Information for Doctors & Referrers

CONTENTS

Introduction

This page is designed for referrers who might like to know more about Jungian analysis and psychotherapy and why they might refer a patient to North Coast Psychotherapy.
The Executive Summary is designed to provide a point form synopsis of the more detailed descriptions provided below under each of the headings.
To read a more detailed description just click the “read more” button at the end of the summary section.

Executive Summary

REGULATORY PARAMETERS OF JUNGIAN PRACTICE

Jungian analysis has a long and distinguished international history
All Jungian analysts are internationally and locally regulated by reputable professional associations
Jungian analysts are nationally registered via various professional associations
Jungian analysts participate in ongoing professional development and supervision
Jungian analysts are required to maintain professional insurance coverage
Jungian analysts adhere to strict professional ethical codes

WHY CHOOSE JUNGIAN ANALYTIC PSYCHOTHERAPY?

There is a very strong evidence base for the Jungian therapeutic model
Jungians are trained to treat a wide range of disorders including disorders of the self
Jungian work fosters long-term positive ‘structural’ changes for patients with developmentally inflicted disorders that result from early neglect abuse and deprivation
The Jungian model takes an holistic approach to clinical wo

TRAINING OF JUNGIAN ANALYSTS

A one hundred year tradition of theory, training and clinical practice
Internationally regulated training and professional oversight
High standards of educational and personal qualities for entry into Jungian training institutes
Selection involves exhaustive personal, professional and clinical appraisal and rigorous interview processes
In-depth and lengthy training which includes preparation for working with serious mental disorders

EVIDENCED BASED RESEARCH (EBR) AND JUNGIAN PSYCHOTHERAPY

Strong evidence base for the Jungian analytic therapeutic model and its effectiveness
Considerable and growing evidence-base that demonstrates long term effectiveness of analytic psychotherapy – particularly the case for patients with more severe mental dysfunction
EBR for analytic psychotherapy shows hospital re-admission down, work time lost reduced, on-going improvement after therapy is completed
EBR for long term psychotherapy over short term modalities for personality disorders, multiple mental disorders, and chronic mental disorders

APPROPRIATE CARE FOR PATIENTS WITH APPROPRIATE CLINICIANS

Regulatory parameters of Jungian Analytic Practice

Analytical Psychology has an illustrious international history of over one hundred years. Analytical Psychology is the branch of depth psychology developed by C.G. Jung, the distinguished Swiss psychiatrist. Jung worked with Sigmund Freud in the early development of Psychoanalysis but later broke with Freud to form his own understanding of the human mind. Analytical psychology practitioners are usually referred to as Jungian analysts or Jungian psychologists.

The Zürich based International Association for Analytical Psychology (IAAP) is the international regulatory authority in Analytical Psychology. It certifies, accredits and monitors the professional practice of Analytical Psychology throughout the world. The organization was co-founded by C.G. Jung in 1958 to assure quality control in Analytical Psychology.

The Australian and New Zealand Society of Jungian Analysts (ANZSJA) was formed in 1978 and is one of 38 worldwide member societies functioning under the aegis of the IAAP. It is the only IAAP society in Australia and New Zealand. It is, therefore, the official body in Australia for Analytical Psychology. The C. G. Jung Institute of ANZSJA is the educational and professional training body of ANZSJA. Any trainees accredited by it are eligible to join ANZSJA and thus become members of the IAAP. Jungian analysts also belong to other professional associations like ANZAP, the Australian Psychological Society and the Royal Australian and New Zealand College of Psychiatry.

The practice, training and professional ethics of Jungian analysts are on par with those of Psychoanalysis. These two groups are both part of the Psychoanalysis and Psychoanalytic Psychotherapy Section within The Psychotherapy and Counselling Federation of Australia, a national “umbrella” association comprising affiliated professional associations that represent various modalities within the disciplines of Psychotherapy and Counselling in the Australian community.

As North Coast Psychotherapy, we are sensitive to the particularities of the Australian context and are committed to the maintenance of high professional and ethical standards in the practice of Jungian Analysis and Psychotherapy. Our practitioners have all signed stringent ethical codes of practice and are all members of national registers via one or more of the above associations. All our practitioners maintain professional insurance coverage.

Why choose Jungian Analytic Psychotherapy?

Jungian psychotherapy is suitable for treating a wide range of disorders and human problems from mild to severe. The Jungian psychotherapy model has been concerned with disorders of the self from the very beginning. It has independently converged with developments in post-Freudian psychoanalysis (object relations and Self psychology) and developments in the understanding of the brain over the last thirty years or more.

In essence, what is provided is an empathic reflective mode of longer-term therapy which has been shown across a large range of strong studies to foster long-term positive “structural” changes for patients with developmentally inflicted disorders of self-organisation that result from early neglect, abuse and deprivation. These “disorders of the self” conditions are both very prevalent and very debilitating. Afflicted individuals are often bright and talented but frequently very dysfunctional, e.g., problematic relationships, chronic dysthymia, occupational disasters, suicidality, eating disorders.

