4/ Editorial introductions

Current trends in therapeutic intervention take on a particular light when set against the backdrop of the massive demographic, political and socio-economic changes seen over the last decade. Not only do brief psychotherapies appear cost effective in relation to particular outcome criteria in individual clients and local budget constraints. They may also serve to dissipate belief in the state's responsibility in certain areas, by locating the source of clients' problems in their attitudes to life and responsibility for their plight within their individual sphere of influence. In chapter twenty two, Vincent Deary examines these and other aspects of the current trend within the NHS of purchasing brief, individually focussed therapies.

This paper considers the three main therapeutic modalities and their development as ideology, rather than offering what may be seen as a complete account of all the schools. In this way, this chapter highlights the most crucial point of section three, which is to encourage the reader to look at how ideology is influencing their experience and their belief in this or that (apparently) moral principle. It may, after all, not be a moral principle at all, but simply ideology that one has been induced to introject. Vincent does not seek to argue that one is gullible for having done this - after all, there are vast philosophical, scientific, cultural, financial, religious and other interests at play, and at play over a long period of history, in developing the ideology. Particular therapeutic ideologies have almost become an ethical touchstone for those of us subscribing to them, so that it is possible to blind ourselves to any merits of the alternatives. In this respect, Vincent exposes his own position in the enmeshed hierarchy of interest and professional status, describing his experience of work as a behavioural nurse psychotherapist, exposing also the dread that scrutiny of these issues induces in him as one person trying to sort out the chaff of ideology from the wheat of clear judgement about what is right and fitting in the care of the mentally ill.