Skip to the content
CBT Watch
CBT Watch: An Independent Mental Health Watchdog & Discussion Forum
  • Home
  • About
  • Forum
  • Contact
  • Topics
  • Home
  • About
  • Forum
  • Contact
  • Topics
  • Twitter

Tag: Transdiagnostic

Categories
BABCP Response - NICE Consultation January 2022

Focus On The Chief Psychological Complaint And Miss The Boat

  • Post author By admin
  • Post date 19th May 2020
  • No Comments on Focus On The Chief Psychological Complaint And Miss The Boat

 

Post-traumatic stress disorder (PTSD) is an example of this – only a fifth of those with PTSD present with it as their principal problem, according to a just published paper by Kiefer et al (2020)  in The Journal of Nervous and Mental Disorders. Most commonly PTSD sufferers present with depression, bipolar disorder or borderline personality disorder as the principal diagnoses. These are so likely to absorb a clinicians attention that the PTSD does not get a look in. But it is likely to be one of the elephants in the room that sabotages therapeutic efforts. If working in IAPT the hapless clinician, post the lockdown, is likely to be hauled over the coals for not reaching recovery and/or feels incompetent.  The seeds of the problem is that IAPT clinicians are not trained to make reliable diagnoses. But unreliable diagnosis is not confined to IAPT, it is the norm, bolstered by the dominance of an unthinking anti-psychiatry stance amongst psychological therapists. The banner of ‘Formulation Rules’ is unfurled and brandished but without any evidence that it makes a real world difference to client’s lives. 

Whilst the starting point for all psychological therapies is the client’s chief complaint, in it’s distilling there is no limit to the range of information considered pertinent (no control for information variance), nor of the operational criteria for deciding whether a particular problem is simply a normal reaction to an abnormal situation or something more (no control for criterion variance). Appeal can be made to a clinician’s formulation, but there are likely as many formulations as clinicians. By default the formulation of the local powerholder, whether it be the supervisor, manager or clinician will likely hold sway. The client will rarely have the wherewithal to articulate their definition of the situation and certainly not to make it stick.

Consider a person referred with ?chronic fatigue syndrome, the psychological therapist will certainly find evidence to support this because a) they will rarely be aware of differing criteria for CFS and b) they will find a symptom to support the diagnosis such as fatigue. Here we have the operation of a confirmation bias seeking only information that supports the original hypothesis. Without considering what body of evidence would be needed to refute hypothesis e.g diagnostic entities such as depression that have some symptom overlap with disorders such as CFS and/or an as yet undiscovered entity that might explain the fatigue e.g the development of multiple sclerosis.

Communications to sources of referral are written in the form ‘it was agreed that course x would be best’ but as the client does not understand how course x, differs from courses y and z, much less why one course would be better than another in their circumstances, it is doublespeak for the Agency doing what it wants.

Having elicited what appears to be the chief complaint, almost anything can be deemed appropriate. Today I read a book [ The Well Gardened  Mind by Sue Stuart-Smith a psychiatrist] review on horticultural therapy, in which the reviewer asked  why such a therapy is not a standard treatment for anxiety and depression? Such an approach was regarded as an enlightened response to the plight of  ‘shell shocked’ soldiers returning from the First World War. The short answer to the question is that there is no evidence it returns people to their former selves i.e that it makes for recovery, as opposed to makes them feel better for a time.

How did we reach the point were de facto we have therapy without any boundaries? In my view it is a product of jettisoning the very notion of diagnosis and treatment. There is almost universal support amongst psychological therapists for an anti-psychiatrist stance see ‘Drop The Diagnosis! ‘ by Jo Watson (2019) and Dalgleish’s call http://dx.doi.org/10.1037/ccp0000482 for a hard trans diagnostic approach  and it is used to justify popular offerings such as Solution Focussed Therapy. But we are short of any independent evidence that the talking therapies without reliable diagnosis make a real world difference.

Dr Mike Scott

Like Loading...
  • Tags #iapt, chief mental health complaint, chronic fatigue syndrome, confirmation bias, PTSD, reliable diagnosis, The Well Gardened Mind, Transdiagnostic

Categories
BABCP Response - NICE Consultation January 2022

Talking Therapies – ‘What Works For Whom?’

  • Post author By admin
  • Post date 15th April 2020
  • No Comments on Talking Therapies – ‘What Works For Whom?’

this is the title of a book by Roth and Fonagy (2005) published by Guilford Press. The authors answer this question with a focus on disorders. Their conclusions inform the NICE Guidelines.

 
 
 
 
 

By contrast the contributors to ‘Drop the Disorder!’ edited by Jo Watson (2019) recommend jettisoning disorder in favour of formulation. However there has been no determination of ‘what works for whom?’  where the focus is formulation. Indeed it is impossible to do this as formulations are inherently unique/idiosyncratic theories about an individual. It is an attempt to personalise treatment without first acknowledging that the person is likely a member of some category or categories. Ironically it is personalised medicine without first getting into the right ball-park.  For the past decade the IAPT (Improving Access to Psychological Treatments) service has been an undercover exemplar of this, paying lip service to the NICE Guidelines. If IAPT had truly done ‘what it says on the tin’, it would have ‘improved’ upon on Roth and Fonagy’s work. But it has signally failed to make any contribution to the question they raised. . 

