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IAPT Behind Closed Doors – ‘Group CBT’

I have had some interesting experiences with regard to group work.  Groups were divided into either Anxiety or Depression groups and it was often a difficult task to understand or to divide those suffering predominantly from anxiety and those suffering mostly from depression.  Added to this, groups were designed to deliver the most information to as many people as possible and were not tailored to individual need.  It was a “scattergun” approach, designed to keep the commissioners happy in terms of figures.  I think the worst example of this, was when a “Welcome Group” was planned which gave “due consideration in terms of numbers of people who could drop out” and asked 15 people to attend.  The room’s capacity in terms of seating was only 12, but in fact, 45 people attended and this would have been more if inclement weather had not prevented others from attending.  This was put down to a mistake with the figures and in the following week, only 3 attended the course.

Courses routinely had the obligatory people who presented with alcohol or drug problems and it was a regular occurrence that either one or the other would disrupt a group.  I once had a complaint made against me by a member of a group who felt that I had not been supportive to her situation and had been tearful and had had to go to the Ladies’ to recover.  I asked my colleague to accompany her.  I was rounded upon by the drunk in the room, who jeered and berated me for “making her cry” and that I should be ashamed of myself.  I told this inebriated person that he may not attend the next session and for this I was abused verbally.  I felt quite threatened, but was asked to explain my actions at a later date, when the complaint came in.  The situation was seen to be “one of those things” but my efforts to point out that anyone with either drug or alcohol problems should not have any place in a depression group, were largely ignored.  I had argued that anyone who had not made some kind of recovery from either drug or alcohol issues should not be permitted to attend a step 2 group, because they would not benefit and could possibly disrupt a group.

Anonymity protected – Dr Mike Scott

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Brief Assessments Are The Norm And Invariably Wrong

Work on the assumption that the assessments of others are wrong because they have probably operated on some idiosyncratic  rule of thumb to save time. My cynicism about the assessments of colleagues was heightened recently, two years ago I saw a lady who had a phobia about driving and travelling as a passenger in a car and needed CBT. I’ve just discovered that her GP has decided she has PTSD and she is consequently, about to undergo 12 sessions of CBT.

In a previous post I talked about the importance of ‘Watching and Waiting’ but if this is done without the appropriate measuring instrument, a standardised reliable diagnostic interview all is in vain. My suspicion is that the GP, like many clinicians has in mind a ‘cardinal symptom’ of PTSD such as flashbacks and/or nightmares and uses this rule of thumb (heuristic) to determine treatment. The advantage of heuristics is that they are quick, the disadvantage is that they are usually wrong

see Daniel Kahneman’s book, resulting in a waste of resources and the client likely defaulting from CBT

Dr Mike Scott.