The need for reappraising psychological therapies in the light of IAPT
| Published date | 18 May 2009 |
| DOI | https://doi.org/10.1108/17556228200900004 |
| Date | 18 May 2009 |
| Pages | 19-26 |
| Author | Edwin Rogers |
| Subject Matter | Health & social care |
19
The Journal of Mental Health Training, Education and Practice Volume 4 Issue 1 March 2009 © Pavilion Journals (Brighton) Ltd
The need for reappraising psychological
therapies in the light of IAPT
Edwin Rogers
Abstract
The government IAPT plan reve als a welcome
determination to tackle the country’s mental health
problems in a comprehensive manner – especially
by using evidence-based psychological therapies
to improve quality of life and prevent mental/
emotional problems worsening. Unfortunat ely,
despite encouraging all alternative psychological
therapy bodies to submit evidence, the scales are
already heavily weighted in favour of cognitive
behavioural therapy (CBT) in that it is already largely
considered the only evidence-based therapy by
most NHS mental health authorities. There are also
signs of an ill-informed, media-lead, groundswell of
public opinion headed in the same direction – which
might well ultimately influence patient choice.
While acknowledging the value of CBT, there is a
strong case that alternative psychological therapies,
by directly addressing the root causes of problems,
can achieve far better results – especially in the
longer term. Unfortunately, the other disciplines
frequently present as poor alternatives – not least
because of their disparate, sometimes archaic,
foundational dogmas, and the alleged potential
cost of their treatment. Fortunately, much dogma
can now be updated in the light of neuroscience,
and the time factors can be shortened, thus rapidly
paving the way for a new, more unified, approach
to mental health therapy; with potentially successful
treatment across all categories of patient.
Key words
IAP T; evi dence -based ; evid enced -base d
psycho logical therap y; CBT; psychodyn amic;
neuroscience; elderly; phobias; inhibitions
Introduction
I write as a former service user: a ‘voluntary inpatient’ of
a psychiatric hospital some 60 years ago, suffering from
a severe emotional breakdown. Inevitably, I bring to my
task not only the benefits of these experiences but imbue
it with a lifelong passion for my subject. My hospital
experiences included nine months of psychoanalysis and
close environmental relationships with fellow ‘inpatients’
– who between them probably encompassed all types
of neuroses and psychoses recognised today – together
with some that are now differently classified. Some
experiences were vivid, and I still have memories of the
sad manifestations of tertiary syphilis and of fascinating
examples of the rare fugues in action. I also benefited
enormously from the close ‘relationship’ that inevitably
developed with my Freudian therapist and ‘tutor’, the
deputy medical superintendent of the hospital; memories
of which remained to support me on my travels along
the boulder-strewn road to complete self-recovery after
leaving hospital.
The above experiences have, over recent years, been
augmented by training in CBT, psychodynamic, and
person-centred therapies, and from working with current
service users while practising as a counsellor within the
NHS and the charity, Mind.
My main reason for writing at this particular time
is that, although welcoming it in principle, I believe
that the government’s Improving Access to Psychological
Therapies Programme (IAPT) – already at various stages of
implementation by regional development centres (RDCs)
throughout the country, carries implications that I believe
may actually deprive many seriously disturbed potential
service users, including elderly people, of adequate
treatment in the longer term. For, despite its declared
intention to allow for other forms of evidence-based
psychological therapy, the IAPT programme structure, as
revealed by my enquiries of all RDCs, already reveals an
enormous bias in favour of cognitive behaviour therapy
(CBT). And it is my contention that CBT is inadequate for
treating the categories of service user I have just mentioned.
Furthermore, the physic alistic n ature of supporting
evidence for that particular therapy is to be the yardstick
by which the alternative psychological therapies (APTs) are
judged – and thus may not always be appropriate.
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