An estranged relationship

Dr Venetia Leonidaki on the Improving Access to Psychological Therapies programme.

The decision to start my post-qualified career as a clinical psychologist in an Improving Access to Psychological Therapies (IAPT) service seven years ago was met with bewilderment by many of my peers. Looking back, their reaction may have reflected a not yet fully-formed belief that IAPT did not seem the ‘right’ place for a psychologist. Indeed, the arrival of the IAPT initiative in 2009, which aimed to improve access to evidence-based therapy for clients with common mental health problems, triggered lively but mixed reactions in applied psychologists. Responses varied from those celebrating its ‘wonderful’ principles to others warning against its potentially ‘damaging’ effects on various disciplines of applied psychology.

The original promise was that applied psychologists would have a leading role in the new initiative. Drawing on first-hand experiences of recruiting IAPT staff, most applied psychologists have seemed far from enthusiastic about this prospect. In the six years that I spent in both frontline and managerial roles in IAPT services across London, I saw many applied psychologists spending just the first couple of years post-qualification in IAPT, before embarking on specialist services or private practice. I recently departed from IAPT myself to follow a similar career trajectory. These experiences have sparked reflection on the relationship between applied psychology and the IAPT model, and how they seem to have grown far apart from each other.

My research into the published literature indicates that applied psychologists have distanced and separated themselves from IAPT. Over the last 10 years, two key BPS journals published just five papers on IAPT. In contrast, 51 papers on IAPT were published by journals from other professional therapy bodies in England over the same time period. I also think that IAPT services have found ways to survive and even thrive without applied psychologists. In a brief audit of the jobs advertised in adult IAPT services on the NHS jobs website between September and October 2018, approximately 80 per cent required a CBT qualification and/or BABCP accreditation as part of their essential criteria. For only 11 per cent of the advertised vacancies, a qualification in applied psychology alone was deemed sufficient.

Further, the recent workforce proposal from the Psychological Professional Network Alliance, identified a need for the recruitment of 4000 new staff in adult IAPT services. Yet the proposal does not recommend applied psychologists to be among them. Instead, it points to the need for more applied psychologists in specialist services. Could their proposal imply that applied psychologists are no longer needed in IAPT?

At the core of the apparent division between the two worlds lie professional identity struggles. IAPT now arguably extends beyond a service model. It represents a paradigm of what psychological distress is and how it needs to be treated, which is not always compatible with core values inherited in psychologists’ collective professional identity. Indeed, values such as critical thinking, innovation, integration, and idiosyncratically-driven approaches often do not fit comfortably in the realm of protocol-based diagnosis-specific CBT and fast-paced target-driven clinical delivery.

Even though it’s not entirely clear how deep and real this division may be, its result is missed opportunities for our professions, services, and most importantly clients. Primary care is located at the heart of the new mental health strategy, and applied psychologists, who are among the most highly-trained professions in the field, miss out on influencing the action. This includes theories of mental illness and cure, conveyed in the public via their contact with primary care services. Our specialist skills of higher-case formulations, which could help guide treatment plans and adapt IAPT protocols for more complex client groups, are not utilised. In an era with perhaps the largest pool of practice-based data in history, our research skills are highly pertinent, yet we seem to be less involved.

Even if IAPT services and applied psychologists can function separately, a seemingly harmonious co-existence has created a barren landscape, which has stifled potential development and partnerships. Is it time to invigorate this relationship?

Dr Venetia Leonidaki
Consultant Clinical Psychologist

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