Escaping IAPT

This section is for discussion relating to the Layard report, and subsequent schemes like Improving Access to Psychological Therapies where lower intensity inteventions are offered in primary care
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Escaping IAPT

Post by Milka » Wed May 18, 2016 9:25 pm

I've worked in IAPT for a long time (too long!) at both low and high intensity level and have now decided it's time to move on but I feel really trapped. I'd still like to use my CBT training and skills but in a different setting. However I'm struggling to figure out how to do this as it feels like I'm not qualified/experienced to work in a different field/service.
One option would be to apply for the DCLin (which was my original plan when I left uni) because clinical psychologists have a much wider range of job options but I know this isn't realistic given the competition for places. I've also looked into going down the health psychology route and applying for a MSc in health psychology but not 100% sure about this.
Just wondered if there's any former IAPT therapists on here who have managed to escape IAPT and if so what have you done instead? I'd be really interested to hear others experiences.

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Re: Escaping IAPT

Post by alexh » Wed May 18, 2016 9:39 pm

What's the downside in taking a chance on the dclinpsy next year?

If you're considering alternative roles, what aspects of your current job bring you most satisfaction?

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Re: Escaping IAPT

Post by Milka » Thu May 19, 2016 7:08 pm

Thanks for your reply Alex H.
There's no downside to taking a chance on the Dclinpsych but I don't think I'm likely to be successful as I'm lacking breadth of experience and haven't done anything research-y for 10+ years. Also not sure if I want to go back to being a trainee again and all the stress that entails since I'm already qualified as a therapist.
The part of my current role that brings satisfaction is the reward of helping clients to overcome/manage their difficulties but I don't like the setting (the high volume of clients, the pressure of targets, politics etc) I know all organisations have targets, especially in the NHS, but the targets in IAPT are particularly harsh and unrealistic and lead to a situation where it feels the focus is on achieving the targets rather than what is best for clients.

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Re: Escaping IAPT

Post by miriam » Thu May 19, 2016 8:02 pm

Can't you apply for other jobs as a CBT therapist?

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Re: Escaping IAPT

Post by jamesivens » Fri May 20, 2016 8:35 am

there's loads of cbt jobs these days in different settings and services which you would be able to work in. BABCP jobs website is a good place to look, plus all the other general job searches through google etc

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Re: Escaping IAPT

Post by LIWY » Fri May 20, 2016 1:51 pm

I suppose it depends where you are in the country, in the South East of England where I am, many have found work in specialist services or private services. Just look regularly on the BABCP jobs page and speak to all the main agencies that provide locum staff and you'll hear what's out there.

What is particularly insidious with IAPT is that it is under government targets so the target pressure is much higher I find than in specialist services where the targets are not scrutinised continually by the CCG and performance published on the HSCIC website.

Given that the majority of IAPT therapists do appear to find the targets unrealistic and not in line with NICE guidelines or the best patient care I have been thinking a lot about how to make the budget setters take notice. We know from the recent survey carried out in conjunction with the New Savoy Conference that levels of distress among IAPT staff are extremely high. Economically, staff attrition and staff sickness mean that the costs of overworking the staff are higher than lowering targets and adding more staff. I find that a lot of IAPT staff too easily think they are to blame for not making targets rather than the system being at fault and do not feel empowered to speak out. As the BABCP statements have said too, there is bullying in some services with people fearing to speak up. It's sad I think to see staff leaving and happier elsewhere, it shouldn't have to be that way.

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Re: Escaping IAPT

Post by Milka » Fri May 20, 2016 6:01 pm

Thank you all for your responses and suggestions. It's encouraging to know that there are other CBT jobs out there but I'm not convinced there's loads in my local area. I've only ever found CBT jobs in IAPT but maybe I'm looking in the wrong places?
Other than IAPT what other services and settings might employ CBT therapists? Whenever I've seen jobs in CMHT and specialist services they have been for clinical psychologists.

