A Damaging State Monopoly: Criticisms & Struggles Against The Restrictions of Traditional CBT Model in the NHS, NICE & IAPT

Viktor Mikhailovich Vasnetsov Gamayun – The Prophetic Bird

There is something deeply concerning about the state monopoly over mental health counseling and psychotherapy.  The bias towards the medicalization, seeking those who have medical backgrounds for training is beginning to limit and impact the profession and choice for consumers and people seeking help in their lives.  The incredible CBT bias in the NHS through NICE recommendations and IAPT is something I believe we should all strongly be fighting against. 

A very important study from the Centre for Social Justice concludes that the NHS is failing to offer the mentally ill or emotionally struggling, any choice in their psychological counseling and therapies. Their report from 15 April 2012, say that this is a disgrace that fails nearly 90% of patients.

The scale of mental illness is startling and is the single most debilitating cause of disability in our society that is estimated to cost the economy £105 billion annually.  Yet we are being enforced a one size fits all policy.  This report and many independent thinkers feel patients and clients could benefit from many different approaches aligned to the individual and their rights for freedom, choice and options.  Research and funds needs to be given fairly and other research considered, rather than relying on that which is carefully selected to fit the biases of the policy makers.

Despite the rhetoric that the Department of Health is listening to the needs of the patients, this important report suggests they have done nothing to break the bureaucracy, monopolization, and one size fits all approach favored by NICE and IAPT.

As a counselor, psychotherapist and hypnotherapist with several postgraduate professional qualifications having a focus on integrative skills across a wide spectrum of theories and applications, this is a frustration on several different levels. 

Recently I have been to 2 interviews where GPs have wanted to offer me employment in Greater Manchester. Both GPs have made business cases to take me on as someone who has CBT skills, person centered skills, humanistic counseling skills, acceptance and commitment therapy, schema therapy, and compassion focused therapy learning, as well as the practical application of relaxation, mindfulness and hypnosis.

What is incredibly frustrating for them and for me is that the NHS turned down such business applications, even though I offer far greater value and fractionally hourly costs than CBT practitioner (trained in the expensive and medically-based establishments and rare universities that specialize in ‘acceptable’ CBT across England); Even though they have waiting lists of over a year for clients who cannot access therapy; Even though computerized CBT is a failing initiative where clients quite rightly would rather see face-to-face people and therefore are not motivated to interact with a computer.  Such disappointments must amplify for the GP in being able to access the clients and patients that they care about, and for those trained with master degrees from reputable universities with good professional qualification or backgrounds, who are being run out of the job market. 

The rule of the club is if you don’t have CBT which is taught from the certain medical angle, from specific institutions, you’re not coming in!

Many organizations, experts and professionals are calling for the great need for change in how this monopoly interacts and decides state policy.  This is not happening.  Is this reluctance to consider other therapies due to an educational and theoretical elitism?  Is the resistance indicative of a stubborn bureaucracy?  Or is it indeed about financial monopolies, protection of employment, funding and income for the selected few and their attempts of control and exclusion?    

I strongly advise all therapists, clients and patients who feel strongly about this to sign the online petitions, to stop the medical profession having the monopoly and power to restrict choice and advocate certain types of training through the biases inherent in their selective data.

Richard House for The Alliance for Counselling and Psychotherapy has launched a new petition challenging the unscientific bias towards CBT of the UK Department of Health’s NICE clinical treatment guidelines.  Also the influence this is having over the Improving Access to psychological Therapies (IAPT) scheme.  They believe that the combined impact of which is drastically reducing access to, and threatening the very existence of, a diverse range of clinically effective therapeutic approaches which have thrived for many decades.

The petition can be found here, so please do consider signing it: http://www.ipetitions.com/petition/stop_nice-iapt_bias/?utm_medium=email&utm_source=system&utm_campaign=Send%2Bto%2BFriend

Whereas countries like Sweden pioneer in changes by allowing people to have choices in their psychotherapies, we are almost relying on a Draconian, biased and financially driven system that celebrates political power and political sway. 

Scott Miller (M.D.) suggests though Sweden even went through a period like us where CBT became dominant due to the ‘evidence’ basis; there health service is now looking to the fact that this data is skewed, that people were failing with the traditional second wave CBT where improvements in anxiety and depression in the long-term were certainly not near to the statistics of ‘total success’ that were declared.  Sweden now realizes the need to change  and tailor psychotherapeutic services to the individual, so why can’t we?  Why is the power often so skewed in English speaking countries, especially the UK? 

There is something unpalatable about the state medicalization in limiting the choices for patients and for clients.  Not only in the time of recession and economic hardship is a government effectively killing off a talent pool of well-equipped therapists, the pressures are also making it very difficult for many therapists to survive.

