Monday 6 October 2014

What happened when I introduced energy psychology to the NHS ...

On introducing energy psychology to the NHS ....

Before describing the results when I introduced energy psychology (initially in the form of EFT) to a mental health Trust in the British National Health Service, I would like to outline how I came to be interested in EP, and how this was part of my ongoing search for better methods of therapy. As I explained in the previous post, conventional methods of psychological therapy are not actually very effective - despite the extensive hype and heavy marketing.

I completed training in clinical psychology back in 1976, at the University of Leeds. Typical of the trainings of that time, its predominant therapeutic approach was behaviour therapy, based on both classical and operant conditioning models of anxiety and behavioural learning, all derived ultimately from either Pavlov's dogs or Skinner's pigeons. There was some discussion of other approaches, such as psychoanalysis, Rogerian client-centred therapy, Gestalt therapy, and Ellis's rational-emotive therapy - all of which were viewed as less scientific and as having a limited research evidence base. To understand the evolution of clinical psychology in the UK, it is important to be aware of the position taken by the highly influential Hans Eysenck and colleagues (1949) in their statement of how clinical psychology should develop in this country. Explicitly contrasting their view with that prevailing in the U.S.A, Eysenck stated "... it is our belief that training in therapy is not, and should not be, an essential part of the clinical psychologist's training; that clinical psychology demands competence in the fields of diagnosis and/or research,, but that therapy is something essentially alien to clinical psychology ...". Later, Eysenck became an enthusiastic advocate of behaviour therapy, viewing this as a scientifically legitimate pursuit for clinical psychologists - but the general suspicion of psychotherapy remained (perhaps also reflecting the attitudes within British culture more generally at the time).

With my passion for psychoanalysis (I had first written to the Institute of Psychoanalysis in London at the age of 16, asking how to pursue a career in psychoanalysis), I could not wait to get to London and explore the world of psychoanalytic psychotherapy - based predominantly at the Tavistock Clinic. I undertook some part time programmes there, and then, on my third attempt, I was fortunate enough to be selected for their full time training in psychoanalytic psychotherapy - and enjoyed an intense and rewarding 4 years, and also began my PhD research. Somewhat later, I undertook a long training in psychoanalysis at the Institute of Psychoanalysis, and qualified as an analyst around 1999.

In 1987, I began work as head of clinical psychology and psychotherapy services at a modern hospital in Hertfordshire, seeing a wide variety of both inpatients on the ward and outpatients. I was asked to see some of the most troubled patients within the service - and found, to my dismay, that my psychotherapeutic skills were, in some cases, literally worse than useless. People would talk to me and get worse! They would leave the session and self-harm. This was not the case with those I had worked with whose disturbances were more moderate, but the people I was now asked to see had often suffered very severe and prolonged traumas in childhood. Talking therapy, even when based on gentle empathic enquiry, was clearly not adequate to the task. These were people who seemed most in need of psychotherapy - and yet psychotherapy held the potential to overwhelm and retraumatise them. This seemed a terrible dilemma - and one which set me searching for better ways of helping people. At the time, there was very little literature or understanding of trauma - the American literature was not well known here. I endeavoured to read and learn all I could that might be of relevance. A colleague told me of EMDR, which seemed an exceedingly strange approach involving waving a finger in front of someone's eyes, and said he knew of someone who was getting extremely good results using it - so much so that my colleague himself undertook a training in EMDR. He began to assail us every day with astonishing stories of EMDR, so persuasively that I trained in this myself in the early 90s - and indeed found it to be very good, the first really effective treatment for psychological trauma. Nevertheless, EMDR still contained the potential to overwhelm and retraumatise people.

Towards the end of the 90s, we were beginning to hear, within the EMDR networks, of somewhat similar but different methods involving tapping on acupressure points - and the word was that this could be even more effective than EMDR. I then came across a book in my local shop called Emotional Healing in Minutes, by Valerie and Paul Lynch. It described an acutapping method - essentially EFT, although that name was not used. I found it effective, and easy to incorporate into EMDR procedures (particularly since EMDR itself has a tapping variant). A little later, I found Gary Craig's website, and obtained and studied all his video teaching material, as well as training in EFT with two UK organisations - and became a trainer of EFT. By this point, I had also realised that EFT was part of a much larger family of energy psychology methods, and my own mode of work gradually moved beyond EFT - helped enormously by attending the wonderful conferences of the Association for Comprehensive Energy Psychology [ACEP]. However, in the early 2000s, I had become fluent in EFT, it had transformed my work (as well as aspects of my personal life), and I was eager to share it with anyone who might be interested.

