Clients' perceptions of unhelpful factors in CBT in IAPT serving a deprived area of the UK

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Abstract Aim/Purpose Improving access to psychological therapies (IAPT) is a main provider of psychological therapy for adults within the NHS. NHS Digital (2016) reported the dropout rate in IAPT to be as high as 43%. Proctor (2014) found that unhelpful factors in therapy could contribute to the dropout rate. As CBT is the main modality in IAPT, it is important to explore unhelpful factors in CBT as they might be contributing to the dropout rate in IAPT. Design/Methodology Nine clients (five men and four women) for whom CBT was not helpful were interviewed using a semi‐structured protocol. The interviews were analysed using thematic analysis. Results/Findings Six themes have been identified: 1) Difficulties with CBT itself (e.g. identifying and challenging negative thoughts and finding alternative evidence as well as homework); 2) Negative perception of therapists (e.g. queried if therapists were committed and had empathy); 3) Clients’ unhelpful internal patterns (e.g. unrealistic expectations or feeling self‐critical); 4) Physical health, mental health and psychosocial barriers (e.g. feeling too depressed or anxious to undertake CBT); 5) Unhelpful IAPT processes (e.g. difficulties with outcome measures and assessments); and 6) Consequences of unhelpful treatment (e.g. not addressing core underlying issues and clients feeling worse). Conclusions/Implications (including practice implications) The findings indicate that all practitioners should consider unhelpful factors in therapy, as they have potentially detrimental effects on clients' outcomes. Additionally, this research found that therapeutic interventions need to be tailored to clients' goals, internal patterns and preferences. Importantly, it was found that unhelpful factors extend to health and psychosocial issues which should be addressed prior to therapy.

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