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BABCP Response - NICE Consultation January 2022

NHS Talking Therapies – Doublethink Without Informed Consent

 

In practise clients begin their journey through NHS Talking Therapies at the promptings of the least qualified clinicians, Psychological Wellbeing Practitioners (PWPs). They are not trained therapists. I am not aware of this NHS service formally seeking any informed consent, it is likely unique in this regard. But the public have a right to know what they are letting themselves in for and the effectiveness of the said interventions. If pushed most PWPs would probably reiterate the mantra of its employer that 50% of people recover. But there has been no independent verification of this claim. Rather the best independent evidence suggests that the tip of the iceberg recover. It would not be a sufficient justification for a PWPs action to claim that he/she was only doing/saying what most colleagues are doing. How can there even be an ‘informal’ informed consent if the PWP does not make it clear that they are not a trained therapist, there is an absence of transparency. Further it is doubtful that they have the expertise to advise clients of the sequelae of different pathways.

Would a client who did not make the progress he /she had been led to expect be able to make a claim? Would the family of a client who committed suicide be able to claim that there had been no informed consent garnered at the outset of treatment?

I ran these concerns via a Barrister who opined ‘In principle, however, a person who is given inaccurate or misleading information about the chances of successful treatment, or about the qualifications of a person treating them, may well be found not to have given informed consent’.

 

Dr Mike Scott

13 replies on “NHS Talking Therapies – Doublethink Without Informed Consent”

Definitely something needs to change. The PWP role offers a false power and with no accurate systems in place which IAPT need to put in for all trusts the individual can easily do what they feel/think is right – the outcome can be corrupt.

The service I work in has three steps, low, intermediate and high. One part of the intermediate level used to be called ‘brief integrated therapy’ This for me is quite an honest description of what was on offer. However it’s now been changed and people are sold into the idea that they are getting ‘intermediate CBT’ but none of the people picking up from this list are CBT therapists or even PWP’s. Most are counsellors and related therapists – most have done a coupe of days training in basic CBT from over a decade ago. Having said this we know from the common factors research that model of therapy has next to no impact on therapy outcomes. We also know outcomes are manipulated at best and fake at worst.

If we read the careful critics of the therapy industries research base we see none of it has any robust evidence base and it can all be harmful – see William M Epstein – the illusion of psychotherapy, psychotherapy as religion and psychotherapy and the social clinic, soothing fictions and all of David Smails books or try the Therapy industry by Paul Maloney.

Hey Dr Scott

I am quite concerned about your perception of the PWP role.

I have worked as a PWP for 3 years and always introduced myself as a trained Well-being practitioner and never a trained therapist. In an initial assessment and the first therapy sessions practitioners regularly obtain consent. We explain the limits of the role, and is very specific about the training equipping practitioners with skills to support mild to moderate depression , anxiety , phobia excluding emetophobia and social phobia, or panic, the first steps in any PWP script following the university teaching curriculum. Having worked with colleagues from different universities I can see that people generally follow this rule and always stepping them up if they are not suitable

If practitioners generally follow this rule, I do wonder as a clinical psych whether you have a skewed opinion of the PWP and the role they play in supporting community mental health. The right engagement from the patient, maybe add some minimal family support and a good practitioner, indeed would be an excellent recipe for success. Be it guided by self-help or e-CBT the above group do recover fortunately, which is immensely satisfying for the practitioner

Is it not helpful for someone to be seen and learning some basic skills to cope before ending up in a never ending wait list ?

Hi Sind
I don’t at all decry the efforts of PWPs any more than I do of Citizens Advice Bureaux volunteers, both encounter people with mental health problems. But I am concerned that there is no evidence that PWPs do any better than the CABX staff with this population.
In 2021 Drew et al (see Gagging..blog) examined audiotapes of Psychological Wellbeing Practitioners (PWPS) and revealed that clients were not listened to and the PWPs were hellbent on pursuing orders.
Together this raises questions as to why we are funding PWPS. They at a minimum ought to be listening as much as CABx staff. IAPT was set up to provide psychological therapy on the basis that it would translate the treatments of rcts for depression and the anxiety disorders to routine practise but there has been no evidence of this, no fidelity checks, no independent evaluation. From being neutral about IAPT at the outset (see my Simply Effective CBT series of books) I became increasingly concerned that it just was not delivering and my review of 90
cases showed only the tip of the iceberg recover. My protest is that any treatment has to begin with proper listening and a reliable assessment. Cutting waiting lists short by not listening is a disaster.
To my knowledge there is no signed informed consent form, given that IAPT is now NHS Talking therapies my point (and that of a barrister’s), is that the service could be open to legal action.

I have been repeatedly prodded to self-refer to TT by GPs (strangely they hate to make the referrals themselves) even though after several years I have very low expectations of it by now. The last time was absolutely terrible and left me feeling 10 times worse. Seemingly lacking in structure or method, with a lot of inane common sense advice and a clear implicit message of “get a job and leave us alone”—not the scientific-sounding approach I was promised or signed up for at all.

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