I found that energy psychology methods were even more effective than EMDR, yet were more gentle and safer, running much less risk of eliciting flooding of emotion. They could be combined with EMDR very well. 

After formal discussion with psychologist colleagues, and the agreement of our committee, I offered a workshop on EFT within the NHS Trust. It was well-attended and enthusiastically received. I received many e mails from people who had not been able to attend, asking me to repeat it - which I did. This was followed by yet more requests for a further repeat. People began using EFT and reporting very good results. Patients liked it, and were using it themselves, finding it a very effective and empowering method of affect regulation. Both on the ward and in the community, nurses found that EFT provided them with a simple method of helping people become more calm and less distress, without resorting to additional medication. In my locality, we formed an interdisciplinary study group, meeting regularly to share experiences and learning, and to undertake a research audit of our clinical results. Members of the study group included psychologists, psychiatrists, nurses, occupational therapists and arts therapists. Our waiting lists collapsed. People were getting better - and rapidly! 

Meanwhile, the 'reaction' to these positive developments was germinating. Across the other side of the Trust, a consultant psychiatrist, whom I had never met or spoken to, began fomenting disquiet amongst her colleagues. She spoke of her perception that "you cannot get proper CBT in this Trust because they are all doing this tapping therapy", which she asserted was spreading across the Trust "with evangelical fervour". Using material readily available on the internet, from skeptics websites and so forth, she put together a lurid presentation for her colleagues, outlining what she saw as the dangerous and pseudo-scientific nature of EFT etc., and its lack of any evidence-base. As a result of her presentation, the Consultant Psychiatrists petitioned the head of practice governance for the Trust. My workshops were stopped. We were asked to cease using EFT. I was required to present the evidence-base for EFT to an 'innovations in practice' panel. Such steps were entirely appropriate and necessary once concerns had been put to the clinical governance lead - I am not implying any criticism of the process. It was, however, a stark illustration of a conflict between two professional groups - the psychologists (and their committee and process) that had agreed to the use and teaching of EFT, and the (more powerful) psychiatrists who objected to psychologists not behaving as the psychiatrists thought they should. 

I spent a number of weeks preparing a systematic review of the evidence for EFT and related methods. It was quite an extensive document. I carefully sent it to each member of the panel, as requested, in good time for the meeting where I was to present it. Naturally I assumed the panelists would have read it, and that we could take it as the basis for our discussion. My assumption turned out to be naive and misguided. Certainly the Head of Practice Governance, a very fair minded and decent man (from a nursing background), had indeed read it, and made apt comments. Others had not. One key psychiatrist had not even brought the correct document, but instead had some very brief summary I had written for a quite different context. The 'discussion' was far from satisfactory or productive. The lead for the psychiatrists listened to my account of the evidence-base and declared "there is no evidence", and also expressed the view that EFT must be based solely on distraction. 

There was also mischievous meddling by at least one psychologist, who wrote letters to various managers indicating his 'concern' about methods used by some of his colleagues that lacked an appropriate evidence base. He claimed to have looked at the evidence and found nothing to indicate EFT would be suitable for the kinds of patients seen within the Trust. 

Despite these discouraging reactions, the eventual outcome was that Practice Governance agreed that EFT could be used by psychologists who had received training in its use. Later, this position was modified to state that EFT could not be offered as a standalone method since the purchasing commissioners had not requested this. The wording carefully and intentionally left open the possibility that we could incorporate EFT into other approaches - which was, of course, what we were doing. For a number of years, a small group of us quietly got on with our clinical work, incorporating EFT and other EP methods, adapting these as best we could for each client - and getting very good results. Such methods were not an alternative or substitute for more conventional approaches, but were an addition that seemed to make all the difference. Clients would leave sessions feeling lighter and more positive. Change would come about more easily and more quickly. Sessions would seem less tiring and heavy. There would often be humour, laughter, and play. 

In subsequent years, the culture of the Trust, and the NHS generally, began to change. Ironically, this coincided with the increased emphasis upon the provision of psychological therapy, and concern for its evidence base. This process had begun in the mid 1990s - and was marked by the arrival of the government commissioned book What Works for Whom? by Roth and Fonagy. The NICE guidelines - initially concerned with advising the government and the NHS on appropriate medication and treatments for physical illness - were becoming increasingly influential and were now turning their attention to psychological therapies. In 2005, an economist, Lord Richard Layard, tabled a paper outlining his view that making evidence-based CBT available more widely for people suffering anxiety and depression would be of benefit to the economy, enabling those on long term sickness to return to gainful employment. He had been influenced by enthusiastic proponents of CBT - although, interestingly, his own father, John Layard, was an Jungian analyst, who had received treatment from Jung, and (according to Wikipedia) appears to have led a colourful life. Layard's proposal to make CBT widely available in the UK resulted in substantial government funding and the launch of the Improving Access to Psychological Therapies [IAPT] programme. 

