I read with great interest Thornicroft & Susser's (Reference Thornicroft and Susser2001) editorial on evidence-based psychotherapeutic care in schizophrenia. It called for evidence-based interventions being implemented in the face of resource limitations and a remedy to the absence of implementation plans for well-established effective interventions such as family therapy. However, Thornicroft & Susser dismiss psychodynamic approaches. Although the general view is that people with schizophrenia do not benefit from intensive psychoanalytic psychotherapy, there are some heroic efforts by analysts such as Herbert Rosenfeld (Reference Rosenfeld1987). In particular, such approaches do address the imperfection of our models of mental disorder.

One thing the psychodynamic way of thinking can offer members of the community mental health team (CMHT) is understanding of complex mental states from the patient's perspective, and new ways of understanding those that fall outside of our management strategies. There is no doubt that the delivery of psychoanalytic psychotherapy to people with schizophrenia, on an intensive basis, will not be resourced, nor will the symptom outcomes necessarily be better. Therefore, the cost cannot be justified. However, part of the problem that faces CMHTs is the long-term nature of their work with little reward in terms of symptom improvement and recovery for those with enduring severe mental illness. This can be frustrating and de-skilling for staff, particularly if they have a limited range of therapeutic models. I have worked in an assertive treatment team for the people with severe mental illnesses and one for homeless people with mental illnesses. Staff retain curiosity and capacity to think and question their formulations about patients in a psychodynamic way. Their work continues to be fresh and motivating. This is particularly welcome in light of Wykes et al's (Reference Wykes, Stevens and Everitt1997) finding that CMHT staff are not uncommonly depersonalised and therefore unable to empathise with their patients. At a time when there is a movement to ensure good human relationships as well as therapeutic relationships with patients, dismissal of the relevance of psychodynamic thinking in the healthy functioning of a CMHT is premature. This is one area of CMHT functioning that warrants further research, as suggested by Thornicroft & Susser.