This paper critically reflects on controversial aspects of the English service model of frontline psychological therapies. The Improving Access to Psychological Therapies (IAPT) programme in England has had worldwide influence and embodied core psychotherapy debates between clinical practice, research evidence, and politics. The paper initially focuses on the definition of evidence-based therapy in the programme and the resulting dominance of protocol-based, specific-disorder, Cognitive Behavioural Therapy (CBT), which has ostracised other treatment models. The medical model, the outcome research paradigm, and the English clinical guidelines, treated as the pillars of the CBT hegemony, are critically examined. Omissions are highlighted, including the therapist’s effect, the effectiveness of psychodynamic psychotherapy and integrative practice, and the contribution of client-related factors to treatment outcome, all which contradict key principles of the IAPT philosophy.
An innovative initiative to integrate a relational pathway, including brief psychodynamic and relational integrative therapy, into the English service model is then presented. The paper discusses the potential remedying effect of injecting relational therapies into the programme philosophy. Indeed, the IAPT framework has extended beyond a service model to represent a certain paradigm of what psychotherapy should look like, emphasising diagnosis and technical manuals. On the contrary, a relational pathway places the client, the therapist and an individualised approach to treatment at the heart of therapy. Thus, integrating relational therapies in IAPT would entail renegotiation of core psychotherapy dialectics, including technical knowledge versus clinician's expertise and diagnostic-driven versus individually-tailored treatments. The wider implications of such negotiations are pointed out