Tag: Psychologist

What is Improving Access to Psychological Therapies?

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Introduction

Improving Access to Psychological Therapies (IAPT) is a National Health Service (England) initiative to provide more psychotherapy to the general population.

It was developed and introduced by the Labour Party as a result of economic evaluations by Professor Lord Richard Layard, based on new therapy guidelines from the National Institute for Health and Care Excellence as promoted by clinical psychologist David M. Clark.

Brief History

Richard Layard, a labour economist at the London School of Economics, had become influential in New Labour party politics and was appointed to the House of Lords in 2000. He had a particular interest in the happiness of populations and mental health; his father, John Layard, was an anthropologist who had survived suicidal depression and retrained as a Jungian psychologist after undergoing psychoanalysis by Carl Jung. In 2003 Richard Layard met the clinical psychologist David M. Clark, a leading figure in Cognitive Behavioural Therapy who was running the Centre for Anxiety Disorders and Trauma (with Anke Ehlers and Paul Salkovskis) at the Institute of Psychiatry and Maudsley Hospital. Clark professed to high rates of improvement from CBT but low availability of the therapy despite NICE guidelines now recommending it for several mental disorders.

Layard, with Clark’s help, set about campaigning for a new national service for NICE-recommended treatments, particularly CBT. One key argument was that it would be cost-effective and indeed eventually pay for itself by increasing productivity and reducing state benefits such as Disability Living Allowance and Incapacity Benefit (which had seen rising claims since their introduction by John Major’s Conservative Party in 1992 and 1995 respectively). The plan was accepted in principle by the newly re-elected Labour government in 2005 and gradually put into practice directed by Clark. Layard names several others as having helped gain the initial political traction for the initiative – MP Ed Miliband, psychiatrist Louis Appleby (then National Director for Mental Health), David Halpern (psychologist), psychiatrist David Nutt, MP Alan Milburn (married to a psychiatrist) and eventually the Prime Minister Gordon Brown.

In 2006 the Mental Health Policy Group at the LSE published ‘The Depression Report’, commonly referred to as the Layard Report, advocating for the expansion of psychotherapy on the NHS. This facilitated the development of IAPT initiatives, including two demonstration sites (pilot studies) and then training schemes for new types of psychological practitioner. The programme was officially announced in 2007 on World Mental Health Day. Some mental health professionals cast doubt on the claims early on. In the official publication of the British Psychological Society in 2009, experienced clinical psychologists John Marzillier and Professor John Hall strongly criticised IAPT’s promoters for glossing over both the data gaps acknowledged in the NICE reports and the complexity of the multiple issues typically affecting people with mental health problems and their ability to sustain employment; they were met with much agreement as well as angry criticism. One researcher cited the UK initiative as the most impressive plan to disseminate stepped-care cognitive behaviour therapy. But the plan appears not to have worked, Davis (2020) in the Journal of Evidence Based Mental Health, noted that 73% of IAPT clients receive low intensity therapy first (guided self help, computer assisted CBT or group psychoeducation) but only 4 % are transferred to high intensity therapy and the first transition appointment is the least well attended.

Aims

The aim of the project is to increase the provision of evidence-based treatments for common mental health conditions such as anxiety and depression by primary care organisations. This includes workforce planning to adequately train the mental health professionals required. This would be based on a ‘stepped care’ or triage model where ‘low intensity’ interventions or self-help would be provided to most people in the first instance and ‘high intensity’ interventions for more serious or complex conditions. Outcomes would be assessed by standardised questionnaires, where sufficiently high initial scores (a ‘case’) and sufficiently low scores immediately after treatment (below ‘caseness’), would be classed as ‘moving to recovery’. The NICE (National Institute for Health and Clinical Excellence) therapy guidelines presume reliable diagnosis. IAPT therapists do not make formal diagnoses. This calls into question IAPT’s claimed fidelity to the NICE guidelines, particularly as it does not monitor therapists treatment adherence.

