Categories
l

Flexibility Within Fidelity

was the title of a great CBT workshop that I attended yesterday, delivered by Prof Philip Kendal. He described how time saving rules of thumb, can short circuit the therapeutic process (described in his book with the same title, published in 2022 by Oxford University Press). One of the attendees, a low intensity practitioner, volunteered one such heuristic, automatically disqualifying a client from the Service (presumably NHS Talking Therapies) if they had had a bereavement. Prof Kendall replied:

‘when the system is screwed up change  the system’  

A totally reasonable response from an objective observer outside the system. In the Webinar didn’t hear further from the therapist, and Prof Kendall did, understandably, not quite appreciate that bringing about such a change is a monumental task for anyone in IAPT’s successor. He did opine that one way of changing a system is to set up a comparison of the current system with the proposed system. But there has been no independent assessment of NHS Talking Therapies. He opined that the most credible randomised controlled trials were those in which there had been a blind, independent assessor. The Service’s  clientele have never been involved in such a trial, much less in a comparison of the Service’s routine practice with the mode of delivery suggested in my 2009, tome Simply Effective CBT, published by Routledge.

Prof Kendal said that in the US a lot of CBT therapists don’t give homework and in this  context clients do no better than in an attention control condition. This side of the pond, in my review of numerous records, for the Court I have never seen the written specification of a homework much less its’ monitoring. It is a myth that CBT is routinely provided, literally it would not stand-up in Court. Nevertheless the UK Government continues to fund adult and child and adolescent mental health to the tune of £2 billion a year. Where else could this happen without independent evaluation?

Prof Kendal insisted that his workshop was not about flexibility with infidelity but that is what routine psychological treatment in the UK amounts to. There is nothing in the UK NHS Talking Therapies approach that prevents therapists using unbridled clinical judgements. Its’ therapists perform what Prof Kendall terms a ‘diagnostician’ role, in that they assign ICD 10 codes to the client’s problems (without making an ICD 10 or DSM-5) diagnosis, but this has not stopped treatment wandering from a recognisable diagnostic pathway.  I felt he ducked the importance of reliable diagnosis. 

Prof Kendall rightly insisted on the importance of personalising treatment and having a therapeutic relationship. both of which Drew et al (2022) found notably absent in NHS Talking Therapies low intensity interventions. In Personalising Trauma Treatment: Reframing and Reimagining Routledge (2022) I give lots of examples as to how this can be done in the trauma field. I agree with him that both personalising treatment and a therapeutic relationship are necessary but not sufficient conditions for effective treatment. The other necessary active ingredient for treatment is that it must address the mechanism that is pivotal in the maintenance of the condition. With regard to trauma I have suggested it is the centrality accorded to the trauma and not arrested information processing.

Thank you Prof Kendall for such a human and illuminating workshop.

 

Dr Mike Scott

 

 

134 replies on “Flexibility Within Fidelity”

‘I felt he ducked the importance of reliable diagnosis’ there is no such thing in mental health and never will be.

I loved even more than you could possibly be able to accomplish right here. The picture is beautiful, and your language is elegant; yet, it appears that you are rushing through it, and I believe that you ought to give it another shot in the near future. That is something that I will most likely do again and again if you protect this hike.

Everything is very open with a very clear description of the challenges.
It was definitely informative. Your site is useful. Thank you for
sharing!

Hello there, I discovered your website by
means of Google at the same time as searching for a
related matter, your site came up, it appears great.
I have bookmarked it in my google bookmarks.
Hi there, simply turned into alert to your blog through Google, and located that it’s truly informative.
I’m going to watch out for brussels. I’ll be grateful if you proceed this
in future. Lots of people will be benefited from your writing.
Cheers!

I have learn a few just right stuff here. Certainly value bookmarking for revisiting.

I wonder how so much effort you set to make any
such great informative site.

It is the best time to make some plans for the future and it’s time to be happy.
I’ve read this post and if I could I want to suggest you few interesting things or
advice. Maybe you can write next articles referring to this article.
I desire to read even more things about it!

