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

Omylinska‐Thurston, J; McMeekin, A; Walton, P; Proctor, G


A McMeekin

P Walton

G Proctor


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.


Omylinska‐Thurston, J., McMeekin, A., Walton, P., & Proctor, G. (2019). Clients' perceptions of unhelpful factors in CBT in IAPT serving a deprived area of the UK. Counselling and Psychotherapy Research, 19(4), 455-464.

Journal Article Type Article
Acceptance Date Jun 14, 2019
Online Publication Date Jul 22, 2019
Publication Date Dec 1, 2019
Deposit Date Mar 9, 2020
Publicly Available Date Jul 22, 2020
Journal Counselling and Psychotherapy Research
Print ISSN 1473-3145
Electronic ISSN 1746-1405
Publisher Wiley
Volume 19
Issue 4
Pages 455-464
Publisher URL
Related Public URLs
Additional Information Access Information : This is the peer reviewed version of the following article: Omylinska‐Thurston J, McMeekin A,Walton P, Proctor G. Clients’ perceptions of unhelpful factorsin CBT in IAPT serving a deprived area of the UK. Couns Psychother Res. 2019;19:455–464, which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Funders : BACP small grant
Projects : Clients' perceptions of unhelpful factors in CBT in IAPT serving a deprived area of the UK


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