‘Numbers and Faces’ economic analyses and psychotherapy

SUMMARY

This paper addresses the difficulties which surround the economic analysis of psychoanalytic psychotherapy. Economic evaluations have as their explicit aim the allocation of scarce resources. The methodology of economic research remains crude, with little consensus over what constitutes costs and benefits, and how they can be measured in the field of mental health. The value of psychotherapy may be undermined by narrow economic considerations, for both defensive and destructive purposes, and we need to differentiate between these differing attitudes. Using one of Auden's poems, ‘Numbers and Faces’, the paper addresses how economic analysis takes a perspective on psychotherapy that focuses more on ‘numbers’, as opposed to process research that more sticks to ‘faces’. The detrimental effects of adopting a belief in numbers is discussed. Two clinical vignettes highlight the limited application of economic evaluation to the clinical setting.

The Kingdom of Number is all boundaries Which may be beautiful and must be true: To ask if it is big or small declares one The sort of lover who should stick to faces

— From Numbers and Faces by W.H.Auden