Hello, Neat post. There’s an issue with your site
in internet explorer, would check this? IE nonetheless is the marketplace chief and a
huge component of people will leave out your excellent writing because of this problem.

Hi! I know this is kind of off-topic but I had to ask.
Does operating a well-established website like yours
take a lot of work? I’m completely new to running a blog but I do write in my diary every day.
I’d like to start a blog so I will be able to share
my personal experience and thoughts online.
Please let me know if you have any kind of suggestions or tips for new aspiring blog owners.

Thankyou!

I think this is among the most vital info for
me. And i am glad reading your article. But should remark on few general things, The site style is wonderful,
the articles is really nice : D. Good job, cheers

I think this is one of the most significant information for me.
And i am glad reading your article. But want to remark on some
general things, The web site style is ideal, the articles is
really great : D. Good job, cheers

Howdy are using WordPress for your site platform? I’m new
to the blog world but I’m trying to get started and create my own. Do you require
any html coding knowledge to make your own blog?

Any help would be greatly appreciated!

Hi there! I could have sworn I’ve been to this site before but after checking
through some of the post I realized it’s new to me.
Anyhow, I’m definitely glad I found it and I’ll be bookmarking and checking back frequently!

You actually make it seem really easy together with your
presentation but I find this topic to be actually one thing
that I feel I’d by no means understand. It sort of
feels too complicated and very vast for me.
I’m looking forward in your subsequent post, I’ll attempt to get the grasp of it!

I was curious if you ever considered changing the page layout of your blog?

Its very well written; I love what youve got to say.
But maybe you could a little more in the way of content
so people could connect with it better. Youve
got an awful lot of text for only having one or 2 images.

Maybe you could space it out better?

First of all I want to say superb blog! I had a
quick question in which I’d like to ask if you don’t mind.
I was interested to find out how you center yourself and clear
your head before writing. I have had difficulty clearing my thoughts in getting my thoughts out there.
I do enjoy writing however it just seems like the first 10 to 15 minutes are generally wasted simply just trying to figure out how to begin. Any ideas or hints?
Cheers!

Hello, i feel that i saw you visited my web site so
i came to go back the favor?.I’m attempting to find issues to improve my site!I guess
its good enough to make use of some of your concepts!!

Hey I am so delighted I found your site, I really found you by mistake, while I was searching on Google for something else, Anyhow I
am here now and would just like to say thanks a lot for a incredible post and a all round thrilling
blog (I also love the theme/design), I don’t have time to go
through it all at the minute but I have book-marked it and also added your RSS feeds, so when I have
time I will be back to read a great deal more, Please do keep up the fantastic b.

Hi there just wanted to give you a brief heads up and let you know a few of the pictures aren’t loading properly.
I’m not sure why but I think its a linking issue. I’ve tried it in two different internet
browsers and both show the same results.

I’m curious to find out what blog platform you have been utilizing?
I’m having some minor security issues with my latest blog and I would like to find something
more safe. Do you have any solutions?

I like the valuable info you supply to your articles.
I’ll bookmark your weblog and test once more right here
regularly. I’m quite certain I will be informed plenty of new stuff right right here!

Good luck for the next!

You could certainly see your expertise within the article you
write. The world hopes for more passionate writers such as you who are not afraid to mention how they believe.
All the time go after your heart.

This is very fascinating, You’re an overly skilled blogger.
I’ve joined your rss feed and look ahead to searching for more of your magnificent post.

Additionally, I’ve shared your site in my social networks

My developer is trying to persuade me to move to .net from PHP.

I have always disliked the idea because of the costs.

But he’s tryiong none the less. I’ve been using WordPress on various websites
for about a year and am anxious about switching to another
platform. I have heard excellent things about blogengine.net.
Is there a way I can import all my wordpress content into it?

Any help would be really appreciated!

I got this website from my friend who shared with me regarding this site and now this time I am browsing this site and reading very informative posts at this place.

What i don’t realize is in reality how you are no longer really
a lot more well-preferred than you might be now. You’re very intelligent.

You realize thus considerably in the case of this topic, produced
me personally believe it from numerous varied angles. Its like men and
women don’t seem to be interested unless it’s something
to do with Woman gaga! Your own stuffs great.
Always take care of it up!

