A Pragmatic Guide to Low Intensity Psychological Therapy
Care in High Volume
- 1st Edition - May 17, 2023
- Imprint: Academic Press
- Authors: Elizabeth Ruth, James Spiers
- Language: English
- Paperback ISBN:9 7 8 - 0 - 3 2 3 - 8 8 4 9 2 - 1
- eBook ISBN:9 7 8 - 0 - 3 2 3 - 9 0 4 5 1 - 3
With the rapidly growing demand for mental health care there is a need for efficient and effective psychological treatment options. Low Intensity Psychological Therapy has be… Read more
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Request a sales quoteWith the rapidly growing demand for mental health care there is a need for efficient and effective psychological treatment options. Low Intensity Psychological Therapy has become well established in the England Improving Access to Psychological Therapies (IAPT) programme as a beneficial and versatile treatment option for mild-moderate symptoms of depression and anxiety. A Pragmatic Guide to Low Intensity Psychological Therapy: Care in High Volume, provides a guide to Low Intensity Psychological Therapy from the perspective of the Low Intensity Practitioner. This book describes the Low Intensity role as part of a multi-disciplinary approach to psychological care. The authors use a series of case vignettes, personal experience and current literature to help navigate the context of the role and its potential for ethical and safe expansion.
- Offers a practitioner perspective on the efficacy research of Low Intensity psychological interventions in adult populations, with a focus on working with diversity
- Aims to support Low Intensity Practitioners in developing competency within the role, with a focus on reflective practice, supervision, and personal wellbeing
- Includes case vignettes and examples to explore the real world implementation of Low Intensity interventions in group and individual settings including the management of long term physical health conditions
- Explores the benefits and pitfalls of the current role of the Low Intensity psychological practitioner within the IAPT programme
- Discusses the expansion of the Low Intensity psychological practice to international regions
IAPT trainee, Clinical Psychologist, CBT trainees, Supervisors
- Cover image
- Title page
- Table of Contents
- Copyright
- Dedication
- Foreword
- Acknowledgements
- Introduction
- References
- Chapter 1: Low-intensity psychological interventions
- Abstract
- Who are you?
- ‘Low intensity’ defined
- Something new
- A bigger picture
- Who are we, and where did we come from?
- Barefoot therapy
- Evolution
- The land before IAPT
- No help
- PHASING
- Self-help
- Bibliotherapy
- Guided self-help
- Self-help resources
- Low-intensity group work
- Graduate Mental Health Workers
- High volume
- NICE
- Stepped care
- Options
- Base or apex
- Who does what?
- Bringing it all together
- Evidence, economics, and serendipity
- Training and competencies
- IAPT into action
- Give me the right lever
- What’s in a name?
- Informed consent
- Professional terms
- Outcome measures
- High volume and low intensity
- Outcomes vs experience
- Predictable problems
- Stability
- Really high volume, really not low intensity
- Low-intensity supervision
- Social context
- Expand or exchange?
- Psychological safety
- Gaps in guidelines
- What now?
- References
- Further reading
- Chapter 2: Defining success
- Abstract
- Key aims for this chapter
- IAPT: Debating success
- The business of wellbeing
- Wrong doors
- Right doors
- Locked doors
- Revolving doors
- The journey to IAPT: Kasia’s story
- Urban myths: A panacea
- Progressive stepped care
- Stratified stepped care
- Challenges with progressive stepped care in IAPT
- Stepped care: My [un] successful experience
- Evidence for progressive care in IAPT
- Defining success: Low-intensity intervention
- Defining success: Routine outcome measurement
- Psychoeducational groups
- Individual guided self-help
- Re-humanising systems
- References
- Chapter 3: Training and competency
- Abstract
- Simple and agile
- What makes us different?
- Medication management
- What is in an ‘intervention’?
- Self-help material
- Not everybody reads…
- Where book and relationship meet
- Stay in your shipping lane
- A unifying model
- Step-by-step
- On teaching new practitioners
- Training cultures
- Manualised training
- Principles to practice
- Celebrating grace
- Assessing competence
- SPSR
- Single-strand versus multi-strand
- Two options for multi-strand work
- Implications for ethical implementation
- Complexity and burnout
- Differences between high-intensity CBT and low-intensity interventions
- What is our model and method?
- Training a profession
- Can training help with burnout?
