The UK government’s Improving Access to Psychological Therapies (IAPT) programme has come under attack from various quarters for its focus on CBT. People who practise other kinds of psychological therapy in the NHS are understandably concerned that their work will not be valued so much when CBT becomes widely available.
As it happens, they might not need to worry. There are some indications that IAPT’s version of CBT could fall far short of CBT’s real potential, and at the same time the definitions of mental illness are changing so as to include more and more people who were previously thought to be well. It’s unlikely that IAPT will make the NHS run out of patients with apparent mental health problems..
Even so, an extraordinary statement by IAPT last week is indicative of intense argument behind the scenes as, in this case, counsellors demand their slice of the imaginary cake. An article, The relationship between counselling and IAPT, makes soothing noises about continued need for counselling both as a part of, and alongside, recommended treatments in the NHS for illnesses like depression and anxiety.
BACP
I described the difference between counselling and psychotherapy in Whodunnit? Counselling in the UK was organized until 2000 by a body called the British Association for Counselling (BAC), but after some internal strife they added P for Psychotherapy to their name and became the BACP.
Turning counsellors into psychotherapists is not just as easy as adding a letter to your organization’s initials, though. There’s a real difference between helping people to cope with everyday life and treating mental illness.
The significance of the IAPT statement is that it firmly rejects that extra P. It’s saying that counsellors are counsellors, and that their role, while valuable, is strictly limited. If counsellors want to become psychotherapists, it taunts, they are welcome to train in CBT.
Confusion
The BACP (for counsellors) and the BABCP (for CBT therapists) probably cause a lot of confusion with their very similar names. Counsellors in private practice usually charge less than CBT therapists, so that some members of the public might think they are getting cheap psychotherapy when they are really only getting counselling.
The sooner the BABCP changes its name to make the difference clear, the better, it seems to me. It already owns the Internet domain cbt-uk.org, so I guess the name CBT-UK must have been considered at some stage.
A future NHS
It seems likely that a future NHS will have to learn to spend money more wisely and carefully than it does at present. It’s possible that a future NHS might take the view that its job is to treat illness, not to help people with the difficulties of everyday life.
In that case, counsellors in the NHS might find that retraining in CBT is the only way to keep their jobs. But really, that’s not such a bleak picture. One of the commonest deficiencies in CBT therapists is an inability to form a therapeutic alliance. In part, that’s the reason for the proliferation of ‘overlay’ techniques that allow the therapist not to engage too closely with patients, making patients do the work for themselves.
An influx of skilled former counsellors could sharpen up CBT, bringing it back to its roots in the traditions of psychotherapy, and be a good thing for everyone.
It is true that counselling provision would be a welcome addition to the IAPT process – as would other modalities such as Solution Focussed Therapy and Psychodynamic approaches.
However, CBT does not need them to help it to sharpen up its practices. It just needs the therapists who have been trained on comprehensive courses, that taught not only sound behavioural and cognitive theory but also enforced rigourous practice standards prior to completing training – not just an odd tape here or there – to stand up and not collude with the current practice of training individuals from non professional health backgrounds i.e. Graduate Mental Health Worhers over a year (part time) and kidding everyone that they are competent practitioners of CBT.
Sadly most of these courses have long ceased to exist or have deteriorated to the amazing array of wishy washy courses currently being accredited by the BABCP – supposed Guardians of the standards of CBT practice. Unfortunately, the therapists of whom I speak, dare not speak for fear of being accused of being out of date or resistent to change. I guess they would, of course, because whereas training to be a CB Therapist / Psychotherapist was a vocation, now it is a means to a better NHS Grade or the road to the magic private practice. These days, rather than places being limited to the most appropriate trainees, now the flood gates have opened and it now seems everyone and anyone can drift in by the hundreds.
The problem with this is that those with the ‘newer’ training are becoming the majority, don’t know their own limitations and worse still are going on to train others.
CBT has never been all things to all people, but over the next few years it is going to even less so as it is peddled by poorly trained individuals, supervised by slightly less poorly trained (maybe) individuals – but who are good at filling in forms so they can get easily accredited.
God help the public.