Stressed Because You Are Asked To Do What Is Not Possible?

‘I am not IAPT’s employee of the month’, ‘For all to view, I am nowhere near the top of the league table for recovery rates’ – just two of the voices of stressed therapists that I have heard in recent months. Unfortunately challenging the Organisational zeitgeist that generates such demoralisation is likely to be seen as a further sign of ‘inadequacy’.

But the American Psychological Association, Clinical Psychology Division, have refined the criteria for an evidence based treatment in such a way, that it could add ‘grist to the mill’ of those who wish to take issue with what they are being asked to do. The new criteria contain the added requirement that there must be evidence of effectiveness in at least one study, in a nonresearch setting using non-academic therapists and also evidence of effectiveness on functional impairment and not just symptom improvement. [The new requirement is based on the Tolin et al (2015) paper Empirically supported treatment: recommendations for a new model. Clinical Psychology Science and Practice, 22, 317-338]. With this added criteria many of the CBT treatments for health anxiety, psychosis and long term physical health problems and computerised cbt would not clear the raised bar for evidence based treatment. Even an accepted treatment such as exposure and response prevention for OCD has just one routine practice study and this was without a control condition, Tolin still strongly recommended the treatment but suggested that there did need to be further evidence.

Pencil in ‘and CBT’ next to ‘antibiotics’ in the poster below and display in Staff and ? Waiting Rooms for the coming Winter

 

Often times a client has considerable comorbidity, I have just seen a person with ptsd, depression, binge eating disorder, panic disorder with mild agoraphobic avoidance and ?body dysmorphic disorder following an rta 4 years ago. No randomised controlled trial has ever been conducted on a population with such extensive comorbidity. There has to be proper acknowledgement of the challenges such a client presents for a therapist, it is insufficient to label a client simply as ‘complex’ because this can easily be seen by the powers that be as a ‘cop out’, the only true defence is a comprehensive reliable assessment.

The bottom line may be to challenge, where you can, whether there is evidence of effectiveness for this specific type of client in the routine context in which you are working – a reality check.

 

Dr Mike Scott

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