UK: Improving Access to Psychological Therapies (IAPT) articles, blogs and discussion

Sly Saint said:
coincidentally...........



http://www.cbtwatch.com/iapt-the-myth-and-the-reality-vanquished-by-babcp-presidents/
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When you look at the accusations that the BPS gang make about us... it's all projection. All of it. Every accusation a silent confession.

Anyway we've known about Wessely's and Sharpe's (and probably Gerada's, judging by what I've seen) bullying for years so it's no surprise this is widespread. It's clearly part of the culture and it's no coincidence with such leaders. The fish is rotten from the head down.

The basis for much of IAPT's promises are in PACE and FINE, CODES and ACTIB. All of which will soon be dismantled because they are incompatible with proper handling of COVID-19. IAPT is as top-heavy as it gets, it's wobbling as we speak and once you take out the flimsy foundations there's nothing but spinning hot air about to crash down.
 
Mithriel said:
(we never discussed my pain in 5 sessions)

As a psychologist who works in a chronic pain clinic I finds that really shocking. A massive lost opportunity. How can she help you if she doesn't ask and try and understand what is happening for you and what your pain issues/thoughts are? At best she could have helped you to cope - if that was appropriate - or she could have validated that you were doing loads to help yourself - that's so important and often minimised by many. And an appointment with pain clinician to review meds would be totally appropriate. And still would be now if your GP can refer you to pain clinic rather than for pain management - many GPs are not aware these things are usualy different depending on how your local service is configured.

Something I have never understood in all the discussion of pain is that I do not feel I have chronic pain. I believe that every day I get acute pain because of whatever is going wrong with my body. There doesn't even seem to be an acknowledgement such a thing exists.

I would have liked to discuss that in a clinic but not to be.
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I think that would have been a really interesting and helpful discussion to have had with pain physician/physio to talk through your experience. Was this a long time ago or recently?
 
Joan Crawford said:
I think that would have been a really interesting and helpful discussion to have had with pain physician/physio to talk through your experience. Was this a long time ago or recently?
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It was about twenty ago so it might have been when they were just starting to look at alternative ways to manage pain. Having seen your posts, she may have treated me the way she did because of what was written in the referral from my neurologist. A previous neurologist diagnosed me with ME but when I developed new symptoms and was admitted I had a horrendous experience on the ward - amongst other things he got all my benefits stopped.

She did tell me that it was only his opinion as I was devastated feeling judged and called a liar. She may genuinely have felt that anxiety was causing my problems - I considered I was dealing with a lot of anxiety making problems in a good way.
 
Mithriel said:
She may genuinely have felt that anxiety was causing my problems - I considered I was dealing with a lot of anxiety making problems in a good way.
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This right here is what really bothers me. I've noticed a knee jerk reaction before when being asked questions about job or life events or whatever. That sounds stressful, therefore you must be stressed, therefore we can help you cope with that. Without actually asking if you feel stressed or overwhelmed, or finding out what coping strategies you might have and if you are, in fact, coping.

I think it's really dangerous to go taking apart people's coping/management strategies, without first assessing if they are effectively working for that person. Instead of helping them cope you could end up completely undermining them & leaving them.unable to cope.

That's harm in my book.
 
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IAPT, No Better Than Placebo?
There is no compelling evidence that the Improving Access to Psychological Therapies (IAPT) service is any better than a placebo, yet its’ expansion continues to be funded, despite £4 billion having already having been spent on it.

Barkham and Saxon (2018) https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-018-1899-0 in their study of IAPT, found a within subjects overall effect size of 0.93, amongst clients attending a mean of 6-9 treatment sessions. [Effect size is calculated by subtracting the mean post-treatment score from the mean pre-treatment score and dividing by the pooled pretreatment standard deviation]. But Huneke et al (2020) https://doi.org/10.1017/ S0033291720003633 cite placebo effect sizes of between 0.65 to 1.29 in anxiety disorder outcome studies. This raises serious doubts on the added value of IAPT.
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http://www.cbtwatch.com/iapt-no-better-than-placebo/
 
IAPT’s Black Hole – Accountability
14th December 2020
I recently asked the National Audit Office to restart it’s investigation into IAPT. I am expecting their reply in the next week or two. There has been no independent scrutiny of IAPT. They have been answerable only to Clinical Commissioning Groups, which have consisted largely of GPs and allowed IAPT to mark its’ own homework.
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Most recently IAPT has offered webinars, for its staff on helping those with long term COVID. There is a tacit assumption that this will be within the expertise of IAPT therapists just as helping those with long term physical conditions such as irritable bowel syndrome. But the IAPT staff working with LTCs were never consulted, before this new foray. Client’s with LTCs were never asked whether they were back to their old selves (or best functioning) before this proposed further extension of IAPT’s empire.
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http://www.cbtwatch.com/iapts-black-hole-accountability/
 
