Lacap The London Association for Counselling and Psychotherapy 

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The Group Practice here is an outsource if your practice does not have existing counselling services, or if those services are overwhelmed by numbers. We can provide follow-on from GP attached counsellor services:- patients can be offered further treatment that is not time-limited or frequency-bound.

Our therapists engage in long-term psychotherapy, and offer prompt, sustained and low-cost treatment for those who could not usually afford it. Therapists are psychoanalytically trained, and offer psychotherapy and counselling. Please take a moment to take a look at our website sections, and consider whether your practice has patients that might benefit from being referred on to our services.

We encourage self-referral from the patient, and it is usually sufficient for you to pass on the contact details, and to add that if low-cost work is required, this should be discussed with the Referrals Therapist. Please see the article below for more information on effective referrals over to counselling and psychotherapy services. The patient is usually seen within four days of their contacting us. We are very interested in establishing personal links with GP Practices. If you would find it useful to have a meeting or a telephone call in which to discuss our services, please do contact us.

Access to Psychotherapy

Access to counselling services does not depend on the individuals' ability to pay for the value of the service, but upon the individuals' wanting to do this work. We will offer individual psychodynamic treatment on demand, unless there are sound clinical reservations concerning that candidate's suitability for the work (in which case, the clinician may direct the patient towards other services from which he or she might benefit).

In practice, this will mean that the clinician will assess each individual and, bearing in mind the indications and contra-indications for that individual, will undertake counselling or psychotherapy as appropriate. Psychotherapeutic work may open into a full psychoanalysis.

Access to a a therapist is immediate. The patient will be supplied with the name of their therapist when he or she first makes contact with us (allowing for gender, age and language preferences where these can be accommodated). The patient and the therapist will then arrange a first consultation. There are no forms, no waiting lists and no institutional hurdles to jump.

The Psychotherapy

The clinicians work within guidelines, but they are free to negotiate the working contract with each patient. This means that they can give an appropriate and commensurate frequency of sessions, and timing of sessions.

Long-term and open-ended treatments are offered. In principle, the group has no problem with supporting therapy for as long as each treatment takes to conclude. The duration will not be limited by a set number of sessions or an artificial time boundary. Thus the needs of the patient will take priority over the supply of therapeutic time.

Our clinicians are psychoanalytically orientated, and therefore the treatments are derived from the psychoanalytic model, but varied according to the patient's ability to engage with and derive benefit from that model.

Fees & Charges

We support low-fee work (e.g. a person not in work would expect to pay under £10 per session). Our therapists are encouraged to charge fees for the therapy because it gives an additional meaning and impetus to the work. The fees that form a part of the working contract will always be based on the individual's ability to pay.

The group does not restrict itself only to low-fee work, but has a sliding fee scale. Where a referral is made and that patient can afford a standard (
£30 - £35.00) or high fee, the therapist will undertake the treatment at those affordable rates - in effect there is an internal re-distributive tax policy This is an essential element for us, because such standard or higher fee patients subsidise the work at lower fees by sharing costs.

We wanted to deal with the question 'what happens after brief intervention?'. The group was formed as a response to the perception that current service provision fails some of those who could most benefit from a prompt, sustained therapeutic intervention but who cannot afford it privately.

Control & Supervision

Our therapists are individual members of the Psychoanalytical Section of the UKCP, the BACP, or the BPS and as such are responsible for their work. In the case of a complaint coming from a patient about their treatment, the management will automatically refer the matter on to the therapist's member organisation to be dealt with in the usual way. Each therapist has individual professional indemnity insurance for the work that they do.

The therapists' who are not yet qualified members of the UKCP, BACP or BPS will only undertake casework with the express approval of their training organisation, which will be a member organisation of the UKCP or training organisation for the BACP or BPS. Therapists in training will work according to the guidelines of that training organisation.

Supervision of all work is carried out within the usual practices of each therapist's training organisation. Supervision of the counselling group's work is therefore external to it. The aim is to create a culture that keeps the focus for the work between the therapist and the individual. Control and supervision of that work is best done by the professional training organisation that has developed and known the therapist for many years. We carry out regular checks to ensure that supervisors are satisfied with each therapists work.

 

Psychotherapy & Counselling Services Referral:

The recognition and treatment of anxiety & depression, and knowing when to refer to psychotherapy or counselling is a challenging area of clinical practice, especially in primary care where there are many patients with various presentations and a multitude of causes for distress. Then there are, despite the evidence showing patient preference for psychotherapy & counselling above treatment by medication, the twin problems of counselling & psychotherapy service availability in London, and the barriers both to referring over and to entering psychotherapy and counselling treatments.

Guidelines exist for use of antidepressants and psychotherapy or counselling for mild to moderate depression, although psychotherapy needs effective policy implementation in clinical practice to maximise its impact for patients receiving this treatment. This is where referral over to our Counselling & Psychotherapy services can be effective: at the psychotherapy assessment the clinician can decide with the patient the nature of the psychological  i
ntervention amongst the field of psychotherapies and counselling offered in our London group practice. There is consistent evidence from service users in London that people want a counselling or psychotherapy, which takes into account their preferences and concerns. So, rather than the ‘forced marriage’ of referral over to a sole psychotherapy practitioner, with us you have an ‘introduction agency’.

