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

Post by Will » Wed Jul 18, 2012 10:36 pm

Keyser_Soze wrote:
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.
I agree with everything you say - especially about the skills required at step two, and low or high being considered better or worse than the other. I hate that! I've worked at step two for a long time and you'll never find anyone more willing than me to advocate for it! I think step two work has many challenges and the points you mention are really relevant - I think often PWPs underestimate the skills they use and see high intensity work as some mythical wondrous intervention.

However your initial point - that low and high intensity are 'CBT' - is what I disagree with. To return to your supermarket analogy, yes, both are checkouts. However, they are not the same. The 'intervention' being offered to customers is different.

If you look at protocols for high intensity CBT - or even read CBT manuals - they involve detailed guidance of what CBT involves. It's very different from 6 sessions of guided self help. CBT therapists receive training which is more intensive, covers a greater range of interventions in more detail and involves use of specific protocols. The longer sessions are delivered over a longer period of time, allowing for greater exploration of more in-depth and long term beliefs. That's how CBT has been designed and modified over the years into the intervention it is today.

To use one of your own points against you :D if GSH isn't CBT, why aren't we able to call PWPs CBT therapists? By that same theory, why isn't anyone who reads a book on CBT then a CBT therapist? The level of intensity is absolutely integral to the definition.

I absolutely think it's vital we are clear to patients and practitioners about what PWPs offer - for me, stating that we deliver guided self-help interventions based on CBT is a clear and concise summary of the work done at step two. It makes clear that the work is based on a set of principles (and therefore different to support, counselling etc.) but also allows the patient a good understanding of what can be offered within a CBT intervention at step three. I think stating that PWPs offer "CBT" causes confusion and is totally at odds with how the NHS, BABCP and NICE guidance would define step two work.
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Re: Why is it impossible for PWPs to progress into HIT??

Post by Keyser_Soze » Wed Jul 18, 2012 11:06 pm

I think we'll have to agree to disagree here... ;)

Whoever is correct, I think it's too early to tell. Once IAPT matures as a service we'll have our answer!

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

Post by LIWY » Fri Sep 07, 2012 8:54 pm

Several PWPs are leaving my service over the next few weeks having been successful with a high application so I think it is safe to say that, this year, it is not impossible (they are all 2 years or more post Cert, 3 years or more in post).

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

Post by Somni451 » Thu Mar 28, 2013 4:16 pm

I can confirm my appointment to the PWP Trainee role was to fill a post vacated by a qualified PWP moving into HI training.

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

Post by JPinkman » Sun Sep 01, 2013 9:08 pm


I just wanted to add that I have followed the route of PWP to high intensity therapist and I know quite a few colleagues who took the same route over the past couple of years. So don't lose hope if this is what you would like to pursue as I think many courses and trusts consider PWPs to be very well placed for HIT posts.


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