This blog goes out to everyone who is starting or already on the Low Intensity CBT training course.
Congratulations, you’re in IAPT! Don’t look at me like that, I wasn’t being sarcastic. I actually love this job and get excited every time we welcome new trainees to the team.
A foot in the door
Getting into Low Intensity (LI) training in IAPT isn’t easy; I (and every other available body in the service) shortlisted for our trainee interviews this year. If I’d applied this year I wouldn’t have got an interview. We had to close the advert at 400 applicants for 8 posts. We had three interview panels running every day for a week. The competition is tough. The competition also consisted of people whose whole application statement didn’t mention evidence based low intensity CBT based treatment for depression and anxiety once, so you know… It was a bit eye opening to see how few applicants seemed to know what a Low Intensity Therapist in IAPT does. Fair warning: By the end of the training year you still wont have got your head around it but you will be a lot more comfortable with uncertainty.
I’ve been going back and forth about what to put in this blog. I decided on a numbered list of suggestions and thoughts that might be helpful, or at least give a perspective. Just for the heck of it I’m going to try to colour it like a rainbow; a reminder that there is always hope. I’ll pepper this with some of the comments that I had in response to a Twitter shout-out for things that people think about LI and LITs.
1. Make friends
We welcomed our Low Intensity trainees to my team last week. I was talking to one of them and one of our Senior PWPs, we were talking about our training cohorts.
Trainee: Everyone’s so lovely
SPWP: Oh yes, they’ll be your lifeline this year, you’ll know each other really well by the end of the course.
NaG: It’s great to see a big cohort, I was one of ten…
SPWP: you sound like you’re describing your family
NaG: Well they were like my siblings! We really bonded.
SPWP: That happens every year, it’s really good.
Trainee (with a shifty side-eye at the door): That sounds…intense.
Like any other higher education course this one is tough. Your fellow trainees are in it with you, enjoy the unique relationship you’ll have with them. The more you can trust each other the easier things like fish-bowl role plays and late night writing sessions will be.
When the first of my cohort of ten left (for ClinPsy training) I recited a funeral poem at her leaving dinner. Dramatic? Sure, sometimes I am. But also an accurate reflection of what the loss felt like, and how much wine we’d drunk that night.
Use your team too; your supervisor, your manager, the other people who are around are likely to be lovely. Never struggle alone or in silence.
2. Take time out
For ten months you’ll be working in an IAPT team and studying a course that is designed to teach you how to work in an IAPT team. It would be reasonable to expect that the messages and expectations from the two would match. They wont. Seeing the funny side of that does help.
The university course will teach you the competencies that you have to demonstrate to practice as a Low Intensity CBT Therapist (What I call a LIT and you know as a PWP). Your team is trying to meet local and national commissioning targets and will have its own priorities and things that it needs to do with your time. What you learn at Uni and see in practice will not match. If you aren’t very good with uncertainty then stock up on antacids now.
You will also be expected to be transparent about your work. You will do skills practice in public, a supervisor will review all of your clinical work and your manager will examine your activity. If you are a perfectionist or are uncomfortable with the risk of negative evaluation from others, this will be tough for you. This transparency is something that I value now, but it reduced me to a sweating, crying, shaking mess a few times in the early months.
You’ll also have to do a load of academic writing and produce a thick portfolio. It’s going to be OK, it’s only one academic year.
To cope with all of this my top tip is to plan and prioritise your breaks. Do something that is a treat or fun every day. Use your annual leave for an actual holiday and not to study. Sure, you’ll work a lot of evenings and weekends. Make sure you schedule other stuff too, and do the other stuff. Go on a date, eat loads of good food, swim, run, dance around the living room, buy a hula hoop; whatever it takes to put a smile on your face.
3. Ignore everything I’ve ever written.
Seriously, avoid my other blog posts until you’ve got a few months under your belt. I rant about the systems that we work in; I can see how that might put you off, but it shouldn’t detract from the fact that the job itself is brilliant. Qualify, make your own observations, then give me a shout and join me in a good old cathartic word vomit; I’m more than happy to provide a platform if you want to take it public.
4. Protect your heart
A lot of us come into this work because we’ve had our own times when things were very difficult; we’ve navigated through them and come out of the other side with things fairly well settled. Or at least not so live that it would interfere with clinical decision making to a dangerous extent. The wounded healer, lived experience, all of that; it can be very valuable and might be what sparked your interest in a psychology-related job.
