Half of 10,000
new therapists should be clinical psychologists
By Angela Hussain
of a possible 10,000 new NHS psychological therapists to treat depressed
people should be clinical psychologists, according to an influential
government last month took its first step on realising a plan for
the NHS to employ more counsellors and therapists by launching two
pilot cognitive behavioural therapy (CBT) centres for people with
depression and anxiety in Doncaster, Yorkshire, and Newham, London.
economist Lord Richard Layard, credited with providing the idea
behind the initiative, is the lead author of a new report on depression
which states that 5,000 extra clinical psychologist could be brought
into the NHS if the current intake of 550 yearly trainees was expanded
temporarily to 800. Other psychologists could be recruited from
outside the NHS.
5,000 therapists could be trained from among the 60,000 nurses,
social workers, occupational therapists and counsellors already
working in the NHS, recommended Lord Layard and co-authors in the
London School of Economics (LSE) report.
If the pilot therapy centres are effective, similar centres will
be rolled out to the rest of the country, the government has promised.
the British Psychological Society, which accredits clinical psychologist
training courses, last month complained that funding for clinical
psychologist training in England and Wales has been slashed by 20
LSE report - entitled Depression Report - A New Deal for Depression
and Anxiety Disorders - was last week backed by four of the UK’s
most influential mental health charities - Mind, Rethink, The Mental
Health Foundation and the Sainsbury Centre for Mental Health.
want to see the government invest massively in psychological therapies
for people diagnosed with not only depression and anxiety, but also
2004 the National Institute for Clinical Excellence (NICE) advised
that people with mild to moderate depression or anxiety can benefit
more from counseling of psychotherapy than medication. NICE recommended
in 2002 that psychological therapies, particularly CBT, should be
available for people diagnosed with schizophrenia. Usually, however,
such an option is not available, and waiting lists can be years.
a joint statement, the chief executives of the four charities said:
“We call upon the NHS to implement NICE guidance on mental
health and to invest urgently in sufficient capacity to offer people
the treatment they need in a timely manner and to high quality standards.”
government's eagerness to follow Lord Layard's advice is largely
driven by a desire to slash incapacity benefit payments by finding
ways for the 1.3 million people with a mental health problem who
claim such benefits to return to work.
report, compiled by LSE's mental health policy group headed by Lord
Layard, states that there should be 250 new psychological therapy
centres in England, each serving a population of 20,000 by 2013.
course of therapy costing £750 would pay for for itself in
the reduced expenditure on incapacity benefits from people being
able to go back to work, said the report.
Depression Report, by the London
School of Economics' mental health policy group (pdf)
May 11, 2006:
Government takes first step to bring in thousands more counsellors
and therapists into health service - Patricia Hewitt (left)
announces launch of two pilot cognitive behaviour therapy centres
in Doncaster and London
Oct 11, 2005:
Family fortunes - If a West Midlands family therapy programme
is as good as it claims in reducing"relapse" rates for
family members diagnosed with a mental illness why has it not been
rolled out to the rest of the country?
psychologists - expensive and no more effective
Serieys, CBT therapist, GP practice
June 27, 2006
Could someone please explain why 50% of the proposed 10,000 new
therapists should be clinical psychologists?
They are the most expensive therapists and, as I understand it,
there is no evidence that they are more effective than CBT therapists
who are counsellors, nurses, occupational therapists or, indeed,
from any other discipline.
Surely it would be more sensible and cost effective to recruit or
train appropriately experienced personnel regardless of professional
The British Association for Behavioural and Cognitive Psychotherapies
is currently piloting the registration of trained CBT therapists
who are not nurses, counsellors, OTs, or indeed psychologists.
It is to be expected that they will be just as effective therapists
as those who are psychologists, counsellors or from other health
professions. Surely these therapists should also be incorporated
into these new proposals?
ill' don't need therapists...do they?
