Struggling in IAPT service as untrained

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

Struggling in IAPT service as untrained

Postby goldflakepaint » Tue Nov 14, 2017 12:09 am

Hi all,

Just wanted some advice- I have recently started a PWP job with one of the IAPT services that employ people who haven't done the PWP course. I had previously worked in mental health for a few years and had used a few of the more basic interventions (exposure, behavioural activation) with reasonable success, plus I had just finished a masters in psychology which went really well so was feeling pretty good about myself and I think that was reflected in my interview. I was offered a fixed-term post which I was really pleased about and was looking forward to all the clinical experience as my aim was to progress to clinical or counselling psychology doctorates.

So far so good. But after being there for a few months, I have become to feel very overwhelmed as (surprise surprise) I am working with patients who are far more complex than you would expect going by the IAPT model, presenting with everything except mild-moderate depression or anxiety. I was somewhat aware of this before I began as I did some research but perhaps wasn't completly prepared for the reality and thought that I'd be eased into the role a bit more considering that I'm not PWP trained. I am doing my best to read up on and learn the interventions and models that were unfamilar to me and there are decent levels of supervision and CPD here but the stress of trying to get up to speed is getting to me and honestly starting to affect my own well-being. A few other unforeseen issues at work have made things even harder and I am now very much considering quiting. Fundamentally, I do enjoy working with people psychologically but the level of pressure and lack of experience is really hindering that enjoyment and I'm starting to dread going into work each day. I have about half of my fixed-term left.

My thoughts about this is that maybe things would have been different if I had been able to do the PWP course first or even if I hadn't taken this job right after coming off a stressful masters. But at this point, although I really value the experience, I'm not sure if the stress is worth it. So I just wondered what others (especially people who are or have been in a similar position to me) thought, what they would do or any advice that they have. The saddest thing for me is that this whole thing is making me question whether psychology in general is really the right place for me.

I have spoken a little bit to my colleagues and my manager about this but mostly, they have just offered me reassurance and told me that they found it hard when they started. I'm pretty sure that they are not aware of the level at which it has been affecting me. Any thoughts?

Thanks for reading and sorry for the essay!
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Re: Struggling in IAPT service as untrained

Postby LIWY » Tue Nov 14, 2017 11:11 am

So sorry to read this is happening to you. This is not your fault! As you say yourself you are untrained and being given the workload that would likely be too advanced for a trained PWP, let alone someone who has had to rely on bits of in service CPD provided often by people who too lack formal training.

A few IAPT services have sunk to a new low in their desparate exploitation of willing people who want to work in psychology. There's a dreadful culture in a minority of services where this use of untrained workers at a lower band helps services to get the patients numbers through, they seem to care nothing of the burnout and destruction it reaps on people allocated work above their training level or the danger it poses to patients to be treated by people who have not been trained to do so. These services often grow their Step 2 managers out of this culture so these managers find it normal that this day to day level of stress and problems, even serious incidents, for patients and staff exist. These managers have grown up in this culture and have been groomed in turn by these few Leads who should be nowhere near a mental health service to the extent that they think that it is OK to work in this way - hence the lack of someone stopping and saying - this is totally unacceptable - and you being told to get over it and get on.

I wish I could tell you to speak out but the sort of service you work in may punish you for it and try to make you believe it is your fault. They may try to make you believe that you are not managing when really what they are doing is the equivalent of sending you to do the work of a nurse after doing only first aid training or the work of an accountant after only doing a bookeeper course. Would you give up on the idea of nursing for instance because you'd been expected to work on a ward with only first aid training? Or would you find another way to learn about the profession and work to your training level?

Although even many trained PWPs eventually find themselves exploited and overwhelmed, they at least have had a grounding from the courses on what they are competent to do and what they are not, they have the courses to step in if the services try to make them run before they can crawl. You also have no professional body such at the BABCP or BPS to advise you - although you could contact them and ask for an opinion on your workload versus training and I presume they would take a very dim view of it.

You say you want advice. The only advice I can give is to look for another job, you can ask via occ health for reduced caseload, more supervision in order to keep you mentally well but unless there is a major change in managment culture where you are, it will likely not be forgotten that you "didn't cope". Although not coping is actually in my opinion showing insight into what is a dangerous and damaging working culture. I wish I could say that all of you being used in this way (are you mostly working at Band 4 also?) with no proper training should get together and demand you are properly trained and only allocated suitable cases, but this likely isn't realistic. Most will be trying to keep their head down and get the references they need to get on proper trainings, a few may be taken in and may want to rise in this culture that promotes people with so little experience and training. Mental health needs people who will stand up and say, this is not OK. Once you are settled in a better place with more training behind you then perhaps you can do this. For now if it was me, I'd try to get myself to a better place.

Stay well, take care - whatever you'd advise to a patient going through stress, do put it into practice yourself.
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Re: Struggling in IAPT service as untrained

Postby Spatch » Tue Nov 14, 2017 12:49 pm

This is why unions are so important.

Having seen some of this across multiple iapt services, i share LIWYs view completely. I am struck with how damaging this is on a systemic level because bad experiences with overworked undertrained services not only lead to immediate damage, but also put people off seeking help in the future. There are so many people who now dismiss the entirety of CBT because of inappropriately applied low intensity interventions, that it will ultimately undermine the profession at this rate.

There is much to be said for whistleblowing. It shows courage and strength and character . (It is awesome reflective material for future interviews but that's another story).
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Re: Struggling in IAPT service as untrained

Postby LIWY » Tue Nov 14, 2017 1:11 pm

Spatch wrote:
There are so many people who now dismiss the entirety of CBT because of inappropriately applied low intensity interventions, that it will ultimately undermine the profession at this rate
- Absolutely, it's also my experience that those who are thrown into low intensity work with no training are told to present this as CBT more than self-help support and again, without a course or trainer to let them know that there is a big difference, it's really very bad news for CBT, I'm suprised David Clark, Salkoviskis etc are not stepping up to speak out about this.

Spatch wrote:There is much to be said for whistleblowing. It shows courage and strength and character . (It is awesome reflective material for future interviews but that's another story).
- sadly even seasoned professionals can be destroyed by the fallout of whistleblowing, let alone someone early in their career quite isolated from other mental health professionals. Courage and strength of character don't pay the rent.
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