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The portable therapist: The challenges for therapists working in primary care settings
Abstract
The term portable therapist captures the idea that therapists in primary care carry within themselves the tools required to undertake therapy in different physical locations. To successfully do this, the therapist needs skills beyond her capacity to work therapeutically. She needs to manage the challenges of working in primary care, particularly that her work and the needs of her patients are situated in a setting that does not necessarily prioritise psychological distress. This paper also explores the experience of being seen as a part-object because of her position on the periphery of the organisations in which she works.
... Owen-Pugh (2010) discussed how ideological differences might create resistance issues for counsellors training in IAPT-compliant modalities. These findings echo themes in the practitioner opinion literature of being out-group (Howard, 2012), and ideological conflict (Rizq, 2011(Rizq, , 2012. ...
Since implementing the Improving Access to Psychological Therapies (IAPT) programme in 2008, provision of counselling and other idiographic approaches to psychological therapy in the English National Health Service (NHS) has been reduced to several manualised therapies supported by NICE guidelines for depression and anxiety. Many counsellors who previously provided psychological therapies in the NHS subsequently left or retrained in IAPT compliant models of treatment. This study explores the effect that working in IAPT services over an eight-year period had on the professional and personal development of the primary author, resulting in a strong exhortation for counsellors to take advantage of, and influence the professional development opportunities it presents. This study takes an analytical autoenthnographic approach, undertaking the thematic analysis of naturally occurring data, taken from previously published opinion columns in a professional journal, and an unpublished doctoral assignment to illuminate previously unrecognised narrative. Themes of ideological resistance, and being out-group resulting in a sense of professional loss, uncertainty and cessation of professional development preceded acceptance of the IAPT nomothetic ideology. After which, a sense of being in-group facilitated a sense of gain, certainty, and the re-implementation of professional growth. Counsellors in IAPT may be prejudiced by their idiographic ideology. Professional uncertainty and a sense of loss could inhibit professional development. Development of a pluralistic ideological stance, and integrative approach to treatment is encouraged. Counsellors who accept a Cinderella like status in IAPT, are exhorted to adapt, influence from within, and thrive in IAPT.
The purpose of this study was to examine the attitudes of practicing art therapists toward evidence-based practices (EBPs). EBPs, which have become an integral part of the managed care mental health system, refer to the use of empirically validated research to make clinical decisions that best meet the needs of each client. We used mixed methods with a survey that had quantitative and qualitative components to investigate the attitudes of art therapists from one graduate program toward EBPs and the factors that might affect their attitudes. Most expressed confidence in their ability to integrate EBPs with art therapy. Roughly half of the participants indicated a belief that art therapy can sometimes be validated by scientific evidence; however, the majority wanted to see increased research on the evidence base of art therapy.
All general practitioners and psychiatrists working in a single health district were sent a questionnaire on their perceptions of the prevalence of psychological problems among patients consulting in general practice. One hundred and twenty-one GPs (75%) and 10 (83%) psychiatrists responded. GPs and psychiatrists agreed that up to 20% of consulting patients were likely to be clinically depressed; they also agreed on the most appropriate management, although GPs tended to be more conservative than psychiatrists would advise on making use of hospital services. GPs, however, believed non-specific psychological problems to be significantly less common than did psychiatrists. This expectation may help explain the reported failure of GPs to diagnose all psychological problems identified by formal psychiatric instruments.
The analytic setting exists not only externally but also internally as a structure in the mind of the analyst. The internal analytic setting constitutes an area of the analyst's mind where reality is defined by unconscious symbolic meaning. Clinical examples illustrate how a secure internal setting allows flexibility in the external setting without sacrifice of its analytic quality. The internal setting can help analysts listen inwardly to themselves in a way that is free-floating with regard to their internal processes. This points beyond usual ideas of countertransference. An analytic encounter may stir up elements that belong to the analyst's psyche which, rather than impeding the analysis, can actively enrich it. Seamus Heaney's writings evoke comparisons between listening to poems and listening to patients, and a week in a patient's analysis is described in relation to these themes.
Skills in psychodynamic counselling and therapy
- S Howard
Howard, S. (2010). Skills in psychodynamic counselling and therapy. London: Sage.