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‘ A Strong Therapeutic Alliance Is an Essential Element of (CBT) Treatment’

so writes Judith Beck, President of the Beck Institute for CBT (2019 Moorey and Lavender) in a book to be published next week, echoing what her father Aaron Beck wrote in 1979 in his seminal work Cognitive Therapy for Depression. But IAPT have made their own fundamentalist translation of Beck’s work, indoctrinating its’ footsoldiers, Psychological Wellbeing Practitioners (PWPs), one of whom from Liverpool (2019 p214 Jackson and Rizq) has written:

‘The PWP role is high volume low intensity, just churn them out… young PWPs straight from universities, who are naively prepared to do as required by the service…There’s a big gap between the data and the reality of what we’re trying to do’.

It is disturbing that the most vociferous critics of IAPT are also fierce critics of CBT, [ see Jackson and Rizq (2019)] creating a caricature of the latter as mechanistic and uninterested in the the therapeutic relationship. But I have just contributed a chapter the Moorey and Lavender (2019) edited volume. Anyone reading my chapter on Group CBT in this work can be in no doubt about the importance I attach to the alliance/ cohesion in a group.

I am still reading the Jackson and Rizq (2019) book and it contains many perfectly valid criticisms of IAPT. But it does engage in unnecessarily distracting polemics about the medical model and diagnosis.

The contributors to the Jackson and Rizq (2019) work seem blissfully unaware that no medic or psychologist has ever espoused anything other than a biopsychosocial model, it is only the mouthpieces for drug companies that have ever voiced purely biological explanations. To say that biology will be involved in psychological reactions isn’t at all to say that the former determines the latter or its course.

Breathtakingly Jackson and Rizq (2019) are profoundly mistaken when they assert that IAPT believes in diagnosis, they do not at all, they pay lip service to it to secure funds!. IAPT never ever perform a standardised diagnostic interview such as the SCID which is the ‘gold standard’ for establishing whether a person has a recognised psychiatric disorder. The first part of the SCID begins with an open ended interview in which clients are given the space to tell their story, only then is their systematic enquiry about each of the symptoms in a diagnostic set and a clinical assessment of which symptoms are significantly interfering with real world functioning. If IAPT started to use the SCID it would stop the production line referred to by the PWP above. There has to be space created for any relationship. But in my personal communication with David Clark, IAPT’s progenitor he baulked at the cost involved, but did not criticise my proposal per se.

Diagnosis provides a common language and it is the least worst way of communicating, try trying to talk about say ‘power threat meaning ‘ in a medico-legal case! Its’ usage does not at all depend on believing in a particular biological pathology rather it is pragmatic and subject to revision.

Jackson and Rizq (2019) reiterate the ‘Dodo verdict’ that all therapies are equal and must have prizes citing Wampold’s work, but Tolin’s findings

https://www.dropbox.com/s/r3bja27takbicnc/Tolin%202015%20Dodo.pdf?dl=0

are very different. But notwithstanding this, in routine practice one does not find evidence of fidelity to any psychotherapeutic protocol, I have yet to see any written evidence in treatment notes of fidelity that would satisfy anyone from any of the psychotherapeutic schools. Manuals are seen as anathema, with a total ignorance that flexibility is an integral part of all such published manuals. Unfortunately the manuals have never been tested out by the Jackson and Rizq (2019) advocates, nor has the viability of using a standardised diagnostic interview, instead theirs is a fundamentalist view that they and their client will somehow find the right way. In their own way they are as ideological as IAPT.

References

Moorey, S and Lavender, A eds (2019) The therapeutic relationship in cognitive behavioural therapy. London: Sage Publications

Jackson, C and Rizq, R (2019) The industrialisation of care counselling, psychotherapy and the impact of IAPT. PCCS books

Dr Mike Scott

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