Evaluation

Initial demonstration sites reported outcomes in line with predictions in terms of the number of people treated (especially with ‘low intensity’ interventions such as ‘guided self-help’) and the percentages classified as recovered and as in more employment (a small minority) to ten months later. It was noted that the literature indicates a substantial proportion of patients would recover anyway with the passage of time or with a placebo – in fact the majority of those whose condition had lasted for less than six months, but only a small minority of those whose condition had been longer-lasting.

There has been some debate over whether IAPT’s roll-out may result initially in low quality therapy being offered by poorly trained practitioners.

Beacon UK benchmarked IAPT performance across England for 2011-2012 and reported that 533,550 people accessed (were referred to) IAPT services – 8.7% of people suffering from anxiety and depression disorders – with around 60% entering treatment sessions. Most local IAPT services did not reach the target of a 50% ‘recovery’ rate.

In 2012-2013, 761,848 people were referred to IAPT services. 49% went into treatment (the rest either assessed as unsuitable for IAPT or declined), although around half of those dropped out before completing at least two sessions. Of the remainder, 127,060 people had pre-treatment and post-treatment mental health questionnaires submitted indicating ‘recovery’ – a headline rate of 43%. A report by the University of Chester indicated that sessions were costing three times more to fund than the original Department of Health estimates.

For 2014-2015 there were nearly 1.3 million referrals to IAPT, of which 815,665 entered treatment. Of those, 37% completed sufficient sessions, with 180,300 showing a ‘reliable recovery’ (on anxiety and depression questionnaires completed before and immediately after treatment) – which was just over one in five of those who entered treatment, just under half of those who completed enough sessions. Opinion on IAPT remained divided. The number of trained IAPT therapists did not appear to have met the government’s target of 6000, resulting in high caseloads. Some complained of seeing more ‘revolving door’ patients and excess complexity of cases, while the NHS has acknowledged problems with waiting times and recovery rates. However Norman Lamb, who championed IAPT within the coalition government 2010-2015, disagreed with picking faults with such an extensive and world-leading advance in evidence-based treatment. Others lauded the success in rising numbers of referrals, but warned of the failure to improve recovery rates. It was noted that both antidepressant prescribing and psychiatric disability claims have continued to rise.

In 2017 fewer than half of the Clinical Commissioning Groups met the target (15.8%) for the number of people who should be accessing talking therapies. There has been no publicly funded independent audit of IAPT . A study of 90 IAPT cases assessed with a ‘gold standard’ diagnostic interview revealed that only the tip of the iceberg recovered, in the sense of losing their diagnostic status. The results were identical whether or not the person was treated before or after personal injury litigation.

In July 2021 55,703 appointments out of the total 434,000 which went ahead involved one or more practitioners who did not have an accredited IAPT qualification. There are about 2000 psychological wellbeing practitioners in the service, with another 1,200 trainees. They are supported by high intensity therapists and counsellors of which there are about 4,000 with 700 trainees.

Updates

In December 2010, Paul Burstow, Minister for Care Services, announced an extension to the IAPT project to include Children and Young Peoples services. The government pledged £118m annually from 2015 to 2019 to increase access to psychological therapies services to children and young people.

When the programme officially started in 2008 it was only for working age adults, but in 2010 it was opened to all ages.

In 2015 Clark and fellow clinical psychologist Peter Fonagy, writing in response to wide-ranging criticism from child and adolescent psychiatrist Sami Timimi, stated that IAPT now has increasing support for the non-CBT modalities recommended by NICE for depression: counselling, couples therapy, interpersonal psychotherapy and brief psychodynamic therapy; and for Children and Young People (CYP-IAPT) more systemic family therapy, interpersonal therapy and parenting therapy is on the way. Timimi described the changes as still “light” on relational/collaborative therapy compared to the ‘technical model’ derived from ’eminence-based’ NICE guidelines via inadequate diagnostic categories.

