BABCP Response - NICE Consultation January 2022 IAPT

‘What Proportion of People With This, Recover With This Treatment?’

If you are undergoing a medical procedure this is a pressing question. Curiously, psychological therapists create an aura in which clients are disuaded from asking this question, with responses that amount to ‘we don’t like to use labels, just complete questionnaires to see how you go’, masking a wholesale distrust of the medical model.  Clients are intimidated from voicing their basic concerns, when asked whether they were given a diagnosis usually the response is ‘no’ or  “they said I had ‘x’ symptoms” either way they do not feel on solid ground. Invalidating a person/client’s nascent question whether it be the ‘meaning of life’ or the likelihood of treatment that makes a socially significant difference is direspectful.

IAPT obscures the answering of this question by a sleight of hand, using changes on 2 psychometric tests to indicate recovery, with no blind, independent assessment of outcome and no use of a ‘gold standard’ diagnostic interview. But this obscurantism is not confined to Government funded psychological therapy services, in private practice there is an equal failure of diagnostic accuracy and comprehensive evaluation at both initial assessment and at the end of treatment. However at least in the private sector one can search out a therapist who can deliver, no such option is available within IAPT.


Dr Mike Scott

One reply on “‘What Proportion of People With This, Recover With This Treatment?’”

Services are meant to at lease use “anxiety disorder specific measures”, the ones listed in the IAPT directives from NHS England. However, because it usually takes a lot more therapy to improve scores reliably on these, any service in trouble with its recovery rates tend to drop them and just rely on the GAD-7, which the system allows. In their returns NHS Digital should say what percentage of the column, “ADSM” are GAD-7 to show up which services are gaming the system on this.
It’s right though that there is no “diagnosis” given – the one thing that IAPT clinicians fought and actually won on was changing the label “diagosis” to “presenting problem” in the returns. Most people going through IAPT come into contact only with workers who are not qualified to give a diagnosis (often a PWP) so the safest thing is to say, this collection of symptoms comes nearest to “X” so we’ll treat it as that. As it is these “presenting problem” labels often end up as a diagnosis on people’s medical records at the GP anyway. So if you score 10 on the PHQ-9, which so many of us would during a difficult period, and you say, this has happened before, you could end up with “recurrent depressive disorder” on your medical records.

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