A Year of NaG-ing (The One With the Flashbacks)

This week it will be a year since I set up notaguru.blog and posted Welcome. It’s been a year since I last went for a walk and didn’t look for a scene that I could snap to set as a feature image on a blog post. 65,190 words and 29 posts later what was supposed to be a bit of a creative side project and a way to make sense of my time at low intensity in IAPT has turned into… I don’t know, something else. Anyway, I’m a sucker for an anniversary so here’s a post about how the blog came to be, what’s happened this year and what I want to do next. The amazing guest bloggers who have appeared on the site this year have let me include their pictures. Before I start I want to say a huge thank you to all of the guest bloggers who have contributed to the site this year, and to the people on Twitter who have encouraged and supported me, it’s all mattered and I’m grateful to you.

Genesis

I wanted to write about being a Low Intensity Therapist in IAPT about five years ago. My degree is in Literature and I’ve always written to make sense of things, and I’m a bit of a tech geek, so it wasn’t a huge leap to imagine a small blog that would double as a writing and computer project/hobby. Why did it take four years to get started? Put that down to the demand of working in low intensity therapies. A couple of years ago one of our qualified LITs, a woman in her early 20s, described that at the weekend after a five day working week in IAPT she just wanted to stay at home; ‘I’ve had enough of people by Friday’. This job uses up a lot of bandwidth.

‘Welcome’ described why I started to write about work as a LIT

It wasn’t until I was working a four day week as a Lead PWP with just half a day of clinical contact in a week that my creativity regenerated enough to sit down and type something. Even then the thought of saying anything critical of IAPT felt transgressive, and the idea that I was going to have an opinion in public sent me into an anxiety attack. A friend talked me into getting started; once the first post was up and nobody read it, it felt safe to carry on. The first three posts were an exercise in anxiety management. The point that IAPT uses far too much jargon is still valid but I really didn’t need six thousand words to make it. The IAPT Glossary posts are on the site because I was too frightened to post anything else, and every time someone views one of them I die a little inside.    

What’s in a name?

Why NotaGuru? Well, having NaG as a pen name really appeals to me for a start, but the origin of the name was in a conversation with a colleague a few years ago. Talking to my clinical lead about mindfulness in our team I mentioned one practitioner who was seen as a leader and ‘mindfulness guru’ in the service and my clinical lead laughed and came back with ‘You’re not a guru and that’s what I really like about you.’ ‘Not a guru’ stuck in my head and got attached to the idea of the blog. It’s always felt like a good fit because despite ten years of low intensity practice there’s still volumes of stuff that I don’t know, and people keep surprising me. That there is always something new to learn is one of the things that I love most about this job.

Saiqa Naz (far left), Adriana Nitranska, James Spiers and NaG, Bath 2019

Notaguru.blog hasn’t been a single person project. After the first three posts flew very low under the radar and I realised that I had managed to build a website (whoo!) and the world hadn’t ended I started to feel proud that I had made something and showed it to a colleague. She sent it on to James Spiers. At the same time the act of writing meant that my thoughts about low intensity work had started to become more organised and the first post that said something that felt important to me went up. High Volume, Low Intensity and Chaos is where I started to find my voice, and James shared it on Twitter. That day I travelled to Bath for the 2019 BABCP conference and kept refreshing the WordPress stats page in disbelief. Hundreds of people visited the post, it got re-tweeted a few times and people left comments praising it on social media. According to my Fitbit my heart rate stayed in the exercise zone for eight hours that day. James became my first guest blogger in October 2019 with the excellent Stress, Sex and Side Effects: Why I Routinely Talk to Men About Their Penis. Oddly enough the post with genitals in the title was the most viewed on the site for many months. Can’t think why.

All alone…

I didn’t have a plan, I just wanted to write about the job that I love and the system that hurts, and figure out what it had all done to me. More than that though, I wanted to hear from other low intensity therapists. We all know that IAPT is different everywhere and I wanted to know what the job looked like in different services, how it felt to be a LIT across the country. There are some networking opportunities but they’re few and far between. LIT’s are employed in IAPT to move numbers, not talk to each other. In September 2019 I started to teach on the Low Intensity training course at my local Uni. As well as discovering a passion for teaching the new role forced me to go back to the literature and I realised how little was written about this job by people who are doing it. Where were the low intensity voices describing the reality of the work instead of the sanitised manuals that filled the shelves? I’m still frustrated that other people are teaching us our work and speaking for us.   

