BABCP Response - NICE Consultation January 2022

Rapport vs 6 Sessions In High Intensity IAPT

The final straw for a friend working in High Intensity ‘I’ve just been told that in the 1st session , I must tell the client that in our service and nationally most people manage with 6 sessions in Step 3’. He’s had enough, sorting out his mortgage, then leaving for private practice!  We agreed that IAPT management seem to have never heard of the importance of rapport.


A study just published by Sara Antunes-Alves et all of 43 clients undergoing CBT for depression found that the only predictor of outcome was rapport, examples of this included exchanges where the therapist and client were joking , laughing together. In the study rapport was observer rated none of the competence skills predicted outcome, however the  study was small, technically underpowered and they may have been predictors with a bigger sample. Nevertheless the study is a salutary reminder of the importance of humanity. Antune-Alves et al (2018) Therapist interventions and patient outcome: addressing the common versus specific factor debate. Archives of Psychiatry and Psychotherapy 3, 7-35.  Interestingly clients had at least 12 therapy sessions with a maximum of 20, this is the number of sessions that quality research has found necessary for real world change. The ‘norming’ of 6 sessions in IAPT is an insult to clients and a betrayal of trust – a sub-therapeutic dose of treatment.


Dr Mike Scott

13 replies on “Rapport vs 6 Sessions In High Intensity IAPT”

I couldn’t agree more. With the increasingly ‘complex’ clients being seen at both steps 2 and 3 I would have expected even more focus on building rapport but there seems to be less and less. IAPT feels to me primarily like a numbers game, with plenty of gaming the system going on behind the scenes. It really is shocking.

Thanks Kojay, it gets even worse, I have just heard that some services are going to take on ‘mild’ eating disorders and body dysmorphic disorder! Leaving aside the issue of how you would reliably determine ‘mild’ in those areas, clinicians burdens seem set to become impossible, added to which an IAPT demonstration site has demonstrated the ‘value’ of a group intervention for bipolar disorder (see Behaviour Research and Therapy) doubtless this will be rolled out before long.


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