The contexts in which CBT Practitioners work vary enormously, from independent practice to secondary care, from low intensity IAPT to a specialised trauma unit. For the most part we are Engineers struggling to work within the organisational constraints we are given. Drawing on our knowledge and skills, working with a diverse population, trying to make a real world, socially significant difference in client’s lives. The pressing question is how can I deliver effective CBT where I am?
A practitioner working in secondary care in Ireland, told me he faces the challenge of cases come to him via psychiatrists, there is a preliminary assessment within 4 weeks of referral, a maximum of 12 sessions of CBT are offered. There is a progress review about the 6th session and a decision is made as to whether another 6 sessions would be beneficial. He asks is this best practice? The managerial edict he believes is to throughput as many clients as possible.
Another practitioner, from IAPT High Intensity told me that she had taken up her post on the understanding that the 6 session maximum was flexible and clients could be quickly re-referred back in for more sessions, but this has proved to be very rarely the case. What should she do?
Dr Mike Scott