Sometimes this work will bring you into contact with people whose experience resonates deeply with your own. It’s important not to just ignore this. If there are areas of life that are sensitive for you, if the emotional difficulty is still live, tell your supervisor and manager. If an area of work is not emotionally or psychologically safe for you then that can usually be absorbed in a team. For example I find it very difficult to work with people who have got Chronic Fatigue Syndrome because of my own diagnosis and where I’m up to with the difficulties associated with that. For the sake of our patients getting an excellent service we’ve agreed that I wont work in that particular area. In the future I hope that will change, and I function very well in every other area of our work. But don’t put yourself at risk, or put yourself in a position that could compromise patient care.
People have come into this job with a lot of stuff going on that could do with more attention. I’ve seen trainees who used the position of power as “the therapist” to rescue people instead of to empower and equip people with self help tools, often because they wanted that rescue themselves. They showed no awareness of what was happening which made it difficult to protect our patients and care for the trainee. This will be picked up in supervision and it can become a fitness to practice issue, please be self-aware.
5. Stop and smell the roses
This might not be (statistically it probably isn’t) your forever job, that doesn’t mean that you should rush through it, or that it shouldn’t change you. You might get into this role, complete the training and be filling in applications the whole time. You might, like me, be a low intensity therapist for a decade before you start to feel that you could offer something valuable in other roles.
Whenever it happens, there’s absolutely nothing wrong with ambition. The more ambitious you are for yourself, for your patients, for psychological therapies and excellent patient care, the better. Ambitious and effective people can make a lot of difference. You could even be ambitious for LI therapies, I don’t think we’ve achieved everything we can yet.
As well as being ambitious, please engage with the LI job while you’re in it, take as much from it as you can, appreciate where you are:
- Look around you, learn from your colleagues
- Learn from your patients
- Learn from the other professions that this job will bring you into contact with
- Learn what this role is, what it’s extent and limitations are
- Recognise the achievements of LI CBT
- Know its place in the system
- Practice doing the basics brilliantly
- Carry that understanding and value with you into your future positions.
People have gone from the Low Intensity role into further clinical training in CBT, Counselling Psychology, Clinical Psychology and Counselling, into senior management positions and roles in NHS England amongst other things. This job is an opportunity to acquire and practice a huge range of skills that will help you in the future. It has importance and value for itself too.
6. Decide who to be
To secure your place on the training course your local commissioners have to pay the University thousands of pounds. Your salary also comes out of the local healthcare budget through a convoluted process. Your training and employment happens at the cost of other healthcare provision. I’ve always felt like that deserves some respect.
There have been people who have occupied this highly sought after job as if they could barely stand to touch it with their fingertips. They speak openly about the fact that they don’t think low intensity interventions have clinical value, they they disrespected the policies and systems in their team and trust, and communicate with other teams in a way that does not reflect well on us; they take sick leave to attend interviews, don’t work their contracted hours, and don’t take line management appointments seriously because they aren’t interested in developing in the role; they don’t chat in the office and are reluctant to accept supervision from other LITs. They are there to pass through.
Maybe don’t be that person, you could pick door number 2:
A lot of people who have found their way to LI in IAPT recently are in a pretty enviable position; they’re well educated, experienced in a variety of areas of mental health work, usually able and willing to move cities for a job, might not have demanding commitments at home, and are not frightened of a spreadsheet. There’s a lot that you’ve got to offer. By the time you’ve qualified and done the job for a year or two you’ll have a lot more to offer. If you find that you’ve got capacity (and only if), you could consider adding something back to your team.
This year one of our newly qualified LITs initiated and ran a project that helped us to communicate better with our local Community Mental Health Team. It wasn’t a big job but the fact that she’d spotted a problem, thought of a solution and got on with it meant a lot. She moved on to ClinPsy training after less than two years in the team. We’d invested in her training and supervision, given her moral and emotional support through some rough life events, and trusted her with our reputation, and she respected all of that, and gave us something back. It doesn’t have to be big or time consuming (you’ll have more than enough on) but if you can find a way to honour the investment that has been made in you as a trainee it will be appreciated.
7. Understand how valued and brilliant you are
A good LI trainee has value greater than pearls and diamonds, to mis-quote someone famous. Everyone wants to see you succeed, and believes that you will. I want to give you a huge CONGRATULATIONS for getting to where you are. I hope to meet some of you in the future.