Why is it impossible for PWPs to progress into HIT??

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
Mya
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Why is it impossible for PWPs to progress into HIT??

Post by Mya » Mon Jun 25, 2012 5:04 pm

Hi everyone
Apologies if this question has already been answered... I have checked out the IAPT section of the forum to try to clearly answer my question but having no luck!
Why are a lot of people stating on the forum that PWPs can not progress further up the IAPT ladder? People have gone as far as to state that this is impossible?!
Just wondering where this info coming from? Apart from the obvious answer that there are more PWPs needed than HIT.. what other reasons are there that PWPs may not be able to train and work beyond the band 5 position? I thought all careers could lead to some form of progression, or this just me being naive? :oops:

M

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Peach
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Re: Why is it impossible for PWPs to progress into HIT??

Post by Peach » Mon Jun 25, 2012 5:21 pm

This thread pretty much covers it: viewtopic.php?f=27&t=12798
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Mya
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Re: Why is it impossible for PWPs to progress into HIT??

Post by Mya » Mon Jun 25, 2012 5:34 pm

ahh thanks for that :) could not find that in my search :oops:
M

LIWY
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Re: Why is it impossible for PWPs to progress into HIT??

Post by LIWY » Mon Jun 25, 2012 9:03 pm

I don't think we can say it is impossible, in my region it is certainly much much harder than it was in 2009 when a number of PWPs and GMHWs were accepted into high training. I don't know any PWPs who applied for this round of high training; I expect some did though. We can maybe put up a thread in a few weeks to see if anyone knows of PWPs who did get to interview for high?

As for career progression, the "ladder" is not meant to be low to high, a step 2 progression is envisaged, it just isn't happening much yet, although I have seen Band6 PWP posts advertised once in a while. Nothing above this band yet though that I'm aware of...

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Will
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Re: Why is it impossible for PWPs to progress into HIT??

Post by Will » Mon Jun 25, 2012 9:32 pm

It isn't impossible at all, and many HITs are former PWPs. There is guidance around how much experience a PWP should have before being considered for HIT, with many trusts now being quite strict about only short listing those with two or more years post qualification experience. Though it may have been introduced for the wrong reasons, I find it hard to argue with this really - low intensity work isn't CBT and it takes time to develop the skills required for HI training. Those PWPs who work well within their role, demonstrate enthusiasm for development and do well on applications / KSA and at interview will have a good chance of being selected - like anything they go on to apply for!
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Mya
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Re: Why is it impossible for PWPs to progress into HIT??

Post by Mya » Wed Jun 27, 2012 7:44 pm

Thanks for your replies Will & LIWY.
I've just been offered a PWP interview in a couple of weeks so I'm gona go for it and see what happens :)
IF I am successful and go onto do the PWP training I was wondering if 2 years as an assistant psychologist prior to PWP training would be viewed favourably if I decided to aim for HIT after PWP experience?
...Just me thinking of the future as always.. I really should try to use mindfulness more and just focus on Now :oops:
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baa
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Re: Why is it impossible for PWPs to progress into HIT??

Post by baa » Wed Jun 27, 2012 7:53 pm

I used my ap work in my ksa, and Mr Manager certainly liked that I worked in other areas of the nhs. So I definitely think it counts!
At least I'm not as mad as that one!

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Re: Why is it impossible for PWPs to progress into HIT??

Post by Clothilde » Thu Jul 12, 2012 4:55 pm

it definitely *isn't* impossible - all of the HI trainees that I have appointed into our service this year were previously PWPs. (though last year no PWPs even got through the shortlisting).

the things that stand out and make service leads take note are going above and beyond the usual scope of a PWP role, so other mental health experience, knowing what IAPT is, knowing about the different CBT models, showing that you might have developed and built on the PWP role with developing resources for the service, supervision of other PWPs, assisting step 3 therapists (in groups or with behavioural experiments).

LIWY
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Re: Why is it impossible for PWPs to progress into HIT??

