| Notes |
It has led to a number of government-funded initiatives, known as the Increasing Access to Psychological Therapies (IAPT) programme, focused on therapeutic help for adults with common mental health problems (in particular mild to moderate depression and anxiety). The core therapeutic modality that is recommended within these programmes is cognitive behavioural therapy (CBT), while other modalities, such as interpersonal therapy, are also commended. A clear distinction is made between low-intensity treatment (four sessions) and high-intensity treatment. This initiative has already had an impact on NHS psychological therapy services within adult mental health services, injecting much needed extra finance and thus extra resources into a chronically under-funded service.
Although Layard’s focus is very much on CBT, and this is particularly true of the IAPT programmes, we stress that our critique is not meant to be an attack on CBT, which has much to commend it. What concerns us more is the way CBT, and therapy in general, is seen as a collection of techniques to be delivered by a band of specially trained therapists in order to get people off benefits and back to work. Whether or not one supports what some might see as an Orwellian idea, there is one major drawback – it won’t work. We explain why we think this below. One consequence is that, when the dust settles and it is realised that CBT is not the panacea it has been made out to be, there may well be a backlash against all psychological therapies. What started as a positive initiative for psychological treatments could end as reaction against them (especially if the cost savings underpinning the initiative fail to materialise as promised).
What concerns us with the Layard analysis is the way this complexity has been glossed over to arrive at general conclusions that seem superficially plausible but in reality are not. The attraction may be that at last the value of psychological therapy is recognised and serious money made available for it. But if the basis for this expansion is flawed, there will be trouble ahead. If the equations do not work, there may well be a backlash as the new breed of psychological therapists fails to deliver what it promises and the cost savings predicted by Layard do not materialise. The worry of the IAPT programmes is that people are being trained to work in one particular way (as CBT therapists) with the result that managers think this is the only way. Put crudely, the message is that most mental health problems will be ‘solved’ if we train enough therapists. This should be exposed for the nonsense it is. For a rigorous critique of the NICE guidelines and the way they have misrepresented both the complexity of clinical practice and large amounts of psychotherapy research evidence, see Mollon (2009). |