Can i ask your experience of IAPT please?

[StripeyChina]

I am someone who has just started training in this field.
I have some concerns and wondered if anyone has been receiving any therapy via the IAPT system please?

I had CBT with them and was referred after 4 sessions as I needed far more help than they could offer. I have no end of respect for the therapists, as mine was hopelessly out of his depth but he tried, he really did and for what it's worth, he was there, even when all he could do was sit on the toilet floor and hold my hand under the door; I wouldn't have coped without him at that point.

I've not received treatment via IAPT but I have seen the data on its efficacy...so I have concerns too.

It seems pretty bad that almost all patients are treated the same regardless of cause or severity, even when it is proven that an unsuccessful round of treatment decreases the probability of success at a higher intervention level.

Better triaging seems essential.

Thanks for replying.
My service (contracted out from NHS) puts huge pressure on staff to hit a 50% 'recovery' rate. But that is the same as 'watchful waiting'??
I think the concept is great - offering MH support to as many folk as possible free at point of demand. CBT can be very helpful but that is what is pushed, VERY heavily, and it is not for everyone.
Maybe it's just my service but I find its all about getting the next contract and hitting targets. Clients are not advised of (long) waiting lists between triage and treatment, and those at PWP level are not well trained. We are told to call service users 'patients' and we record them as having either 'major depressive episode' or 'generalised anxiety disorder' then are encouraged to stick them on an online 'package' which is basically self help. If they dont 'recover' the general attitude seems to be that they are 'not therapy ready'.
Maybe i've been unlucky with my placement but it dosent sit well with me.

Utterly awful.

I had to phone a number I was sent in a letter, where I spoke with a woman who went through a tick-box form, asking me questions that weren't always relevant and offering a series of answers, most of which didn't apply to me and there was no option of supply my own answer, I had to respond with one of their accepted answers. At the end of this farce, I was told 'ah yes, you are suitable for CBT.' I thought this was bollocks at the time, because I didn't think that was what I needed, but I went along with it because what do I know? I'm not a psychotherapist. (By the time I actually went along, I was optimistic about it helping.)

I was heavily sold group therapy, despite my repeated explanation of why it wasn't for me. I refused it and said I would go back to my GP and explore other avenues as there was nfw I was discussing my issues in front of total strangers who had no obligation for confidentiality.

At this, I was offered some appointments, one to one, with a trainee who was very nice but came across as being rather dim. Some people are people people, some are incredibly academic but unable to really connect with others and have been trained within an inch of their life to follow the party line - she was the latter.

The sessions were a total waste of time and money and according to the information I was later shown, actually made me more depressed! They didn't help me and I felt like a total failure, and I would get so anxious before going and I would have flashbacks of experiences in the past, where I would be dreading going somewhere. It was awful.

In the last session I filled in a form and was pressured into adding a bit on the end about how my increased anxiety and depression wasn't my therapist's fault.

The word I would use to describe my treatment is 'damaging.'

I have had my ADs increased in dosage twice since then. I wasn't listened to, I was treated as a number and a statistic, and I regret ever seeking help. I'm under the impression that if you can't get better within their timeframe, you can fuck off. I don't think a dr would stop your ABs because an infection hadn't fully cleared up, you'd be given another week's worth or put on a different AB. No one would say 'ah, yes, your three chemo sessions haven't completely cured your cancer, so rather than explore the possibility that you need more doses because your tumours are more troublesome than the average, we'll just let you die because you haven't conformed to our treatment plan.'

I never usually post but wanted to add my experiences - been referred to IAPT three times in last 5yrs-ish and offered CBT each time (tbh there seems to be little evidence they actually offer anything else) both short and more intensive courses, all equally useless. Been discharged early each time because I 'wasn't ready to make changes'. Told to get in touch with charities/private counselling instead.
My life is ridiculously small and pathetic because of my MH - I feel like I've been begging for help for nearly 8yrs, and the only help there is is yet more CBT - after going round and round in circles of assessments and waiting lists of months/years.
I feel like such a failure - I even fail at the thing that's meant to stop me feeling like a failure.

It was pretty feeble in all honesty. I was suffering from a major depressive episode and was suicidal, yet was referred for a 6 week course of group CBT entitled 'stress control'. It felt like very one who had a MH assessment had to do this course before being allowed to access any other forms of therapy, no matter how ill you were, such a waste of money and time. Eventually I got a proper referral to CMHT and I had a course of DBT which took about 18 months, which was excellent.

