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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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
3 replies on “Talking Therapies Institutionalised Psychologising of Physical Health Problems”
Thank you for highlighting your misgivings – you have articulated something that many women experience (being dismissed and gaslighted into having their physical health issues interpreted as “all in the mind”). I would be curious to know how many of the clients you describe are female.
From the blog post :
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.
My response :
I am under the impression that IAPT is supposed to be a way of limiting the costs of healthcare, in preparation for the total privatisation of the NHS. Blame everything on mental health and you don’t need so many hospitals, surgeons, drugs (apart from anti-depressants).
I’m female and I struggle to get any healthcare at all. I suspect my medical records are littered with dozens of insults suggesting I am attention-seeking, lying, drug-seeking, a hypochondriac. When I bought my own GP records a few years ago I realised that some big chunks of my medical history are missing entirely. Operations that are recorded are shown as “laparoscopy” (or whatever) with no indication of the findings. I’ve had surgeries where the internal organs I have have been miscounted. I’ve had miscarriages that happened to someone else recorded against my name – but my doctor decided that I just didn’t know when I’d had a miscarriage because my GP records can never be wrong, can they? I’ve had internal organs removed (in real life) but not recorded in my medical records. But then… Hallelujah!… they’ve allegedly grown back! But not to worry. They’ve been removed again later. Then grown back again.
I have given up with doctors and the healthcare business. The only time I will willingly attempt to see a doctor is if I have a visible problem. Doctors are a profession in which most members have no compassion, in my experience.
If I have any mental health problems they are caused by the atrocious medical care that I’ve had throughout my life. Any pain I suffer from is assumed to be drug seeking. But it isn’t. I have always wanted to be diagnosed and fixed, not doped up to the eyeballs. I have always wanted to be healthy, not brain-dead due to drug effects.
Thanks for your honesty and integrity- this is something that I, as a person with ME/CFS (and, yes, a woman) have faced. The only treatments I’ve ever been offered are graded exercise (widely acknowledged to make the condition much worse) and psychological treatment. I can’t help feeling this represents the latest in a long line of blaming women for their health problems- from wandering wombs, through hysteria to somatisation disorder/ MUS.
I really appreciate you speaking your mind like this- thank you