I agree totally with what you're saying about IAPT LIWY but I'm at a loss as to how to make the budget setters aware of this. I think our trust management do try to challenge the targets that are set by commissioners but are powerless to change those targets because they come from central government and are non negotiable. I don't feel empowered to speak out because no one in government is listening when organisations like the BABCP try to make a stand. Maybe we therapists need to learn from the junior doctors......

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Re: Escaping IAPT

Post by astra » Fri May 20, 2016 9:16 pm

Have you thought about private practice? Have a look around at what therapy services are available privately in your area, make some enquiries re pricing etc. You might be quite surpriseed by what is possible.
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Re: Escaping IAPT

Post by Milka » Sat May 21, 2016 11:33 am

I've thought about it vaguely but not looked into it seriously yet. I'm kicking myself now that I didn't attend the BABCP CPD event earlier this year about working in private practice as I think that would have been really helpful.
I think for me it would be a huge shift in mindset to move into private work and charging for therapy rather than working for the NHS. I always thought I'd stay in the NHS and believe in the values it was founded/based on but private practise is becoming an increasingly attractive option for me. I know from this forum and what I've heard/read elsewhere that more and more therapists and psychologists are getting out of the NHS or attempting to do so due to the unpleasant working environment and the impact on their mental health. As LIWY said below it's sad that staff are feeling that have to leave NHS :(

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Re: Escaping IAPT

Post by mungle » Sat May 21, 2016 4:43 pm

Often people work privately part time and then switch over to majorly or only private work when they feel comfortable an have built a client base.

I've seen it vary across the country whether posts are open to therapists as well as clinical psychologists but the places I have seen CBT Therapists work include:
- health psychology e.g. pain management, chronic fatigue, medically unexplained symptoms, phobia work where appropriate for people with phobias relating to their hospital treatment
- secondary mental health including adult mental health psychotherapy services or CMHTs, CAMHS etc.
- Hospices
- Children's charities

Things that might be helpful - if IAPT for SMI ("severe mental illness") is hapennign in your area and you can gain training and experience, gaining a specialism in one of the above areas e.g. through setting up an IAPT group for pain management, adapting CBT for people with learning disabilities etc.

Another option might be to branch out a little, for instance with some training in another approach e.g IPT, CAT, midfulness, ACT, brief psychodynamic, systemic/family therapy (e.g. an introduction or family course).

Another direction might be to get involved in the research time - you could be a research therapist on a CBT trial and this might also involve being trained up in a specialist area.

It depends on your interests and strengths but you have a recognised mental health profession and therapy qualification so think about where this could take you - anywhere from NHS or private hospital management to training/teaching to research co-ordinator to mental health policy work to........

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Re: Escaping IAPT

Post by icebluesparkles » Sat May 21, 2016 5:36 pm

Thanks for starting this great thread. I am in a similar position - a HI therapist in IAPT and wanting out.

I think all the ideas about alternative settings in the NHS are great in theory but there is one fundamental difficulty that I have experienced. That is the issue of a 'core profession'. So, basically all the OTs, RMNs, social workers and psychologists who have done High Intensity training are fine but those who came through a PWP route do not have a recognised core profession and in my experience are limited in their choice. My situation is also difficult - I trained as a psychotherapist before doing HIT and, while the BABCP recognises it as a core mental health profession, many NHS Trusts do not. I find that incredibly annoying/frustrating since my training was to Masters level which is a higher level qualification than that needed to fulfil the OT/social work/nursing requirement.

It simply boils down to the fact that the UKCP/BPC/BACP did not play ball and go in with HCPC. In trying to preserve their identity they have shot pretty much anyone who is not either independently wealthy or living off a spouse in the foot. This issue has meant that many highly skilled mental health professionals from psychotherapy/counselling backgrounds (yes, of course I know psychotherapy and counselling are not regulated meaning that anyone can call themselves one BUT that doesn't mean that those of us who HAVE followed Masters level qualifications at reputable universities plus gone through very rigorous accreditation processes and often have many many years of experience in a wide range of mental health settings are not working to standards equivalent to those of other mental health professions).

