Referral
criteria to psychodynamic psychotherapy counsellinghe following are guidelines only, as all referrals to the service will receive an in-depth assessment, not only of the-person's problems and past history but of their capacity for a therapeutic alliance. During this period the person's aims, expectations, degree of commitment and ability to co-operate with a therapist in what may be a prolonged, time-consuming, often painful process, is assessed before a decision can be made as to whether this would be an appropriate approach.
Who is suitable for referral for assessment for psychodynamic psychotherapy? (tier 3 / 4 but also appropriate to some tier 2 patients)
Presenting problem:
- Enduring interpersonal difficulties which are based on psychological conflicts.
- Complicated bereavement reactions.
- Prolonged difficulties coping with other losses, eg hysterectomy.
- Mild to moderate personality problems.
- Persistently requesting psychotherapy.
- Some somatising presentations may be suitable.
- Failure to respond to other approaches.
- Complex picture of history of abuse, eg sexual.
About the individual:
- Does this person have a reasonably intact coping personality or is he/she considerably chaotic with a fragile sense of self, at risk of decompensation, or floridly psychotic?
- Does the person have the capacity to form relationships and is he/she able to anticipate developing a positive relationship with the therapist? Is the person able to communicate about him/herself and his/her feelings (ie emotionally literate)?
- Is the person psychologically minded - that is able to talk about feelings and thoughts?
- Are there indicators of past success in therapy or of dealing with life events?
- Does the person want to get to the bottom of the problem?
- Is there motivation to male personal changes?
- Does the person want to understand self and life problems in order to find better solutions and is he/she able to see psychotherapeutic conversations as meaningful and potentially helpful?
- Does the person have the capacity/willingness for sustained, often emotional painful work and tolerance for frustration? Does the patient have a supportive network of relationships and a containing structure around them (ie family, work, community, other agencies etc)?
- Is the patient in midst of a crisis and in need of urgent intervention, or able to wait not only until therapy starts but in between sessions (ie not in need of acute intensive intervention)?
Who is unlikely to be suitable for psychodynamic psychotherapy?
What patients want from a therapy for themselves can be a good indicator of whether psychodynamic approach likely to be appropriate. The following are unlikely to benefit from psychodynamic psychotherapy but may benefit from a different approach, for example cognitive behavioural therapy:
- Wants to learn better coping strategies.
- Wants simply to get over the present crisis.
- Wants a quick fix' solution or cure.
- Is convinced the problems are only physically based rather than being able to think of them in psychological terms.
Referral Route
- Referrals can be made directly to named individuals in each sector (see service description) or centrally to Dr Esti Rimmer, Psychotherapy Service, Department of Psychological Therapies & Research, St George's Hospital.
- It is helpful to discuss potential referrals with the local psychotherapy service before referral is made in order to be advised regarding appropriateness of referral, waiting time and on how to present and discuss the referral with the patient.
- Referrals can be made directly by GPs, Consultant Psychiatrists, and other professions, ie psychology, care managers, OT, nursing, counsellors etc.
- Referrals for Regional Department of Psychotherapy should be discussed with the local psychotherapy service and are likely to be assessed locally prior to further referral.
If in doubt the members of the psychodynamic psychotherapy service are always happy to discuss a particular acse or provide further information.