There is a growing gap between what Psychological Wellbeing Practitioners were trained to do and what they are actually being asked to do. A new study published in The Cognitive Behaviour Therapist (Wynne, Kunorubwe & O’Leary, 2026) gives that gap a name – and the findings deserve the attention of everyone commissioning or managing NHS Talking Therapies services.
What the Research Found
The study, carried out by researchers at the University of Reading, gathered qualitative data from 104 PWPs working within NHS Talking Therapies (formerly IAPT). Participants were asked about their direct experience of working with complexity in clinical practice.
Seven themes emerged. Taken together, they tell a clear story: PWPs are routinely managing cases that fall well outside the scope of low intensity CBT.
The complexity they described was not incidental or occasional. It included clients with moderate to severe mental health difficulties, high risk presentations, severe and enduring conditions, and co-occurring social and systemic challenges – housing instability, poverty, domestic abuse, physical health conditions. These are not the mild to moderate presentations that the PWP role was designed around.
The emotional toll was significant too. Practitioners reported feeling underprepared, under-supported, and caught between the expectations of their role and the reality of the caseloads in front of them. Many described a need for better supervision, clearer clinical leadership, and more structured training in managing complexity.
Why This Matters for Commissioners and Service Leads
The IAPT model – now NHS Talking Therapies – was built on a step-care principle. PWPs deliver high-volume, low intensity interventions for mild to moderate presentations. High intensity therapists and specialist services manage the rest.
What this research suggests is that the reality on the ground has drifted considerably from that design.
When PWPs are managing complexity above their training level, several things tend to happen:
- Clinical risk increases. Not because PWPs are poor practitioners, but because they are working beyond the parameters their supervision and training were designed to cover.
- Outcomes suffer. Clients with complex needs placed in low intensity pathways are less likely to recover, more likely to disengage, and more likely to re-present later.
- Workforce retention is affected. The emotional burden described in this research – managing high-risk cases without adequate support – is a direct driver of burnout and attrition.
- The step-care model fragments. When triage is not clinically robust enough to distinguish complexity at the point of referral, patients enter pathways that cannot serve them well.
None of this is the fault of PWPs. It is a service design and commissioning problem.
The Structural Question This Research Raises
The study’s authors are direct in their conclusion: there is a growing disconnect between the intended role of PWPs and the realities of clinical practice.
That disconnect does not sit at practitioner level. It sits at system level – in the way referrals are triaged, in how supervision is structured, in whether the workforce that receives complex cases is appropriately resourced to manage them.
For NHS Trusts, ICBs and Primary Care providers, the relevant question is not whether PWPs are doing their jobs. Most clearly are, often under significant strain. The question is whether the pathways around them are designed to appropriately allocate clinical complexity – and whether higher intensity and more specialised resource is available where it is needed.
What Good Pathway Design Looks Like in This Context
Services that manage complexity well tend to share a few consistent features.
Clinically led triage. When complexity is identified at the point of referral – rather than partway through a low intensity episode – patients can be matched to the right level of care from the outset. This protects PWPs and improves patient outcomes.
Supervision that matches the clinical reality. If PWPs are managing presentations above their core training, supervision needs to reflect that. Regular, accessible clinical supervision from a higher-intensity practitioner is not an optional extra in this context – it is a clinical governance requirement.
Access to higher-intensity capacity within the pathway. Where complex presentations are identified, there needs to be somewhere appropriate for them to go – without lengthy delays or re-referrals. Embedded high-intensity therapists, or rapid step-up mechanisms, reduce the risk of unsuitable cases sitting in low intensity caseloads.
Clear role boundaries, maintained in practice. PWPs benefit from clarity about where their role ends and specialist input begins. This is a leadership and governance function, not something individual practitioners can resolve alone.
A Note on the Workforce Implications
The research also highlights something that should concern anyone responsible for NHS Talking Therapies workforce planning: the conditions described are a retention risk.
PWPs who feel unsupported, overwhelmed by complexity, and unclear about their scope of practice are more likely to leave the profession. Given the significant investment required to train and develop PWPs, losing them to burnout is both a clinical and a financial problem.
Services that invest in the right infrastructure – supervision, leadership, clinical step-up capacity – are better placed to retain their workforce and deliver consistent quality.
How HG Mind Works Can Support Your Service
At HG Mind Works, we work with NHS Trusts, ICBs, Primary Care and Blue Light and Emergency Services to strengthen mental health provision in a way that is safe, clinically governed, and designed around what patients and practitioners actually need.
That includes supporting Talking Therapies services to review pathway design, ensure appropriate clinical oversight, and introduce embedded higher-intensity capacity where current provision is under strain.
If the issues raised in this research reflect challenges in your service, we would be glad to talk.
Reference: Wynne, J., Kunorubwe, T. & O’Leary, C. (2026). Psychological wellbeing practitioners experiences and perspectives of complexity in talking therapies for anxiety and depression. The Cognitive Behaviour Therapist. (In Press). Available via CentAUR: https://centaur.reading.ac.uk/129319/