The result of the IAPT programme was that CBT was indeed made widely available - and many young CBT practitioners were trained on new courses at various universities. These CBT trainings were distinct from the already existing trainings in clinical and counselling psychology and in psychotherapy. Practitioners were trained in the use of evidence based clinical protocols, specific to each condition - rather than generically in therapeutic principles that could be adapted to each client. Thus it is 'therapy by manual' that is increasingly provided in British NHS services. In this climate, therapeutic methods became increasingly restricted to those officially approved - with much less scope for clinical judgement. The use of energy psychology methods seemed more and more difficult - a trend intensified locally when a new head of service took over who (unlike the previous incumbent) was clearly completely wedded to the new paradigm of NICE, IAPT, and CBT.

My own unease with the increasing deference to NICE guidelines had developed some years earlier - see papers listed below (2009; 2010). The 2010 paper is available via this link - the 2010 paper on the NICE guidelines is available here - and my 2007 article on Debunking the Pseudoscience Debunkers is available here.

However, pressure and hardship give rise to creative adaptation. I tried to find stress relieving procedures, helpful to clients in the NHS, that did not involve tapping. Thus I developed various techniques, including a modified collar bone breathing technique, lung meridian breathing, combinations of eye movements and tapping the K27 points, imagery with internal eye movements, and variants of Diepold's 'touch and breathe' - making use of the various acupoints as 'emotion-release buttons' (since the different meridians are associated with different emotions). All these were embedded in broader frameworks that always included the best of psychodynamic, CBT, EMDR, and interpersonal therapies. Thus the clients were never deprived of a NICE approved therapy but were given something additional as well. Such work was always based on the best available evidence from clinical practice and research evidence. 

Over these years of exploring innovative psychotherapeutic methods within the NHS, driven by clinical need, I have noticed broadly two sorts of people working within the system. One type of person is generally trying to do the best he or she can for the patient, and is open to new information and different ways of working. This does not mean that such a person would necessarily embrace energy psychology - not at all - but he or she would not oppose it if there is clinical or research evidence of its value. Such people try to do a good job, help and support colleagues where possible, and learn ways of working that are suited to their natural talents and interests. Like anyone else, they may be awkward and difficult at times, but they are basically well-intentioned people. The second type of person can initially appear to be like the first - but their basic motivation, attitudes, and mode of operating are different. Their overriding aim is to facilitate their own progress and material success within the organisation. Thus, their apparent attitudes and beliefs will adjust to the prevailing culture, and they will at times behave in rather ruthless ways to further their own position. They can be extremely deceptive. Unfortunately, it is often (although certainly not always) such people who do succeed in making their way into positions of power and influence within large organisations such as the NHS. It is in the nature of their psyche to be opposed to both psychoanalysis and energy psychology, since each of these, in different ways, has the potential to challenge prevailing assumptions and narratives, conscious beliefs and perceptions, and structures of social, organisational and political power. No wonder that I like to combine these, in the approach I call Psychoanalytic Energy Psychotherapy! link

In March of this year, I was made redundant from the NHS.Of course this had nothing to do with my love for energy psychotherapy ..... 


Eysenck, H. J. 1949. Training in Clinical Psychology: An English Point of View. American Psychologist., 4, 173-177.

Mollon, P. 2005. EMDR and the Energy Therapies: Psychoanalytic Perspectives. London: Karnac.

Mollon, P. 2008. Psychoanalytic Energy Psychotherapy. London: Karnac.

Mollon, P. 2007. Debunking the Pseudoscience Debunkers. Clinical Psychology Forum [Division of Clinical Psychology: British Psychological Society] 174, June: 13-16 click

Mollon, P. 2009. The NICE guidelines are misleading, unscientific, and potentially impede good psychological care and help. Psychodynamic Practice. 15 [1] February 9-24. click

Mollon, P. 2010. Our rich heritage – are we building upon it or destroying it? Some malign influences of clinical psychology upon psychotherapy in the UK. Psychodynamic Practice. 16 [1] February 7-24. click

Research evidence for energy psychology:
For the research summary on the website of the Association for Comprehensive Energy Psychology [ACEP] click here

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