Failure to ‘Watch and Wait’ Results In Unnecessary Treatment

I doubt that ‘watchful waiting’ has been applied as a policy post the Grenfell Fire, as it is not usually operative in the aftermath of more everyday trauma.  Distressing emotions in the aftermath are oftentimes ‘pathologised’ instead of being seen as part of normal healing process.

A client of mine was involved in a bad car accident, saw her GP who identified whiplash and was concerned that she was troubled by memories of the incident and referred her to IAPT. At IAPT she was offered a choice between a 10 week waiting list for face to face treatment or immediate treatment via telephone counselling. She wanted face to face counselling  and so instead took up her employer’s offer to provide counselling. The two sessions did not help and did not involve cbt.  All this took place within weeks of the accident.

There is a pressing need for GP’s, IAPT and counsellors to be seen to do something, but in all this haste, in the aftermath of a destabilising incident there had been no reliable definition of the problem. Further there was no recognition that typically those destabilised generally find that their own resources are, given time, sufficient to help them regain their balance.
In the event when I saw her 4 months post incident she simply needed CBT for a phobia about driving and travelling as a passenger.
Operating a Watch and Wait over the first 3 months would have resulted not only in a far better use of resources but also the development of a necessary therapeutic alliance. It also advances ‘Saving Normal’ the title of an excellent book by Allen Francis.

Watchful waiting is nothing to do with administering a PHQ-9 every month for 3 months and then concluding ‘something’ must be done if a high score is maintained or the score worsens. Rather it involves the careful tracking of a reliably identified disorder/difficulty.

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