There has been much attention paid in recent months to the IAPT training programme for cognitive behavioural therapists, and its potential impact on the counselling profession. Many counsellors and psychotherapists feel concerned that our work may be squeezed out as primary care is putting a strong emphasis on CBT, in response to NICE guidelines, for treating various mental health difficulties. This letter is for those of you who may be considering applying to join the Improving Access to Psychological Therapies (IAPT) workforce. 

I completed my counselling training in 1997 and was accredited by BACP in 2003. I’ve been fortunate to find paid work in the NHS over the past 10 years, but in October 2008 I took a leap of faith and joined IAPT. I approached it with trepidation, as I knew very little about CBT, but an overriding concern was survival and job security, and this seemed a sensible, reliable career direction.

The IAPT programme is a huge project, and I have no doubt it has suffered, and will continue to encounter, many hiccups and growing pains as it attempts to meet ambitious treatment targets, upon which it relies for future funding. For me as a practitioner, it has been a real adventure, and I would recommend it to therapists who are interested in different ways of working and who are academically motivated.  

For the first year, the High Intensity CBT trainees attend university two days per week and work clinically for three. From the beginning, you are paid a full-time NHS Band 6 salary despite being enrolled on a post-graduate diploma, and having 40 per cent of your week devoted to learning and training – quite a luxury for counsellors used to seeing the money for training flowing in the other direction.

Our diploma course is divided into three modules; in the autumn we studied CBT history and basic methods. In the second term we studied CBT for anxiety, and the third term is devoted to CBT for depression. The training is very comprehensive and in-depth and some of our guest lecturers are international figures in the field.

One thing integrative and person-centred counsellors might shy away from is a slight ‘medical model’ orientation. Clients are sometimes referred to as patients, they are required to fill in brief measures of depression (PHQ-9) and anxiety (GAD-7) at each session, DSM-4R diagnoses are discussed in supervision groups, and the student is expected to implement ‘disorder-specific treatment protocols’ – obviously not the kind of language many of us normally use.

An interesting flipside of that, however, is that if a client were referred to me with something I might previously have found baffling or de-skilling, such as post-traumatic stress, major depression, hypochondriasis or obsessive compulsive disorder, in IAPT there is a system in place to support the student through the therapeutic process, through in-depth supervision and specific evidence based interventions.

The clinical side of the work is undeniably interesting, and for counsellors who like to stay busy and engaged with a number of clients suffering from a variety of problems, IAPT provides the caseload as well as paying you to do the work.
I would describe the academic side as not for the faint hearted: there are academic essays, detailed case studies, and rigorously scrutinised therapy tapes that must all pass in order for the trainee to be assured of a permanent NHS contract as a CBT therapist. Academic standards are high; there is a scientific as well as a humane ethos: it is expected that the CBT trainee read widely and in depth on the current debates and developments in the field, and clinical competencies are formally measured.

It is also a unique way to network with other helping professionals. Nineteen of the 25 students in my training group work on the same clinical site, and there is pleasure and support when course peers are also work colleagues, and all are in the same boat, on a steep learning curve. We have many psychiatric nurses, but also mental health workers, occupational therapists, counsellors and psychologists, and the skills mix and collegiality are a real strength of the programme.

In summary, it is my feeling that some readers of Therapy Today might find joining IAPT a truly interesting and rewarding experience. Particularly for accredited counsellors with some interest in CBT, it might represent a very good opportunity to join the NHS and move into an expanding and exciting branch of the practice of psychological therapy.