• Professional Development Implications for Counsellors Who Have Worked in The English Improving Access to Psychological Therapies (IAPT) Programme

      Reeves, Andrew; Gubi, Peter; Mason, Richard (University of Chester, 2020-12)
      Background: Prior to the implementation of the IAPT programme by NHS England in 2008, counsellors were commonly employed to deliver psychological therapy in English NHS Primary Care Mental Health (PCMH) services. Pre-IAPT, professional development for PCMH practitioners, like the therapeutic approaches they offered, was non-standardised. Post-IAPT, PCMH provision became standardised, utilising manualised therapies alongside a commitment to outcome data completion. IAPT operates a highly structured approach to PCMH provision, arguably a treatment paradigm, in which ontological and epistemological entities are controlled. The model allows minimal flexibility in relation to what should, and how it should be treated; what data should, and how it should be gathered, and how outcomes should be interpreted. Clinical Commissioning Groups, contract to deliver IAPT services to any qualified providers, using IAPT data to determine performance. Arguably, IAPT has franchised PCMH in England. Professional development of IAPT practitioners is confined to training that supports the delivery of its aims. Consequently, service investment in training is focussed towards NICE approved approaches that are considered to be evidence-based. These approaches are epistemologically nomothetic, creating ideological challenges to counsellors who are epistemologically idiographic. This incommensurability between the IAPT treatment paradigm and counsellors, can affect professional development. Objectives: This research focusses on implications for professional development of counsellors who have worked in IAPT. Conducted amongst ex-IAPT counsellors, to explore: the degree to which counsellors engage in IAPT professional development opportunities; how facilitative IAPT service is to professional development; how counsellors conceptualise and respond to those professional development opportunities. Method: Semi-structured interviews of eight participants who had worked in different IAPT services across England were completed and analysed utilising an Applied Thematic Analysis. Findings: Three themes were identified, exposing many implications for counsellor professional development, influenced by: the IAPT Business and Clinical Models, and Participants Responses to those influences, reflecting both external and internal ideological challenges towards professional development. Conclusions: Ideological incommensurability, can result in both positive and negative professional development outcomes. Business and clinical models contributed to the struggle to identify, secure, or adapt to formal opportunities that are ideologically incompatible. However, participants capitalised on informal professional development opportunities. Exposure to the IAPT program, and the working environment of primary care mental health, enhanced knowledge and experience, administrative competence, and provided valuable exposure to wide-ranging variety of type and complexity in clinical presentation. This was identified as contributing to the development of a notable level of pluralistic practices. Participants did not disclose planned professional development strategies (appearing to respond intuitively to opportunity), suggesting that professional development was lacking intent. Therefore, counsellors are encouraged to reflect upon the type of psychological therapist they wish to become; contemplate the benefit of a structured professional development plan to achieve that aim; recognise the rich potential IAPT offers, and consider how IAPT might contribute to their professional development.