Is IAPT damaging clinical psychology?

Dr Karin Carter is concerned; a British Psychological Society representative responds.

I am writing in response to the President's letter and call for feedback about the Society, October 2016.

Since the implementation of the Improving Access to Psychological Therapies (IAPT) initiative I am not aware of any formal analysis or research to evaluate the impact of IAPT training courses on access to training placements or jobs in Clinical Psychology primary care. With this in mind I propose that the BPS should consider and explore several important issues arising that impact on the profession:

1)     What impact has IAPT had on Clinical Psychology training placements in adult mental health (Primary Care)?

2)      What impact has IAPT had on graduates of Clinical Psychology courses working in primary care (step 3)? For example, can they access step 3 jobs without a diploma in CBT? This could be a serious issue, not least because if Clinical Psychologists cannot work at step 3 how are they to hone their clinical skills to work at other levels and with more complex presentations?

3)     Are there any long term consequences for Clinical Psychology with the expansion of IAPT into other specialisms (Child and Adolescent services, Serious Mental Illness services, research etc.)?

4)     Several years ago the Society and Division of Clinical Psychology gave primary importance to the protection of Clinical Psychology and the roles of Clinical Psychologists. The MAS Review of Clinical Psychology services (1989) and subsequent publications (e.g. Derek Mowbray, 2003, 2010) have disappeared from the profession. How is the BPS addressing the needs of this specific role and the profession of Clinical Psychologists?

5)      The BPS is promoting their Accreditation Program for Psychological Therapies Services (APPTS) which could include IAPT services. In the event that Clinical Psychologists are not employed or are excluded due to a lack of a specific qualification within such services from seeing the same patients, does this pose a conflict of interest for the society and bring the work on protected titles and levels of working some time ago to a point of redundancy?

Dr Karin Carter Chartered Clinical Psychologist.

NHS Clinical Psychologist, North West Region 


Mary O'Reilly, Co-Chair of the British Psychological Society's Committee on Training in Clinical Psychology, writes:

Thank you to Karin for responding to the President's feedback. Rather than answer point by point, I should like to put forward some relevant points of information about the current position of the Society in relation to the IAPT initiatives.

Clinical psychologists as well as counselling psychologists do work in Improving Access to Psychological Therapies services, and are often in the leadership positions of those services. This is in no way universal, and this has much to do with the history and inception of IAPT. Our training remains good value if we are able to position ourselves to take responsibility for the agenda: let’s improve the availability of psychological therapies to all, rather than protect our job title. It has been the case for many years that psychological therapies are provided by non-psychologists. IAPT takes this to a further point and asks how can what is good about psychological therapy be afforded for all? How can NICE guidance requiring psychological approaches be used as a first line treatment (for anxiety and depression) be bad news for psychological therapies in general and clinical psychology in particular?

Surely the broadening of IAPT to areas beyond common mental health problems for adults of working age poses similar opportunities and asks the clinical psychology workforce to 'step up' and show leadership in these areas, too. 

As a professional body, the BPS were invited by the IAPT programme to acredit the training of Psychological Wellbeing Practitioners. We in CTCP see this as a very beneficial move, helping to ensure that Psychology maintains an important overview role. Our remit has been expanded to cover the developing work with children and young people, and as well as this, we are looking at how the many psychological assistants and associates who take Master's courses in applied psychological practice can be assured that this training meets the standards set by the BPS. The Society has just agreed to look at how this new workforce who use psychology may have a place within the BPS. This then can start to bring in the idea of the BPS as being the place that promotes Psychology as well as Psychologists. 

For several years now, clinical psychology courses have had to demonstrate how their graduates meet a level of competence in CBT alongside one or more other evidence based approach/es. It is therefore the case that individual clinical psychologist ARE able to practice CBT, and should they wish to or feel they require it, can make their case to other bodies, for example the British Association of Behavioural and Cognitive Psychotherapy as meeting their criteria for practitioner membership. Of course as in any generic training, there is always scope for further training and experience to develop specific knowledge and expertise, but it is important we do not dismiss the levels of skill graduate clinical psychologists possess. 

It might indeed be interesting to see how the introduction of the IAPT has impacted on the provision of psychological therapies in the NHS, and scrutiny of the numbers of employees in specific areas may be one way to explore this. Any conclusions drawn, however, would rely heavily on the quality of the data on employee numbers. I am aware that the Division of Clinical Psychology in England has undertaken a project to determine the number of clinical psychologists working in the NHS, and one of the early findings in this project was how inaccurate the data kept by employers was. For example, some Trusts counted all their psychological therapists as clinical psychologists, regardless of grades (i.e., band 5 & 6 as well as 7 & 8). 

Finally, there is a programme underway to accredit Psychological Therapies Services, of which the BPS is a partner alongside the Royal College of Psychiatrists amongst others. While this is not an area that I have any detailed knowledge of, I am of the view that it is better to have us involved with this process rather than uninvolved. 

I hope this adds to the debate of these issues within the Society. 

Mary O'Reilly

Chartered Psychologist

BSc, M.Clin. Psychol., AFBPsS

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