Reflections on a specialist LTC secondment and implications for IAPT

1. Reflections on a specialist LTC secondment and implications for IAPT Dr SarfrazJeraj Clinical Psychologist/CBT Therapist Lambeth Talking Therapies (IAPT) South London & Maudsley Foundation NHS Trust

2. Background Dr SarfrazJeraj is a clinical psychologist working as a CBT therapist in the Lambeth Increasing Access to Psychological Therapies service. He also works part time as a lecturer on the CBT training programme at the University of Surrey. He currently co-leads on Long Term Conditions for the Lambeth IAPT service, supporting supervision and training for staff and providing one to one therapy for people with mental and physical health difficulties and facilitating a support group for people with chronic pain. He is interested in training processes and up skilling psychology clinicians in working with Long Term Physical Health Conditions.

3. Context • The NHS 5 year forward - target of increasing access to primary care mental health services • Target to increase access to treatment for people with Long-term Physical Health Conditions and Medically Unexplained Symptoms • Integrating physical and mental health service provision • In order to meet these targets, IAPT services need to have the necessary referral pathways and clinical capacity

4. Increasing clinical capacity • Evidence based practice • Teaching • Supervised clinical practice • Assessment • Formulation Integrating mental and physical health • Intervention • 6-12 month secondment in KCH Department of Psychological Medicine under supervision of Dr Jane Hutton

5. Why reflect on the experience • To develop clinical competency, you need teaching, practice and reflection (Leahy, 2010) • Kolb’s learning cycle for me and service

6. Concrete experiences • Anxious • Weight of expectation (self-inflicted) and feeling de-skilled • Various unfamiliar conditions, models, people, and protocols for treatment • Differences in how clients attend, ability to implement, pace of change, interaction with physical health professionals • Slow work – frequency of appointments

7. Reflective observations • Anxiety related to: • More medicalised referral information and unfamiliar conditions e.g. POTS and EDS • Broader holistic assessment with physical emphasis (bio-psycho-social) • Differences in rate of change, engagement meant I was questioning myself more • Lack of confidence with physical health professionals

8. Abstract conceptualisation • Anxiety is normal • Don’t pathologise it • It needs time, exposure and support • Different presentations need a different way of working • Change the ways of working, not the expectations on myself • Measures of change, time frames, attendance policy, client goals • Physical health professionals lack confidence with mental health professionals too • Scope to be mutually supportive • Scope to integrate, work together in own expertise for client that incorporates other perspectives

9. Active experimentation • Trying out new models and getting feedback • Supervisor • Clients • Exposure to more physical health terms and professionals – win-win • Keeping holistic perspective throughout treatment AND evaluation (beyond CORE-10), not just at assessment

10. Implications for IAPT • Supervision support • Debunking myths about need for extended specialist long term training to enhance skills to work with LTCs • Encompassing broader range of measures for change • Reviewing attendance policies • Integration opportunities • Pain nurse explaining pain pathways to CBT for pain group • Diabetes workshops