Over the past 20 years, counselling and psychotherapy, as provided by the NHS and charities, has been reorganised into an assembly line of formulaic, ‘medical model’ diagnosis and treatment, backed by misleading statistics.
Since 2008, IAPT (the Improving Access to Psychological Therapies service) has monopolised funding for therapy provided in the public and third sectors. IAPT is based on a pseudo-scientific model of ‘evidence-based’ short-term CBT (cognitive behavioural therapy). It is increasingly provided digitally rather than face to face with a therapist.
Most IAPT practitioners share the same ethical and professional values as other counsellors and psychotherapists. However, the dominance and rigidity of the IAPT model and its managerial and political priorities is currently constraining the creative potential of therapeutic relationships for clients and practitioners alike. Both have become cogs in the machinery of the government’s management of the country’s mental health.
For practitioners, the pay and working conditions of counsellors and psychotherapists in the public and charity sectors has been deteriorating for years. Many therapists are currently working for very low pay, long hours, sometimes on part-time, gig-economy contracts. At the same time, many trainee and newly-qualified therapists are working for no pay at all as so-called “volunteers”, a growing army of free labour in a health sector desperately understaffed.
Meanwhile, for people looking for therapy, IAPT offers very little choice – of therapist, therapeutic approach or setting. However, people are different. Behavioural and short-term therapies are not right for everyone. Many would benefit from a therapist who takes one of the many other approaches available in the rich field of counselling and psychotherapy. All of this may help explain why two-thirds of referrals to the IAPT service never complete a course of treatment.
We are campaigning for people to have access to a wide range of counselling and psychotherapy in the NHS, and for it to be available through local community services and charities, as well as in schools and colleges. We want services to respond to the needs of local communities and to be client-led rather than provider prescribed.
We also want therapists to be made available to work with community groups across a range of settings where their skills and experience can facilitate peer-led initiatives in support of mental health. This is because we also respect the capacity individuals and communities have to support each other with the empathy and emotional wisdom of their everyday lives – independently of professional services.
The campaign for universal Access to Counselling and psycho Therapy (uACT) is working for fundamental change in the organisation of support for people experiencing emotional suffering and distress.
We want this support to be organised around the following principles:
- community-led, not provider-led
- client-led, not diagnosis led
- client need, not imposed time frames
- lasting changes, not quick fixes
- client/counsellor relationships, not manuals or websites
- listening to clients, not telling them
- life changes, not short-term goals
- emotional depth, not positive thinking
- understanding people, not collecting statistics
- benefit for clients, not benefit for service funding
- relational approach to assessing progress, not tick-box number crunching.