Post by LIWY » Sun Jul 15, 2012 8:59 pm

Clothilde wrote:it definitely *isn't* impossible - all of the HI trainees that I have appointed into our service this year were previously PWPs. (though last year no PWPs even got through the shortlisting).

the things that stand out and make service leads take note are going above and beyond the usual scope of a PWP role, so other mental health experience, knowing what IAPT is, knowing about the different CBT models, showing that you might have developed and built on the PWP role with developing resources for the service, supervision of other PWPs, assisting step 3 therapists (in groups or with behavioural experiments).
Thank you for the feedback Clothilde, I know a lot of PWPs who did not apply this year after last year's knock back so, if more training is sponsored next year, some of us will probably think about applying. Quite a turn around from last year. Do you know what made the difference this year?

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Re: Why is it impossible for PWPs to progress into HIT??

Post by Clothilde » Mon Jul 16, 2012 3:12 pm

apparemtly last year there was a real lack of clinical psychology placements, so lots of people who would ordinarily have gone in that direction looked to IAPT instead.

In London, the universities are fairly rigid about enforcing the "2 years post pwp qualification" criteria too, which ruled out lots of last year's applicants.

Keyser_Soze
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Re: Why is it impossible for PWPs to progress into HIT??

Post by Keyser_Soze » Mon Jul 16, 2012 6:26 pm

Will wrote:It isn't impossible at all, and many HITs are former PWPs. There is guidance around how much experience a PWP should have before being considered for HIT, with many trusts now being quite strict about only short listing those with two or more years post qualification experience. Though it may have been introduced for the wrong reasons, I find it hard to argue with this really - low intensity work isn't CBT and it takes time to develop the skills required for HI training. Those PWPs who work well within their role, demonstrate enthusiasm for development and do well on applications / KSA and at interview will have a good chance of being selected - like anything they go on to apply for!
Hi all,

I've been reading through this forum and noticed something interesting in the above post which may be interesting to explore. It seems like a common belief (at least in my experience) that low intensity work is not CBT. I've heard people describing it as a CBT 'taster', 'CBT lite' or 'based on CBT principles'. I held this belief until I started my current role.

The idea of low intensity work not being 'proper CBT' is something I discussed with my supervisor (clinical psychologist and seasoned cognitive therapist), who made the following points:

- Low intensity work is a form of CBT.
- Low intensity work does not equate to lower quality or lower skill level of the practitioner (different - yes, but not lower).
- Assuming the above may create a scepticism around step 2 treatment which may lead to patients/service users being less engaged with the therapy as well as eliciting an apologetic tone from clinicians, which may impact on how well the treatment is delivered.

I'm still not quite sure where I stand. In a sense, I do believe that LI work is CBT, because there is considerable overlap between the interventions used and the skills needed to deliver them. I think the fact that PWP's can now become accredited with the BABCP adds weight to this. The crucial difference of course, is the extent to which a patient/service user is expected to 'go it alone' and this is where I see the notion of LI work being 'therapy', sliding away. Either way, I think some care does need to be taking in categorically stating that LI work is not CBT. I think this has the potential to create a negative attitude around the work which may lead both patients and professionals to think that it is a substandard service, which it isn't in my experience.

With regards to the OP, I think LI work will certainly give you relevant skills to progress to HI work, but from what I've heard I get the impression that there is a push to expand the LI services in order to prevent people migrating to HI work/clinical psychology (e.g. Band 6 senior PWP roles). On that note, it's likely that in the near future progression within the LI role may be easier than between roles.

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Will
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Re: Why is it impossible for PWPs to progress into HIT??

Post by Will » Mon Jul 16, 2012 9:16 pm

Keyser_Soze wrote:
Will wrote: - Low intensity work does not equate to lower quality or lower skill level of the practitioner (different - yes, but not lower).
- Assuming the above may create a scepticism around step 2 treatment which may lead to patients/service users being less engaged with the therapy as well as eliciting an apologetic tone from clinicians, which may impact on how well the treatment is delivered.
I absolutely agree with this. I think a lot of PWPs need to big themselves up a bit more!

