High intensity therapist

High intensity therapists support individuals who are experiencing mental health conditions, in particular moderate to severe depression and anxiety

As a high intensity therapist, you'll offer a range of high-intensity cognitive behavioural therapy (CBT)-based interventions to help your patients manage their own recovery.

You'll typically manage a caseload of 30 to 40 clients per year, over a period of time, with each patient session usually lasting around 60 minutes. Sessions are usually weekly.

Managing referrals and signposting to other agencies are common parts of the role and you'll need to work closely with other healthcare professionals, such as psychological wellbeing practitioners (PWPs), employment advisers, other therapists and support staff.

High intensity therapists work specifically in Improving Access to Psychological Therapy (IAPT). Outside of IAPT, you will be referred to as a CBT therapist.

Types of intervention

As a high intensity therapist you will usually offer CBT, although there is a range of other psychological interventions you may use. These include:

• dynamic interpersonal therapy (DIT)
• counselling (specifically for depression)
• couples therapy (e.g. behavioural)
• interpersonal psychotherapy (IPT)
• mindfulness-based cognitive therapy.

Responsibilities

As a high intensity therapist, you'll need to:

• assess a patient's suitability for high intensity interventions
• discuss therapy plans with patients, focusing on areas they want to change
• formulate and implement patient therapy programmes
• encourage patients to talk about their feelings and behaviour
• offer specialist advice and consultation to other professionals across mental health/primary care trusts and charities
• assess the risk your patient poses to themselves and others
• interact with a range of patients using easily understood language
• make decisions on the suitability of new referrals, referring patients to alternative services where appropriate
• provide high intensity interventions, such as psycho-educational interventions, guided self-help and computerised CBT
• use a range of delivery methods, such as face-to-face, telephone and web-based support
• review and evaluate patient progress and tailor treatment accordingly
• attend multidisciplinary meetings about referrals or patients in treatment
• develop strong professional relationships with primary and secondary care staff, such as general practice staff and mental health workers
• liaise with external agencies, including housing, police, local authority, employers and employment support workers
• provide and receive information related to mental health and CBT to individuals or groups of patients, relatives, carers, members of the public and professionals
• educate and involve family members and others in your patient's treatment as necessary
• undertake clinical supervision on a regular basis in line with relevant professional guidelines and policies and, as you gain experience, to provide supervision
• keep accurate records of clinical activity and use these in clinical decision making.

Salary

• Trainee high intensity therapists usually start on £33,706 (Band 6) of the NHS Agenda for Change (AfC) pay rates.
• After qualification, salaries within the NHS progress to Band 7, which ranges from £41,659 to £47,672.
• With experience you can progress to senior roles that include additional management and specialist responsibilities. Salaries at this level (Band 8) range from £48,526 to £65,262.

The NHS pays a London high-cost area supplement at 20% of basic salary for inner London, 15% for outer London and 5% for fringe areas.

Salaries in the voluntary and independent sector may vary.

Income figures are intended as a guide only.

Working hours

You can expect to work a standard 37.5 hours per week, Monday to Friday. You may be required to work shifts that include some evening work, for example 12pm to 8pm.

Part-time work is sometimes possible. Career breaks and short-term contracts are also available.

What to expect

• You'll typically see patients on an individual face-to-face basis or in groups. However, you may have telephone appointments instead.
• The work can be challenging as you'll be working with distressed people with high emotional demands, sometimes at risk of self-harming. Therefore, you'll receive regular clinical supervision from colleagues. It can also be rewarding, however, as you're helping to improve people's wellbeing and quality of life.
• Jobs are available throughout England, but more varied opportunities may be available in larger cities.
• Smart casual dress is expected when meeting clients.
• You may need to travel during the day to visit other sites.

Qualifications

To practise as a high intensity therapist you'll usually need to complete a British Association for Behavioural and Cognitive Psychotherapies (BABCP) Level 2 accredited postgraduate diploma in cognitive behavioural therapy - high intensity IAPT.

On completion of the course, you'll be eligible to apply for accreditation with the BABCP, provided you meet their Minimum Training Standards (MTS).

The IAPT diploma usually takes one year full time and includes two days a week at university and three days in supervised clinical practice.

To access the training, you'll need to apply for a post as a trainee high intensity therapist with an organisation providing IAPT services (either an NHS organisation or a charity commissioned by the NHS). The IAPT service and course provider will decide together whether you're suitable and you'll be offered a job and training place if successful.

To get a place on a training course, you'll usually need a registered core professional qualification, which includes a large amount of mental health training, and professional post-qualification experience working in a mental health service. Core professions include:

• art therapy
• clinical or counselling psychology
• counselling
• education, health or forensic psychology
• medicine
• mental health or learning disability nursing
• occupational therapy
• psychotherapy/psychotherapeutic counselling
• social work.