Take for example Nicola Bannings article in June’s addition of Therapy Today, where many other interviews suggested students feeling misled by courses as there is such an absence of paid work.  Much of this is implicated by a state that is setting CBT as the only choice.  Many students simply will not get on CBT courses unless they are a Doctor, mental health nurse or social worker.  Such a restriction in choice in deciding who can train in ‘traditional CBT’, biases and annihilates the mental health profession from having any true scope and misses the point on flexibility, talent and pertain to a medical monopoly. 

Briefly, so as to not be tedious, there are many misconceptions and misunderstandings of the proclaimed success rates in traditional CBT.  These are the sources of error in statistics, the placebo effects, the demand characteristics to ‘be better’, the issue that was considered randomized controlled trials are actually extremely biased and leading. There is evidence that many psychotherapies work equally as well, yet are excluded from research and the distribution of wealth into their study.

Realistically psychotherapists cannot be universally applicable to all people.  Mind write about recurrent and despondent users being forced to use NHS CBT and feeling no benefit.  In my private practice I meet clients who complain, in their tight CBT schedules they did not touch the surface of their concerns and felt they needed to pay for private therapy.  

Being taught in a banal way, ‘this is a negative thought’, ‘you must challenge this negative thought’, ‘negative thoughts are bad’ – when applied to crisis, trauma and identity is experienced as ever-so-patronizing and is ever-so-unhelpful to many!  

Similarly the charity Mind in their “We need to talk: getting the right therapy at the right time” report suggests an appalling lack of choice for clients and often been forced to return to a therapy that they did not feel benefits from is exhausting.  They suggest only 8% had a choice about what therapy they received, only 40% had the psychological therapies explained to them, and only 13% have a choice about where they received therapy.

What is extraordinary is that in the most recent developments in the third wave CBT, where acceptance, compassion and mindfulness is advocated, the state CBT returns to a medical model that is taught to medical professionals and therefore excludes so many from their training.  Certainly this financial monopoly is making somebody a lot of money and stroking some powerful egos!

Of course in the news there’s also been a huge amount about the increasing University fees, the application to University courses and the bias is so inherent in the selection for educational courses.  This could not be stronger than in the psychotherapy profession!  

When CBT skills are easily picked up and practice by psychotherapists, and were intended to be easily applicable skills by its first pioneers, why should it be restricted to the medical and political elite to make the choices in social policy? 

It also sits very badly with me that possible future schemes are making the psychotherapist very political, in a therapist or counselor having a role in determining if people’s benefits are stopped in terms of job seeking.  How will such a politically motivated socially conservative bias can be acceptable to our profession is something that disturbs and frustrates me.

In the Centre for Social Justice’s report (2012), Dr Callan suggests “If the Department for Health used a similar approach to the DWP, they would create a range of safe, new choices without having to invest in a new workforce, and without wasting public money on unsuccessful treatments.” She continues “The current system has limited the number of experienced therapists available to supply the NHS at a time when the need for their effective contribution has never been more urgent.  The patients have spoken and demand more choice. If the NHS genuinely allowed any qualified provider to provide therapy rather than the small number whose work is approved by National Institute for Health and Clinical Excellence (NICE) guidelines then patients would have greater choice and greater chance of recovery.”

What then are the resistances to change when there is such a crisis in the mental health care for the public and when so many general practitioners cannot access or give care to the patients and clients that they were wished to access?  Why is state and social politics so determined to bind educational choices into such a limited and constricted, as well as extremely expensive and narrow choices of educational courses? 

I think it is time to look at how the tight and narrow guidelines are squeezing out talent.  It is time for options for people to receive choice and real care in how they deal with their difficulties in life.  I feel that choice is necessary and useful for people to have, and I would ask people to contribute to overcome the insidious nature of the bureaucrats that are damaging and restricting choice and freedom in therapy and its openness in training and research. 

Please find this petition now, client and practitioner alike. http://www.ipetitions.com/petition/stop_nice-iapt_bias/?utm_medium=email&utm_source=system&utm_campaign=Send%2Bto%2BFriend

Best wishes to now and keep on keeping on.

 

Links and references: 

http://www.centreforsocialjustice.org.uk/client/media/Talking%20Therapies.pdf

http://www.scottdmiller.com/?q=node/160

http://www.mind.org.uk/assets/0001/0027/Mind_We_need_to_talk_Report.pdf

http://www.therapytoday.net/article/show/3127/print/

http://www.ipetitions.com/petition/stop_nice-iapt_bias/?utm_medium=email&utm_source=system&utm_campaign=Send%2Bto%2BFriend

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