The March BABCP Article of the Month is from the Cognitive Behaviour Therapist (tCBT) and is entitled “‘It’s been quite a poor show’ – exploring whether practitioners working for Improving Access to Psychological Therapies (IAPT) services are culturally competent to deal with the needs of Black, Asian and Minority Ethnic (BAME) communities” by Afsana Faheem.

It is relatively well known that individuals from disadvantaged backgrounds experience greater health inequalities, poorer treatment outcomes, and increased disengagement from mental health services when compared to the White British population. Improving Access to Psychological Therapies (IAPT) services, recently rebranded “Talking therapies”, took centre stage to offer evidence-based psychological therapies to people with anxiety and depression related disorders. Despite its substantial growth, research indicates that people from Black, Asian, and Minority ethnic (BAME) communities continue to show poorer treatment outcomes compared to their White British counterparts. Over recent years, a number of researchers, like me, have attempted to explore the possible reasons behind these disparities.

Given the inherent Eurocentric nature of mainstream psychotherapy (and psychology), the aim of my doctoral research was to explore the cross-cultural validity of evidence-based psychological therapies. This included exploration of how Western notions of therapy (e.g., Cognitive behavioural therapy) are perceived, adopted, and ultimately accepted by BAME communities. By drawing on cross-cultural theoretical concepts, I considered the experiences of both BAME service users and IAPT practitioners’ in receiving and delivering therapy. As an ‘outsider’, that is, someone who is external to IAPT services and therefore has no direct vested interest in the programme, I found that participants openly [and critically] shared their personal experiences. What I discovered was both enlightening and somewhat alarming.

In my first article – ‘Not a cure, but helpful…’ (Faheem, 2023a),I interviewed BAME service users to explore whether evidence-based psychological therapies are suitable to their needs. Findings revealed that service users valued the inclusion and consideration of their culture within therapy, but felt that this wasn’t common practice and therefore therapists needed to develop their cultural competency skills. Service users reviewed their own recovery outcomes following treatment and generally felt that therapy was helpful, but it did not help ‘cure’ them. During the interviews, I noticed that service users’ often felt disgruntled by the type of therapies that were offered to them, particularly therapies such as CBT that failed to consider their cultural needs. Contrary to common belief, service users desired therapy, but felt there was a need for more community awareness and psychoeducation about the services available to them.

In my second article – ‘It’s been quite a poor show…’ (Faheem, 2023b), I interviewed IAPT therapists, which included early career psychological wellbeing practitioners to senior CBT therapists. The aim of the study was to explore whether therapists are culturally competent to deal with the needs of BAME service users. Findings revealed that therapists often encountered cultural dissonance between Western concepts of therapy and BAME service user needs. Therapists talked about the challenges they experienced in making cultural adaptations to therapy, particularly given the fast-paced environment of IAPT services. Surprisingly, out of sixteen therapists interviewed, only nine received one-day formal training throughout their therapeutic career, whilst seven reported that they had no cultural competence training at all. Therapists reflected on their own cultural competency needs and felt that appropriate training was needed so that BAME communities could be better served. During the interviews, it was overwhelmingly clear that IAPT therapists valued and cared about their profession. However, BAME therapists often felt that unlike their White colleagues, they were left to take on additional responsibilities (e.g., community development work) to their clinical role.

Given the findings of both studies, it is clear that there is an urgent need for more cultural competency training within IAPT services. This needs to be embedded early on within clinical training programmes and incorporated as part of therapists’ continual professional development. It’s not a short fix; it needs to be a life-long investment. Even though IAPT has recently redeveloped its BAME Positive Practice Guide (Beck, Naz, Brooks, & Jankowska, 2019), it appears that there is a systemic problem that needs to be addressed at the grassroots. That is, for more representation in senior positions, more funding for community development work, and decolonisation of Western therapy and practice. I hope to continue this important work through my research so that BAME communities can be better served and IAPT therapists can be better supported in their roles.

References:

Beck, A., Naz, S., Brooks, M., & Jankowska, M. (2019). Improving Access to Psychological Therapies (IAPT) Black, Asian and Minority Ethnic service user positive practice guide. Retrieved from https://www.babcp.com/files/About/BAME/IAPT-BAME-PPG-2019.pdf

Faheem, A. (2023a). ‘Not a cure, but helpful’ – exploring the suitability of evidence-based psychological interventions to the needs of Black, Asian and Minority Ethnic (BAME) communities. The Cognitive Behaviour Therapist, 16, e4.

Faheem, A. (2023b). ‘It’s been quite a poor show’ – exploring whether practitioners working for Improving Access to Psychological Therapies (IAPT) services are culturally competent to deal with the needs of Black, Asian and Minority Ethnic (BAME) communities. The Cognitive Behaviour Therapist, 16, e6.

Author Bio:

Afsana Faheem is a lecturer for the MSc Applied Clinical Psychology programme at the University of Bath, UK. Her research interests include working with disadvantaged communities, health inequalities, and cultural competency training. As part of her doctoral research, Afsana focused on IAPT services with a vision to help improve services for BAME communities. 

From Richard Thwaites, Editor-in-Chief of tCBT: Why I chose this article 

I chose this second of Afsana’s papers as BABCP Article of the Month due to the importance of the issue and the framework and solutions suggested. We know that some ethnicities have significantly worse outcomes in IAPT services. We also know that staff consistently report their core training or ongoing Continuing Professional Development events (and also models and journal articles) don’t always consider how to ensure that evidence-based therapies are inclusive and applicable across ethnicities and cultures. The curriculum and BABCP Training Standards tweaks are a very good start, but this paper challenges therapists, supervisors, trainers, researchers and service leads to step up in terms of inclusivity and is applicable way beyond IAPT services with important learning for CBT therapists in all settings.