The role of a Psychological Wellbeing Practitioner (PWP) truly is a mixed bag.  If you wanted to see the word “multitasking” personified than look no further than the NHS’s very own PWPs.  First and foremost, the role is a mixture of administrative and clinical work. 

Administrative duties

The ratio between these two will vary between different services but generally you tend to find that PWPs are doing some of their own administrative work although some of it is streamlined to an in-house administrative team. This can involve anything from letter writing to printing off self-help materials to stapling thirty copies of said materials together for dissemination at a CBT group.  This might not sound too arduous but I think I speak for the majority when I say that when you have a long list of clinical tasks to follow up on, these administrative bits and pieces can often take up valuable time for those tasks.

Clinical duties

The clinical work is the real meat of the job that most of us got into this line of profession for.  Clinical duties will be (more or less) similar for all trainee PWPs no matter what service they are in. This is particularly the case if you are a trainee PWP because your NHS service has a duty to ensure that the clinical work you undertake matches what the national curriculum for training expects you to be doing.  Typically, this involves: conducting screening assessments (lovingly given different pet-names by different services e.g. triage, FSA’s, BSA’s etc), co-facilitating CBT groups, providing one-to-one Guided Self Help (GSH) treatment and providing one-to-one Computerised Cognitive Behavioural Therapy (CCBT) treatment.  All these different appointments on your calendar, week by week, can make for a pretty full and varied working day!

(1) Conducting Screen Assessments

Different services will have different names for what they call these assessments but despite the name difference, they all assess the same thing: the suitability of the client being treated within IAPT, and if the client is suitable, at what step.  As a trainee PWP, you work within low intensity Step 2 but this does not mean that who you assess will be “Step 2 suitable.” 

These assessments are usually over the telephone but some services do provide face-to-face assessments, and nearly all services will accommodate face-to-face assessments for those who require it for special reasons e.g. hearing difficulties.  The time for assessments varies too between different services. I’ve heard a range between 20 minutes to 40 minutes. The average time is usually about 30 minutes.  I personally plan an hour for each assessment because between the actual assessment and the clinical notes you must complete afterwards, it will take about that much time.  However, I have had assessments which have lasted 30 minutes and other which have lasted well over an hour.  It is impossible to plan what a client might bring to the conversation in terms of their history, their presenting problem and the complexity of this. Sometimes, it can take longer to elicit all the required information and this is generally understood by managers (similarly, some hard-nosed “target-driven” managers may be less understanding!)

The assessments involve use of questionnaires such as the PHQ9, GAD7, Work and Social Adjustment Scale, a risk assessment and a brief discussion about the presenting problem and the impact of this on the client’s day to day life.  As a trainee, you will usually defer back to a supervisor as to the next steps for the client after an assessment and therefore you will have plenty of support in ensuring a suitable treatment choice is made.

(2) Co-facilitating CBT groups

Again, different services will have different types of groups and different ways that they have set this up.  From my experience when I was a trainee, we co-facilitated groups for depression, anxiety and stress. We were paired up with an experienced PWP and delivered CBT-based material for managing anxiety or whatever the group was based around to a group of 15 to 30 clients.  These groups are initially nerve-wracking as for most trainees, it is their first face-to-face experience with clients.  

However, it does over time become a lot easier. Your training will render you more knowledgeable without you even realising it until someone in a group puts you on the spot about something and you find yourself able to reply coherently!

(3) Guided Self Help (GSH)

Guided Self Help is CBT-based treatment for a variety of disorders: depression, anxiety disorders, etc.  It involves about 6 to 8 sessions lasting 30 minutes on either a weekly or bi-weekly basis with a patient which are offered either face to face or over the telephone.  The modality really depends on what your service has the resources to accommodate.  In my experience, the service I worked for did not have the resources to allow ten trainee PWPs to have ten different clinical spaces to see patients face to face. It just was not financially viable so treatment was usually done over the telephone unless there were special circumstances for the patient which meant they had to be accommodated face to face.

GSH can be daunting for a trainee, similar to how a group can be.  In GSH, you are alone with your patient. You are the one supporting them through treatment. You are the one supplying knowledge to empower them to make decisions and changes in their life.  It is a lot of responsibility. It can be stressful. However, it is also incredibly rewarding! I personally found GSH to be one of the treatments where I learnt the most and developed the most as a trainee.

(4) Computerised Cognitive Behavioural Therapy (CCBT) treatment

CCBT is essentially like GSH but online. You work one to one with a client and you usually have telephone support calls that last about 15 minutes either once a week or bi-weekly.  Different services will have different CCBT packages.  These packages are websites which allow patients to login with usernames and passwords and work through interactive materials about their disorder (e.g. depression, anxiety, etc). The programme essentially teaches our clients about how to better understand their symptoms, their illness and then what they can do to manage this using CBT principles. Our role as their clinicians is to check in with them either through the online messaging system or through a telephone call at agreed intervals (a week or two weeks).  This has two functions; to motivate clients to continue and to also support them with any aspect of the programme that they may have difficulty with.

Different services use different programmes but some common names are Silvercloud, Beating the Blues and FearFighter.

Personally, CCBT Has been my least enjoyable treatment intervention with patients mainly because of my own hang-ups about whether it could be effective in treating disorders such as depression and anxiety. However, it is an intervention that does work for some – so that has proved my preconceptions wrong!

So what is a typical day in the life of a PWP?

So, a typical day is a mix of all of the above – usually not all of the above as we only work 8.5 hours a day and despite trainees having some pretty austere targets at times, they’re not that cruel! Usually though, you can expect to find a range of all the above in your average week.

I would say for me, the job has had a lot of variety to it. As a PWP, you see lots of different presentations of disorders, you learn so much from your supervisors and senior colleagues and you continuously have daily opportunities to improve your clinical skills.  However, as a role, it is one that only allows you to scratch the surface of clinical work. It allows you to sample different things without intensely focusing on one thing.  This is great for experience and in terms of keeping yourself interested. However, after a while, most PWPs want a bit more challenge and something deeper to sink their teeth into.  Thankfully, there are opportunities to advance further within IAPT to keep you satisfied!