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Counsellors in IAPT
Improving Access to Psychological Therapies (IAPT) services provide a range of evidence-based, NICE recommended therapies alongside Cognitive Behavioural Therapy (CBT) to ensure service users can benefit from a range of treatment options suited to their needs. In the first of a series of blogs from members of the IAPT workforce, Sarah Aldridge tells us about her experience of working as a counsellor:
I have been working as a counsellor in Ealing IAPT service since June 2016 but my career as a counsellor began in 2010.
Before joining the Ealing IAPT team I worked with complex clients within a home visiting psychotherapy service, which was highly rewarding but I missed the relational aspects of the role. I took up a part-time role in Ealing IAPT service as the idea of working in a structured service in a therapeutic capacity was attractive.
To secure such a role, counsellors usually require NHS primary care experience, some clinical practice in short-term work and must be accredited by the British Association for Counselling and Psychotherapy (BACP) or registered with United Kingdom Council for Psychotherapy (UKCP).
IAPT counsellors are also known as high intensity therapists and we work at step three of the mental health stepped care model.
The stepped care model is a system that provides the least intrusive and most appropriate level of care to meet the needs of the person; only ‘stepping up’ to more specialist treatments as clinically required. At each step within the pathway IAPT services deliver National Institute for Health and Care Excellence (NICE) recommended, evidence based therapies to people with depression or anxiety disorders.
Since joining IAPT, I have completed additional training and I am now qualified to deliver different types of therapy to my clients including Dynamic Interpersonal Therapy (DIT) and Couple Therapy for Depression (CTfD).
Couple therapy for depression is helpful where there is relationship distress and depression in one or both partners. DIT is a type of therapy delivered over 16 sessions and it is particularly helpful for people with relationship problems, especially when it is linked to attachment difficulties.
One patient found DIT highly beneficial as she was better able to understand her family relationships, saying: “I was pretty desperate and needed external help outside of friends and family as I was depressed; anxiety and panic were a daily part of my life. Meeting week on week proved to be very helpful to enable me to unpack some deep hurts, pains and unhelpful beliefs that I had about myself. As the weeks went on I was able to see things for what they really were and not always what I thought about those around me and myself. I have more energy and have a positive outlook on my personal life, work and most of all, myself.”
High intensity therapists can also train in other interventions, including interpersonal psychotherapy for depression (IPT) and counselling for depression, so there is a lot of scope to diversify your skillset and gain the appropriate qualifications.
I didn’t know how my career might develop when I joined IAPT but thanks to the training opportunities available to me, my experience has exceeded my expectations. Recently, I was promoted to senior counsellor, which means I now provide supervision and have managerial responsibilities.
Not only have I had the chance to develop my career but I also get to work with a variety of clients. It is interesting working with people of different ages and from a range of nationalities and backgrounds although the nature of the work can sometimes be challenging, as we juggle large caseloads with steep targets.
It is fast-paced and I often find myself moving between a couple to an individual, from one type of therapy to the next, and from a more reflective piece of work to then providing a client with more immediate support. However, being able to see positive changes in clients and helping them gain insight and understanding about their psychological wellbeing is a privilege.
Being a counsellor within an IAPT service is really valuable. We work alongside Psychological Wellbeing Practitioners (PWPs) and CBT therapists and thanks to our diverse experience, we can share our different perspectives on approaches to treatment.
Counselling is an important offering in IAPT and I hope it remains a key part of the IAPT provision for many more years to come.
- The NHS Long Term Plan commits to expanding access to IAPT services for adults and older people with common mental health problems. By 2023-24, an additional 380,000 adults and older adults will be able to access NICE-approved IAPT services.
- Find out more about working in IAPT, especially the role of a high intensity therapist.
I have a friend who’s father was murdered recently. She was very close to her father after her mother divorced him. Apparently when he was murdered the police said that they would arranged counselling but on her fathers side only and nothing for her. She is at university but not coping at all, I directed her to IAPT but all they did was take her name and said some one would contact her but she is still waiting and she is at a loss and really low and I feel that she is going down a spiral with thought that are suicidal. I am really worried and not sure where to re direct her too hence why I am trying to find out where I can get further help for her.
How many clinical contacts per day are IAPT counsellors expected to achieve? What is the national average number of counselling 1-2-1 clinical contacts in IAPT services and what is the amount of supervision provided. Please respond ASAP if you can. If you cannot help with this information can you please direct me to someone who can? Thank you I look forward to your comments
Hi Sandra, regarding clinical contact hours, the IAPT manual advises that for high-intensity therapists it is generally considered that achieving 20 face-to-face clinical hours per week is appropriate for a full-time, fully trained individual, with pro-rata reductions for part-time workers, trainees and those with supervision or management responsibilities.
Regarding the number of sessions provided, according to the IAPT manual, services are commissioned to provide the right dose of treatment according to NICE guidelines and must not cap the number of sessions to less than NICE guidelines recommend. Evidence-based treatments should be given at the minimum dose that is necessary to achieve full and sustained recovery.
The IAPT manual also emphasises the importance of staff wellbeing. It states “Staff wellbeing is paramount. Creating a resilient, thriving workforce is essential to delivering high-quality mental health care as staff wellbeing correlates to better outcomes for patients. A highly challenging professional context should be matched with high levels of support. Productivity aspirations should be based on workloads that are consistent with professional and ethical guidelines for sustainable quality of care.
As good practice, providers should implement local strategies to improve and sustain staff wellbeing. It is recommended that services have a written plan for supporting staff wellbeing, which is shared with staff and updated on a regular basis.
So why do some IAPT services demand that their Counsellors undertake 6 clinical contacts per day in breach of the IAPT manual? Surely a workload at this level is unprofessional, unethical and unsustainable in terms of staff wellbeing, let alone the impact that this will inevitably have on the quality of care that can be given to clients?
Hi, I was delighted to discover this guidance and raised it with our IAPT service. I was told that as we see clients for 50 minutes, five per day equates to four client hours a day or twenty a week for a full-time clinician. I don’t think this is what is meant by the guidance and therefore I think in the next manual update it would be helpful if it were to be clarified exactly what ’20 face to face clinical hours’ means so there can be no ambiguity.
I am a PhD student at KCL and would like to know more about IAPT for my study, can I please email you?
Hi Sameera, please email email@example.com and your details will be passed on to Sarah.
What an insightful and informative article.