Feeding the Pigeons

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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myotai
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Joined: Sun Mar 14, 2010 12:23 pm

Feeding the Pigeons

Post by myotai » Tue Oct 04, 2016 9:01 am

Does anyone else experience this subtle attitude of keeping PWP's just outside the therapeutic club? I find it remarkable that we're referred to as PWP's and Hi-Intensity are called 'CBT Therapists'.

Huh?

I use Cognitive Restructuring, Disputation, Exposure therapy (to name a few). I treat people with moderate to severe depression, Health Anxiety, Chronic OCD and even took someone off the waiting list recently who is diagnosed with Schizoid Personality Disorder (and that is NOT unusual). I also know that this rare for experienced PWP's (Step two Therapists, Lo Intensity CBT therapists) in other services.

Come on, credit where credit is due!

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Pink
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Re: Feeding the Pigeons

Post by Pink » Tue Oct 04, 2016 10:26 am

Hey Myotai,

The term 'therapist' is not a protected title, so in theory you could call yourself that if you want to (although probably best to run past your service lead/consider the ethical issues). CBT Therapists are called that because their training has met the required standards for professional accreditation by the BABCP. They hold professional accountability for their practice, can work privately if they wish to, and can be struck off. I thought PWPs were also recognised to an extent by the BABCP, but I could be mistaken. My memory of IAPT back at the start in 2008 was that PWPs were called 'Lo Intensity' but that they complained that this sounded demeaning compared to Hi Intensity and so the title was changed to PWP.

It sounds as though you're speaking more about feeling undervalued for the work you do though, and you highlight the ongoing issue across IAPT services that PWPs are asked to work beyond their competency and training. I think it is really frustrating to be asked to hold difficult, challenging and often risky clients without having a deeper framework of knowledge, and frankly I take my hat off to many of the PWPs I've worked with who do the best they can to deliver an effective piece of work in time-limited and highly pressured circumstances.

I'm not sure how a different title would change this though? What would help you to feel validated and respected in your role? Are there service issues that are creating a 'therapeutic club'? (I wasn't sure what you meant by this?) It's horrible if you are feeling that there is a hierarchy at work that you are excluded from. It's a fair few years since I worked in IAPT, but the PWPs in our service were phenomenal and a really valued part of the team; many of them were very experienced in working with complexity having come from STR roles in CMHTs. I really respected their input and knowledge, and often 'stepped clients down' to them after a piece of therapy, because they would do such a good job of exposure work/pushing people to use the skills. They also added to my formulation, because spending the time with clients outside the therapy room allowed them to see aspects of the clients that I had not (how they were in the supermarket/in groups etc) which enriched and enhanced my work. I trusted their judgement, and valued their clinical intuition.

If you are happy to share it, it would be helpful to hear a bit more about what prompted your post. Maybe there are service issues that are arising that you can think through here and then address in supervision or line management? I wouldn't want colleagues on a lower banding to feel undervalued in the team I am working in, and it is sad to hear that you do. Is there anything we can do here that is helpful to you?


warm wishes

Pink
Kintsukuroi: 'to repair with gold'. the art of repairing pottery with gold or silver lacquer and understanding that the piece is more beautiful for having been broken.

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myotai
Posts: 36
Joined: Sun Mar 14, 2010 12:23 pm

Re: Feeding the Pigeons

Post by myotai » Tue Oct 04, 2016 11:40 am

Hi,

Thanks for such a comprehensive reply.

Though I have to say my sense of value comes from the results I see, my high recovery rates and the fact that....frankly... I am good at what I do.

The frustration you hear from my post is as a result of the PWP role being a cul-de-sac and that no matter how its dressed it is NOT valued in anything other than lip service.

For my part I am in the last year of studying for another qualification (in mental health) that will be my ticket out! After 8 years doing this (because I loed the work, NOT the job) I can't see it getting any better. PWP staff retention seems dire across the board with little notice taken to the adverse effects unreasonabley high caseloads are having on their own mental health. Its wholly unethical in my opinion.

If someone would listen instead of ignoring the facts we might avoid that embarrasing moment in the future when we look back and hang our heads in shame as to how PWP's are treated.

...you did ask! :)

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