After working as a psychiatrist in England, I became a Bach flower practitioner in New Zealand. The Bach flower remedies are a long-established complementary therapy intended to improve emotional balance. While not an adequate treatment for serious forms of mental illness, they can be used for the same sort of problems – anxiety and phobias, mild to moderate depression, responses to loss or stress, adjustment reactions, relationship difficulties – that often present in mental healthcare settings. Without a clinical trial, it would be impossible to say whether Bach flower therapy, orthodox psychiatric treatment or a combination of both works best. There are several points of contrast between the two approaches, as outlined below.

The style of interview: The traditional psychiatric interview and mental state examination involves asking patients a great many questions, covering not only the detail of their present complaints, but also their life history and social circumstances. This elicits a great deal of information, some of which may be highly relevant for future management, but some patients may find it intrusive or feel it does not allow them enough time to express their real concerns. A Bach consultation, in contrast, is more exclusively focused on current emotional state, and it is up to the clients to reveal as much or as little as they wish. Practitioners may ask for clarification, but do not probe too deeply – a key word is Simplicity. I believe this is more relaxing and therapeutic for those on the receiving end, however it may mean that important material – for example symptoms of a medical disorder, or suicidal ideation – is missed.

The diagnostic assessment: Psychiatrists assign their cases to a diagnostic category from the official classification systems, ICD or DSM. These categorisations are valuable in enabling research into the causes and treatments for different conditions. Bach practitioners, in contrast, make little or no use of diagnostic groups but aim to understand exactly what negative emotions the individual is currently experiencing; for example the same client might be feeling fear for no apparent reason, combined with regrets about the past and lack of confidence to apply for a new job.

Medication: A great advantage of Bach flower remedies over psychotropic drugs is their lack of side effects or interactions. They can also be more accurately tailored to the individual case, as up to six of the 38 flowers can be mixed together, giving rise to multiple possible combinations; suitable remedies for the fictional client described above would be Aspen, Honeysuckle and Larch. The key question is whether they work? Many authorities are sceptical, given that their mode of action is obscure and that most  published trials have shown no significant advantage over placebo. However most of the trials have not used the remedies correctly, having given all subjects the same mixture rather than individual prescriptions chosen at interview. The lack of scientific validation stands in contrast to the worldwide popularity of the therapy, still continuing 90 years since it was first developed by Dr Edward Bach. I have found that about 80% of clients respond well, a success rate comparable to that seen with psychotropic drugs. I have not been able to find any randomised trials comparing Bach flowers with antidepressants or anxiolytics, and would be pleased to hear of any that I have missed.

Relationship with patients/clients: While doctor-patient relationships are no longer so authoritarian as in the past, the doctor (or other orthodox clinician) is in charge, the patient has a passive role, and there are firm professional boundaries. With Bach flower treatment there is a more informal and egalitarian relationship, with clients being encouraged to take part in choosing the remedies they need. I have never found this familiarity abused, having had many friends as clients, and clients who have become friends. It is stated in the Bach Foundation code of practice that clients remain responsible for their own well-being, and I believe this self-responsibility contributes to the success of the treatment – though it would not be appropriate for cases of severe psychiatric illness, which should not be treated solely by Bach flowers in any case.

Psychological treatments: In mental health settings, a range of psychotherapeutic techniques may be used either alongside or instead of drugs. Formal psychotherapy is not part of Bach flower treatment, although all practitioners need basic counselling skills, and some are qualified to use other methods that can successfully be combined with the flowers – I have used my life coaching training in this way.

Professional support: Clinicians working in a public health service are obliged to interact with colleagues, fulfil requirements for audit and continuing education, and attend meetings. All this helps with maintaining standards and keeping up-to-date, though can divert time and energy from direct patient care. In contrast, Bach flower practitioners often work in isolation and are not strictly regulated. They have more time and energy for their clients, and are very unlikely to cause them direct harm, but there is some risk they may fail to recognise a serious mental or physical disorder that needs prompt medical assessment.

A few psychiatrists around the world already use Bach flowers in their practice, and there seems no reason why these remedies could not be more widely integrated with orthodox treatments.