Some of you have probably heard of the 'Improving Access to Psychological Therapies Programme' set out by the Department of Health. This morning I had the pleasure to hear journalist Kati Whitaker from BBC Radio 4 (Woman's Hour) investigating Government's plan to make Cognitive Behavioural Therapy (CBT) more widely available. The IAPT Programme aims to help nearly a million of patients who suffer with depression and anxiety. Following successful NHS pilot schemes in Doncaster and Newham (east London), programmes are being set up in twenty new areas - and three and a half thousand new CBT therapists are being recruited.
The programme unveiled not only advantages of the IAPT but focused also on the issues surrounding the scheme, including the suspicion by experts and academics that the most vulnerable patients will lose out on the access to vital drugs and highly qualified counsellors.
The 29-year-old Kate had been suffering from depression since her early years at university. She had seen counsellors and GP's in surgeries that as she mentions tended to focus on the why's and meanings for her depression but that she claimed were not enough to 'move her forward'. It was not until she had received CBT in combination with drug therapy that she had experienced improvements in her symptoms.
Professor John Taylor, president of the BABCP, shows his appreciation for the Government's scheme to make CBT more widely available and explains on a nutshell the principles of CBT as method for clinical intervention.
The interview continues by exploring what other experts in the field of Psychotherapy are saying about this scheme. Andrew Samuels, Professor of Analytical Psychology at University of Essex, calls for re-evaluation of how these schemes are being administered and adds his perspective that other Psychotherapeutic models may serve better patients whose problems are more deep-rooted and past oriented, as opposed to what he says is the core of CBT intervention: the here and now. He also shows his concern about the most vulnerable people receiving on the 'cheap' psychological therapies by professionals who receive very little and quick training.
On the issue exposed by Professor Andrew Samuels, experts disagree that CBT is based only on the here and now, and urge that this simplistic view of CBT be challenged. In e-mail exchange (BABCP at Jiscmail.ac.uk) Professor Stephen Palmer, PhD, adds that: "The working in the 'present' aspect being portrayed negatively by others means that they avoid mentioning that we look at beliefs which developed historically. Perhaps BABCP could issue a press release or two explaining that complex cases may involve more than just a chat about the here and now!"
Some other experts suggest that there should be flexibility on the system, and that improvements ought to be made in the delivery of a broad range of services, that aren't just CBT based. A rather difficult task, in my view, since the National Institute for Health and Clinical Excellence (NICE) seems to be very much centred on CBT approaches in the deliverance of Psychological therapies for the treatment of most Anxiety disorders and Depression as well as more complex disorders even.
In discussion with colleagues at St Thomas Hospital (London) it is clear that the NICE Guidelines are recommendations based on research that focus on the efficacy of Psychological treatments in the various areas they propose CBT works efficiently. Nevertheless it is important to be said that the argument in favour of CBT is not only based on the assumption that this is the case because the model is relatively cheaper and briefer than other Psychological therapies, but that most of the research at present seems to be CBT oriented. The answer to the problem, one would assume, is that other schools of Psychological therapies ought to be engaged in more evidence based research methodologies to account for the efficiency of their Psychotherapeutic models, and in so doing, making sure that attention is directed towards these findings.
The programme at BBC Radio 4 continues by giving a brief explanation of self-help computerised CBT programmes (like Beating the Blues). Professor John Taylor shows his understanding on the subject and compares the importance of these with other self-help materials like books and tapes as way to help people alleviate their symptoms. Research suggest, however, that these methods may only be suitable to help people suffering from mild-moderate depression and so complex cases ought to be accompanied by the intervention of fully qualified professionals.
At the end of the programme Kati Whitaker refers to widespread application of CBT, and that recently research has suggested that CBT can also be very effective in helping people to manage to cope with more physical symptoms (for example diabetes, irritable bowel syndrome, fibromyalgia, etc).
The programme was presented by Jane Garvey at BBC Radio 4 on 18/02/08 for those of you would like to hear it again on their website.
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3 comments:
My wife, an acredited BACP counsellor with over 3800 hours experience has just received notice that her services will no longer be required by Suffolk Mind partnership who run the GP counselling services in Suffolk. She works as an Intregative Counsellor in her private practice and also has a diploma in eating disorders as well as many other qualifications. Whilst working within her role as a GP counsellor she uses Short Term therapies which are required by her service which have proved highly successful with her clients.
Now because of IAPTS being introduced she is told (along with all the other counsellors not IAPT trained ) that she is no longer qualified for this type of work. The probability is that she will be replaced by a 'Counsellor' who has jumped through all the IAPTS hoops but will be sadly lacking in experience that can only come from real work with clients. I only hope that this 'One size fits all' approach does not damage counselling as a whole
These are indeed very serious allegations and in my opinion should not be overlooked. I do wonder if these are however a mismanaged local problem rather then a more deep rooted systemic problem as you may be inferring from your comment. I have not heard of such issues affecting services like this anywhere else. Tell us more.
In response to comments from Animal Artist. I have recently secured a post with IAPTS. Whilst I am currently untrained in CBT/DBT, I am currently trained to Degree Level - this with distinction, in Mental Health Nursing. I have been employed in acute settings, organic and functional dementia settings, community based settings and child and adolescent services. Through these, I am able to confidently say that I have an excellent working knowledge of people, mental health illness and symptoms attached, medication, educating both patients and their families in mental health illness and above all, communication and engagement/disengagement skills. I have been advised that extensive training shall be provided in order that effective CBT/DBT may be forwarded. It saddens me that Animal Artist would think that IAPTS employees are considered as lacking in experience of working with persons that are experiencing a deterioration in mental state.
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