Life Beyond Trauma Focussed Therapy

I have just been preparing for a Workshop, I am delivering to the Merseyside Branch of BABCP, on October 4th 2018, titled ‘CBT for PTSD and Beyond’. At this Workshop I shall  unveil my KISS Model of PTSD. KISS for the uninitiated stands for Keep It Simple Stupid. Unlike trauma focussed models of CBT and EMDR, it does not assume a flawed traumatic memory or arrested information processing.

 

 

As part of the presentation I will be saying that therapists should beware of questionnaires as they will overidentify symptoms because:

a) they don’t tease out whether a particular symptom is making a ‘Real World’ Difference e.g a respondent might indicate upsetting dreams, but if they are not woken by the dream and distressed this is not significant functional impairment and so would not count as a symptom that is ‘present’

b) in completing a questionnaire client’s are often not clear about the time frame under consideration, endorsing flashbacks/nightmares when they did have them initially but they are past, and also endorsing symptoms currently present such as poor sleep. For a diagnosis of disorder symptoms have to be simultaneously present and each must make a ‘real world’ difference. Only in an interview can you tease out both and request concrete examples of the extent to which a symptom is impairing functioning

Dr Mike Scott

The Cost of IAPT Is At Least Five Times Greater Than Claimed

The British Medical Journal has just published the following letter of mine online with the above title:

‘Six years ago a News headline in the BMJ proclaimed ‘Increasing access to psychological therapies will cost NHS nothing’ BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e4250, citing a report of Lord Layard  of the Mental Health Policy Group of the Centre for Economic Performance http://cep.lse.ac.uk/_new/research/mentalhealth/default.asp, that claimed ‘after an average of 10 sessions half the people with anxiety conditions will recover, most of them permanently, and half the patients with depression will recover’ .  Far from being substantiated an independent assessment by Scott (2018), http://journals.sagepub.com/doi/pdf/10.1177/1359105318755264, using a standardised diagnostic interview, suggest a 10% recovery rate. This represents a five-fold increase of the cost of treatment per cured person.

The progenitors of IAPT, Clark and Layard in their book Thrive (2015) claim that the cost of treatment in IAPT is £650 per person, for people having attended 2 or more treatment sessions.  This leaves out of account the 40% of its clients who attend only one treatment session [IAPT (2018)] and the costs of the initial assessments which totalled £92 million in 2016-2017, with total costs of £367,219,192 in that period.  This means that the true cost of IAPT is at least 5 times greater than alleged, all without any government funded independent audit. Further average session attendance for those ‘treated’ in IAPT is 6.6 [IAPT (2018)] not the average of 10 sessions that Lord Layard deemed necessary, so that the average patient in fact receives a sub-therapeutic  dose of treatment.

In 2012 Lord Layard claimed ‘the average improvement in physical symptoms is so great that the resulting savings on NHS physical care outweigh the cost of the psychological therapy’. This claim remains unproven and what limited evidence is available points in the opposite direction. How do Clinical Commissioning Groups justify paying such inflated sums? how can they be sure another agency could not achieve the same for less? how do they know that GPs simply tracking clients with depression and anxiety disorders would not achieve the same outcomes? NHS England should surely advise CCG’s to ask searching questions and organise a long overdue government funded independent audit of IAPT focusing on real world outcomes, such as loss of diagnostic status..

BMJ (2012) ;344:e4250 Increasing access to psychological therapies will cost NHS nothing, says report

Clark, D.M and Layard, R (2015) Thrive: The Power of Evidence-Based Psychological Therapies London: Penguin.

IAPT (2018) Psychological Therapies: Annual report on the use of IAPT services England, 2016-17 Data Tables. NHS Digital: Community and Mental Health Team.

Mental  Health Policy Group of the Centre for Economic Performance (2012) How mental health loses out in the NHS.   http://cep.lse.ac.uk/_new/research/mentalhealth/default.asp.

Scott, M.J (2018) IAPT: The Need for Radical Reform. The Journal of Health Psychology, 23, 1136-1147.

 

Dr Mike Scott

The Annihilation of The Therapeutic Relationship

The therapeutic relationship has withered under the blistering sun of IAPT. The latest IAPT annual report (2018) shows that 40% of clients attend only one treatment session, with the average client attending just 6 sessions. The therapeutic relationship needs the space of at least 10 sessions to flower according to NICE guidelines.  For assessed only referrals 43% were deemed suitable but declined treatment , 23% were deemed not suitable  and only 9% discharged by mutual agreement (IAPT 2018).

 

 

 

I’ve just edited the proofs of my contribution to ‘The Therapeutic Relationship In Cognitive Behavioural Therapy’ by Stirling Moorey and Anna Lavender to be published by Sage. The contributors cover all the  disorders and contexts (my own chapter is ‘CBT Delivered in Groups’ written with Graeme Whitfield). Most of the authors are well known and agree on the importance of the therapeutic  relationship. The approach taken in the book contrasts sharply with the practices in IAPT.

 

Dr Mike Scott