''The Perversion of Care: Psychological Therapies in a time of IAPT''

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In this article, I argue that sweeping changes brought in by thegovernment’s Improving Access to Psychological Therapies (IAPT)programme have resulted in a perversion of care where National HealthService (NHS) mental health services now disavow the realities ofsuffering, dependence and vulnerability and turn away from thecomplexities of managing those in psychological distress. By disavowingthe realities of suffering, dependence and vulnerability, these services areincreasingly turning away from the complexities of managing those inpsychological distress. Drawing on work by Freud [1927. Fetishism. InSE Vol XX1: The future of an illusion, civilization and its discontents andother works (pp. 147–158).], Steiner (1993. Psychic retreats. London:Routledge.) Chasseguet-Smirgel (1981. Loss of reality in perversions –With special reference to fetishism. Journal of the American PsychoanalyticAssociation, 29, 511–534.) and others, I argue that the NHS‘market for care’ turns a blind eye to the emotional realities of suffering,instead constructing what has been identified as a ‘virtual reality’ whereattention to targets, outcomes, protocols and policies is privileged overattention to the patient’s psychological needs. Drawing on an organisationalcase example, I propose this virtual reality is part and parcel of amore general fetishisation of governance systems within the NHS, whichis used to mask unbearable feelings of helplessness in the face of ourlimitations when trying to help those in psychological distress.

© 2012, published by Taylor & Francis. This is an author produced version of a paper published in Psychodynamic Practice, uploaded in accordance with the publisher’s self- archiving policy. The final published version (version of record) is available online at the link below. Some minor differences between this version and the final published version may remain. We suggest you refer to the final published version should you wish to cite from it.
Original languageEnglish
Pages (from-to)7-25
JournalPsychodynamic Practice
Issue number1
Publication statusPublished - 2012

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