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Perhaps I could start my presentation by telling you about the setting in which I work, so that you will immediately see my bias.
I work part-time in the National Health Service as a consultant psychiatrist specializing in psychotherapy; most of this time is spent at an NHS out-patient psychotherapy clinic, but one day each week I work and teach in a psychiatric hospital. I also work as a psychoanalyst in private practice, and I am on the professional committee of the Lincoln Clinic and the Institute for Psychotherapy. I am therefore in both the independent and the public sectors, and have been for a number of years.
The hospital where I spend the one day each week is a 120-bed psychiatric unit, with day-hospital capacities for a further hundred patients and a large out-patient department. There are many more than a hundred staff working there; I am the only member employed as a psychotherapist, and — I emphasize — I work there only one day a week!
In many parts of the country, district health authorities have no psychotherapists at all. This is so even within a few miles of London. The North West Thames region has districts without a psychotherapist — medical or non-medical — and I am sure the same is true of the other regional health authorities around London.
It is not necessary for a psychiatrist in training in Britain to gain any clinical training in psychotherapy, let alone basic counselling skills. It is recommended that he or she do so, but there is no obligation,