If you don't have one of these core professional qualifications, you'll need to have had training and experience in another mental health field. You'll have to provide a portfolio of evidence showing that your skills, experience and competencies meet the BABCP's Knowledge, Skills and Attitude (KSA) requirements.

Courses are usually funded by your employer as it's a requirement of the trainee role.

For more information on training and accreditation, see the BABCP website.

Skills

You'll need to have:

• communication and interpersonal skills to develop good therapeutic relationships with patients and their families
• a genuine concern for the wellbeing of patients
• active listening skills and empathy
• teamworking skills to collaborate with other healthcare professionals, such as GPs, nurses and other mental health staff, as well as key stakeholders from other organisations
• the ability to cope under pressure, in particular when working with high-risk patients
• written communications skills for writing reports and letters, for example
• an understanding of client confidentiality
• a commitment to equal opportunities - you will be working with patients from different cultural backgrounds and of different ages
• a high level of enthusiasm, resilience and self-motivation
• the ability to manage your own case load and time in order to meet agreed service targets
• organisation skills to manage a high-volume workload
• sound judgement and a solutions-based approach to work
• an interest in using clinical supervision and continuing personal development (CPD) positively and effectively
• basic IT skills, including word processing and database packages
• a flexible approach to work in order to meet patient and service needs.

Fluency in a community language can also be useful.

You may also need a driving licence or access to transport.

Work experience

You'll need post-qualification professional experience of working with people with mental ill health in mental health services to secure a trainee high intensity therapist role. Consider looking for opportunities in primary care services.

Evidence of long-term volunteering is also helpful as it shows that you're emotionally strong and committed to working with people with mental ill health. These types of vacancies can be found in the not-for-profit and health sector.

It's sometimes possible to arrange to talk to a high intensity therapist or do some work shadowing in your local IAPT service to get a feel for the role. Find your local psychological therapies (IAPT) service.

For free mentoring resources and experiences designed to support aspiring healthcare and legal professionals - including virtual work experience that is accepted by medical schools, see Medic Mentor.

Find out more about the different kinds of work experience and internships that are available.

Employers

You may be employed directly by the NHS or by a charity that has been commissioned to deliver IAPT services on behalf of the NHS, such as Mind, Turning Point or Rethink Mental Illness.

Settings can include:

• community mental health teams
• GP surgeries
• health centres
• hospitals
• social services.

There are also some opportunities to work within the prison service.

Look for job vacancies at:

• Mind
• NHS Jobs - for trainee and qualified posts.
• Rethink Mental Illness
• Turning Point

Local press and hospital websites also advertise vacancies.

You may wish to set up an email alert at the NHS Jobs website to receive notification of trainee high intensity therapist vacancies in your area.

Further advice about local training and recruitment opportunities can be gained from contacting your IAPT regional services.

Professional development

As a newly-qualified high intensity therapist, you'll be expected to identify your own continuing professional development (CPD) needs, which may include a range of in-service and external training opportunities provided by the BABCP and other relevant organisations.

You'll be encouraged to take courses to further develop your CBT knowledge and skills. This post-qualification training can be either short courses, lasting up to one week, or longer courses leading to a diploma or Masters.

With experience, you may be encouraged to undergo training in supervisory, management and leadership skills to oversee the work of other high intensity therapists. You can also undergo further training to work with specific groups of clients, such as those with post-traumatic stress disorder (PTSD), an eating disorder, trauma or body dysmorphic disorder, or in a specialist area such as in a prison.

Alternatively, you could develop specialist research skills and knowledge through getting a clinical doctoral research fellowship and completing a PhD. Whichever route you choose, expertise beyond the core high intensity therapist role is required and you'll need to undertake relevant training.

However, CPD is not limited to training courses and you'll also be encouraged to take part in other activities that contribute towards your professional development such as shadowing others, undergoing supervision from colleagues, reviewing literature, being mentored or working on specific projects.

Career prospects

There's a clear progression route in place in the NHS and to advance through the pay bands you'll need to show that you have the required skills, experience and knowledge.

With experience you can apply for senior high intensity therapist roles (Band 8) by undertaking additional duties involving:

• clinical leadership
• project leadership
• quality improvement
• supervision
• service management.

You could also move into teaching and research to help further develop the profession.

You may also be interested in training in other psychological therapies, for example eye movement desensitisation and reprocessing (EMDR), interpersonal psychotherapy (IPT) or counselling.

Once you have experience, you can move into private practice or to other employing organisations outside of IAPT services as a cognitive behavioural psychotherapist.