Dalgleish et al (2020) in their just published paper a Transdiagnostic. Approach to Mental Health Problems http://dx.doi.org/10.1037/ccp0000482 advocate a ‘hard transdiagnostic’ approach, similarly wishing to totally jettison the diagnostic nomenclature of DSM-5. But this hard trans diagnostic approach is so bewildering in its’ complexity, it would serve only to totally muddle practitioners. There is no evidence that trans diagnostic approaches add value. To date studies have only been conducted by the developers of the trans diagnostic approaches, leading to likely allegiance bias.  There are no effectiveness studies in real world settings with independent evaluators.

Dr Mike Scott

Like Loading...
  • Tags #iapt, "Drop the Disorder!', Dalgleish, Transdiagnostic, what works for whom

Categories
BABCP Response - NICE Consultation January 2022

The Gagging of Clients as Storytellers

  • Post author By admin
  • Post date 11th August 2019
  • 1 Comment on The Gagging of Clients as Storytellers

‘don’t listen to the story treat the symptom’ that is the advise to be given to IAPT’s PWP’s attending a 3 hour workshop on November 28th 2019 on groupwork. It reflects similar advise given to IAPT clients attending a 6 week course on ‘Understanding PTSD’ in which clients are instructed not to talk about their trauma rather to reflect on what they have found helpful so far. This gagging of IAPT clients is consistant with the Organisation’s 30 minute telephone assessment. But it is inconsistant with the need to help client’s overcome cognitive avoidance e.g in PTSD avoiding talking about their trauma.

In Simply Effective Cognitive Behaviour Therapy, Routledge (2009)

I suggested that clients need treatment simultanously for all the disorders from which they are suffering. This is to look at the totality of the clients story, not to elevate one part of it (e.g the disorder that is most impairing) and just treat that. Interestingly Barlow et al 2017 see link below compared focussing just on the main disorder from which a person was suffering (from amongst panic disorder, GAD, social anxiety disorder and GAD, even though most people had more than one disorder) with a protocol that could be adapted for any of these disorders ( termed a Unified Protocol) and retention of clients was better with the latter. This suggests that addressing the whole story is best as well as being more respectful.

Care has to be taken however with Barlow’s transdiagnostic approach, in that the term denotes just those suffering from an anxiety disorder excluding PTSD. Over half of clients had a degree. All treatments were developed by Barlow and his colleagues, there has been no independent replication. Treatment was individual, no evidence that it works in groups. The treating clinicians were highly qualified/trained and did both treatments, as the UP was the new kid in the block and their ‘kid brother’ that may explain the slightly better results with UP.

Barlow et al (2017) https://www.dropbox.com/s/22qz932flxroas3/The%20Unified%20Protocol%20for%20Transdiagnostic%20Treatment%20of%20Emotional%20Disorders%20Compared%20With%20Diagnosis-Specific%20Protocols%20for%20Anxiety%20Disorders.html?dl=0

Dr Mike Scott

Like Loading...
  • Tags #iapt, Gagging clients, group CBT, Simply Effective CBT, Transdiagnostic, Unified Protocol
  • Twitter
  • Twitter

Subscribe to CBT Watch

Enter your email address here to be notified when new posts are published. Your email address will not be used for any other reason.

Recent Posts

  • NHS Talking Therapies – Wasting Access to Psychological Therapy
  • In NHS Talking Therapies We Doubt
  • NHS Talking Therapies – Doublethink Without Informed Consent
  • The Gagging of NHS Talking Therapy Clients
  • Why Is NHS Talking Therapy The Only Unregulated NHS Service?

Categories

  • Abuse of Power
  • BABCP Response – NICE Consultation January 2022
  • Current Psychological Therapy Issues
  • Group CBT
  • IAPT
  • Resources
  • Safe Space for CBT Therapists
  • Wounded Healer

Recent Comments

  • admin on NHS Talking Therapies – Wasting Access to Psychological Therapy
  • Topher on NHS Talking Therapies – Wasting Access to Psychological Therapy
  • Homepage on The Scientist Practitioner Delusion?
  • URL on The Department of Health Has Failed To Regulate Routine Mental Health Services
  • URL on A Psychological Wellbeing Practitioner’s Damning Indictment of Her Role

Archives

  • March 2023
  • February 2023
  • January 2023
  • December 2022
  • November 2022
  • October 2022
  • September 2022
  • August 2022
  • July 2022
  • June 2022
  • May 2022
  • April 2022
  • March 2022
  • February 2022
  • January 2022
  • December 2021
  • November 2021
  • October 2021
  • September 2021
  • August 2021
  • July 2021
  • June 2021
  • May 2021
  • April 2021
  • March 2021
  • February 2021
  • January 2021
  • December 2020
  • November 2020
  • October 2020
  • September 2020
  • August 2020
  • July 2020
  • June 2020
  • May 2020
  • April 2020
  • March 2020
  • February 2020
  • January 2020
  • December 2019
  • November 2019
  • October 2019
  • September 2019
  • August 2019
  • July 2019
  • June 2019
  • May 2019
  • April 2019
  • March 2019
  • February 2019
  • January 2019
  • December 2018
  • November 2018
  • October 2018
  • September 2018
  • August 2018
  • July 2018
  • June 2018
  • May 2018
  • April 2018
  • March 2018
  • February 2018
  • January 2018
  • December 2017
  • November 2017
  • October 2017
  • September 2017
  • August 2017
  • July 2017
  • June 2017
  • May 2017

Meta

  • Log in
  • Entries feed
  • Comments feed
  • WordPress.org

RSS CBT News & Research

© 2023 CBT Watch

Powered by WordPress

To the top ↑ Up ↑
 

Loading Comments...
 

    %d bloggers like this: