Psychological treatment centres

Editor—Layard presents a strong argument for the need for more practitioners trained in empirically supported psychological treatments for mood and anxiety disorders.¹ Treatments such as cognitive behavioural therapy are as efficacious as leading drug treatments for mood and anxiety disorders but have lower relapse rates. They can also be effectively administered in groups, typically of six or eight patients, and are more cost effective than drug treatments.²

Although such psychological treatments have been available for decades, the shortage of qualified practitioners is woeful, both in England and elsewhere, including North America. Layard estimates that to meet the need for providing empirically supported psychological treatments in England some 10 000 new therapists must be trained. To meet similar needs elsewhere in the world some tens of thousands of additional therapists are required.

Skilled providers in psychological treatments are typically clinical psychologists or psychiatrists. University training programmes for these specialties are typically small: as few as 6-12 newly trained specialists might graduate from a clinical psychology programme or psychiatry residency programme in any given year. They are unlikely to have the necessary resources or number of faculty staff to be able to meet the training needs for the thousands of new therapists recommended by Layard.

Diploma programmes in community colleges or other institutions could train large numbers of therapists quickly. But the question arises whether diploma mills can produce therapists with sufficient skills for clinical practice. In addressing the important problem of making psychological treatments available on a large scale, we face the important challenge of balancing quality with quantity. Poorly trained therapists, like poorly trained practitioners in other parts of clinical practice, may do more harm than good.