A Payment by Results system is being developed for IAPT, whereby each local Clinical Commissioning Group can reward each local provider according to various targets met for the service and for each client – particularly for how much change in scores on the self-report questionnaires. The March 2021 issue of the British Journal of Clinical Psychology has highlighted the considerable controversy over IAPT’s claims of success, Scott( 2021) and Kellett et al., (2021) have responded with their own commentary ‘The costs and benefits of practice-based evidence: Correcting some misunderstandings about the 10-year meta-analysis of IAPT studies’.

On This Day .. 12 January

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People (Births)

  • 1896 – David Wechsler, Romanian-American psychologist and author (d. 1981).
  • 1914 – Mieko Kamiya, Japanese psychiatrist and psychologist (d. 1979).
  • 1941 – Fiona Caldicott, English psychiatrist and psychotherapist.

David Wechsler

David Wechsler (12 January 1896 to 02 May 1981) was a Romanian-American psychologist. He developed well-known intelligence scales, such as the Wechsler Adult Intelligence Scale (WAIS) and the Wechsler Intelligence Scale for Children (WISC).

Wechsler is best known for his intelligence tests. He was one of the most influential advocates of the role of non-intellective factors in testing. He emphasized that factors other than intellectual ability are involved in intelligent behaviour. Wechsler objected to the single score offered by the 1937 Binet scale. Although his test did not directly measure non-intellective factors, it took these factors into careful account in its underlying theory. The Wechsler Adult Intelligence Scale (WAIS) was developed first in 1939 and then called the Wechsler-Bellevue Intelligence Test. From these he derived the Wechsler Intelligence Scale for Children (WISC) in 1949 and the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) in 1967. Wechsler originally created these tests to find out more about his patients at the Bellevue clinic and he found the then-current Binet IQ test unsatisfactory. The tests are still based on his philosophy that intelligence is “the global capacity to act purposefully, to think rationally, and to deal effectively with [one’s] environment”.

The Wechsler scales introduced many novel concepts and breakthroughs to the intelligence testing movement. First, he did away with the quotient scores of older intelligence tests (the Q in “I.Q.”). Instead, he assigned an arbitrary value of 100 to the mean intelligence and added or subtracted another 15 points for each standard deviation above or below the mean the subject was. While not rejecting the concept of general intelligence (as conceptualized by his teacher Charles Spearman), he divided the concept of intelligence into two main areas: verbal and performance (non-verbal) scales, each evaluated with different subtests.

A Review of General Psychology survey, published in 2002, ranked Wechsler as the 51st most cited psychologist of the 20th century.

Mieko Kamiya

Mieko Kamiya (神谷 美恵子, Kamiya Mieko, 12 January 1914 to 22 October 1979) was a Japanese psychiatrist who treated leprosy patients at Nagashima Aiseien Sanatorium.

She was known for translating books on philosophy. She worked as a medical doctor in the Department of Psychiatry at Tokyo University following World War II. She was said to have greatly helped the Ministry of Education and the General Headquarters, where the Supreme Commander of the Allied Powers stayed, in her role as an English-speaking secretary, and served as an adviser to Empress Michiko. She wrote many books as a highly educated, multi-lingual person; one of her books, titled On the Meaning of Life (Ikigai Ni Tsuite in Japanese), based on her experiences with leprosy patients, attracted many readers.

Fiona Caldicott

Dame Fiona Caldicott, DBE, FMedSci (12 January 1941 to 15 February 2021) was a British psychiatrist and psychotherapist who also served as Principal of Somerville College, Oxford. She was the National Data Guardian for Health and Social Care in England until her death.

On This Day … 11 January

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People (Births)

  • 1842 – William James, American psychologist and philosopher (d. 1910).
  • 1867 – Edward B. Titchener, English psychologist and academic (d. 1927).

People (Deaths)

  • 2007 – Robert Anton Wilson, American psychologist, author, poet, and playwright (b. 1932).

William James

William James (11 January 1842 to 26 August 1910) was an American philosopher, historian, and psychologist, and the first educator to offer a psychology course in the United States. James is considered to be a leading thinker of the late 19th century, one of the most influential philosophers of the United States, and the “Father of American psychology.”

