Struggling in IAPT service as untrained

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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Struggling in IAPT service as untrained

Post by goldflakepaint » Tue Nov 14, 2017 12:09 am

Hi all,

Just wanted some advice- I have recently started a PWP job with one of the IAPT services that employ people who haven't done the PWP course. I had previously worked in mental health for a few years and had used a few of the more basic interventions (exposure, behavioural activation) with reasonable success, plus I had just finished a masters in psychology which went really well so was feeling pretty good about myself and I think that was reflected in my interview. I was offered a fixed-term post which I was really pleased about and was looking forward to all the clinical experience as my aim was to progress to clinical or counselling psychology doctorates.

So far so good. But after being there for a few months, I have become to feel very overwhelmed as (surprise surprise) I am working with patients who are far more complex than you would expect going by the IAPT model, presenting with everything except mild-moderate depression or anxiety. I was somewhat aware of this before I began as I did some research but perhaps wasn't completly prepared for the reality and thought that I'd be eased into the role a bit more considering that I'm not PWP trained. I am doing my best to read up on and learn the interventions and models that were unfamilar to me and there are decent levels of supervision and CPD here but the stress of trying to get up to speed is getting to me and honestly starting to affect my own well-being. A few other unforeseen issues at work have made things even harder and I am now very much considering quiting. Fundamentally, I do enjoy working with people psychologically but the level of pressure and lack of experience is really hindering that enjoyment and I'm starting to dread going into work each day. I have about half of my fixed-term left.

My thoughts about this is that maybe things would have been different if I had been able to do the PWP course first or even if I hadn't taken this job right after coming off a stressful masters. But at this point, although I really value the experience, I'm not sure if the stress is worth it. So I just wondered what others (especially people who are or have been in a similar position to me) thought, what they would do or any advice that they have. The saddest thing for me is that this whole thing is making me question whether psychology in general is really the right place for me.

I have spoken a little bit to my colleagues and my manager about this but mostly, they have just offered me reassurance and told me that they found it hard when they started. I'm pretty sure that they are not aware of the level at which it has been affecting me. Any thoughts?

Thanks for reading and sorry for the essay!

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Re: Struggling in IAPT service as untrained

Post by LIWY » Tue Nov 14, 2017 11:11 am

So sorry to read this is happening to you. This is not your fault! As you say yourself you are untrained and being given the workload that would likely be too advanced for a trained PWP, let alone someone who has had to rely on bits of in service CPD provided often by people who too lack formal training.

A few IAPT services have sunk to a new low in their desparate exploitation of willing people who want to work in psychology. There's a dreadful culture in a minority of services where this use of untrained workers at a lower band helps services to get the patients numbers through, they seem to care nothing of the burnout and destruction it reaps on people allocated work above their training level or the danger it poses to patients to be treated by people who have not been trained to do so. These services often grow their Step 2 managers out of this culture so these managers find it normal that this day to day level of stress and problems, even serious incidents, for patients and staff exist. These managers have grown up in this culture and have been groomed in turn by these few Leads who should be nowhere near a mental health service to the extent that they think that it is OK to work in this way - hence the lack of someone stopping and saying - this is totally unacceptable - and you being told to get over it and get on.

I wish I could tell you to speak out but the sort of service you work in may punish you for it and try to make you believe it is your fault. They may try to make you believe that you are not managing when really what they are doing is the equivalent of sending you to do the work of a nurse after doing only first aid training or the work of an accountant after only doing a bookeeper course. Would you give up on the idea of nursing for instance because you'd been expected to work on a ward with only first aid training? Or would you find another way to learn about the profession and work to your training level?

Although even many trained PWPs eventually find themselves exploited and overwhelmed, they at least have had a grounding from the courses on what they are competent to do and what they are not, they have the courses to step in if the services try to make them run before they can crawl. You also have no professional body such at the BABCP or BPS to advise you - although you could contact them and ask for an opinion on your workload versus training and I presume they would take a very dim view of it.

You say you want advice. The only advice I can give is to look for another job, you can ask via occ health for reduced caseload, more supervision in order to keep you mentally well but unless there is a major change in managment culture where you are, it will likely not be forgotten that you "didn't cope". Although not coping is actually in my opinion showing insight into what is a dangerous and damaging working culture. I wish I could say that all of you being used in this way (are you mostly working at Band 4 also?) with no proper training should get together and demand you are properly trained and only allocated suitable cases, but this likely isn't realistic. Most will be trying to keep their head down and get the references they need to get on proper trainings, a few may be taken in and may want to rise in this culture that promotes people with so little experience and training. Mental health needs people who will stand up and say, this is not OK. Once you are settled in a better place with more training behind you then perhaps you can do this. For now if it was me, I'd try to get myself to a better place.

Stay well, take care - whatever you'd advise to a patient going through stress, do put it into practice yourself.

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Re: Struggling in IAPT service as untrained

Post by Spatch » Tue Nov 14, 2017 12:49 pm

This is why unions are so important.

Having seen some of this across multiple iapt services, i share LIWYs view completely. I am struck with how damaging this is on a systemic level because bad experiences with overworked undertrained services not only lead to immediate damage, but also put people off seeking help in the future. There are so many people who now dismiss the entirety of CBT because of inappropriately applied low intensity interventions, that it will ultimately undermine the profession at this rate.