The Jungian model takes a holistic approach to clinical work. Since its inception, it has always been open to the creative arts and spiritual domains of life and sees these as being integral parts of the healing process.

The training of Jungian Analysts

The Jungian analytic tradition and practice has stood the test of time. All Jungian analysts are highly trained and Jungian training programmes are specifically post-graduate in nature. The post-graduate nature of Jungian training means that analysts have had substantial life experience and professional experience before they start practising in the profession. This fact should not be overlooked by referrers. A firm grounding in “the ups and downs of life” and a mature attitude are essential components in the personality of the therapist for successful treatment of the psychological difficulties of patients.

A tertiary degree and relevant professional experience
Participation in a comprehensive lecture and seminar programme on Jungian, post Jungian and psychoanalytic theory and clinical practice usually over five or more years
At least weekly clinical supervision for the duration of clinical training work
Twice weekly personal Jungian analysis with an approved Jungian analyst for the duration of training
Completion and presentation of seminar papers to a panel of senior supervising analysts
Completion of a rigorous case presentation and examination to a panel of senior supervising analysts
Completion and presentation of a thesis to a panel of senior supervising analysts.

The training requirements for the Australian and New Zealand Society of Jungian Analysts can be seen at C.G. Jung Institute of ANZSJA

It should be noted that these are the minimum training standards which are often exceeded by individuals in their training. In addition to these initial training and entry requirements, Jungian analysts are required to be engaged in ongoing professional development and clinical supervision.

For doctors and referrers, it is worth noting the possibility that the current government position of only funding a limited range of practice modalities may create the false impression that only those professionals who have access to rebates possess the training and experience to treat serious mental health disturbances. It is important to consider whether particular professionals have adequate training, experience and supervision to provide the appropriate level of care for all types of patients. The Jungian analysts in our North Coast Psychotherapy practice not only possess high levels of theoretical and clinical training but have also undergone substantial personal psychotherapy. Putting this alongside their life experience and maturity, we consider this to be essential in equipping them to deal with serious mental disorders.

Evidenced based research and Jungian Psychotherapy

There is a very strong evidence base both for the “construct validity” of the Jungian therapeutic model (fMRI studies) and its effectiveness especially the German Outcome studies (Keller W, Westhoff G, Dilg R, Rohner R, Studt HH 2006). Outcome studies are so strong that in Europe, this kind of psychotherapy is supported by Government funding and Health Insurance Systems. Germany, for instance, recognises Jungian Analytic therapy for Health Insurance benefits.

In a long-term study, Keller and his colleagues investigated the effectiveness of Jungian analysis and the utilization of health insurance benefits. The results speak for themselves:

The objective data from health insurances revealed improvements in the health status and illness behaviour, leading to markedly reduced medical utilization (sick days, hospital days, number of physician visits, drug intake) in the majority of patients even 5 years later and thus to a considerable cost reduction. These results are clinically very important, in view of the long prevalence period of 5 years … this is indicative of the long-term effect of psychoanalysis or long-term psychotherapy.

— Keller et al 2006, P.33

This research indicated that patients reduced sick days by 66.6% in the year after therapy and was reduced by 50% after 5 years. In terms of hospitalization, hospital days were reduced 87.5% in the year after therapy and 50% after five years. These reductions of sick days or hospital days after long-term psychotherapy is all the more significant when one considers that the cohort of the study was 10 years older at the time of the research and that there was thus an increase in the disease risk and the number of sick days or hospital days.

In Australia, Professor Leon Petchkovsky, from North Coast Psychotherapy, has been conducting an EBR project on the nature of the “Complexes” supported by a grant from the International Association for Analytical Psychology (IAAP). This work continues Carl Jung’s pioneering EBR work on the Word Association Experiment over 100 years ago with the twist of using the latest brain scdrishti brain imageanning technology. Petchkovsky’s fMRI findings were very robust, suggesting that the internal conflict at the heart of the complexes involves bilateral Anterior Insular Cortex AIC (areas for self awareness and social discrimination) and Supplementary Motor Area SMA (supraordinate mirror neuroneregion). Interhemispheric cross-talk, as well as interactions between “self” (AIC) and “other” (SMA) were also involved. The word search is mediated by L hemisphere interactions between expressive ( L Broca’s) and receptive (L middle Temporal) verbal association areas. Petchkovsky’s research demonstrates that the complexes (at the heart of the psychoanalytic understand of psychodynamics/internal process and its impact on relationships) are clearly not just metapsychological constructs.

