whilst they may describe to a greater or lesser extent the psycho-social context in which the client is operating, different therapist would disagree about the relative importance of the psychosocial stressors and have a different collection of them. One may emphasise the clients current relationship another a harsh/ ? abusive childhood another poverty.
At a recent workshop I gave a PWP (Psychological Wellbewing Practitioner)defended reliance on the use of problem descriptors on the basis that they could be complemented by the therapists intuition. But this was precisely the therapeutic task centred approach adopted by social work in the 1970’s, it failed to demonstrate effectiveness and by the 1990’s social work had become confined to largely a policing role, replete to this day with meaningless checklists. I speak as a former social worker, consumer of social services for over three decades and as a psychologist.
With my psychologist hat on I am very aware of the the work of Daniel Kahneman on the use of rules of thumb (heuristics) in decision making, for example the use of the availability heuristic – the vividness of a description giving a mistaken impression of its’ likelihood, so that a therapist hearing the horrific details of a trauma assumes it must be PTSD. Loretta whom I saw recently simply had a specific phobia about driving/travelling as a passenger in a car as a result of very serious rta. Nevertheless the PWP directed her to a 6 week stabilisation group that did nothing at all for her difficulties. But the stepping up procedure offered no protection, she attended 3 individual sessions in which she was asked to talk about and write about the trauma, she dropped out because she found the procedure too toxic. Loretta’s difficulties in driving and travelling as a passenger were not addressed at all. I broke the good news that her problems could be simply addressed.
The PWPs were totally unaware that Beck’s first paper was on the unreliability of the standard interview. This led to the inclusion of standardised diagnostic interviews in CBT outcome studies. In my view the PWP training however quick and simple is not fit for purpose.
Dr Mike Scott
Ps Do listen to Radio 4 on Tuesday Sept 24th at 8.0pm for its’ investigation into ‘The Therapy Business’
4 replies on “PWP’s Floundering – Problem Descriptors Are Unreliable”
Using therapist intuition doesn’t seem particularly evidence based but I think it is often what therapists use in the absence of anything else. When I started in iapt I think we were given a half hour talk on identifying a problem descriptor and that was it!
I know I’ve been guilty of hearing people describe a few associated symptoms and then jumping to conclusions about the problem descriptor without considering things like frequency or intensity and without really considering context. I’ve lost count of the number of people who come through for treatment of GAD who are going through an adverse life event eg redundancy and are (unsurprisingly) really worried about it.
Just 30 mins on problem descriptors in IAPT is appalling as it is claimed by the Service that these lead to the selection of the appropriate NICE protocol! Therapists are not equipped to distinguish lifes normal adjustment difficulties, to as u say redundancy, and treat everything, ‘might as well call it GAD’, the result is overload and mistreatment.
Hope the Radio 4 programme at 8.0pm tonight ‘The Therapy Business’ starts to put things right
I’m not sure if IAPT services are CQC regulated. If so, how many? Perhaps a FOI request could help clarify this?
The CQC is mentioned on pages 63 and 64 of the IAPT Manual published last year, so I presume IAPT is accountable to the CQC, it is just that the latter has not discharged its’ duty to assess outcomes in this case.