IAPT Service

By Dr Gemma Applegarth

Gaining the prized title of Counselling Psychologist has been a long and emotional journey. Hours of study, endless case reports and a research project which I poured my heart into have left me with a sense of pride. Equally important, it has served me well for my chosen career in a busy primary care mental health service. I spend my days within the local Improving Access to Psychological Therapies (IAPT) service. Over the last few years these vital services have received an increase in funding with the intention of allowing individuals to easily access evidence based therapies. The increase in resources has meant I am one of many counselling psychologists, mental health nurses, clinical psychologists and cognitive behavioural therapy (CBT) practitioners working together to help those with anxiety or depressive disorders.

My diary involves a mixture of screening assessments, individual therapy sessions, conducting therapeutic groups, liaising with GPs and of course a fair amount of electronic paperwork. It can be a lonely job as I spend four out of five days in a clinic and just one day a week in the main office for supervision, team meetings and training.

My therapeutic clinic is located within a local GP surgery and will usually involve seeing five or six clients in a day. Typically clients are experiencing symptoms of depression or an anxiety disorder including obsessive compulsive disorder, generalised anxiety, body dysmorphic symptoms and post-traumatic stress disorder. My work begins with an assessment of their needs and the development of a strong therapeutic relationship. Sometimes this can take a while as clients are often nervous and apprehensive of therapy. In time we are able to work collaboratively on understanding the clients concerns. I will then deliver an individualised treatment plan based on cognitive behavioural therapy protocols.

Typically I will work with an individual for anywhere between six and twenty sessions depending on their needs and complexity. The setup of IAPT services is a stepped care model in which individuals enter the service at a lower level and work their way up. In practice what this means is that following their screening assessment many people will work with some form of self-help material guided by a practitioner. Following this, individuals requiring further support will enter the next level, which involves a one-to-one therapy episode with me. During this time I will endeavour to understand the person, help them to make sense of their experience and introduce them to practical coping strategies. We work together to help them find where their difficulties stem from, to locate their concerns in the present and help them challenge the thoughts or behaviours which maintain their difficulties. This is something that is unique to the person and requires a mix of psychological knowledge and the individual’s personal experiences. Often this treatment phase will focus on weakening core beliefs by getting them to test out these beliefs both in and out of the therapy room. Treatment is a personal and active experience in which the client takes part in the sessions and tries out ideas in between seeing me. Following a successful period of therapy I will help them to create a plan, focused on how they can continue to increase their wellbeing.

As I work with evidence based therapy it is vitally important that I continue to read, listen and develop my skills and knowledge, resulting in an endless learning curve. An important aspect of my job involves learning from other colleagues, this happens in the form of colleague-delivered training, regular skills meetings and group supervision. During these moments the variety of practitioner training backgrounds often plays a role in how we see therapeutic work. The differences between our therapeutic lenses allow an opportunity for both skills development and personal growth.

My identity as a counselling psychologist is one that is uniquely valued by both me and my service. The role allows me to make use of the training acquired while working towards my psychologist status. I have the opportunity to develop assessment skills, therapeutic skills and there are endless opportunities to get involved with trials and research. The service will regularly conduct projects aimed at testing out the service’s effectiveness on particular groups of clients including older adults, those on benefits and individuals with long term physical health conditions or unexplained medical conditions. These projects will require the personal skills of working within a multi-disciplinary team, specialising in particular areas and organising the practical elements and training.

The role of a counselling psychologist in an IAPT setting is varied and challenging. Its main function is to provide assessments and evidence based treatments for common mental health concerns. This can be exhausting due to the high numbers of people seeking therapeutic support and can be frustrating at times when resources are limited. However, the role offers an opportunity to work closely with individuals, to develop relationships with the clients that help them heal and to watch them grow. I have lost count of the number of times I have been overwhelmed by the progress of motivated and courageous clients. I regularly feel incredibly blessed to be able to join them on their journey. Ultimately it is a role which develops and embodies the most unique elements of being a counselling psychologist, especially the core skill of developing a therapeutic relationship and being at the forefront of applied research.