In general, there is a considerable and growing body of evidence-based research that demonstrates that long term analytic psychotherapy is very effective. This is the case for a broad range of psychological disturbance and is particularly the case for patients with more severe mental dysfunction. The evidence strongly suggests that psychodynamic models (which includes the Jungian analytic modality) are more suited to this patient population. These evidence-based research studies show that analytic psychotherapy treatment outcomes are not only effective but that re-admissions into hospital have decreased, as has lost work time. It could be argued that the shorter term model of the Better Access Initiative of the Federal Government does not provide a setting or time frame for proper mental health care for this patient grouping.

The research also shows that patients continue to improve even after the analytic psychotherapy treatment has ended. Milrod et al (2000) established statistically significant and clinically meaningful improvements in panic, depression, anxiety and functional impairment both at treatment termination and at follow-up six months after completion of psychodynamic psychotherapy. Leichsenring and Rabung’s (2008) meta-analysis of the effectiveness of long-term psychodynamic psychotherapy showed it “was significantly superior to shorter-term” treatment modalities and that “long-term psychodynamic psychotherapy yielded large and stable effect sizes in the treatment of patients with personality disorders, multiple mental disorders, and chronic mental disorders”. Bateman and Fonagy (2001) indicated that borderline patients who completed a program of long term psychodynamic psychotherapy not only maintained their substantial gains at the end of treatment but also showed a statistically significant continued improvement on outcome measures.

In an Australian context, Meares and his colleagues have shown a similar outcome with a similar population (Meares, Stevenson & Comerford 1999). His long-term follow up of patients treated intensively using analytic psychotherapy not only revealed positive clinical outcomes but also positive economic outcomes in terms of reduced hospitalisation and use of other services (Stevenson & Meares 1999; Hall, In praise of counsellingCaleo, Stevenson & Meares 2001).Sandell and his colleagues in Sweden (Sandell R, Lazar A, Grant J, Carlsson J, Schubert J, & Falkenström F) examined more than 400 people before, during and after subsidized long-term psychotherapy as part of the Stockholm Outcome of Psychoanalysis and Psychotherapy Project (STOPPP). They demonstrated that patients in psychoanalysis continued to improve after termination. These studies strongly suggest that analytic psychotherapy establishes a process that continues after the formal end to the work. This suggests an advantage to longer term, in-depth psychotherapy over short-term modalities.

Appropriate care for patients with appropriate clinicians

Given that the Federal government’s Better Access Initiative limits the Medicare coverage to a limited treatment modality (mainly short term CBT, Interpersonal Therapy, and Narrative Therapy with indigenous populations) and given the above studies, there appears to be real inequities in the system. This inequity means that some highly trained and experienced practitioners are being effectively under-utilised.

ANZSJA and its Australian umbrella organisation The Psychotherapy and Counselling Federation of Australia (PACFA) are currently negotiating with Government and Insurance bodies to have non-medical, non-psychologist Jungian analysts and psychoanalysts gain eligibility for longer term treatment of “disorders of the self”. Some psychotherapists report seeing patients who have tried brief, structured interventions such as CBT and found them to be of limited effectiveness. This is not to suggest that CBT and other approaches are not helpful, but that, rather, their usefulness is limited to certain patient populations.

As the above research demonstrated, this is particularly the case for the more difficult disorders, for example, multiple or chronic mental disorders, “personality disorders” or long term abuse/trauma cases. The National Mental Health Policy 2008 recognizes this need to have a broad range of treatment modalities with its statement that: “Central to the population health framework is a range of high quality, effective interventions that target those at different levels of risk or with different levels of need. The interventions should be comprehensive, ranging from prevention and early intervention through treatment to continuing care and prevention of relapse” (p.10).

At North Coast Psychotherapy, our approach to mental dysfunction is holistic. As a result the patient is not fitted into one model but rather is fitted into an individual formulation and treatment plan based on the needs of the individual patient.Labyrinth woman Thus, North Coast Psychotherapy supports diversity in service providers to reflect the diversity in clients’ needs. These needs are not necessarily obvious to the patient in treatment but must be crucially kept in mind by the treating psychotherapist. Clinicians need to have the training and experience to know the complex psychological treatment needs of their patients.

Psychotherapists and analysts who are trained to deal with complex mental disorders are not eligible to receive referrals under the BAI unless they are also psychologists or Social Workers. This has meant that some highly-trained practitioners in the mental health field are under-utilised in their area of expertise. Yet, there are BAI endorsed practitioners who seek clinical supervision from psychotherapists and psychoanalysts. This situation is inequitable but also raises ethical questions. The promise of free, short-term therapy attracts people who may receive limited or no benefit from short term work. If the expectation of improvement is not met, the work could even be damaging and counter productive and could lead to a negative attitude to further treatment. For further discussion on this theme see: Evidence Based Psychotherapy Outcomes Studies. Do they make any sense?

For a comprehensive bibliography of EBR for Psychoanalysis and Psychoanalytic Psychotherapy click here.