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Lacap initially took its referrals from primary care practices, and by 2004 had a base of some 42 GP referring practices. On 1st January 2005 lacap published its website, and now receives the majority of its work through self-referral. This media path does make a difference. We hypothesise that entry by the the primary care path meant that patients had already ‘medicalised’ the symptom, were prepared then to address it to the authority of a Doctor, and accepted a passage where lacap was a point of termination for that symptom to be received. The GP will have added screening. Self-referral is different. The patient arrives without ‘screening’. There is little culture for psychoanalysis in the UK, and you cannot expect the patient to have any reference points beyond the demand to lose the suffering in the symptom. The internet offers the endless sliding along research pathways. Master discourses such as the medical/psychiatric discourse are drowned out by other noise. Quite where lacap has fixed a point of addressee, as interlocutor, as knowledge, for that patient in that cyberspace medium cannot be controlled for. |
The other classic control is to reference lists of indications and contraindications for psychoanalysis. But as the clinical openings at lacap are so diffuse and varied, there is little chance of establishing work according to a notion of ‘What is a standard patient?’. What we have experienced then is that lacap clinicians have often found the clinical openings to be quite ‘left-field’; governed as they are by the nature of self-referral through this medium. Symptoms are more diffuse and less-organised. The demand can be correspondingly vague, and desire can be low and problematised by paranoia. This does not need a wholesale re-writing of the rule-book, but does call for work to be done to build the analytic transference and stabilise the initial wild-transference without assuming you |  |
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| represent ‘analytic authority’. (Bucketloads of ‘analytic attitude’ and frustrating silence are appropriate for the training organisation, but not for coal-face therapy. You might also wish to consider this when choosing your supervisor.) Most treatments then take on the flavour of more standard work after this opening has been transited in the first six or eight meetings, and are ‘business as usual’. So, we are delighted that retentions beyond six months remain at around 66%. | |||||||
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| You are being asked to commit to a caseload that is a minimum of
ten and a maximum of eighteen in the first six months. After the first six months, you may ask for new referrals to be made over to your offsite premises, although you must still retain an onsite reception capacity of a minimum of six patients. After six months you may ask to receive volumes to a maximum of 30 patients. Because lacap advertises its services, we cannot guarantee your patient volumes; that will also depend to a large extent on the amount of time-slots that you place on the service front-end as available hours, and the times that you hold open. Not surprisingly, the demand for evening and weekend slots far outstrips those for daytimes, and the fees are often higher. Pressure on clinical room resources means that it is unlikely that you can retain ‘open slots’ to build an ‘only high fee’ practice. On the ground, those resource hours will be taken by therapists accepting ‘standard fee’ rates. Lacap does not believe that the psychoses, the addictions or the perversions are beyond the therapeutic remit, although you will have to decide for yourself whether your practice can address without risk to the patient, & let us know.
| In this sense, assessment is the assessment of the clinician’s capacity to receive the patient, not an assessment of the patient’s capacity to receive treatment. You will find that lacap does not oversee your day-to-day practice, and is on the whole management-lite. However, we cannot ignore that lacap is a transferential object in your clinical work, and we do try to minimise that presence. But it is because lacap does continue to function in the patient’s minds that we do insist that emails are generated in lacap’s name that ‘rubber stamp’ any variations that you agree with the patient to the contract. In essence, the patient is a lacap patient. If you cannot accept this stricture, you cannot work here. At the end of six months, you may ask at any time to disassociate yourself from lacap, and |  | ||||
| for its part lacap will be pleased to advise the patients’ that you are receiving that your association has ended, and to recommend that they continue their work with you elsewhere. In the event that lacap is forced by concerns to end its association with you, the patients will be advised, and without recommendation that they retain you. There is at all times clarity about when the patient is with, or separate from lacap.
When taking LACAP patients either offsite or taking them with you as you
go, referral fees are always payable in full.
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