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Clients Cast Adrift By Individualised Treatment Without An Anchor

Psychological therapists in the UK and beyond almost universally believe that they are equipped to personalise treatment and jealously guard their autonomy. Services feed the quest for autonomy by taking no steps to ensure clinicians make reliable diagnosis. This, despite the fact that the NICE approved psychological treatments are almost all diagnosis specific. As therapists are promoted the system perpetuates itself.

Not too long ago it was believed that physical and mental disorders arose from an imbalance of the four humours – blood, yellow bile, black bile and phlegm. A person with disordered blood would obviously improve with bloodletting. Years of experience of people recovering after thoughtful personalised bloodletting were confirmation of efficacy.

 

Evidence based psychological treatment (EBT) still requires a clinical judgment as to whether a particular person could be matched to the population of a particular randomized controlled trial. But EBT’s prevent the unbridled use of clinical judgement .

Moving towards reliable assessment will need nothing short of a revolution because it runs counter to the current expert consensus. This consensus does not accept that current provision simply does not work, a 9.2% recovery rate, when assessed independently Scott (2018) https://www.dropbox.com/s/flvxtq2jyhmn6i1/IAPT%20The%20Need%20for%20Radical%20Reform.pdf?dl=0 and calls for replication studies have fallen on deaf ears amongst the power holders and the media [ Marks (2018) https://www.dropbox.com/s/uw47oh03k9uvpo0/Marks%20IAPT.pdf?dl=0 There is an understandable concern about an increased cost of assessment but this will be offset by a treatment that might actually work. There is a massive vested interest in the status quo that extends to courses and politicians. The latter want to be seen to be on the side of mental health, happy to be seen opening mental health facilities or advocating more mental health personnel in schools but they run shy of considering independent assessment of outcome, it is of no short term political advantage. Politicians have let the National Audit Office get away with not publishing the results of its investigation into Improving Access to Psychological Therapies  ( IAPT) .

Scott, M.J (2018) IAPT – The Need for Radical Reform, Journal of Health Psychology, 23, 1136-1147.

Marks, D.F (2018) IAPT Under the Microscope, Journal of Health Psychology, 23, 1131-1135.

 

Dr Mike Scott

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