I’m very excited to introduce Saiqa Naz as the second guest blogger to appear on notaguru.blog. Saiqa is a Low Intensity CBT Worker, CBT Therapist in Sheffield’ Specialist Psychotherapy Service, Chair of BABCPs Equality and Culture Special Interest Group and on the Board of Editors for Behavioural and Cognitive Psychotherapy and The Cognitive Behaviour Therapist Journals. You can follow her on Twitter @saiqa_naz. Saiqa told me that the purpose of this post is to encourage people to appreciate Low Intensity Therapists which I’m happy to get behind!
Firstly I would like to thank NotaGuru for giving me this opportunity to share my thoughts on IAPT, some of my experience of working in IAPT and Low Intensity CBT work/workers.
Has any other psychological therapies profession come under the level of scrutiny LICBT has? 10+ years on and it’s still fighting to be accepted in the psychology world. The fact LICBT workforce is still here in the face of austerity is much to be celebrated and be proud of.
In comparison to other psychological professions, the LICBT is a relatively new workforce. This is the route through which I managed to get my first full time post in the NHS. I have much to be grateful to IAPT for this opportunity, otherwise there were literally no other opportunities for me to enter the psychology profession in my hometown of Rochdale.
Please don’t let a set figures define your worth as a therapist.
No measure will triumph
I’ve had some great times, and equally not so great times working in IAPT. I am well aware of IAPTs shortcomings, but I am also aware of the difference it makes to people’s lives. I don’t mean in relation to the measures, but the experiences I’ve had working with people. No measure will ever triumph over this! They may not have recovered on the dataset, but their lives were in a different place than when they started therapy. Seeing people’s struggles first hand has made me into a bit of an activist or people say I am one!
While we’re talking about measures, my recovery rates varied between 0%- 80%. Sometimes I was made to feel ashamed of my lower recovery rates and I pushed myself to do more (alas those viral infections I’m now prone to). I now realise my recovery rates were by no means a reflection of my clinical skills, but I still felt pressure to improve recovery in areas of high levels of deprivation with little external resources to rely upon or with BAME communities with absolutely no resources (not a lot has changed here). It was suggested I put a recovery plan in place. Needless to say, feeling pressurised and demoralised that doing my best given these circumstances was not good enough, I like many other therapists sadly decided to bow out of IAPT.
Sadly LICBT workers are taking the brunt of criticism due to decisions made by others, some as a direct result of austerity and others through poor leadership
I do wonder if this is one of the reasons some therapists alter their data or encourage patients to score more positively than the patient feels? Paul Salkovskis wrote about this in the last BABCP CBT Today magazine. Paul mentions in his article that falsifying data amounts to malpractice and people should report this through NHS England’s or the CCGs complaints procedure. Please remember, the recovery rate is only 50%, which means 50% don’t have to move into recovery. I would consider the majority of people I worked with to be in the latter category. Please don’t let a set figures define your worth as a therapist.
Do my experiences mean I don’t think IAPT is fit for purpose? No. It means IAPT will only work when its managers and commissioners understand inclusion, fund services adequately, have realistic expectations and work closely with other agencies and community organisations. There is plenty of guidance on how to do this in the IAPT BAME Positive Practice Guide.
Space to be creative
The LICBT workforce is extremely passionate and talented. It absolutely needs to be given the space to be creative. Creativity is lost when systems place too much pressure on clinical teams (you can read James’ blog on resilience here) and moving most of the sessions to telephone/ online limits choice. I have heard managers having a call centre board system in place where they encourage competition between therapists and use people’s recovery scores to shame them and even deny them development opportunities. This is deeply upsetting. We all need to be clear on this- this is disgraceful behaviour and must be challenged by us all should we see it happening.
Unsurprisingly, IAPT services are struggling to recruit (as is the case in Clinical psychology I believe) and perhaps placing additional pressure on LICBT workers in their teams to do more when they don’t have the capacity to do much more. If the LICBT workforce was treated equitably, with more respect and given the opportunity and conditions to flourish, those vacancies would be filled and the pressure to meet targets would be more evenly distributed. The IAPT model also encourages services to recruit from local communities. These people will have local knowledge and perhaps even lived- experience which is invaluable to services. It also provides people without psychology degrees an opportunity to be part of the psychology world- how exciting to be able to support their development!
feeling pressurised and demoralised that doing my best given these circumstances was not good enough, I like many other therapists sadly decided to bow out of IAPT.
Given that I spend much of my time in the community heavily using my LICBT skills and feeling frustrated that IAPT services are not reaching into local communities, I do feel LICBT workers should be allocated one day a week for community development work. This is in addition to their admin time. I would like to see some brave commissioners try this. Are there any out there? When I first started working in IAPT, we were given time to do this. I was based in some voluntary sector organisations developing relationships with them, taking referrals directly from them and getting to learn about the needs of the community. You can’t do this when the only option you have is telephone working. The whole point of improving access is to give people choice. It seems as if this has somewhat got lost due to funding pressures and some senior leaders reverting to what I would consider as unfair and unethical practices.
Moving forwards, I feel IAPT services need to revert back to what the initiative was intended to do- to improve access to psychological therapies and embed itself firmly into local communities. Sadly LICBT workers are taking the brunt of criticism due to decisions made by others, some as a direct result of austerity and others through poor leadership. Some of them are very young practitioners and some without psychology degrees. I assume many will not feel able to speak up to older/ more experienced psychology professionals criticising them.
I have heard managers having a call centre board system in place where they encourage competition between therapists and use people’s recovery scores to shame them and even deny them development opportunities. This is deeply upsetting.
LICBT isn’t appropriate for everyone. The model recognises this. We also shouldn’t assume people require and want in-depth and extended sessions. They don’t. Equally people shouldn’t feel like the only option they have is LICBT and those treatments are imposed on them.
LICBT was never meant to replace secondary care. I frequently hear people criticising this way of working, yet how often do we hear of LICBT workers criticising other psychological professions? They don’t have time to and really value learning from different psychological professions.
I have recently returned from doing a Keynote speech on LICBT working in Pakistan. The irony is that the very workforce that is treated the way it is in their work environments and also by some psychological professionals are key to supporting the development of psychological therapies in Low and Middle Income Countries.
During this whole COVID-19 crisis they have dived in and supported the different psychological professions to revert to online/ telephone working. NotaGuru also collected information and shared a blog on this which reached over 6,000 people in 83 countries.
Collectively we should then focus on improving funding for both primary and secondary care, and think about how we can be allies of this incredible workforce and support them with their clinical work. I hope the Psychological Professions Network can help facilitate this. We will all be stronger this way and be in a better position to support LMICs develop their mental health care.