Thank you SO much for sharing this.
As I say, the concept is great, the reality seems less so. I was worried about it potentially harming some people.
We are told to push the computerised 'treatment' as it is cheapest.
Then 'group therapy' (12 people 'treated' by 2 therapists in 6 hours).
Then 1:1 (telephone) but you can wait 5 months for this.
Lastly F2F (and you can wait much longer for this).
We are not allowed to say how long the wait will be. Not even 'a few weeks'. That seems wrong to me - doesn't empower the client.
I also feel that falsely holding out hope (re waiting times) / offering the wrong treatment or at the wrong level could potentially stop a person seeking other help / help in the future. The basic level that everyone is Triaged at is mostly Risk Management Qu's and it is: 'on a scale of 1-10 how suicidal do you feel' over and over. You are allocated less than 5 mins to get a persons 'history/life story'. Then people are mostly pushed towards Step 2 (the basic entry level CBT). It feels like a call centre and I feel like I'm selling bad mortgage products / phone deals. I've not been treated very well by my employer so i was trying to work out if it was sour grapes on my part or if I was right to have doubts about the whole concept.
I think that offering a supportive therapeutic relationship can be so important for a person's mental well-being. Even if the therapist isn't especially skilled or experienced (staff turnover is high) it is still possibly better than nothing. But it seems like it doesn't always work from the clients end too :(

I've had treatment twice with IAPT. First I had telephone counselling about 5 years ago. The therapist was nice, but it was totally unhelpful. I wasn't able/ready to disclose what was really going on in my head, so we ended up trying to tackle OCD with phone counselling for generalised anxiety. I'm also far too distractible for telephone based therapy!

Then a couple of years later I read some articles about OCD online and finally realised what was wrong with me. My GP referred me for an assessment with the CMHT, and the CPN advised me to refer myself to IAPT for level 3 CBT (she told me which providers in the area could deliver that).

So I had a long course of face to face CBT which included some ERP techniques and this time it was honestly life changing. My symptoms were so massively improved. I built up an excellent relationship with my therapist, I really felt she understood me and I trusted her. I left my 'final' session with real hope for the future, and it's had a lasting impact I think it was a combination of the right therapist, longer time frame and ERP techniques which made the difference.

anon and fromage

Please don't assume all CBT is equal. It honestly isn't. I saw three therapists and got no further than 'nip negative thoughts in the bud' and 'make me time'.

Then I got hooked up with someone with some mad skills who got me back on my feet and back to work within a month.

I now have survivors guilt because the last guy was private and cost 1000 pounds for the full course. It was easily the best value for money I ever spent - it gave me my life back, but I know not everyone has that kind of cash to throw at their health.

So my message is please don't give up because you've encountered some under skilled therapists. It isn't you, its them and their lack of training (and resource in the case of IAPT) to formulate a treatment plan that is matched to your needs.

If you can't afford to go private, then please keep trying - you may get lucky, the guy who treated me also works NHS one day a week.

The thing is, CBT is not a cure-all. It was totally unsuitable for me. I believe it's a great therapy for some issues, but it was totally irrelevant to mine. They might as well have given me anti biotics or physiotherapy for all the good it was ever going to do. I dealt with 2 trainees who were lovely but in the wrong job, all because of an underfunded system.

I have since seen a different type of therapist who was wonderful and helped undo some of the harm IAPT did.

Frankly, going private is the only way I can ever imagine getting any better.

It’s not you, OP I think it’s the system. From what I remember CBT was chosen because it was cheap and effective ish. Problem is it isn’tthe most effective treatment for a lot of people and therapists seem to be trained on just delivering CBT. Where I am it seems to be being used as a gateway to accessing CMHT.

My last flare up was ridiculous. The therapist who did the phone consultations was quite upfront about the fact that I was so ill they probably weren’t going to be able to help me. But you still have to go through the 6 weeks of phone consultations, the wait for F2F, the initial F2F sessions and the extra sessions before I got referred to CMHT. By the time I’d got to the end of that waiting list I was pretty much better.

The system before IAPT was far from perfect though. Getting seen by CMHT wasn’t really an issue. The waiting lists for therapy with them could be measured in years.

from no , it certainly isn't. I apologise, I should have read your post more carefully. Was it a PTSD related treatment that helped you in the end?

I was so lucky in that the person I ended up with could also treat the elements of post traumatic depression I had, without which pure CBT was unlikely to be more than a stopgap. I think this is entirely the problem with IAPT. It doesn't make any effort to actual diagnose the specifics...just enters everyone on a treadmill and if people give up then....well that just helps with the waiting lists right?

Its actually tragic.

I've worked in IAPT for a number of years in a couple of different services and it does make a difference where you work.
OP get to know your service policies like the back of your hand plus DSM criteria and NICE guidance. Back up all your clinical decision making with policies and remember patient choice should trump all stepped care models.
We are supposed to offer pwp support as first line interventions unless we have a clear rational to suggest an alternative.
Your service should also offer counselling & IPT right?

