Organisations adjusting to change: A discussion of the impact of an Improving Access to Psychological Therapies (IAPT) service on the organisational dynamics of an existing psychological therapies department

Abstract

Content and FocusHealth systems are typical examples of what Halton (1995) describes as ‘dependency cultures’. People who chose to work in such cultures are, it is argued, vocationally motivated by a desire to help those in the ‘dependent’ position. The primary value of this culture is to maximise the development, health and welfare of the people who need these services. The introduction of market forces into the National Health Service (NHS) has gradually undermined this value as scarce resources dictate to who and how much service could be given. Re-evaluation and restructuring of therapeutic services is necessary to ensure they are run efficiently and effectively; however, problems arise when lack of recognition or matching of the ‘dependency values’ and the implicit primary task of ‘caring for others’ obstructs the vocational motivation of practitioners. This has the potential to introduce conflict between the values of the different staff groups within and between services leading to confusion and stress. The introduction of Improving Access to Psychological Therapies (IAPT) has been criticised for promoting an idealised culture of ‘cure’ which has failed to acknowledge the real complexity, and often comordidity of mental health problems (Fairfax, 2008). This change of emphasis from ‘care’ to ‘cure’ denigrates both the primary task and the morale of staff whose abilities to care and to act realistically by accepting the often complex and chronic nature of mental health problems, are undermined (Stokes, 1994). Bion’s (1961) concept of unconscious processes within groups and organisations is used to provide a psychodynamic understanding of how the introduction of IAPT into an NHS psychological therapies department created tensions between the non-IAPT and IAPT services, disrupting the organisations ability to work towards its primary task of care. Using the author’s observations and experiences as a trainee counselling psychologist within this service, the paper concludes with a discussion of how counselling psychology’s humanistic values and pluralistic training provides a unique perspective from which to arbitrate professional conflicts, and facilitate adjustment to organisational change.