Along with Charles Sanders Peirce, James established the philosophical school known as pragmatism, and is also cited as one of the founders of functional psychology. A Review of General Psychology analysis, published in 2002, ranked James as the 14th most eminent psychologist of the 20th century. A survey published in American Psychologist in 1991 ranked James’s reputation in second place, after Wilhelm Wundt, who is widely regarded as the founder of experimental psychology. James also developed the philosophical perspective known as radical empiricism. James’s work has influenced philosophers and academics such as Émile Durkheim, W.E.B. Du Bois, Edmund Husserl, Bertrand Russell, Ludwig Wittgenstein, Hilary Putnam, Richard Rorty, and Marilynne Robinson.

Born into a wealthy family, James was the son of the Swedenborgian theologian Henry James Sr. and the brother of both the prominent novelist Henry James and the diarist Alice James. James trained as a physician and taught anatomy at Harvard, but never practiced medicine. Instead he pursued his interests in psychology and then philosophy. James wrote widely on many topics, including epistemology, education, metaphysics, psychology, religion, and mysticism. Among his most influential books are The Principles of Psychology, a groundbreaking text in the field of psychology; Essays in Radical Empiricism, an important text in philosophy; and The Varieties of Religious Experience, an investigation of different forms of religious experience, including theories on mind-cure.

Edward B. Titchener

Edward Bradford Titchener (11 January 1867 to 03 August 1927) was an English psychologist who studied under Wilhelm Wundt for several years.

Titchener is best known for creating his version of psychology that described the structure of the mind: structuralism. After becoming a professor at Cornell University, he created the largest doctoral program at that time in the United States. His first graduate student, Margaret Floy Washburn, became the first woman to be granted a PhD in psychology (1894).

Robert Anton Wilson

Robert Anton Wilson (born Robert Edward Wilson; 18 January 1932 to 11 January 2007) was an American author, futurist, and self-described agnostic mystic. Recognised within Discordianism as an Episkopos, pope and saint, Wilson helped publicize Discordianism through his writings and interviews.

Wilson described his work as an “attempt to break down conditioned associations, to look at the world in a new way, with many models recognized as models or maps, and no one model elevated to the truth”. His goal was “to try to get people into a state of generalized agnosticism, not agnosticism about God alone but agnosticism about everything.”

In addition to writing several science-fiction novels, Wilson also wrote non-fiction books on extrasensory perception, mental telepathy, metaphysics, paranormal experiences, conspiracy theory, sex, drugs and what Wilson himself called “quantum psychology”.

Following a career in journalism and as an editor, notably for Playboy, Wilson emerged as a major countercultural figure in the mid-1970s, comparable to one of his co-authors, Timothy Leary, as well as Terence McKenna.

On This Day … 09 January

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People (Births)

  • 1879 – John B. Watson, American psychologist and academic (d. 1958).

People (Deaths)

  • 2012 – William G. Roll, German-American psychologist and parapsychologist (b. 1926).

John B. Watson

John Broadus Watson (09 January 1878 to 25 September 1958) was an American psychologist who popularized the scientific theory of behaviourism, establishing it as a psychological school.

Watson advanced this change in the psychological discipline through his 1913 address at Columbia University, titled Psychology as the Behaviourist Views It. Through his behaviourist approach, Watson conducted research on animal behaviour, child rearing, and advertising, as well as conducting the controversial “Little Albert” experiment and the Kerplunk experiment. He was also the editor of Psychological Review from 1910 to 1915. A Review of General Psychology survey, published in 2002, ranked Watson as the 17th most cited psychologist of the 20th century.

William G. Roll

William G. Roll (03 July 1926 to 09 January 2012) was an American psychologist and parapsychologist on the faculty of the Psychology Department of the University of West Georgia in Carrollton, Georgia.

Roll is most notable for his belief in poltergeist activity. He coined the term “recurrent spontaneous psychokinesis” (RSPK) to explain poltergeist cases. However, RSPK was never accepted by mainstream science and sceptics have described Roll as a credulous investigator.