- Some solutions are worse than the cure
- Don’t be common
- Types of practitioner
- Research to practice
- Exclusion
- Manualisation as the first step towards integration
- Problems with ‘free-for-all’ practice
- Assessment
- The reflective practitioner in action
- An effective course of low-intensity treatment
- Reflective space
- References
- Further reading
- Chapter 4: Working with challenging social contexts
- Abstract
- Key aims of this chapter
- Between a clinical rock and a socially hard place
- Assessment challenges in low-income areas
- Social neglect
- Social disorder
- Problems with suitability
- Anger and low-intensity intervention
- Anger and IAPT
- Suitability: People vs systems
- Case study: Tom
- Power and prognosis
- Assessment phase: Tom
- Second assessment session (treatment session one)
- Complicated maintaining factors: Barriers to change
- Dissociated systems
- Motivation for change
- The human story of anger and shame
- Difficulty containing disclosure
- Reflecting on Tom’s case
- Adaptations and flexibility
- Core conditions
- Problems in supervision
- Informed care
- Neglecting and dismissing our own needs as clinicians
- Reflective exercise
- References
- Chapter 5: The role of low-intensity psychological interventions in physical healthcare
- Abstract
- In this chapter
- Part 1: Defining terms and background information
- Part 2: Identifying themes in this area of work
- Part 3: Implementation
- References
- Chapter 6: Working inclusively with gender and sexual diversity
- Abstract
- Being queer
- Reflective learning task
- Construction and deconstruction of LGBT identities in psychotherapy
- ‘Conversion’ therapy
- Age as a factor in LGBT experiences
- Social relationships: Power and intersectionality
- Minority stress modelling
- LGBT access and outcomes in mainstream UK psychological services
- Outcomes: Considering therapeutic paradigms
- The journey to therapy as LGBTQ+
- LGBT visibility: Reducing access barriers?
- Affirmative practice
- Active inclusion vs inactive tokenism
- The LGBT champion
- Common fears: Working with gender and sexual diversity
- Case study: David
- Assessment of risk
- Initial impressions
- Adjustments to the service policy
- Session 2: Barriers to engagement (COM-B)
- Five areas: The right here, right now
- Complex problem or complex context?
- Fine-tuning the problem
- Supervision: Fine-tuning the intervention
- Session 3: Selecting materials
- Guided self-help: Standardisation
- Equality of access vs equity of access
- Adaptations in guided self-help
- Deficits vs strengths
- Sessions 4–8: Outcome and ending
- Challenges to the alliance: Therapeutic boundaries
- Reflecting on the work with David
- Summary and reflective task
- Next steps to active inclusive practice
- References
- Chapter 7: Psychological practitioner wellbeing
- Abstract
- Why wellbeing?
- Mapping the problems
- High-volume, low-intensity work
- Recognition, reward, and respect
- Comparative deprivation
- Complex work
- Not a guru
- Normalising Step 2.5
- Clinical drift
- Supervision and reflection
- Target driven
- Micromanagement
- Progression frustration
- Consequences
- What are vicarious trauma, compassion fatigue, and burnout?
- Sick leave
- Loss of reward
- Complaints and whistleblowing
- Go private?
- Plugging the gaps
- Consequences
- So what are we going to do?
- Progressing a career
- Role definition
- Specialisation
- Negotiating targets
- Recognition
- Gaslight …
- … Or learn
- Top tips: Do’s
- Top tips: Don’ts
- Finally
- There’s always room for a sequel
- References
- Chapter 8: Navigating relationships and therapeutic boundaries
- Abstract
- Key aims of this chapter
- Professional boundaries in human services
- The mill pond
- The wing mirror
- Therapist effects
- Challenges with engagement
- Patients who drop out of treatment
- Relational drift
- Therapeutic content and process
- Low-intensity coaches
- Low-intensity psychological practitioners
- The laboratory vs home testing kits
- Clinical drift
- Upward vs downward drift
- Intentionality of drift
- Understanding therapeutic relationships
- Transference and countertransference
- Transference relationship
- Transference
- Countertransference
- Case vignette: Jane
- Navigating ethical relationships in low-intensity practice
- Exiting defensive practice
- The relational dynamics of systems
- Relational challenges in the current IAPT system in England
- Understanding ruptures in systems: Whose anxiety is this?
