Dear all,
In the spirit of gaining a balanced commentary, and because I was recently surprised by somewhat positive input from a recent graduate who is working as a 'low-intensity' therapist, I forwarded the thread to a colleague who is working day to day as a supervisor in an IAPT programme, to ask his opinions. I thought you might be interested in much of his response to me:
"I'd agree with a lot of the comments re showing up limitations of and demand for therapy (and in some respects the exclusivity of psychotherapy); but my experience is overwhelmingly that people find the interventions helpful (and we have a fair bit of patient experience surveys to back that up). It may be that I've necessarily have had to follow a fairly rigorous medical model - i.e. stringent assessment procedures (especially to gauge ability to engage with, in particular, CBT interventions), protocol adherence with the less experienced therapists, some attention to condition specific criteria and tight supervision. Move beyond those boundaries and IAPT starts falling apart, granted... It is in its infancy and one could argue that any new system/organization requires tight boundaries initially. I get the argument therefore from a community psych perspective and can see how the medicalisation of therapy could be perceived, but I can already start seeing how we can perhaps begin to relax into an easier model of delivery. (Good example - I have a Community Development Worker on my team and we do a lot of work on access, cultural appropriateness and adaptability issues..) Recovery rate statistics are arbitrary and never convincing, as impressive as they may seem (nationally about 50%). There are various difficulties with the assessment instruments and the benchmarks are inappropriate in more complex populations (for example in places with high social deprivation levels). Far more convincing are the reported experiences of the therapists and the impact on patients' lives. I'm utterly convinced of the "use" of what we are doing, even if ideologically IAPT might not have it right. I can see how people can experience it as threatening and an exercise in steamrolling, but loads can be done from within.
Supervision for me has always been a space where we can explore the therapist's notions of complexity, holding, non-protocol driven therapy and conceptualizing in other modalities. I think the biggest problem is with the training providers who are very condition and protocol specific ... I do feel though that we are making progress with getting staff to not "do" therapy unto patients, but especially with the more experienced ones, very good therapeutic work is happening... We struggle with plenty of inappropriate referrals - notably severe risk and advocacy issues... some of these issues are resource capacity issues, but more so, not having sufficiently trained and experienced staff.'
Jacqui A
-----Original Message-----
From: The UK Community Psychology Discussion List [mailto:[log in to unmask]] On Behalf Of Gaskell Alistair (Cambridgeshire and Peterborough NHS Foundation Trust)
Sent: 20 April 2010 13:50
To: [log in to unmask]
Subject: Re: [COMMUNITYPSYCHUK] literature on IAPT?
i wouldn't want to speak on behalf of clinical psychologists generally either on or off the list, but a personal view from someone who is I suspect more pro therapy than most on the list, is that there is something particularly pernicious about IAPT in that it takes people in distress which often has very deep roots in trauma and neglect both in social and proximal (personal) domains and offers very simplistic solutions (which seem to be things like exercising more and thinking positively.)What's worse these "solutions" are "evidence based" so if they don't work it must be the patient's fault. So there is a huge invalidation someone's experience of distress. Worse than antidepressants in this way.
This criticism could be made to therapy in other contexts too but the way in which IAPT is set up as a low skill / high volume / "quick fix" enterprise puts pressure on the therapists not to listen to their patients and makes the whole problem a lot worse. My own view is that it is possible for therapy to be much better than this, but i guess a lot of people will part company from me at this point (if not before..)
b/w
Alistair
________________________________________
From: The UK Community Psychology Discussion List [[log in to unmask]] On Behalf Of Penny Priest [[log in to unmask]]
Sent: 20 April 2010 08:22
To: [log in to unmask]
Subject: Re: literature on IAPT?
Well Craig, I'm sure the perspective of clin psychs on this list is very
varied and I have various perspectives on it myself. The Midlands
Psychology Group stated some perspectives in the special issue of CPF -
181 and another article in 182.
So some of these ideas/perspectives are that IAPT is a ridiculously
unscientific experiment, doomed to fail, but will no doubt be spun as a
success by some and IAPT is an awfully ridiculous joke.
I would not agree with the perspective that it degrades therapy, but
rather exposes the massive limitations of therapy.
With regards distracting from social issues, I would say that all
psychological work has the potential to do this, so IAPT is not
necessarily any different, but just ploughs that juggernaut on further.
From what I have seen and what I think would be sensibly predicted too,
IAPT has IDPT - it has increased demand for psychological therapies
because it's sold the idea that psychological therapies are a good idea
even further into public awareness.
I don't really understand your point about non-psychologists lacking
knowledge on social issues.
And as for faith and things psychological, I would put them in a similar
arena. These both in my view are best understood as embodied experiences
and therefore being more real/'existing', so to me your point about having
faith in something invalidates itself.
Penny
I'm not sure what the perspective from the clin psychs on the list is here
> - IAPT is bad because it degrades therapy we could do better (and it might
> cost our jobs), IAPT is bad because - as a therapy initiative - it is
> obviously irrelevant, IAPT distracts people from social issues (after all,
> what would non-psychologists know about social issues?). I have no faith
> in IAPT but I have no faith in anything "psychological" as it can't exist.
> I'd be interested to hear why psychologists on the list think it is any
> different from the explosion in Community Psychiatry, SSRIs, Depression
> Awareness or World Mental Health Day - all of which serve Psy and Big
> Pharma.
> C
>
> --- On Mon, 19/4/10, Gaskell Alistair (Cambridgeshire and Peterborough NHS
> Foundation Trust) <[log in to unmask]> wrote:
>
>
> From: Gaskell Alistair (Cambridgeshire and Peterborough NHS Foundation
> Trust) <[log in to unmask]>
> Subject: Re: [COMMUNITYPSYCHUK] literature on IAPT?
> To: [log in to unmask]
> Date: Monday, 19 April, 2010, 14:07
>
>
> its worth looking at what is available from the official evaluation so far
> -I think that some of the comments quoted from service users are very
> powerful eg:
>
> "I was trying to talk about important things but I
> couldn’t. felt very unsafe. It is such a big step
> ..asking for help and now I have failed"
> and
> "I was drowning and someone was throwing me a ring
> that landed about 10 miles away, it just didn’t feel real
> enough to be helpful"
>
> These come from this presentation - but there may be a fuller version
> available
> http://www.newsavoypartnership.org/2009presentations/02_Parry_et_al_IAPT_evaluation_day_one_plenary.pdf
> _
>
> Alistair Gaskell
>
> _______________________________________
> From: The UK Community Psychology Discussion List
> [[log in to unmask]] On Behalf Of John Cromby
> [[log in to unmask]]
> Sent: 17 April 2010 14:21
> To: [log in to unmask]
> Subject: literature on IAPT?
>
> Hi
>
> I'm looking for as many commentaries on/critiques of IAPT as I can find.
> Can anyone recommend anything?
>
> many thanks
> J.
> *********************************************************
> John Cromby
> Psychology Division, SSEHS
> Loughborough University
> Loughborough, Leics
> LE11 3TU England
> Tel: 01509 223000
> Email: [log in to unmask]
> Personal webpage: http://www-staff.lboro.ac.uk/~hujc4/
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