Dr. David Murphy:

I thank the Chairman and members for inviting me to speak about this particular approach to therapy.

I am part of the team of people in England who have been training therapists in a programme called improving access to psychological therapies, IAPT, within the NHS. This initiative was set to roll out evidence-based therapies in order to make it possible for people to access a range of talking therapy, free at the point of access. The particular type of therapy that I am familiar with and of which we have been part of the roll out is based on a person centred and an experiential approach to therapy. It is recognised as a high intensity therapy so that means one can work with people who have both mild and also moderate and sometimes severe depression. The therapies recommended by IAPT is approved by the NHS and was supported and developed by the British Association for Counselling Psychotherapy in conjunction with IAPT.

The therapy is manualised, so what this means is that a series of competencies have been drawn down from a framework, including drawing out from a series of randomised controlled trials of either person-centred therapy, experiential therapy and comparing that with CBT or with controls or against each. The parts of those therapies that were considered to be effective have then been put together into this manual and a training programme has been developed. This means that alongside CBT, people are able to access a choice of therapies and this has been at the heart of and roll out of IAPT.

The therapy is provided by qualified and trained therapists who then engage in this additional training in the manual. The manual is about bringing together the competencies and upskilling a workforce that already exists that might well be underemployed or underutilised within the field of psychological therapies. The training is about six to nine months but it only involves five days of contact in a training institution, the remainder of the training takes place while working on the job. Once people are through the first five days they are ready to go and start delivering this type of therapy.

The training is about bringing people up to a certain level of competence and adherence in the manual and these competencies are drawn from generic, basic, specific, model specific and adaptions and some meta-competencies as well. It means there is a whole range of therapists who can be moved into this particular manualised form of therapy and start to deliver it quite soon. This type of therapy is what we consider and what we call a high intensity therapy. That means a large number of people are able to access it. It is recommended that they access this for up to 20 sessions - certainly at the most severe end, that should be available for them.

There is a range of benefits in having a number of therapies available other than the main therapy, cognitive behavioural therapy, which was the original large-scale roll-out within the IACP. The data that is taken from those therapies as they are applied in routine practice suggest there is virtually no difference in effectiveness between CBT and counselling for depression. There is a real opportunity to develop a pluralistic field of therapies that are effective and evidence based. Clients and patients in the health service will benefit from a range of therapies. Services benefit from having a range of therapies; patients will stay in therapy if they have a choice of therapy, because they will find the right one. It saves on general practitioners if clients or patients can access the right type of therapy for them, rather than having only one type of therapy available to all people. Generally, as people become enhanced in their well-being through having a range of different talking therapies, it has a wider benefit for families, societies, communities - everyone benefits.