A Conflict of Interest Between NHS England and IAPT
20th January 2021

the Improving Access to Psychological Therapies (IAPT) pantomine is likely to continue, with Dr Adrian Whittington, National Lead for Psychological Professions, NHS England and IAPT National Clinical Adviser about to chair a Conference with the leading light of IAPT, Professor David Clark for IAPT staff. IAPT afficionados seem inherently incapable of understanding what constitutes a conflict of interest
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The power holders, wish to believe their fairy tale ‘we are committed to mental health, we have shown this in supporting our world beating IAPT service, as far as possible we will fund expansion of the service, we have broken new ground’ and in small print ‘it is not politically correct to say other and we are too busy with the pandemic/physical health to critically analyse IAPTs data’.
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IAPT therapists do not ask the client, at the end of treatment, whether they are back to their old selves again. Outcome is determined by the Genie that arises out of the psychometric test lamp that IAPT polishes incessantly.
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The horror in the post above regarding IAPT is that not only are people with MUS symptoms poorly served by a therapy that has no bearing on their illness but the people with true mental health conditions are just as ill served. And when they go out into the world, if they have a crisis of functioning the usual response is to shoot them or lock them away.

Mental health conditions also deserve so much better than this worse than useless panacea.
 
Talking Therapies Institutionalised Psychologising of Physical Health Problems
27th April 2021
As a high intensity therapist working in IAPT, I’m finding an increasing amount of the people I see have chronic physical health conditions. The training and supervision I receive emphasises my role as one of treating the depression/anxiety associated with these conditions, and not the condition itself. This sounds plausible in theory, but my experience it just doesn’t work that way in practice.
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  1. Firstly, I get the distinct feeling that a lot of the time the people I see with chronic health conditions are not clinically anxious or depressed, they are just having a normal reaction to a really challenging situation.
  2. Secondly it is impossible for someone with my training and limited medical knowledge to know whether a symptom such as fatigue or poor sleep is down to anxiety or depression or other factors, including physical causes.
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full blog here:
http://www.cbtwatch.com/talking-therapies-psychologising-of-physical-health-problems/

eta: post is by an anonymous IAPT therapist, not Dr Scott.
 
Trish said:
That's a really good, brief, blog post pointing out the dangers of CBT for people with physical diseases. I think it's a good example for NICE to consider when deciding whether to continue with their plan to recomment CBT therapists to help manage ME/CFS. @Keela Too, @adambeyoncelowe.
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I agree.

I also worry that not only could the gaslighting of some patients be continuing but that some of the patients may actually suffer the much greater harm of having their faith in their existing self developed management strategies undermined.

So, not only are they facing a challenge to their mental health undergoing inappropriate CBT & the continuing delay in investigating potentially treatable conditions, the underlying condition may also be made worse by the patient changing their behaviour based on what they learn in CBT rather than relying on their own observations and lived experiences.

This is where membership of patient support groups is invaluable and far more important than CBT in my opinion.
 
Improving Access to Psychological Therapies (IAPT) has potential but is not sufficient: How can it better meet the range of primary care mental health needs?
Results

Of 472 paper identified, 24 articles were deemed pertinent. It appears that IAPT cohorts are complex and current service delivery frameworks may not meet their needs. IAPT developments and research for long-term physical health conditions and serious mental illness have been recently advocated, though whether these are sufficient and viable when set in IAPT’s prescriptive backdrop remains unclear.

Conclusions
Improving Access to Psychological Therapies provision and research at present does not adequately consider the complexity of its clientele in the context of treatment outcomes and service delivery. Recommendations are provided for future research and practice to tackle these deficiencies.
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The review indicates that there is a stark lack of data pertaining to the generalisable, real-world clinical benefits of the IAPT programme as it currently stands.
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https://bpspsychub.onlinelibrary.wiley.com/doi/10.1111/bjc.12314
 
How about the problem with the whole IAPT project is less the implementation and more the underlying assumptions and content, or lack of it?

Maybe a lot of this stuff is just irrelevant at best, and trying to force round pegs into square holes is never going to work?

Ever considered that, guys?
 
PGCert EVIDENCE BASED LOW INTENSITY CBT PSYCHOLOGICAL WELLBEING PRACTITIONER
This programme trains Psychological Wellbeing Practitioners (PWP) working within Improving Access to Psychological Therapies (IAPT) services. During the training you will gain the knowledge and skills to assess and engage patients who may present in IAPT services through referral from a Health Professional or through Self-Referral. You will learn how to undertake a disorder specific patient-centred assessment and how to support patients to use evidence-based Low Intensity CBT interventions in face to face, telephone, group and cCBT formats. You will also be taught about respecting and valuing individual differences and focus on diverse groups. Towards the end of the training you will consider your practice in context by understanding the differences between high and low intensity interventions.
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Module 3 is focused on respecting and valuing individual differences, focusing on diverse groups and ways in which we may need to augment our role to meet individual needs and overcome any barriers towards accessing services. To consider the context in practice, you will learn the differences between high and low intensity interventions as well as considering the use of supervision and power within the therapeutic relationship. You will learn how to augment your interventions and assessments when working with patients with long term conditions (LTCs), sensory impairments, those over 65, people from BAME groups or where there are language, cultural, employment, or sexuality considerations. It aims to equip you with an understanding of the complexity of people’s health, social and occupational needs and the services which can support people to recovery.
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https://www.uea.ac.uk/course/postgr...sity-cbt-psychological-wellbeing-practitioner
 
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