‘Sometimes, I feel that the psychological well-being practitioner role is undervalued’

Katie Bogart outlines her working life and its contribution to improving access to therapy.

I recently qualified as a psychological well-being practitioner (PWP) after studying for a postgraduate certificate in low-intensity cognitive behavioural interventions at University College London. I’m working with Wandsworth Psychological Therapies & Wellbeing Service, South West London & St George’s Mental Health Trust. But what does a PWP actually do? Here, I give an overview of my clinical duties.

First, telephone screenings. I conduct between four and five a day, which are mainly self-referrals. This means that I do not know who I will be assessing, although I do have their basic demographics on screen. This does not give away very much information about the presenting difficulty. I have a target of 20 clinical contacts per week, although I have heard that it can be anything up to 36 depending on where you work. Efficiency is a skill that I have developed throughout this role. There is no time for disorganisation. Whilst it is unlikely that you would assess four clients presenting with imminent suicide risk within one morning, there is not a lot of time set aside in the working day if this were to happen.

This means that there is a potential to be torn between great empathy for a client that is presenting with sufficient risk to themselves, or someone they care for, and the concern about the amount of time the paperwork and referral making will take.

In my experience, my empathic stance has always won; I have never resented a client that has resulted in additional work afterwards. Of course, this is the way that it should be, and I would like to think that I will not fall into this pattern of thinking at any point in my future career. However, I do recognise that the structure of an IAPT service can be so rigid that sometimes the pressure of targets, client turnover and recovery rates, can be prioritised ahead of the well-being of the people that are sent or refer themselves to the service.

After training, I felt somewhat confident and equipped to assess a client who was experiencing mild to moderate symptoms of anxiety and/or depression. These were the types of clients I was expecting to work with during my time as a PWP. Interestingly, I found that these were not the only clients that came for a telephone screening. Realistically, there are gaps in the healthcare system for people with more enduring mental health problems, particularly those that could be diagnosed with a personality disorder.

Fortunately, I have previously worked in a CMHT and have an excellent supervisor, so working with more severe or complex clients at assessment wasn’t too unfamiliar. However, these clients are promised something that we cannot always provide and that is very difficult to explain to somebody in distress.

The aim is for a telephone screening to last half an hour, which occasionally happens. However, realistically, screenings take up to 40 minutes; clients will have questions to ask you and they will also have history that needs to be taken into account in order for the psychologist we speak to afterwards to make a clear decision about the most appropriate treatment for the client. If time is not taken at screening, a client could be allocated to an inappropriate therapy. This would mean a wait of up to six months to meet with a therapist who then directs the client somewhere else. So, constraining the time of a telephone screening to less than half an hour is counterproductive for the service, therapists and most importantly, the clients.

The key difference that I have noticed between our training and seeing clients in the real world, is exactly that. You are seeing a person who has their own life experiences and understanding of their difficulties. Sometimes the rigid framework of a readymade booklet isn’t helpful or compassionate. More often than not, you tailor the key skills you have developed through your training to the person in front of you. Of course, you use supervision in order to do this successfully.

Whilst this is not an uncommon approach for talking therapists, it is different to how I feel I was trained. The structured, fast training helps you to feel prepared to work in your service very quickly. However, I did feel uncomfortable during my first treatment session when somebody started talking about their family history of depression and how it may have influenced them. This wasn’t in my training! I am a PWP, I don’t deal with this, why didn’t the client realise that?

As you develop and actively use supervision, peer support and CPD, you recognise that it is not normal for a client to mirror every part of the Step 2 treatment booklets. The service that you work in can help you to develop your confidence when working with clients in the ‘real world’.

As a PWP, I am aware of how limited my skill set is, but I also recognise its importance and appropriate place. Sometimes, I feel that the psychological well-being practitioner role is undervalued. It is true that we do not see those with a long-standing history, complex social issues or concerns regarding risk to self. It would be highly inappropriate if we did.

However, when Step 2 interventions are provided to a suitable client group, they are shown to be incredibly successful. In my current service, the recovery rate is 63 per cent. Yes, these are more simple cases. Yes, these clients have fewer barriers to treatment. But, we are aligning our work with the Improving Access to Psychological Therapies agenda; promoting well-being. I believe that should be recognised and respected.

What does the future hold? Being a PWP helps you to gain the key skills to enable you to work as a clinician. As a PWP, I use a single therapeutic model that can only reach a very specific group of clients. This has fuelled my desire to progress further in order to broaden the range of clients that I can work with. Currently, there is no clear progression within the PWP career path aside from further training, such as high-intensity or clinical psychology. This may be why there is a deficit in PWPs available to work.

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