There is much to be said for whistleblowing. It shows courage and strength and character . (It is awesome reflective material for future interviews but that's another story).
Shameless plug alert:

Irrelevant Experience: The Secret Diary of an Assistant Psychologist is available at Amazon ... 00EQFE5JW/

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Re: Struggling in IAPT service as untrained

Post by LIWY » Tue Nov 14, 2017 1:11 pm

Spatch wrote:
There are so many people who now dismiss the entirety of CBT because of inappropriately applied low intensity interventions, that it will ultimately undermine the profession at this rate
- Absolutely, it's also my experience that those who are thrown into low intensity work with no training are told to present this as CBT more than self-help support and again, without a course or trainer to let them know that there is a big difference, it's really very bad news for CBT, I'm suprised David Clark, Salkoviskis etc are not stepping up to speak out about this.
Spatch wrote:There is much to be said for whistleblowing. It shows courage and strength and character . (It is awesome reflective material for future interviews but that's another story).
- sadly even seasoned professionals can be destroyed by the fallout of whistleblowing, let alone someone early in their career quite isolated from other mental health professionals. Courage and strength of character don't pay the rent.

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Re: Struggling in IAPT service as untrained

Post by goldflakepaint » Tue Nov 21, 2017 1:30 am

Thanks for your replies LIWY and Spatch and sorry for not replying sooner- stress coupled with a bad cold!

You have both made some good points, articulating better than I could the source of some of my discomfort with the job. I think I was internalising it all a lot, assuming that it was about me and my lack of ability/experience rather than how the service has been set up and what seems to be expected with minimal training or even much of an induction period.

To be clear and fair to the service I work in, I should say that they do offer places on the training course although this requires that you have a permanant full-time post; as I am fixed-term, I am not currently eligible. A number of my colleagues (we're all band 4) started in the service untrained, then did the course, and now appear to be confident and experienced practitioners who are happy in the job. So for better or worse, I guess the approach that the service has taken has worked for some (obviously, I don't know how many people have not done so well and left but suspect there were a few of those). That has made it much harder for me to speak out about my own struggles let alone speak out against the service in general as it does appear that I am the one with the problem, who is 'not coping' rather than my colleagues who appear to be thriving.

That said, I have come to the conclusion that, for me, if I am going to introduce myself as 'trained to treat common mental health problems', I need that to actually be true and CPD and supervision doesn't really cut it. I certainly do not want to contribute to anybody having a poor experience of CBT therapy due to my lack of training. I think I have been lucky so far in my 1:1 work in managing some of the complexities (I do have a good supervisor, colleagues have offered good guidance and I have always represented the sessions as guided self-help) but being able to develop a therapeutic alliance and decent communication skills only go so far and I don't know how much longer I can be cramming in all the additional learning of interventions and models without it further impacting my stress levels! I appreciate that we all have to learn on the job but if I had had the opportunity to build up the more basic stuff on the course, I think this would have felt more managable.

So I will be asking my manager if I can bring forward my end date so that I can move on in a way that doesn't cause them too many problems. I have already spoken to her about the fact that I was thinking about leaving and she was very nice but what she was offering in terms of support seemed more like a sticking plaster than addressing the fundamental issue. I should say that I have largely explained my wish to leave in more general terms that have nothing to do with the service per se (i.e. missing secondary care, struggling with the commute, needing a permanant job) which might be a little cowardly but I can't really afford to burn my bridges with her as I could do with a reference that says something more positive than 'couldn't cope'.

A difficult experience but thank you both for providing me with your really useful perspective on this. I particuarly appreciated the nursing analogy LIWY and it helped me with not writing off a career in psychology all together. Part of me is of course concerned about giving up the amount of clinical experience this job has given me but I hope to find a way to acheive this in a job where I am also appropriately trained!

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Re: Struggling in IAPT service as untrained

Post by myotai » Thu Nov 30, 2017 4:22 pm


....and leave ASAP.

Contrary to the party line being towed religiously - the job is a dead end. Its simply not as advertised - effectively a con.

Those aspiring to the 'role' need to find a way to discuss this with existing PWP's. Get it from the horses mouth and see what comes of that particular conversation.

There is NO consideration for you as an individual, you're merely a VERY small cog in a massive machine that is designed to do nothing more than to satisfy the pre-defined KPI's and expectations of those who labour under the illusion that the PWP role is the same as that which is 'taught' at Universities (those particular institutions are another story altogether)!

Those KPI's and expectations will be met by hook or by can bet on that!!!

You will leave at some point - NOT because you move on to bigger and better things - but because the role becomes untenable and you will be gagging to leave.

These are the facts....not the PR stuff!

Good luck.

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Re: Struggling in IAPT service as untrained

Post by maven » Tue Dec 05, 2017 4:24 am

myotai wrote:These are the facts....not the PR stuff!
No, these are your opinions, and other people's experiences might be entirely different. So please remember that when posting, and refrain from being defamatory about specific courses or employers, or entire career branches on the forum. Please cease stating that your personal subjective perspective is the reality/truth/facts, when others are clearly stating that your experience is not representative.

Wise men talk because they have something to say, fools because they have to say something - Plato
The fool thinks himself to be wise, but the wise man knows himself to be a fool - Shakespeare

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Re: Struggling in IAPT service as untrained

Post by theballboy » Tue Apr 10, 2018 11:44 am

Wow, some food for thought here with regard to experiences surrounding pwp jobs. currently in Northern Ireland there is no real evidence of pwp jobs (as we are always lagging behind). I've been considering training in this area but I will have to digest and consider the experiences in this thread in the context of pursuing this training

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