Scrutinising NICE: The impact of the National Institute for Health and Clinical Excellence Guidelines on the provision of counselling and psychotherapy in primary care in the UK

Abstract

This article explores the key assumptions that underpin the National Institute for Health and Clinical Excellence's (NICE) approach to guideline development and describes how those assumptions have led to the current reduction in the range of available therapies in primary care. This reduction, it is argued, conflicts with the government's recent commitment to increase patient choice. It is suggested that we are witnessing a paradigm war between those who seek to treat psychotherapy and counselling as if it was a drug and those who regard it fundamentally as a dialogue. Further, it is contended that though NICE may acknowledge the serious debates concerning the relevance and appropriateness of its approach, by subjecting issues of mental well-being to a biomedical model of research it is effectively ignoring those debates. NICE's process is deconstructed and areas of contradiction and ambiguity within NICE's own work are highlighted. The case is made for NICE to move beyond its use of strict diagnostic categories and follow the lead of the American Psychological Association (APA) in adopting a pluralistic approach to psychotherapeutic and counselling research evidence.

Keywords:

• NICE
• patient choice
• medical model
• RCTs
• psychotherapy
• counselling
• psychodynamic practice
• CORE-OM
• qualitative research methods
• guideline development groups

Acknowledgement

The authors wish to acknowledge that this article has been based on the research funded by the United Kingdom Council for Psychotherapy which resulted in the circulation of a paper to UKCP members entitled ‘NICE Under Scrutiny: the impact of the National Institute for Health and Clinical Excellence guidelines on the provision of psychotherapy in the UK’ (Guy, Thomas, Stephenson, & Loewenthal, 2011).

Notes

1. It is worth noting that AGREE is an ‘integrated research programme currently funded by the BIOMED-2 Programme of the European Union’ (AGREE, 2001, Introduction), which ‘In EU terminology area 2 is devoted to “research on biomedical technology and engineering”’.

2. In Lewis Carroll's Alice's Adventures in Wonderland (1865), at a certain point a number of characters become wet. In order to dry themselves, the Dodo decided to issue a competition. Everyone was to run around the lake until they were dry. Nobody cared to measure how far each person had run, nor how long. When they asked the Dodo who had won, he thought long and hard and then said ‘Everybody has won and all must have prizes’.