Talking Therapies Institutionalised Psychologising of Physical Health Problems


As a high intensity therapist working in IAPT, I’m finding an increasing amount of the people I see have chronic physical health conditions.  The training and supervision I receive emphasises my role as one of treating the depression/anxiety associated with these conditions, and not the condition itself.  This sounds plausible in theory, but my experience it just doesn’t work that way in practice. 
  1. Firstly, I get the distinct feeling that a lot of the time the people I see with chronic health conditions are not clinically anxious or depressed, they are just having a normal reaction to a really challenging situation.
  2. Secondly it is impossible for someone with my training and limited medical knowledge to know whether a symptom such as fatigue or poor sleep is down to anxiety or depression or other factors, including physical causes.
  3. I’m quite sure that I have treated people in the past, and will do so again, where symptoms arising entirely from an undiagnosed physical condition were misinterpreted as a mental health issue and I worry that there is a real danger, even with the best of intentions, of gaslighting people here, however sensitive and non pathologising I try to be. 
  4. Time and again I have had people tell me their symptoms were dismissed for years as being “all in their head”, and I worry I am inadvertently feeding into that damaging narrative. 
  5. Greater integration between physical and mental health care in the NHS can only be a good thing, but my experience is there is sizeable gap between the theory and practice on the ground.  IAPT is meant to be integrating more into physical health teams, in practice I am not sure how well this is really happening. 
  6. I know how hard staff on the ground in IAPT work and how dedicated the clinicians are, I worry we are being put in an impossible situation.  I’m very grateful to CBT watch for highlighting some of the predicaments that I can relate to in my day to day work.  


Identity withheld to protect the IAPT therapist

Dr Mike Scott