A career as a high intensity therapist would suit you if you can show empathy, work well in a team, are solution-focused and have experience of working with people with mental health conditions
As a high intensity therapist you'll support individuals of all ages and cultural backgrounds who are experiencing mental health conditions, in particular moderate to severe depression and anxiety. You'll offer a range of high-intensity cognitive behavioural therapy (CBT)-based interventions, such as imagery rescripting and exposure therapy, 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 lasting 60 minutes.
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.
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, implement and evaluate 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 unsuitable patients to alternative services
- 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
- 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
- keep accurate records of clinical activity and use these in clinical decision making.
- Trainee high intensity therapists usually start on Band 6 (£28,050) of the NHS Agenda for Change (AfC) pay rates.
- After qualification, salaries within the NHS progress to Band 7. You're likely to start on £33,222 and progress up one pay point annually until you reach £43,041 (the top of the scale).
- With experience you can progress to senior roles that include additional management and specialist responsibilities. Salaries at this level (Band 8) range from £42,414 to £59,964.
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.
You can expect to work 37.5 hours per week, generally 9am to 5pm, with the possibility of extra hours in the evening or at weekends.
Part-time work is possible. Career breaks and short-term contracts are also available.
What to expect
- The working environment can be stressful and the work is challenging as you'll be working with distressed people with high emotional demands, sometimes at risk of self-harming. Therefore, supervision by colleagues is important.
- You'll usually see patients face-to-face, as home visits and telephone appointments are rare. Smart casual dress is expected when meeting clients.
- Jobs are available throughout England, but more varied opportunities may be available in larger cities.
- Local travel between sites and home visits within a working day are uncommon. Absence from home overnight is unusual. Overseas work or travel is uncommon.
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, which has a curriculum based on guidance by the national IAPT programme. (Only IAPT courses have this curriculum; non-IAPT courses may differ.)
On completion of the course, you'll be eligible to apply for accreditation with the BABCP, provided you have the necessary experience.
The diploma lasts one year full time, or two years part time. After the first few months of study, each week you'll spend a combination of days at university and in a clinical setting undergoing supervised practice. See the BABCP website for a list of Level 2 accredited CBT training courses (which includes both IAPT/high intensity and CBT courses).
To get a place on a training course, you'll usually need a registered qualification and at least one year's experience at graduate level in a core profession, such as mental health, nursing, social work, occupational therapy, counselling, psychotherapy or clinical psychology. See the full list of core professions.
If you don't have one of these qualifications, you'll need to have had training and experience in another mental health field. You'll have to provide the university with a portfolio of evidence showing that your skills, experience and competencies meet the BABCP's Knowledge, Skills and Attitude (KSA) requirements.
Some trainees have gained the necessary evidence through working as a psychological wellbeing practitioner (PWP). If you've qualified as a PWP, you'll need two years' post-qualification experience before applying for high intensity therapy training. You will also need to have completed an undergraduate degree, but this may be in an unrelated discipline.
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 organisation and course provider will decide together whether you're suitable and you'll be offered a job and training place if successful.
Courses are usually funded by your employer as it's a requirement of the trainee role.
You can also get a job as a cognitive behavioural therapist by completing a non-IAPT postgraduate diploma. You may still be able to apply for high intensity therapist posts, as well as other CBT posts, but different NHS trusts may ask for different qualifications. You can also apply for accreditation with the BABCP.
You'll need to show:
- the skills to develop good therapeutic relationships with patients
- interpersonal skills to establish rapport with patients' families
- a genuine concern for the wellbeing of patients
- team working skills to collaborate with other healthcare professionals, such as GPs
- an interest in using clinical supervision and personal development positively and effectively
- the capacity to work under pressure, in particular when working with high-risk patients
- regard for others and respect for individual rights of autonomy and confidentiality
- skills in communicating clearly and persuasively, both verbally and in writing
- the ability to liaise and network with a range of organisations and members of the public
- basic IT skills, including word processing and database packages
- a high level of enthusiasm and self-motivation
- good time management and organisational skills relating to the overall number of patient contacts offered and clinical sessions carried out per week
- how to apply your knowledge of high intensity therapeutic interventions to clinical problems.
In some parts of the country, it's also useful to be fluent in other community languages.
You'll need experience of working with people with mental ill health to secure a trainee high intensity therapist role. Consider looking for opportunities in primary care services, such as community support worker and PWP roles.
Evidence of long-term volunteering is also helpful as it shows that you're emotionally strong and committed to working with people with mental health issues. 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. Find your local psychological therapies (IAPT) service.
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. There are also some opportunities to work within the prison service.
Look for job vacancies at:
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.
As a newly-qualified high intensity therapist, you'll be encouraged to take courses to further develop your 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. 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.
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), 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 gaining 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.
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 supervision, management, project leadership, training, specialism and education.
You may also be interested in transferring to train in other psychological therapies, for example eye movement desensitisation and reprocessing (EMDR), interpersonal psychotherapy (IPT), counselling and alternative areas such as clinical psychology.
With experience, you can move into private practice or to other employing organisations outside of IAPT services as a cognitive behavioural psychotherapist. You'll need to have at least one year's post-qualifying experience in an IAPT service as this is the minimum time needed to develop the portfolio of evidence required by the BABCP.