the mantra is ‘offer just 6 sessions, keep to the therapist’s original formulation of the client’s difficulties, don’t consider alternative hypotheses, even when circumstances change. If necessary offer another 6 sessions’. The case below exemplifies this:
A few years ago Mr X suffered an episode of depression, his GP referred him to the Improving Access to Psychological Therapies (IAPT)Programme were he underwent a telephone assessment. On the basis of the completed psychometric test, he was assigned to a 6 week Group CBT programme with about 12 people attending each session. He found the sessions helpful, in that he then gave less emphasis to work and engaged in more excercise. However at a telephone follow up interview he relayed, that he had been involved in a terrible house fire, struggling to breathe when he escaped. Mr X was taken to Hospital and treated for smoke inhalation and minor burns. The therapist agreed that he should have a further 6 sessions but this time face to face. When I assessed him at the end of the individual CBT he was suffering a further episode of depression, had many of the symptoms of PTSD but not the intrusions, was phobic about the possibility of fire and suffering from binge eating disorder. However the sequelae of the fire was not addressed at all in the IAPT treatment, when he tried to make these concerns a focus, they were dismissed and the therapist insisted on recapping what had been discussed in the group. He and his wife commented that this seemed totally inappropriate. (Some details changed to protect confidentiality).
