transcripts of tape recordings of client’s first contacts with the, UK Government funded, Improving Access to Psychological Therapies (IAPT) service, analysed by Drew et al (2021) https://doi.org/10.1016/j.socscimed.2021.113818 reveal not only steadily increasing access, but a steadfast refusal to let clients tell the story behind their distress. The double message is ‘come to us, but we don’t want to listen to your troubles’
To quote Drew et als’ (2021) study of telephone-guided low intensity IAPT communications:
‘We show the ways in which the lack of flexibility in adhering to a system-driven structure can displace, defer or disrupt the emergence of the patient’s story, thereby compromising the personalisation and responsiveness of the service’
‘routine assessment measure questionnaires prioritised interactionally, thereby compromising patient-centredness in these sessions’
Drew et al (2021) give an example of this surrounding risk assessment:
PWP: So just with regards to question nine, okay so we have a duty of care to yourself or others? .hhh.erm (.) > are we okay just to< have a bit of a chat around.hh what those thoughts might be for you at the moment. ‘Cos you’ve scored a one there haven’t you’ Pause 3 secs
PWP: Are you having current thoughts of wanting to hurt yourself or end your life? Pause 3.5 secs
Pat: No, may. hh Pause for 3.5 secs
Pat: It’s – It’s just feels like a really weird (.) week this week because –
(18 lines omitted in which the patient talks about the pressure they are under; only minimal responses and attempts to close from PWP)
Pat: I still feel like I – I’m not doing anything and not accompanying anything tearful/tremulous
PWP: Mm, mm, okay? .huh
Pat: MHHHH HHH [ and it’s tearful/tremulous]
PWP: Are you having any thoughts of wanting to be better off dead or off wanting to better off dead or hurting yourself
Dangerously The PWP is all at sea – a disaster waiting to happen, there will be a death. The above exchange shows
the therapist unable to move beyond repeating question 9 on the PHQ9, like a broken record, without any reliable
exploration of suicide risk. But then the IAPT Manual provides no guidance in this respect, baldly stating risk
assessment is part of good assessment.
In the exchange above the PWP ignores the client’s story. Assessment and treatment are necessarily built on sand
if the client’s narrative is not first distilled. Making IAPT’s claim of a 50% recovery rate beyond belief. [The average
session was 44mins for assessment and 33 mins for first treatment].
It is bad enough when a friend or relative will not listen to your troubles, but when a Government Agency does it routinely, that is unconscionable. Drew et al (2021) draw attention to the ubiquity of the problem which suggests that it is systemic. However Drew et al (2021) content themselves with recommending that IAPT’s assessors need to ask more open-ended questions at the start of their interviews. The authors claim no conflict of interest, but many of the authors have had previous privileged access to IAPT data, research data may not be so forthcoming if they take a more critical view of IAPT. In this respect they do not question IAPT’s recovery rate or cite data which may disconfirm it Scott (2018) https://doi.org/10.1177%2F1359105318755264.
Dr Mike Scott