The role of a PWP is very different to that of a HIT. They manage large caseloads, mostly independently. They are responsible for promotion of the service and liaison with GPs. It's also a challenge to assess, provide intervention and prep for discharge in such a time limited fashion - skills that are developed through good training and experience.
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Re: Why is it impossible for PWPs to progress into HIT??

Post by Keyser_Soze » Tue Jul 17, 2012 4:24 pm

Will wrote:
Keyser_Soze wrote:
Will wrote: - Low intensity work does not equate to lower quality or lower skill level of the practitioner (different - yes, but not lower).
- Assuming the above may create a scepticism around step 2 treatment which may lead to patients/service users being less engaged with the therapy as well as eliciting an apologetic tone from clinicians, which may impact on how well the treatment is delivered.
I absolutely agree with this. I think a lot of PWPs need to big themselves up a bit more!

The role of a PWP is very different to that of a HIT. They manage large caseloads, mostly independently. They are responsible for promotion of the service and liaison with GPs. It's also a challenge to assess, provide intervention and prep for discharge in such a time limited fashion - skills that are developed through good training and experience.
Certainly. PWP's do a very challenging job and it seems that services are getting more and more stretched. Whether it is cognitive behavioural therapy or not, is something I'd be interested to hear more about, maybe in a separate thread if there isn't already one?

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Will
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Re: Why is it impossible for PWPs to progress into HIT??

Post by Will » Tue Jul 17, 2012 5:14 pm

It's interventions based on the principles of cognitive behavioural therapy. It is different from CBT, but the skills are relevant and a good working knowledge of CBT theory is required.
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Keyser_Soze
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Re: Why is it impossible for PWPs to progress into HIT??

Post by Keyser_Soze » Wed Jul 18, 2012 9:38 pm

Will wrote:It's interventions based on the principles of cognitive behavioural therapy. It is different from CBT, but the skills are relevant and a good working knowledge of CBT theory is required.
I take your point Will, but don't completely agree with it. Could you give me a few examples of why it isn't CBT?

I've given this some thought and I'm of the opinion that low intensity and high intensity work are both forms of CBT. If you look at the published literature, there are some common features to most definitions of CBT. They include:

- An evidence based treatment.
- A logical, systematic approach used to help clients 'reality test' their thoughts.
- A way to monitor and record progress.
- An approach based on 'collaborative empiricism'
- A structured and time-limited approach.

Guided self-help and cognitive behavioural therapy do not diverge at all along these lines in my opinion. In a supermarket you can decide to go to a checkout that is staffed, or one of those 'self-service' machines. In the former, your groceries are scanned by the shopkeeper and in the latter you do it yourself. The point is, they are both still checkouts. One isn't intrinsically better or 'purer' just because it is in a different format.

I do agree with what you've said about GSH being different from other form of CBT. GSH is propelled by the client to a much greater extent, it is briefer and it is more prescriptive. However, this does not mean that PWP's don't need to build up therapeutic alliances, engage in guided discovery with their clients, formulate treatment plans or deliver interventions. At least in my service, this makes up the bread and butter of our clinical activity.

I think there is a subtle yet crucial distinction to be made at this point. For a PWP to call themselves a CBT therapist is not correct. In fact, it is not allowed under the BABCP's standards. However, this does not mean that the therapeutic content of sessions is not CBT, as you suggest. In other words, across the range of roles within the discipline, from LI workers, HI workers, clinical psychologists or pure CBT therapists, what changes is the extent to which these professionals can call themselves 'CBT therapists'. What remains constant however, is the intervention itself, the definition of which will remain the same regardless of whether it is therapist led, client led, delivered on a computer, a book, a podcast or a video. The active ingredients are the same.

This really is an interesting discussion point for me and I'm not trying to be antagonistic, but as I said in my last post, I think it can be misleading for patients and practitioners to say that PWP only 'borrows' from the CBT school of thought.

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