On This Day … 08 January

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People (Births)

  • 1902 – Carl Rogers, American psychologist and academic (d. 1987).

Carl Rogers

Carl Ransom Rogers (08 January 1902 to 04 February 1987) was an American psychologist and among the founders of the humanistic approach (and client-centred approach) in psychology. Rogers is widely considered to be one of the founding fathers of psychotherapy research and was honoured for his pioneering research with the Award for Distinguished Scientific Contributions by the American Psychological Association (APA) in 1956.

The person-centred approach, his own unique approach to understanding personality and human relationships, found wide application in various domains such as psychotherapy and counselling (client-centred therapy), education (student-centred learning), organisations, and other group settings. For his professional work he was bestowed the Award for Distinguished Professional Contributions to Psychology by the APA in 1972. In a study by Steven J. Haggbloom and colleagues using six criteria such as citations and recognition, Rogers was found to be the sixth most eminent psychologist of the 20th century and second, among clinicians, only to Sigmund Freud. Based on a 1982 survey among 422 respondents of US and Canadian psychologists, he was considered the most influential psychotherapist in history (Sigmund Freud was ranked third).

On This Day … 07 January

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People (Births)

  • 1946 – Michele Elliott, author, psychologist and founder of child protection charity Kidscape.

Michele Elliott

Michele Irmiter Elliott OBE is an author, psychologist, teacher and the founder and director of child protection charity Kidscape. She has chaired World Health Organisation and Home Office working groups and is a Winston Churchill fellow.

Early Life

Elliott was born on 07 January 1946 to James Irmiter and Ivy (née Dashwood). She graduated from Dixie Hollins High School in 1964. She attended the University of South Florida and the University of Florida, gaining a BA in Science and Education and a Masters’ degree in Psychology. She began working with families and children in 1968 in London.

Work

Elliott worked as a child psychologist at The American School in London, where her husband was a social studies teacher.

Kidscape

Elliott founded Kidscape in 1984 to help children stay safe from sexual abuse and from bullying.

Elliott has been a high-profile figure and Kidscape was named Charity of the Year in 2000. Writing in The Guardian, David Brindle suggested the award was “an undoubted reflection of the vibrancy of Michele Elliott”.

Female Child Sexual Abuse Offenders

Elliott, who had previously written books about male abuse of children, has undertaken pioneering work in investigating and raising awareness of the problem and extent of child sexual abuse committed by women, and the topic of female paedophilia, publishing the book Female Sexual Abuse of Children The Last Taboo in 1992. The book was well received by professionals and survivors’ organisations. Mike Lew described it as “an important and challenging work”, helping “to forge a new understanding of the issues”. Doody’s annual stated it was “an extremely valuable book for all professionals, and it greatly increases the current state of knowledge, or lack of that knowledge, that can have a profound influence on the survivor’s development and recovery”.

Elliott’s work in exposing the issue of child sexual abuse committed by women has also resulted in hostility from feminists. While compiling Female Sexual Abuse of Children, Elliott organised a conference in London concerning sexual abuse by women. After publishing the book, Elliott was subject to a “deluge” of hate mail from feminists.

Awards

In 2008 Elliot was honoured with an OBE by the Queen for services to children. The following year she was named Children and Young People’s Champion. She was awarded an honorary doctorate by Post University in 1998 and another honorary doctorate by the University of Birmingham in 2003. She was awarded a Winston Churchill Fellowship in 1996. Her book, “Bullies, Cyberbullies and Frenemies” received the Literary Classics Gold Award in 2013.

On This Day … 06 January

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People (Births)

  • 1915 – John C. Lilly, American psychoanalyst, physician, and philosopher (d. 2001).

People (Deaths)

  • 2014 – Julian Rotter, American psychologist and academic (b. 1916).