I am really loving the theme/design of your website.
Do you ever run into any browser compatibility problems?
A handful of my blog audience have complained about my website not working
correctly in Explorer but looks great in Chrome. Do you have any recommendations to help fix this problem?

Woah! I’m really loving the template/theme of this site.
It’s simple, yet effective. A lot of times it’s
difficult to get that “perfect balance” between usability and appearance.
I must say that you’ve done a fantastic job with this.
Also, the blog loads very quick for me on Opera. Exceptional Blog!

Please let me know if you’re looking for a writer for your weblog.
You have some really good posts and I think I would be a good
asset. If you ever want to take some of the load off,
I’d absolutely love to write some articles for your blog in exchange for a link back to mine.
Please send me an e-mail if interested. Kudos!

I am extremely inspired along with your writing skills as smartly as with the structure on your blog.
Is this a paid theme or did you customize it yourself? Either
way keep up the excellent high quality writing, it’s uncommon to look a great weblog like this one nowadays..

Hi, I do believe this is a great blog. I stumbledupon it 😉 I’m going
to revisit once again since I saved as a favorite it.

Money and freedom is the best way to change, may you be rich and continue to guide
other people.

Excellent blog here! Also your website loads up very fast!
What host are you using? Can I get your affiliate link to your host?
I wish my website loaded up as fast as yours lol

My developer is trying to persuade me to move to .net from
PHP. I have always disliked the idea because of the costs.
But he’s tryiong none the less. I’ve been using Movable-type on a number of websites for about a
year and am concerned about switching to another platform.
I have heard excellent things about blogengine.net.
Is there a way I can import all my wordpress posts
into it? Any kind of help would be really appreciated!

I love your blog.. very nice colors & theme.
Did you design this website yourself or did you hire someone to do it
for you? Plz respond as I’m looking to construct my own blog
and would like to know where u got this from. many thanks

Hey I am so glad I found your website, I really found you by mistake,
while I was researching on Bing for something else, Anyways I am here now and
would just like to say thank you for a tremendous post and
a all round interesting blog (I also love the
theme/design), I don’t have time to go through it all at the moment but I
have saved it and also included your RSS feeds,
so when I have time I will be back to read more, Please do
keep up the excellent work.

Thanks for another fantastic article. Where else may just anyone get that type of information in such
a perfect way of writing? I’ve a presentation subsequent week, and I am on the look for such information.

Attractive component to content. I simply stumbled upon your weblog
and in accession capital to say that I get actually loved account your blog posts.
Anyway I will be subscribing for your feeds and even I achievement you get
right of entry to constantly rapidly.

Hey there, I think your blog might be having browser
compatibility issues. When I look at your blog in Opera, it looks fine but when opening in Internet Explorer,
it has some overlapping. I just wanted to give you a quick
heads up! Other then that, excellent blog!

Hi! I could have sworn I’ve been to your blog before but after browsing
through many of the articles I realized it’s new to me. Anyways, I’m certainly delighted I came across it and I’ll be book-marking
it and checking back frequently!

Hi there very nice website!! Guy .. Beautiful .. Superb ..
I’ll bookmark your web site and take the
feeds additionally? I am glad to seek out a lot
of helpful information here in the post, we need work out more strategies on this regard,
thank you for sharing. . . . . .

You really make it seem so easy with your presentation but I find this topic to be really something that I think I would never understand.
It seems too complex and extremely broad for me.
I’m looking forward for your next post, I will try to get the hang
of it!

you’re really a excellent webmaster. The site loading pace is incredible.
It sort of feels that you’re doing any unique trick. Also, The
contents are masterpiece. you’ve done a wonderful activity in this matter!

It’s a shame you don’t have a donate button! I’d definitely donate to this outstanding blog!

I guess for now i’ll settle for book-marking and adding your RSS feed to my
Google account. I look forward to new updates and will share this site with my Facebook group.
Talk soon!

I don’t even know how I finished up here, however
I believed this post was good. I do not understand who you’re but definitely you are going to a well-known blogger when you aren’t already.
Cheers!

