ABSTRACT
This chapter describes the provision of primary care mental health services (PCMHS) in the United States, and the characteristics of a typical primary care mental health service. It discusses a case which was less suitable for the other therapies provided within PCMHS, for example, Cognitive Behaviour Therapy (CBT) and Person-Centred Counselling, but was amenable to experiential dynamic therapies formulation. The Improving Access to Psychological Therapies (IAPT) team typically receives referrals from general practitioners, other health professionals, and patients directly self-referral. The service delivery system widely adopted within IAPT services is the stepped-care approach identifying the least restrictive and least costly intervention likely to be effective for the presenting problem. The case presented herein was undertaken within a pre-IAPT, stepped-care PCMHS in which counsellors and PCMHWs carried out the majority of the clinical work including assessments, psycho-educational courses, computerised CBT, guided self-help, and up to six sessions of therapy using a cognitive behavioural approach or counselling.