John C. Lilly

John Cunningham Lilly (06 January 1915 to 30 September 2001) was an American physician, neuroscientist, psychoanalyst, psychonaut, philosopher, writer and inventor. He was a member of a generation of counterculture scientists and thinkers that included Ram Dass, Werner Erhard and Timothy Leary, all frequent visitors to the Lilly home. He often stirred controversy, especially among mainstream scientists.

Lilly conducted high-altitude research during World War II and later trained as a psychoanalyst. He gained renown in the 1950s after developing the isolation tank. He saw the tanks, in which users are isolated from almost all external stimuli, as a means to explore the nature of human consciousness. He later combined that work with his efforts to communicate with dolphins. He began studying how bottlenose dolphins vocalize, establishing centres in the US Virgin Islands, and later San Francisco, to study dolphins. A decade later, he began experimenting with psychedelics, including LSD, often while floating in isolation. His work inspired two Hollywood movies, The Day of the Dolphin (1973) and Altered States (1980).

Julian Rotter

Julian B. Rotter (22 October 1916 to 06 January 2014) was an American psychologist known for developing social learning theory and research into locus of control. He was a faculty member at The Ohio State University and then the University of Connecticut. A Review of General Psychology survey, published in 2002, ranked Rotter as the 64th most eminent and 18th most widely cited psychologist of the 20th century. A 2014 study published in 2014 placed at #54 among psychologists whose careers spanned the post-World War II era.

On This Day … 01 January

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People (Deaths)

  • 2020 – Elmira Minita Gordon, Belizean educator and psychologist (b.1930).

Elmira Minita Gordon

Dame Elmira Minita Gordon GCMG GCVO JP (30 December 1930 to 01 January 2021) was a Belizean educator, psychologist and politician; she served as the first governor general of Belize from its independence in 1981 until 1993.

She was the first Belizean to receive a doctorate in psychology. She is one of the few “double dames”, having received damehoods in two separate orders: the Order of St Michael and St George and the Royal Victorian Order.

On This Day … 30 December

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People (Deaths)

  • 2002 – Eleanor J. Gibson, American psychologist and academic (b. 1910).

Eleanor J. Gibson

Eleanor Jack Gibson (7 December 1910 to 30 December 2002) was an American psychologist who focused on reading development and perceptual learning in infants.

Gibson began her career at Smith College as an instructor in 1932, publishing her first works on research conducted as an undergraduate student. Gibson was able to circumvent the many obstacles she faced due to the Great Depression and gender discrimination, by finding research opportunities that she could meld with her own interests. Gibson, with her husband James J. Gibson, created the Gibsonian ecological theory of development, which emphasized how important perception was because it allows humans to adapt to their environments.

Perhaps her most well-known contribution to psychology was the “visual cliff,” which studied depth perception in both human and animal species, leading to a new understanding of perceptual development in infants. Gibson was elected to the National Academy of Sciences in 1971, the National Academy of Education in 1972, and to the American Academy of Arts and Sciences in 1977. In 1992, she was awarded the National Medal of Science.

On This Day … 29 December

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People (Births)

  • 1955 – Donald D. Hoffman, American quantitative psychologist and popular science writer.

Donald D. Hoffman

Donald David Hoffman (born 29 December 1955) is an American cognitive psychologist and popular science author. He is a professor in the Department of Cognitive Sciences at the University of California, Irvine, with joint appointments in the Department of Philosophy, the Department of Logic and Philosophy of Science, and the School of Computer Science.

Hoffman studies consciousness, visual perception and evolutionary psychology using mathematical models and psychophysical experiments. His research subjects include facial attractiveness, the recognition of shape, the perception of motion and colour, the evolution of perception, and the mind-body problem. He has co-authored two technical books: Observer Mechanics: A Formal Theory of Perception (1989) offers a theory of consciousness and its relationship to physics; Automotive Lighting and Human Vision (2005) applies vision science to vehicle lighting. His book Visual Intelligence: How We Create What We See (1998) presents the modern science of visual perception to a broad audience. His 2015 TED Talk, “Do we see reality as it is?” explains how our perceptions have evolved to hide reality from us.