If not now, when …?

The contrast between the cover of the August issue of The Psychiatrist and the content of the related article ¹ could hardly have been greater. On the outside: shocking depiction of a winged Freud in drag - women's bathing costume, high heels - flanked by the sphinx. Inside: announcement of change of job title from ‘consultant psychotherapist’ to ‘consultant medical psychotherapist’, buttressed by bland reassurance that ‘the working role of most medical psychotherapists has become more like that of other consultant psychiatrists’ and that warfare between different therapeutic modalities has ceased, and predictable pleas for greater recognition and investment in medical psychotherapy.

Sadly, it's the cover that gets it right. Medical psychotherapy is a chimera trying awkwardly to reconcile two currently incompatible sets of values - medical instrumentalism and psychotherapeutic humanism. A change of name will do nothing to resolve medical psychotherapy's abiding dilemma: how to stay true to psychotherapeutic values without isolationism or, claiming a spot in the mainstream, undermining its case for a separate identity.

I would like to see medical psychotherapy accepting the full irony and challenge of its chimeral status: a ‘hopeful monster’, ² ensuring on the one hand that psychiatry does not become increasingly confined to pharmacology and forensics, and on the other that psychotherapists keep sight of their prime task - contributing to the effective treatment of psychological illness.

But nature abhors a chimera. Cash-strapped chief executives are unlikely to fall in with medical psychotherapy's vague promises when they can get NICE-approved therapies delivered by bureaucracy-savvy clinical psychologists and nurse specialists at half the price.

Which brings us back to Mace & Healy's seemingly proud statement that medical psychotherapy is unique among the CCT-bearing specialties in being ‘not descriptive of the types of patients seen’. But therein lies its great weakness. Despite today's name-change, the rose will smell as uncompelling until the Faculty of Medical Psychotherapy becomes the Faculty of Personality Disorders and Complex Cases. Then at last the unique skills of the medical psychotherapist really will be seen as indispensable, and Mace & Healy's legacy come to fruition. Yesterday's hopeful monster may yet become tomorrow's role-model: the psychotherapeutically sensitive psychiatrist.