Month: September 2022

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‘What trauma means today’ published in ‘The Psychologist’, October 2022

 

Michael J. Scott on books that shaped his thinking around ‘mental time travel’ for his own new offering, Personalising Trauma Treatment: Reframing and Reimagining (Routledge)

Personalising Trauma Treatment: Reframing and Reimagining by [Michael J Scott]

The classic dictum underlying cognitive behaviour therapy (CBT) is that ‘men are disturbed not by things, but by the views which they take of things’. This is attributed to the Stoic Philosopher Epictetus (The Enchiridion Epictetus, translated by Higginson, 2020), who discussed it in the context of death. Epictetus was born into slavery and endured a permanent physical disability. In essence the Stoic philosophers were ‘centralists’ in taking the person’s view of matters as playing a pivotal role in distress. Unlike the trauma-focused CBT theorists, the ancient Stoic philosophers did not see the distress as originating in the particulars of the adversity at the time – what has, in the modern era, been termed arrested information processing. In my new book Personalising Trauma Treatment, I suggest that the key focus should be on what the trauma victim takes the trauma to mean about today, rather than having the client re-live the trauma.

Moving on from Stoic philosophers, Samuel Pepys wrote in his diary on 2 September 1666 (republished in 2003) of the start of the Great Fire of London. Five months later, on 28 February 1667, he wrote ‘it is strange to think how to this very day I cannot sleep a night without great terrors of fire; and this very night I could not sleep until almost two in the morning through thoughts of fire’. From the Restorative CBT (RCBT) perspective evinced in the book, the sights, sounds, smells of what Pepys had seen would be acknowledged and the question of what they mean for today would be asked. In essence, how relevant are these memories? Do they mean that he can’t walk the streets of London? The therapeutic focus would be on helping him realise he was safe. A prime RCBT target is helping the person regain their sense of self by gradually doing what they did before; for Pepys, writing about his daily encounters and the restoration/rebuild of London.

Moving further forward in my time capsule, the Auschwitz survivor, Edith Eger – who later became a Clinical Psychologist – was, in 2017’s The Choice, askance at the idea of deliberate re-living of the trauma. ‘Work through it? I lived it, what other work is there to do? … I’ve broken the conspiracy of silence. And talking hasn’t made the fear or flashbacks go away. In fact talking seems to have made my symptoms worse… we can choose to be our own jailors or we can choose to be free’. She did revisit Auschwitz but her sister, also a survivor, declined.

What is fascinating is Eger coped with dancing in front of the Nazi doctor, Josef Mengele, by transporting herself back to the stage on which she performed ballet. A key feature of my own book is how we do that mental time travel. The RCBT is easy to disseminate and hopefully will be useful for helping the mass of psychological casualties generated by the war in Ukraine.

Dr Mike Scott

 
 
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Unreliable IAPT Gatekeeping – Questions Sent To The Health Secretary, Dr Coffey

1.The Government Improving Access to Psychological Therapies (IAPT) Service is experimenting with public, direct access to a Psychological Wellbeing Practitioner. But PWPs are not trained in diagnostics nor are they qualified therapists. Why then are they being given this gatekeeping role?


2. The IAPT service has cost billions of pounds, since its’ inception in 2008. Why, then has there been no independent audit of the service?


3. With regards to physical health the Government is funding Community Diagnostic Centres, with regards to mental health why is there no facility for reliable
diagnosis in IAPT?


4. With regards to mental health there is no evidence that those availing themselves of IAPT fare any better than those attending the Citizens Advice Bureaux? What then is the added value of funding IAPT?


5. How is the experiment of making PWPs gatekeepers being evaluated and who decided on the criteria?


6. IAPTs claimed recovery rate of 50% has not been independently verified. The independent evidence of an Expert Witness to the Court [Scott (2021) British Journal of Clinical Psychology] suggests that in fact only the tip of the iceberg recover. Is this not grounds for a publicly funded independent audit?


7. How do we know IAPT is value for money?

I await the response with interest

 

Dr Mike Scott

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Fraud and IAPT

Should the Improving Access to Psychological Therapies (IAPT) Service be subject to civil legal action for its’ claim of a 50% recovery rate [IAPT Manual (2019)]? If the answer is ‘yes’ how should this take place?

Important considerations in preparing an action are:

  1. The public and referrer’s to IAPT cannot give ‘informed consent’ to the Service’s ministrations if they are misled on effectiveness. There has been no independent substantiation of the services claim. My own work Scott (2018) suggests that only the tip of the iceberg recover.
  2. IAPT by its’s own admission does not diagnose, how then can it meaningfully speak of ‘recovery’?  
  3. The term  ‘recovery’ implies ‘staying-well’ for a period that an ordinary member of the public would regard as reasonable e.g at least 8 weeks, yet IAPT have published no such data on the maintenance of treatment gains.
  4. IAPT’s claims are based entirely on its own chosen metric, a reduction to a below ‘caseness’  scores on at least one psychometric test and its’ interpretation of the results [IAPT Manual (2019)]. They operate with an attributional bias taking credit  for reduced scores, neglecting competing explanations, including:  

a) people present to services at their worst and there is an inevitable improvement with the passage of time – regression to the mean

b) services that give mental health sufferers attention such as the Citizens Advice Bureaux report 70% of service users claiming an improvement in mental health  yet the CABx does not purport to offer an evidence-based psychological treatment. There is no evidence that IAPT client’s fare any better, suggesting that the service confers no added benefit.

c) the tests are conducted under the auspices of the treating clinician, introducing the possibility that the client will give the latter a favourable answer, rather like being asked as you leave a restaurant ‘was everything ok?

d) neither client or clinician wants to feel that they have wasted their time, predisposing both to make a positive response to any enquiry.  

5. There is no evidence that IAPT delivers the evidence-based NICE compliant psychological treatment it claims. The entry requirement for NICE protocols is reliable diagnosis but as IAPT by its’ own admission does not make diagnoses, compliance has to be a marketing gimmick. There have been no fidelity checks on IAPT.

6. Most people initially accessing IAPT do not in fact receive psychological therapy, the staff they encounter are Psychological Wellbeing Practitioners (PWPs)  not therapists, the public do not get what it says on the tin ‘Access to Psychological Therapy’, to a non-lawyer this sounds like fraud!

The Perils of Seeking Psychological Therapy

It is rather like putting your car into the garage and finding your vehicle serviced rather than repaired as you asked. When you arrive to pick it up you discover the garage  doesn’t do ‘diagnostics’, nevertheless you are expected to pay the bill!

The Fraud Is Perpetuated By All The August Bodies Who Should Know Better

At the very least it all sounds very fishy. Yet NHS England, the National Audit Office, Clinical Commissioning Groups, the British Association for Behavioural and Cognitive Psychotherapy (BABCP) and the British Psychological Society all pay homage to IAPT, at a cost of about £5 billion to the public since its inception. These bodies are desperate to avoid cognitive dissonance, they wish to maintain their positive self-image at all costs, with a free flow of staff between the bodies and steadfastly refuse to consider that the decade long experiment with IAPT is a failure. But even more tragically mental health sufferers are left to feed on morsels. 

  1. Dr Mike Scott