I made the switch from PWP to LIT on 12^th September 2019. Yes, I know it’s a loosing battle but Psychological Wellbeing Practitioner is a ridiculous job title and PWP is meaningless to most people. Liz Kell (who is not responsible for anything that I write or my opinions!) made a strong case for Low Intensity Therapist as a universal job title for people who practice low intensity psychological therapies. At the Bath conference she pointed out that PWP is England and IAPT specific, and low intensity therapies are neither of those things. So I’ve gone with LIT and explained why in From Poop to Porn… In defence of that post title: I had a fever while I wrote it.

…Then not alone

Sheeva Weil was introduced as a collaborator for the first time in October 2019. She gave me tremendous behind the scenes help while I wrote the two posts about domestic abuse in low intensity work. They were tough to put together and I couldn’t have done it without her moral support. Sheeva came up with the tagline for the blog ‘cynicism laced with hope’, and came to the rescue again a few weeks ago when she contacted me to offer two posts that responded to the fresh awareness of systematic racism following news coverage of the murder of George Floyd and the upsurge of the Black Lives Matter movement. I had wanted to write something about this but felt utterly un-equipped to do so. Sheeva smashed it, her account of the experience of racism in IAPT is visceral and powerful, and her practical guide to anti-racist work is exactly what IAPT services need to be reading. So far these two posts are the most viewed on the site after Ring Ring and I’d ask you to please share them with your teams and think about how you’ll implement them if you haven’t already.

Sheeva Weil, author of Racism in IAPT parts 1 and 2

On a related theme Saiqa Naz contributed a post about the essential work that we need to do to engage with communities that it is too easy to label as ‘not psychologically minded.’ Saiqa is an author of the BABCP BAME Positive Practice guide, another essential and practical tool that we need to share and implement. She argues that LITs are ideally placed to have regular time in their working week to engage deeply and consistently with their local communities, to learn about what adaptations are needed to make psychological interventions relevant and accessible to the people who we currently fail to provide a service for. This tied in with my own excitement about truly integrated services that are hosted in accessible community spaces. In The Jenga Solution I described the integrated work that I was doing with a local MSK service, supported by a Move More team and their Places For People facilities. There is huge potential in the low intensity role, but there are challenges to realising this future.

Saiqa Naz, author of A Letter From Saiqa

Resilience and cake

James came back with a second guest post about how the concept of resilience is abused to punish LITs who struggle. There’s growing evidence that most LITs struggle with the demands that the IAPT system places on them, and there’s very little willingness on a national level to make substantial changes to address this. Twitter helped out here with LITs from across the country sharing ideas about what works in It Started Out With a Tweet. At about the same time as that post was published one of the most encouraging developments in the world of IAPT occurred with the founding of The IAPT Workers Café. This exciting group  provides an independent space to reflect on work in IAPT and support practitioner wellbeing. It deserves support and encouragement because it’s a much needed practical response to difficulties that are often ignored and minimised.

James Spiers, author of Stress, Sex and Side Effects, and Resilience: it’s time to change the conversation

If you want someone who IS a bona fide Low Intensity guru then find Liz Kell. After months of appearing and being quoted in so many posts that she ought to be named as co-author of the blog Liz wrote a guest post. In PWPs: The Thin Slice of the Cake she shared her thoughts on how LITs are often at the bottom of the pile when support is needed. We’re a resilient and dynamic workforce who can be relied on to do outstanding work in difficult circumstances. Leave us alone and we’ll keep producing fantastic results. That doesn’t excuse neglect though, or the fact that LIT’s are often treated as if they’re at the bottom of the IAPT hierarchy instead of foundational to its existence.   

