Psychological therapists are feeling the strain of time limits and targets, with many suffering from the very problems that they treat patients for.
The NHS is in deep trouble. Junior doctors are striking about their contract, the Department of Health keeps requiring emergency cash injections,deaths are up, and morale is at an all-time low. Though there is talk of cash injections into therapy services, on the frontline psychological therapists are feeling the strain. When psychologists and therapists meet nowadays, the talk is often less about work and more about who’s just resigned, the latest edict about time limits and targets, and the pernicious market culture that is eroding what we do.
While junior doctors are protesting in public, we’ve heard less from psychologists or psychological therapists. People are scared of speaking out publicly – fearful for their livelihoods and protective of the profession they believe in. Take Rachel. She is a clinical psychologist, currently off sick with depression and anxiety from her NHS job. One day she heard herself telling a distressed client that they only had four sessions left. Rachel vividly describes her anguish knowing that her client – who had been abused, and dropped from several services before – was about to experience the same thing again. Rachel now feels a failure because she had to put service targets above the needs of the client and above her own values. Hearing Rachel’s compassion and love for her work, it’s impossible not to think that the NHS is about to lose someone whose values, commitment and thoughtfulness make her a brilliant therapist.
Rachel’s case is far from unique, so we were shocked but not surprised by the latest survey from the British Psychological Society and the New Savoy Partnership. Nearly half of the NHS psychological therapists who took part said they felt depressed, with a similar number feeling like a failure. Most NHS therapists do their job because they care. But this caring is under attack from external forces, and we now face a workforce crisis. How did we get here?
A key factor is marketisation. The current focus is on producing figures that can win and keep contracts. Staff are often asked to see huge numbers of clients, for ever shorter time periods. What everyone wants from a therapist is someone who listens. But increasingly, listening has to compete with a demand to get to the next person on the list, to fill in outcome measures and assign diagnoses for accounting purposes or to enter in flowcharts that determine the help people get.
Managers are also under increasing pressure to prioritise targets over the wellbeing of their staff. As one psychological wellbeing practitioner put it: “There is no emphasis on looking after you as an individual. I have a ridiculous caseload and high stress levels … When I told my manager how I was feeling I was effectively told to ‘put up and shut up’.” In an unprecedented step, the British Association for Behavioural and Cognitive Psychotherapy has issued a statement deploring “the bullying and coercive environment that our members are describing to us”.
Lip service is paid to the social inequalities that create and maintain mental distress. However, our society increasingly sees suffering as an individual, psychological issue with a technical fix: everything will be fine as long as you have the right attitude and a few sessions of the right therapy. Even the British Psychological Society, which you might think stands to gain from this idea, hasspoken out against it. Together with marketisation and the steady erosion of resources, this way of seeing things sets up an impossible task and leaves a burnt-out workforce struggling to cope. Like the junior doctors, we must now make our voices heard, refusing to appear to do more, quicker and cheaper while society creates distress faster than a struggling workforce can mop up.
In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here