'Think Couple' What needs to happen to make Couple Therapy for Depression a Reality in IAPT?
This week the North West PWP Professional Network welcomed Dr Saba Khan and Kate Thompson from the Tavistock Clinic to their master class at the University of Central Lancashire to explain what Couples Therapy for Depression (CTfD) is and how it is helpful, how to screen for suitability and to explore how elements of ‘Think Couple’ can be used to to enhance the role of the PWP.
Watching the introductory case scenario immediately highlighted the impact of a life event such as redundancy on a couple and their family, and the way in which the husband or the wife that is referred for help with depression may be the person that ‘carries’ or presents with the symptoms, but the most effective solution is one that brings them together to look at how they can cope better together.
Despite being advocated by NICE as a treatment that has a good evidence base for effectiveness alongside the ubiquitous CBT access to CTfad through an IAPT service in the North West of England is still highly unlikely. Wendy Saint, the 'Choice in IAPT' Champion for the PPN explained that whilst IAPT guidelines estimate that around 5% of the workforce should be able to provide CTfD the national 2014 census shows that the reality is that only 1.4% are actually trained in the approach, and even when clinicians are trained to offer the therapy access on the ground is still very limited due to issues such as commissioning limits on session numbers – CTfD, as with other high intensity therapies, can require up to 16-20 sessions, general lack of awareness in IAPT teams about CTfD and practitioners without the skills to screen for suitability.
As such we find ourselves in the perverse vicious circle of the choice of CTfD not being routinely available because IAPT teams that don't know how to assess for or to access CTFD don't identify the need and as a consequence these resources dont get developed. Despite the fact that having choice of therapy would support teams to improve their recovery rates and meet their targets.
So this leads to the question what needs to happen to improve access to CTfD? Is part of the problem that we have developed IAPT services within a very individualised model of distress? How can we can promote ‘Think Couple' throughout IAPT? What do commissioners need to know to help shape services to better suit the needs of individuals, couples and families?
Finally, the workshop raised the further question of whether the core principles of the Couple Therapy model could be distilled into a skills set that could be incorporated into the PWP 'tool kit' to enhance the effectiveness of low intensity interventions provided at step 2, particularly when PWPs are faced with blocks to progress To help inform what would help next?
You can find out more about HENW commissioned CTfD training places by going to the PPN IAPT Education web page https://m.youtube.com/watch?v=SUD_5JHr2kA The funding for training is there we need services to support counsellors, clinical psychologists and other high intensity therapists to take up the opportunity and for commissioners to commission services where CtfD is integral to the range of treatments available.
Let us know your thoughts, how can we make choice a reality in IAPT and put 'Think Couple' in everyone's minds.