Charlatans and ‘Gold Standards’: Traversing the Minefield of Psychiatric Psychotherapy Training

Abstract

BRIDGES TO WHERE? An innocuous enough looking sentence in A15.6 Explanatory Notes, Medicare Benefits Schedule — ‘that the RANZCP has undertaken to establish an appropriate mechanism to enable use of Item 319 by suitably trained psychiatrists’ — appears to have led to a flurry of activity. Although psychotherapy is not specifically mentioned in Item 319, the assumption appears to have been made that we are facing the possible future regulation of intensive psychotherapy and psychoanalysis by accreditation of ‘suitably trained psychiatrists’. This is a little surprising given that to be eligible for Item 319 a patient must not only be so severely ill that they score a GAF of less than or equal to 50 at the commencement of treatment but they must retain this severely impaired score throughout the treatment to retain eligibility for 319 benefits. Surely, this must exclude many if not most, for example, patients who are candidates for a psychoanalysis, who would be unlikely, on account of the continuing severity of their illness, to either tolerate or benefit from significant regression.