I am honestly sick of the NHS attitude in this respect. When I trained, there was no such thing as counselling psychology (showing my age here!) - it was not an option. Many of us in our mid 40s and upwards are not in a position to fork out £30K to do that qualification even if we might quite like to (even though it would mean basically repeating huge chunks of our original training) because we simply aren't going to earn it back at this point in our careers. The same is true of other core professions - how to get one when you can't stop work for 2 years to train to be an OT/RMN/Social worker? There are to my knowledge no ways of acquiring a core profession that don't involve stopping work which many people are simply not in a position to do.

I digress!

My point is that I wish NHS Trusts would open their minds to seeing ACCREDITED psychotherapists/CBT therapists as a core mental health profession...then people would not get stuck in IAPT (quite often working with highly complex cases that should be seen at Step 4 in the first place!).

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Re: Escaping IAPT

Post by Milka » Sun May 22, 2016 4:52 pm

Thank you Mungle for your suggestions re: possible employers and branching out. Unfortunately from the jobs ads that I've seen the NHS trusts in my local area seem to only employ clinical psychologists in secondary care and specialist services and specify this in the ads. We don't have IAPT for SMI in this area yet but ironically the IAPT service I work for actually receives referrals from the local CMHTs and other secondary services, presumably because they don't have the resources to employ enough psychologists to meet demand. It would make more sense for these other services to employ more therapists and give them additional training to work with more complex clients but it seems to be the cheaper option to try and send everyone to IAPT whether or not that is appropriate for client needs...... I've now decided to branch out and do a part-time Msc in health psychology so I'm better qualified to apply research roles.

Icebluesparkles I have the same problem as you re: not having a core profession because I came through the psychology degree, PWP, high intensity route. I have also seen therapy jobs that specify that you need to have one, which would exclude me too even though I'm accredited. Though I guess with your previous training and qualifications you would have more scope to go into private practice outside the NHS if you wanted to? It seems a waste if the NHS won't employ you in a role where you can you can fully utilise those skills e.g in longer term psychotherapy. And I agree with what you are saying about highly complex step 4 cases too :(

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Re: Escaping IAPT

Post by maven » Sun May 22, 2016 5:11 pm

I agree with most of what you said Ice, and I'd agree that it is an unnecessary diversion, but I think there are funded RMN trainings, so it isn't "stopping work" entirely.

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Re: Escaping IAPT

Post by light0end0tunnel » Wed Jun 01, 2016 4:18 am

I can totally relate to these posts about escaping IAPT. I started as a graduate mental health worker in 2008 and then did the high intensity training which I finished 5 years ago and have been working in IAPT ever since. For the past couple of years I have known that I need to leave IAPT but have felt stuck at what to do. I decided to apply for the clinical psyc training. This was my initial intention when leaving uni but I actually really enjoyed IAPT so worked there for several years. I didn't get any interviews the first year of applying for the doctorate but got 2 this year and offered a place. Although the range of experience is an down side, I really felt the depth of my experience helped with many of the interview questions. So it is possible to have worked in IAPT for several years and still get into training. Yes it means studying for 3 years but I see it as short term pain for long term gain.

I hope you manage to find something that is right for you. I just wanted you to know that us long term IAPTers can still get onto training :D

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Re: Escaping IAPT

Post by Milka » Thu Jun 02, 2016 3:24 pm

Thanks light0end0tunnel that's really encouraging. I'd ruled out applying for the clincial psych training because I thought my experience (just primary care/IAPT) would be too narrow but perhaps that's just my negative cognitions! (fortune-telling!). If you don't mind me asking did you have any research experience that you could put on your application? I haven't done anything research based for a very long time so I thought i would struggle to get a good academic reference and would be marked down for lack of research experience.

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