After I originally left a comment I seem to have clicked on the -Notify me
when new comments are added- checkbox and now every time a comment is added I get
four emails with the same comment. Perhaps there is a means you are able to remove me from that service?

Cheers!

Howdy! This is my first comment here so I just wanted to give a quick
shout out and say I genuinely enjoy reading through your articles.
Can you suggest any other blogs/websites/forums that go
over the same subjects? Many thanks!

Hello there! This post could not be written any better!
Reading through this post reminds me of my old room mate!
He always kept talking about this. I will forward this
write-up to him. Pretty sure he will have a good read. Many thanks for sharing!

We’re a group of volunteers and opening a new scheme in our community.
Your site provided us with valuable info to work on. You have done an impressive job and
our whole community will be thankful to you.

Hello there! This is my first visit to your blog!
We are a group of volunteers and starting a new project in a community in the same niche.
Your blog provided us valuable information to work on. You have
done a outstanding job!

Hmm is anyone else experiencing problems with the images on this blog loading?

I’m trying to figure out if its a problem on my end or if it’s the blog.
Any feedback would be greatly appreciated.

My brother suggested I might like this blog.
He was entirely right. This post actually made my day.
You can not imagine simply how much time I had spent for this information! Thanks!

I really love your site.. Pleasant colors & theme.
Did you develop this site yourself? Please reply back as I’m planning to
create my own personal website and would like to learn where you got this from or what the theme is called.
Kudos!

whoah this weblog is fantastic i really like studying your articles.
Keep up the good work! You recognize, a lot of individuals are searching around for this info,
you can help them greatly.

It’s a shame you don’t have a donate button! I’d definitely donate to this brilliant blog!
I guess for now i’ll settle for book-marking and adding your RSS feed to my Google account.

I look forward to fresh updates and will share this website with my
Facebook group. Talk soon!

Hello, I believe your site may be having browser compatibility problems.

Whenever I look at your site in Safari, it looks fine however when opening in IE, it has some overlapping issues.
I merely wanted to give you a quick heads up!

Besides that, fantastic blog!

Thanks a lot for sharing this with all of us you really know what you’re speaking approximately!

Bookmarked. Please also consult with my web site =).
We may have a hyperlink trade agreement among us

50 Lower price Meant for All Private Proxies! Top level superior, Unending data transfer, 1000 mb/s superspeed, 99,9 uptime, Low sequential IP’s, Absolutely no application limits, A variety of subnets, USA as well as Europe proxies – Acquire At this point – DreamProxies.com

Hi, Neat post. There is a problem together with your web site in internet explorer, would test
this? IE still is the marketplace leader and a good component to other folks will
miss your excellent writing because of this problem.

Admiring the dedication you put into your website and in depth information you present.
It’s nice to come across a blog every once in a while that isn’t the
same old rehashed material. Great read! I’ve saved your site and I’m including
your RSS feeds to my Google account.

After looking at a few of the articles on your web site, I honestly
appreciate your technique of blogging. I bookmarked it to my bookmark website list
and will be checking back soon. Take a look at my website as well and let me know how you feel.

Do you have a spam issue on this site; I also am a blogger, and
I was wondering your situation; we have developed some nice practices and we are looking to exchange techniques with others, be sure
to shoot me an e-mail if interested.

My spouse and I stumbled over here different web page and thought I may as well check things out.

I like what I see so now i’m following you. Look forward to exploring your web page again.

I like the valuable information you provide in your articles.
I’ll bookmark your weblog and check again here frequently.
I am quite certain I’ll learn a lot of new stuff right here!
Good luck for the next!

whoah this weblog is great i really like reading your posts.
Stay up the good work! You understand, lots of people
are looking around for this information, you could help
them greatly.

Have you ever considered about adding a little bit more than just your articles?
I mean, what you say is fundamental and all.

But think about if you added some great images or video clips to give your
posts more, “pop”! Your content is excellent but with pics and
clips, this blog could certainly be one of the very best in its field.
Very good blog!

Leave a Reply

Your email address will not be published. Required fields are marked *