Counselling Skills Level ThreeUnit Two

Issues and Challenges for Counselling in Britain Today

You will be invited to:• Check-in• Share your reading/research on IAPT – answering key

questions• Evaluate IAPT – considering successes and concerns• Explore the key features of the medical and non-medical

models in counselling by taking part in small group exercise.

• Discuss the advantages and disadvantages of diagnosis – a feature of the medical model

• Watch and discuss a short dvd on depression in Blackpool.

• Practise Listening Skills in three’s.

Check-in

• Take five minutes to appreciate:• How you are right now.• Your head…• Your heart…• Your body…• Your spirit.

• If you wish, you may share your check-in with the group.

IAPT FeedbackUsing books, articles and the internet, find out

information about the following questions:• What are the main aims of the IAPT programme?• How has IAPT evolved since it was introduced?• How is it delivered in the NHS (find an example)?• What are the NICE (National Institute for Clinical

Excellence) guidelines on the use of psychological therapies for ‘treating’ depression and anxiety?

• How does counselling fit into the IAPT programme?• Agree as a group how you will go about summarising

and sharing this information

IAPT – successes …

• By 31 March 2011:• 142 of the 151 Primary Care Trusts in England have a

service from this programme in at least part of their area and just over 50 per cent of the adult population has access

• 3,660 new cognitive behavioural therapy workers have been trained

• Over 600,000 people started treatment, over 350,000 completed it, over 120,000 moved to recovery and over 23,000 came off sick pay or benefits between October 2008 and 31 March 2011(latest figures available)

• http://www.iapt.nhs.uk/about-iapt

… and concerns

• IAPT favours Cognitive Behavioural Therapies at the expense of other counselling approaches

• Not all patient/client groups can benefit from CBT’s• Research shows that other therapies are at least as

effective as CBT’s• Patient/client choice is increasingly limited.• The provision/success of IAPT is patchy – a post code

lottery?• Both IAPT and the NHS favour the Medical Model – not all

counsellors and clients/patients are comfortable with this. Many people believe that, fundamentally, it is not the right way to think about or address human distress.

N.B. The BACP website includes articles and arguments for and against IAPT. Also, you may wish to read the handout on research methods in counselling.

A positive future for IAPT?

• “From 2011 (IAPT’s) focus has broadened, following publication of ‘Talking Therapies’: a four year plan of Action, one of a suite of documents supporting ‘No health without mental health’, the cross government mental health strategy for people of all ages”

• IAPT website: hppt://www.iapt.nhs.uk/ accessed 20/11/11

A positive message for counsellors?

“At the time of writing (published summer 2011) IAPT is dominated by Cognitive Behavioural Therapies, but more evidence from RCT’s (randomized control trials) and other sources demonstrates that other approaches are equally effective.”

From Pete Sanders (2011) First Steps in Counselling

p169

Also, see handout on research in counselling.

The medical model

Features of a medical model:

• Diagnosis of distress as ‘mental illness’, e.g. Depression, anxiety, panic disorder

• Focus on symptoms and diagnosis• Idea of ‘normality’ versus ‘abnormality’• Focus on ‘treatment’• Use of drug treatments

The case against the medical model

• Some cultures have no word for ‘depression’• Depression is not always easily distinguishable

from normality• Ignores social factors – other causes of misery,

worry, loneliness, poverty etc. • Diagnosis is not always welcome or helpful.

An alternative view of depression

“The capacity to become depressed, to have a reactive depression, to mourn loss, is something that is not inborn nor is it an illness, it comes as an achievement of healthy emotional growth.....the fact is that life itself is difficult...probably the greatest suffering in the human world is the suffering of normal or healthy or mature persons – this is not generally recognised.”

Winnicott, 1988 cited in Barker, Vossler and Langdridge (eds.) (2010) Understanding Counselling and Psychotherapy London: Sage Publications

Discuss in small groups

• What might be the advantages and disadvantages of a diagnosis such as depression or anxiety?

Depression in Blackpool

• Watch a short DVD clip. • Identify and discuss the key issues • Relate findings to the requirements of the second assignment. How

does counselling fit into the big picture?

Homework: Read/research government research on well-being and Happiness – using MOODLE and/internet and handouts provided. You may also wish to consider Carl Rogers ideas about The Fully Functioning Person” – a person-centred view of well-being. (Chapter provided).

You may also wish to consider the experience of IAPT in another part of the country. The borough of Ealing is a great example of a positive response to the needs of a specific community using IAPT funding. It’s not all bad news.

Listening Skills Practise

• Practise Listening Skills in three’s• Listen carefully for ten minutes• Agree the boundaries (time, confidentiality)• Focus on the speaker and their experience• Reflect back content and feelings• Evaluate the listening (first the listener, then the

observer, then the speaker)

Have a good half term.

• In the next session we will:• Explore Counselling and the law focussing on

Duty of Care and the Equality Act• Prepare questions for our visiting speaker