Liz Kell, bona fide PWP guru and author of PWPs: the thin slice of the cake

Health and Wellbeing

It’s no secret that I live with CFS/ME and I’ve dedicated six years of my working life to developing adaptations in low intensity work for people who have got long term health conditions and persistent physical symptoms. Work-wise, this is where I live and it felt good to get that onto the site with a series of posts that I wrote in the wake of a fatigue relapse that was triggered by a bout of flu last autumn. The site went quiet for two months while I rested, but I got Stuck in Solitary out of it, this is probably my most successful attempt at writing about fatigue after years of trying.

The pandemic has been the big news this year hasn’t it? Lockdown forced talking therapies into a digital world that we’ve been edging towards for a couple of decades. LITs have got a head start here and lots of people shared their top tips and experience in Ring Ring: telephone work at the end of the world (again, sorry about the title, that’s down to another fever!). So far 10,900 people have viewed that post, it’s by far the most popular page on the site and a testament to the generosity and expertise of the LITs in IAPT services across the country. Pacing: What to do When You’re Worn Out was another response to the pandemic. We had just finalised our low intensity pacing protocol in my team and I’m watching how Long Covid is turning into CFS/ME with cold horror. I wanted to tell people what I wish I’d known in my first year of the illness, so now it’s out there and a couple of hundred people have seen it.

Feature image from Pacing: what to do when you’re worn out

IAPT: The Next Generation

Last week I created a new category on the site. ‘Low Intensity training’ has now got its own page. This is partly because of the teaching; I’m staggered by what we ask of people in the training year and excited to contribute to the future of this emerging profession. Trainee PWP Amy Worrall approached me and asked for a post about the training year and gave me weeks of support to pull Fishbowls and Friends together. There’s also something in there about who’s attracted to low intensity work and why. Sam Torney covered this brilliantly last week in So You Want to be a PWP? My heart leapt when I read Sam’s post. Meeting people who share your geeky excitement is always a good moment, and her well written enthusiasm made me glad. There are three posts for and about IAPT LI trainees now and I’d love to host a guest blog by someone who’s on the training or just finished, if you want to write about your training year please give me a shout!    

Lead PWP Sam Torney wrote about what recruiters look for in a Trainee PWP

What’s next?

There was space this year to write about some of the general good bits of Low Intensity work. Alliance building, Supervision, working alongside counsellors. I also had a couple of posts that weren’t so happy-clappy; a scan over the IAPT standards and the role of alcohol in LI work.

I still haven’t got a plan. Given the quality of the guest posts I’d like to be able to pay the guest writers for their work so I’m thinking about setting up some kind of optional payment system. If some money comes in I can pay guest bloggers as they deserve and expand the site to host a resource of self help material and maybe even a forum… I’ll see how it goes. I’ve stepped back from the Lead PWP role and returned to a Senior PWP post so that I can teach and still do the work in my IAPT team justice. There’s definitely a post coming about the different roles in low intensity work and some stories of the careers that I’ve witnessed.

As I’ve written and my thoughts have sorted themselves out this year I feel more passionate than ever about the development of a true professional identity for LITs. With the status and independence that recognition as a core profession would give us we would be in a better position to challenge and change the parts of the IAPT system that don’t do us good. Who knows, 2020/21 might be the year we start to move towards the accreditation, regulation and registration we need to find our legs as a profession. Low Intensity therapists are a unique and vibrant group who deserve to work in conditions that allow them to thrive; it would be exciting to be part of bringing that about.

Global viral pandemic aside it’s been a heck of a year in ways that I never predicted. I have to fight a constant urge to delete or re-write everything on the site. The highlight has been the collaborations with guest bloggers and interactions on Twitter that have given me the juice to keep writing. A screen shot of Dr. Kat Alcock of UCL commenting ‘This is a superb piece’ on a Tweet about The Jenga Solution was my lock screen picture for about five months. Thank you again to everyone who’s written, read, commented, encouraged and critiqued the site this year. I wouldn’t have got anywhere without all of you and I hope there will be more LIT voices on here in the next year. My identity isn’t a secret but I have deliberately kept my name and face off the site and Twitter account in case another LIT wants to become NaG one day? Something to think about…