It Started Out With a Tweet, How Did it End Up Like This?

A big thank you to Lisa Atkinson, Marie Boardman, S Fox, Liz Kell, Beth Morgan, James Spiers, Simon Winter and Amy Worrall for permission to use their image and words in this post. Any errors or misinterpretation are entirely my own.

Another article bashing IAPT was doing the rounds this week; amongst that James Spiers and me were exchanging messages about his post from last week. We wondered how we can offer something constructive to follow up on the difficulties that he’d described. What are the things that make working in IAPT, especially at Low Intensity, doable? Is anyone thriving in the role? Helpful replies started to come in from LITs, CBT therapists, low intensity leaders and managers after a shout-out on Twitter, so I’ve pulled them together here. I’ve tried to group them by theme and, you know me, I couldn’t resist the urge to drop a comment in here and there.

Getting started

Time for personal and service development

A sense emerged of how little time people in IAPT have to do anything but charge through the many tasks in front of them. Meeting service targets is often at odds with personal and professional development, or building integrative relationships with local communities and other teams and services. To allow this kind of time there would need to be significant changes in how IAPT services are commissioned. Those negotiations would be demanding for operations and service managers who are often already as stressed as front-line staff.

This reminded me of a paragraph from a previous post.

Team culture and heirarchies

The importance of a supportive culture, and equality between the professions came up. People who deliver low intensity therapies are often managed by people who have never worked in the role. Leaders who demonstrate an understanding of the demands of low intensity work are essential.

In some teams there is a heirarchical attitude, with low intensity at the bottom of the pile (the words ‘low intensity’ don’t help with this!). Most services will have representation from three of four professions, all delivering different modalities. It’s helpful if there’s an attitude within teams that those modalities have equal importance and value for the service and patient care. A sense that the qualifications that you’ve got and the work that you deliver is not equally valued by your colleagues is dispiriting.

Development in the role; training and progression

There is currently a crisis brewing because we can’t retain enough experienced low intensity therapists. Opportunities to develop and advance in the low intensity role are necessary. This could be good CPD to enhance clinical skills within the modality, routes for progression into high intensity roles (having watched a highly qualified colleague recently be declined a place on IPT training I can’t agree with this strongly enough), or progression into roles in leadership and education. Senior and Lead PWP roles are becoming more common, but aren’t advertised frequently enough to make low intensity therapies a viable career choice for many people.

Routes into the role

Funding again! The way that IAPT services are commissioned means that entry into low intensity work is through a full time one year taught course with a clinical placement in service. This potentially excludes many people for whom the role would be a good fit. It can be a chance to do valuable work in the local community on a basis that fits with home and family life, if you can manage that training year. Many people with parental and caring responsibilities, or who manage a health condition, would struggle.

In the end

What emerged was a strong feeling that low intensity therapies and the people who deliver them have got a lot of value, and a lot of ideas. The conversation felt constructive and hopeful, and presented some practical ideas for change. There was also a timely reminder that well known occupational health guidelines apply in IAPT as much as any other place of work. With well defined individual and service targets there comes a temptation to micro-manage. Lets not, shall we?

To wrap up

Sorry not sorry for the title. I’m feeling whimsical this week, and The Killers Mr Brightside has been my earworm. Putting this together I realised that I’m basically writing a Buzzfeed article, if anything IAPT related could ever be considered clickbait 🤣. The next planned post will be sometime in March, and I’ve had a kind offer from another guest writer. Guest posts are my favourite posts! Topics I’ve got on the burner for future posts are LITs working with Counsellors in IAPT, something about pacing, and possibly a relaxation post. You know, the nice stuff. If you’re delivering low intensity CBT in any capacity and want to write about it on here please let me know, I’m happy to give as much or as little support as you like, and unlimited space.


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