid which can be done in the short time available.
I should declare my interest in that I work in a GP practice and meet regularly with a group of colleagues. A short while ago we put together a paper which we sent to the local Health Commission, which contained a number of clinical vignettes, intended to illustrate the range of patients we see, who include the borderline and the psychotic. The work we described ranged between contributing to patient management and extended assessment. If psychoanalysis is hi