Hi Jennylou88
Yes, I know my DSM and NICE (essential, agreed).
It's service policies I worry about.
Patient choice is not really a consideration.
Patients spoken about disrespectfully and data breaches all over.
Counselling is barely offered (and a years wait.) IPT not offered.
Early on, I had an historic abuse disclosure. I was told to use a specific format to record. Only it took 3 emails to 3 different managers and 2 weeks for me to be 'enrolled' on the system that allowed me to do that. In previous settings, it has been crystal clear what the policy is.
Thank goodness it wasn't a complex current abuse / CP issue. I know a trainee who was left 'on her own' with that which seems wrong to me. I know staff who do 12 hour shifts. Staff who are still 'catching up' on their laptops at 11pm. I wonder if it is because it is contracted out and therefore corners are being cut to chase the new contract or if it is like this in NHS provision (and is there much of that or is it mostly contracted out?). Sorry, 20 Qu's!
Also, there appears to be so much time and effort spent on staff covering their backs compared to actual client input. I think the setting is wrong certainly (for me anyway) but I am wondering about the whole system before I try elsewhere.
Have you worked somewhere where you think IAPT 'works'?
i know it's a growing sector so a career in this makes sense so
I guess I am keen to hear good news about it before I give up?!

I'm glad to read its n0t just me. Been trying to reach out for help for about a year. Lucky in the sense am now on third counselling, but it's only really a sticking plaster. The first one was through EAP, and she had endless homework for me I couldn't keep up, then got frustrated and about half way through finally asked what I wanted to talk about, then decided she wanted to delve into my past for the rest of it. The second was online counselling. I actually found that incredibly helpful initially. Sessions are quick (30m) and it's not emotionally draining like cbt. She sussed out what I needed and got me to do an activities sheet. The only thing was that it worked so well in week one that I got over confident and let things slip, then I couldn't get it back and the therapist got increasingly frustrated with me. I grew to resent the lack of human contact. So good if you can stick with it and make progress. The current one is via my Dr and she has some boundary issues as she keeps telling me what to do, but she is by far the nicest warmest therapist I have seen.

Hi there,

I hope you don't mind me contacting you. I was wondering if you would be willing to share a bit more about your experience of IAPT. I am doing some research into this from the point of view of a professional and user. Many thanks,

Good evening lovely people,
I am keen to better understand the still under-researched area of early dropout from Cognitive Behavioural Therapy (CBT) within the IAPT services. This study aims to build a model of predictors that will be able to help IAPT understand when their clients are about to disengage. Understanding what makes people leave therapy before completing all of their sessions could lead to positive changes in this service and the way clients are treated.
To take part, participants have to be former IAPT clients who have undergone CBT in the last 24 months months ago and who have not completed a course of therapy.
Make your voice heard: ntupsychology.eu.qualtrics.com/jfe/form/SV_5jsPNWMZxdFVHee

Horrendous, really.

I have a working diagnosis from my GP, who isn't actually qualified to diagnose, of cPTSD arising from childhood trauma and, basically, a lifetime of abuse.

I was overwhelmed by flashbacks when I first contacted IAPT in November 2017. The woman who did my telephone assessment did not seem to understand what I was saying at all. At one point, she actually said "So you keep thinking about things that happened a long time ago." No, I was having constant, disabling flashbacks. By the end of that phone call I was dissociating and continued to do so for about three months, which was something I had not done for a long, long time.

They gave me the names of two organisations to contact. One would not work with me because I was employed, which IAPT knew. The other assessed me in January 2018 and then finally offered me a counselling appointment in May 2018. It was clear to me that the counsellor again did not understand what I was talking about. I was told they would contact me with another appointment, but they did not.

Disillusioned, and considerably more fragile than before, I gave up for a while.

I finally spoke to my GP in October 2019. She referred me to IAPT and this time I was assessed over the phone by someone who did understand. She said I needed a specific form of counselling and referred me to a local charity. They assessed me in November 2019 and put me on their waiting list. The night after that assessment, I had the best nights sleep I had had in over four years.

Unfortunately, before I got to the top of the waiting list, the pandemic hit and all counselling for new clients ceased. I have chased regularly, but they operate from a hospital that has never come out of lockdown and cannot say when they may be able to start again.

All my GP can offer is anti-depressants, although assessment says I am not depressed. There is nothing else available on the NHS in this area and, as I have now lost my job, partly because of my poor mental state, I cannot afford to go private.

I've just done the silver cloud course though these and it is a load of rubbish
I recieved a message once a week not actual support I ended up paying to see a private therapist which has been amazing luckily inwas in a position to pay because if it was left to that course I wouldnt be as far as I am now
It's a waste of money to be told to watch a video
It's sad really I know covid has a lot to answer for but this could be done so differently