Psychological therapists' wellbeing in the context of IAPT-NHS : a Foucauldian Discourse Analysis

Abstract

This study set out to gain in depth and critical understanding of how psychological therapists working in IAPT-NHS services construct the concept of their wellbeing at work. Foucauldian Discourse Analysis (FDA) was used to identify the available discourses mobilised by these practitioners and map out their impact on subjectivity and practice, as well as the role of the specific NHS-IAPT context. Ten psychological therapists working in IAPT services across two East London NHS Trusts were interviewed, using a semi-structured interview which also featured a visual task to elicit information. The interview narratives were analysed using FDA through the lens of a moderate social constructionist position. The analysis identified four main discursive constructions of wellbeing: (1) wellbeing as an individual responsibility; (2) wellbeing as a collective responsibility; (3) wellbeing as self-actualisation; and (4) wellbeing as productivity. Each presented a picture of duality and contradiction, delineated by the subject positions made available. Notably, for the first two constructions, the subject positions of responsible and irresponsible alternated between the individual and the service, with particular impact on the ability to voice wellbeing difficulties at work. Subject positions of the good/ideal therapist and the good employee, corresponding to the latter two constructions, were mediated by the introduction of IAPT as a sub-context. IAPT was constructed as an inflexible, target-driven system in which participants seemed unable to hold both the good/ideal therapist and good employee position, resulting in a constant tension that seemed to only be resolved by giving up one of the two positions. The conclusion addresses the benefits of approaching the issue of psychological therapists’ wellbeing at work beyond the individualistic, neoliberal perspective, with particular recommendations to: (1) direct more funding to protect the NHS’s therapeutic function, preventing further expansion of the market discourse into mental health services; (2) promote congruence between policies and practices at work, aligned with a collectivist perspective of wellbeing where both the individual and the system share responsibility and support; and (3) increase IAPT’s flexibility to adapt appropriately to diversity.