- Navigating relational boundaries in systems
- The importance of empathic and compassionate relationships
- Key messages
- References
- Chapter 9: Reflecting on interpersonal practice
- Abstract
- Key aims of this chapter
- Personal motivation for LICBT training
- The seesaw of valuing
- Relevance to low-intensity practice
- Devaluing between groups
- Anxiety around patient engagement: The training year
- Therapeutic working alliance
- Becoming a low-intensity supervisor and university marker
- Barriers to the interpersonal alliance
- Low therapeutic alliance
- Avoidance and control
- Cheerleaders
- The quarterback
- The reflective practitioner: Compassionate challenge
- Addressing problems with interpersonal skills
- Reflections from beyond the Emerald city
- References
- Chapter 10: Supervision
- Abstract
- Key aims of this chapter
- Functions and use of supervision in the psychological professions
- Line management versus clinical supervision
- Mentoring versus clinical supervision
- Leadership versus line management
- Monitoring fitness to practice
- Case management versus clinical supervision
- The function of high-volume case management: Supervision versus leadership
- Clinical skills groups
- Contextualising the low-intensity supervisory model in England
- Variation within the current model of low-intensity supervision
- Further challenges with the current model of low-intensity supervision
- Is the current low-intensity supervisory model fit for purpose?
- So what do we do about the current challenges with supervision?
- Supervision contracts
- Recording sessions
- Upscaling the current model of low-intensity supervision
- Implementing low-intensity clinical supervision
- References
- Chapter 11: Professional identity
- Abstract
- Learning aims for this chapter
- The tug of war
- Some outside support
- Describing an umbrella
- Not just CBT
- Towards a definition
- The power of an acronym
- Professional status
- Core professions
- Progression
- Direction of growth
- Imposition
- Tribes
- Different, but equivalent?
- Never alone
- Evidence-based costs
- Counselling in IAPT
- The dawn of a new age
- Tension in the team
- Trainee practitioner recruitment
- The HEE announcement
- Status and inclusion
- ‘Oh bother’
- Next steps
- References
- Further reading
- Chapter 12: Discussing international applications
- Abstract
- Aims of this chapter
- The future of low-intensity practice in England
- Low-intensity interventions in the United Kingdom
- Qualification and training
- How will training be funded outside of the NHS?
- Stepped care as an international model for service delivery
- The wider world
- Core principles of low-intensity psychological practice
- Targets
- Lessons learned from IAPT
- Back to barefoot
- References
- Index
- Edition: 1
- Published: May 17, 2023
- Imprint: Academic Press
- No. of pages: 258
- Language: English
- Paperback ISBN: 9780323884921
- eBook ISBN: 9780323904513
ER
Elizabeth Ruth
Elizabeth Ruth is an Assistant Professor and Psychological Wellbeing Practitioner Course Director at the University of Bradford. Elizabeth worked as a Low Intensity practitioner and supervisor in various roles within the Improving Access to Psychological Therapies programme for eleven years and developed an interest in adapting Low Intensity CBT for patients with long term physical health conditions. Elizabeth writes about the experience of work as a Low Intensity psychological practitioner, and has provided training, consultancy and supervision for NHS and third sector organisations. As a volunteer, Elizabeth has supported the formation of an independent IAPT Workers peer-support service and held various roles within the British Association of Behavioural and Cognitive Psychotherapies, including election to the Board of Trustees in 2022.
Affiliations and expertise
Formerly Psychological Wellbeing Practitioner, IAPTJS
James Spiers
James Spiers is a Counselling Psychologist registered with the Health and Care Professions Council in the UK, with a special interest in remote digital access to psychological assessment and treatment. He initially trained as a Psychological Wellbeing Practitioner in the IAPT programme in England and has worked in a variety of IAPT services as a practitioner and Low-Intensity CBT supervisor. Alongside Elizabeth Ruth, James has also delivered national training and professional development for the British Association for Behavioural and Cognitive Psychotherapies (BABCP), NHS and third sector organisations, aimed at inclusive practice for people with gender and sexual difference, as well as guest lecturer and external marker for the post graduate LICBT training course at the University of Bradford (UK).
Affiliations and expertise
Psychological Wellbeing Practitioner, IAPT services, Low Intensity Therapist and Clinical SupervisorRead A Pragmatic Guide to Low Intensity Psychological Therapy on ScienceDirect