Barker, professor of health sciences, Trinity College, Dublin, Ireland
June 27, 2006
There is no doubt that a radically different 'solution' is needed
for the overwhelming (economically) problem of people who are unable
to deal with 'life and its constant travails' - commonly referred
to as 'mental illness'. Drugs,
clearly, do not 'work'. So, it seems reasonable to look for some
alternative. CBT - which has no specific meaning, but means virtually
anything to anyone with a 'psychological' bent - is the flavour
of the day. Lord Layard has bought this particular ice cream and
now, no doubt courtesy of tea at Chequers, has issued an 'authoritative
set of recommendations'.
have spent more than 30 years working in close proximity to clinical
psychologists. I have also been a psychiatric nurse for almost 40
years and, I fear, that clinical psychology would struggle to find
adequate numbers within its ranks to fulfil Layard's ambitions,
such is their dependent relationship to medicine and bioscience.
who find the going is 'getting tough' need the counsel of people
who have experienced similarly difficult terrain. What they don't
need is 'advisers', far less 'therapists'.
Is it too much to ask that even a handful of psychminded's tens
of thousands of visitors might give some thought to 'what is actually
needed', as opposed to what some government lackey insider views
as politically expedient?
Jane Leary, NHS psychotherapist
April 29, 2008
completely agree with Prof Barker. I have worked with emotionally
troubled individuals in the NHS for many years and Layard's recommendations
and the ensuing tidal wave of funds now being given for the training
and employment of CBT-ists and clinical psychologists is nothing
short of a national scandal.
Clearly, Layard - an economist - has opened up a gold mine for these
two groups of elites under a facade of egalitarian concern that
is paper-thin at best. The real concern is, of course, money and
NHS is well on its way towards the back-door privatisation that
many NHS employees and patients fear. CBT and clinical psychology
are - as Prof Barker states - 'virtually anything to anyone'. Meaning,
they can masquerade as any 'flavour of the month' under a veneer
of scientific credence wholly undeserved of either. Neither reference
nor credit their sources, plaigerising everything from Gestalt methods
to Buddhist meditation. Today it is CBT, tomorrow it will be some
other money-saving series of techniques which further devalue the
content of our patients' experiences, whilst bolstering the vanity
needs of many psychologists and psychological 'therapists'.
personally work as a non-psychologist psychotherapist taking an
anti-establishment, non-psychological model perspective. I entered
the profession as a mental health survivor myself, having been sickened
by the shocking dearth of understanding and compassion within psychology.
Consequently I avoid the self-aggrandisement so common to the psychology
People with mental or emotional troubles should not be made the
scapegoats and exploitees of those elites in government and the
NHS who merely serve their own egos rather than the real needs of
suffering persons we call 'patients'. These people need to be cared
for, respected and valued, not railroaded into compliance with models
of 'normality' handed down by psychologists and cognitive behavioural
psychologists offer flexibility
Jeremy Halstead, lead consultant clinical psychologist, South West
Yorkshire Mental Health NHS Trust
November 28, 2008
reference to Jane Leary's comment, my experience is rather more
positive. The allocation of extra money for psychological therapists
is surely to be welcomed. It is part of a recognition that psychological
therapies are an important - perhaps the important treatment approach.
This is a contrast to years where the assumption has been that the
first approach should be pharmacological.
I have a lot of sympathy with the concern that is expressed about
the overemphasis on CBT. The stated reasons tend to be around "evidence
base" and these can be, and are, over stated. I suspect that
the relative ease of training and turning out new CBT therapists
and the face validity of CBT with non-therapists are as important
as effectiveness as such.
As might be expected, I am less happy with the attacks on clinical
psychologists. Clinical psychologists can be viewed as expensive
when compared with therapists with other professional backgrounds,
but they often offer a good deal as therapists because they are
more flexible in approach and able to formulate problems from a
number of perspectives.
A large proportion of clinical psychologists move on from the one
or two therapy competenceis they have at qualification to adopt
a more integrative approach. My view is that therapists from a wide
variety of backgrounds have a lot to offer and we can all learn
from eachother. Current changes represent a great opportunity. No
doubt mistakes will be made but overall we should be in a position
to learn from these too. The important thing will be that some good
research is undertaken over this time of change.
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