The somatic symptoms of depression and anxiety present the most significant barrier to recognition because patients who somatise their symptoms will often lead their physician to think there is a physical reason for the symptoms. This preoccupation with physical illness often delays or prevents diagnosis.  Care models focus on recognizing depression by initially assessing patient mood and interest, suggesting psychotherapy and counselling for patients who have mild depression, and pharmacologic and psychotherapy or counselling for patients who have moderate-to-severe depression.

Barriers to psychotherapy & counselling - physicians feel that barriers arise most frequently from factors centred with the patients, their psychosocial circumstances, and their attitudes and beliefs about depression and its care, and about pop-psychology attitudes to what psychotherapy & counselling are. Motivation for psychotherapy or counselling is seen as a major factor for the success of psychotherapy. Examination of this motivation process requires procedures which recognize motivation for psychotherapy prior to initiation of therapy. Although still debated, there are protocols such as the Psychotherapy Motivation Questionnaire.

For successful referral over to psychotherapy & counselling, confirmative factor analysis affirms "initiative" and "knowledge" as two separate factors. Patients with somatoform disorders and "unexplained physical symptoms" as the reason for referral show less motivation for counselling and psychotherapy than other patients, and may need more ‘push’ from the referring GP.  Patients with previous experience with psychotherapy or counselling show higher motivation.

Most primary care patients in London who experience depression state that they would prefer psychotherapy over antidepressant medications. However, when referrals for psychotherapy are made, only 20% ever follow up, and of these, half drop out of counselling treatment. This suggests that there are substantial barriers to accessing psychotherapy.

When surveyed, London patients report one or more perceived barriers that would interfere with or prevent initiation or regular attendance of psychotherapy. Perceived barriers were more common among depressed than non-depressed patients making depression both an indicator for psychotherapy or counselling and a barrier to receiving it. London Gp’s can be helpful in the referral process by talking through the patient’s concerns about psychotherapy. A particular concern with patients accessing private psychotherapy in London is the cost. Our Counselling & Psychotherapy service has a sliding fee scale of £6.00 to £80.00 determined by income & circumstances. Our psychotherapy and counselling fee policy is clear, explicit and published – and we believe that this can allay some reservations about accessing private counselling & psychotherapy services in London. A further de-motivating factor is often the perception that access to counselling & psychotherapy services in London is time-consuming, difficult and may require substantial waiting time. With our Counselling & Psychotherapy service, access is by online submission and application, psychotherapy assessment appointments can be made the next day, and referrals onto the appropriate psychotherapist or counselling practitioner in our London practice are usually made within days of that psychotherapy assessment

Studies show the increased probability of referring to a counselling or psychotherapy service for physicians who devote more time to nonclinical activities, perceive psychotherapy consultation in London to be more readily available, have less confidence in their ability to manage antidepressants, and have personal life experience with psychotherapy or counselling. The idea that physicians with academic or administrative responsibilities refer onto psychotherapy differently than full-time clinicians is consistent with the work of Borowsky et al. who found that psychotherapy referrals are extremely common in academic generalist practices. Of course; the association between availability of counselling & psychotherapy services in London availability and utilization is a time-honoured theme in health services research.

Psychiatrists are rarely consulted, perhaps reflecting the “occupational transformation of the mental health system.” Surprisingly, only a minority of patients are given meaningful assistance with making psychotherapy or counselling appointments. Most patients are just told to call a London counselling & psychotherapy service number, utilise BUPA, or use the phone book. We suggest that although you can refer onto our London counselling & psychotherapy services by giving out contact details alone, the more substantial, informed and consolidated the ‘push over’ is made during the referral process, the more successful the referral outcome. The counselling service will benefit from the position and respect that you have with the patient. This is also why, in the brief letter above, we are keen to dialogue with our referring GP practices in London, so that they can have a greater awareness and confidence in our counselling & psychotherapy service.

Indications for Psychotherapy & Counselling:

“What treatment, by whom, is most effective for this individual, with that specific problem, and under which set of circumstances?” Put simply, the assessor seeks to determine which type of psychotherapeutic intervention is likely to be most appropriate and at what level. This calls for

  • expertise in a thorough psychiatric evaluation beyond just making a psychiatric diagnosis;

  • knowledge about the different forms of psychotherapy and counselling and the general indications for each; and

  • how to initiate the necessary referrals to psychotherapy & counselling services or individual psychotherapists.

Evaluation of Psychotherapy & Counselling

Very often the referring doctor fails to follow up with patients they have referred for psychotherapy and counselling. This is unwise from various points of view. Firstly, In London many patients do not even turn up for the first counselling session and some patients drop out of psychotherapy and counselling even under the best hands. Secondly, psychotherapists need to be accountable to the referring doctor to a certain extent. Patients referred for psychotherapy and counselling in London may be vulnerable and may be exploited by unethical psychotherapists since there is no regulatory government body for this profession at present. Thirdly, referring doctors can learn much by following up on the progress of patients undergoing psychotherapy & counselling, including insights into patients’ problems, and appreciating psychotherapeutic techniques.

We are a group practice with over 35 psychotherapists and counsellors.  We will assess referrals into practice, and determine the most suitable treatment intervention. Psychotherapies at our Counselling & Psychotherapy service include most of the major psychotherapy and counselling orientations, CBT, REM, couples and group psychotherapy and full psychoanalysis.