I completely agree about the political manipulation, which is what this thread is really about.
I'm not sure I agree about the isolation, or rather the relevance of it. OK, so if you become a GP you will have worked all kinds of different roles, and no doubt the breadth of this is valuable. If you become a CBTT you may not have. However you can expect the GP to still have little or no idea about CBT/psychology, and it will be a positive result if you even get referred to a service rather than prescribed pills, and this is ultimately what matters at the sharp end.
I would agree with that - I work in a GP practice, and many of them really have no concept of what it is we do.
My comments were based on a number of anecdotal reports about people who had found their IAPT therapist unhelpful, but who had been met with quite a bit of the "well, you can't be trying hard enough" in their response - that's pretty fundamentally counter to the principles on which most therapists operate, and in the context of a DWP referral, quite worrying. I would assume that these were lower-tier practitioners, but I do wonder whether there will be an escalation strategy if a client's needs turn out to be greater than anticipated.
But - and this maybe links the political and the therapeutic issues - the real concern for me is about what this therapy is really expected to achieve. It may be that the DWP's attitude is "we're not here to deal with profound mental health issues, there are other people for that" - but in reality that is often not the case, especially for people who don't have the money to pay for therapy. Many areas in the country have therapy services with huge waiting lists and very high criteria for acceptance, and often the only form of therapy available is CBT, which - while eminently suitable for quite a range of problems - is not a universal solution and frequently not appropriate for many clients. So, in practice there are no other people, and clients will feel pushed into an inappropriate intervention when they might even know that what they need is far more than that.
Personally I was surprised how broadly CBT is applied, and thus what a broad range of patients, backgrounds & problems it might encompass, so I think the typical CBTT is exposed to a fairly wide gamut of patient experiences, if still not getting their hands dirty in diverse NHS roles.
I wish I shared you confidence that it will be the "typical CBTT" who is seeing these people. I suppose all we can do is to wait and see what the DWP comes up with, but I will be truly - and delightedly - surprised if the service is staffed by therapists who've done the kind of training you describe for your girlfriend, rather than those who have done the far less in-depth basic training.
Again it's second hand, but it also sounds like in practice it's not thoroughly isolated from other services; it might not be easily integrated - what is? - but certainly a staple of the role is liaising with CMHTs, GPs, the police, and so on.
*nods* But onward referrals are a perennial problem for anyone in the therapy biz - GPs are often hamstrung by the lack of availability of therapy services in their area, and CMHTs are - as I alluded earlier - generally doing all they can to triage referrals. It's almost a given that a referral to a CMHT will come back with a "not ill enough" response nowadays, and I have seen that bar rise during my 8 years in practice, to the point where it is quite easy to find yourself working quite a long way beyond your competence with quite seriously unwell clients. And that's a fully-qualified therapist after four years of training - asking the more minimally-trained lower-tier IAPT practitioners to hold that kind of material is, without in any way trying to insult their professional competence, taking them even further out of their zone of competence.
It's a tricky thing to explain without sounding precious (or seeming like we're just trying to pull the ladder up behind us), but a big part of counsellor training is learning to recognise what our limits are, and to anticipate the risks that clients might present with.
That isn't to say I don't acknowledge the huge improvement in access to CBT and the enormous help that's been to people.
