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Thursday, 15 October 2009

Whats going to happen to CBT after IAPT is cut back ?

Well...the writing is on the wall. IAPT looks like its in the frontline for public spending cuts.

The Observer this month says that the The Iapt Expert Reference Group (that oversees the project) has been informed that IAPT is failing to meet its targets in a big way - both in training the number of therapists needed, and in the number of people who have come off of benefits as a result of interventions made. Many staff are being asked to reapply for their jobs and the remaining £100 million allocated will not be ringfenced but will be incorporated into local NHS Trusts' budgets - to be spent as they wish. This will almost inevitably mean that traditional mental health priorities will re-establish themselves and that those perceived as "the worried well" will be left out.

The interesting question is whatb is going to happen to CBT as a result ? There are undoubtedly many who are secretly happy to see what is going to happen. Whenever someone grabs a large share of the pie ( and nearly £200 million is a VERY large share) it creates powerful reactions - jealousies amongst non-CBTers who feel unjustifiably excluded, fear amongst traditional CBTers - of which I must count some in my own profession - who fear poorer qualified (and cheaper) therapists taking their jobs.

However, I have strong suspicions that the CBT project is not dead in the water and will continue and even thrive - except in a slightly different format. Here are my predictions for CBT for the next 10 years.

(1) CBT will continue to thrive because both governments and insurance companies (the main funders and benchmarkers of therapy) want evidence that what they fund works and has a clear time limited structure to it. Whatever some people think about the application of RCTs and experimental paradigms to therapeutic outcomes,they are a continuing and growing part of the Zeitgeist we are a part of, and at present CBT is really the only show in town.

(2) CBT will fit in well to the developing mixed economy in mental health that will grow with increasing speed. There will be more people wanting to see CBT therapists on a private basis and CBT will infiltrate (even further) organisations interested in behaviour change. The Welfare-to-Work and the Criminal Justice sectors being obvious first past the post candidates.

(3) The concept of Accredited CBT Therapist will continue to be an aspirational gold standard for many, but will lose its exclusive cache. Expect to see "Non-Accredited" CBTers fulfilling important roles and a greater variation in the types and length of training on offer.

At SDS, we have long been convinced of the need for shorter intensive CBT course that are recognised (our Introductory 3 day course is Approved by The British Psychological Society) but which do not place the same heavy demands on trainees that BABCP Accreditation requires. If you are interested in such a course, by the way, details can be found at

Equally expect distance learning methods to gain pace from training DVD packs ( to webcam conferences.

(4) Finally, we will see other forms of psychotherapy coming to the fore again. These will be those that have learnt the importance of published outcome work as a marketing tool and who already have some footholds within the establishment. Brief Solution Focused Therapy, Brief Dynamic Psychotherapy and Interpersonal Psyschotherapy seem obvious candidates. Those that fight a rearguard action against registration and regulation (you know who you are) and who totally dismiss the value of empirical research will disappear even further into the shadows

Whatever happens, its likely that even a partially completed IAPT will leave its mark on the landscape. In my opinion, for the better. Which is reassuring really. I'd hate to think that £75 million was spend and its effects disappear without a trace.

Paul Grantham
Consultant Clinical Psychologist


  1. Thank you so much Paul for this post.
    I agree with you 100%. I am most intrigued to see how it'll all turn out!

  2. As a matter of interest, how is the number of people coming off benefits as a result of CBT via IAPT evaluated? I benefitted enormously from this service myself, and my scores at the end of my sessions were much improved. But I was still on Incapacity Benefit. This is soon to change however - a couple of months down the line I have found a job, and it's due to the work we did in my CBT sessions. So how is this result recorded?


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