Therapy Exclusion Criteria - general guidance

Therapy Exclusion Criteria - general guidance

General guidance on exclusion criteria for therapy 

This is a broad guide to exclusion criteria at VHG for therapy on our network. This guidance is designed to support network practitioners when reviewing initial triage/referral documents and assessing clients' needs at the start of therapy and on an ongoing basis to ensure that the client and the pathway are appropriately matched. 

We acknowledge that the term "exclusion criteria" can feel jarring when our main aim is to support people who are struggling. We have put careful thought into our criteria; they are not there because these are clients or presentations we do not want to work with, or feel negatively towards.  We strive to make our therapy services as inclusive as possible; however, we must take into account different factors when thinking about the support we can realistically provide for our clients, often within a short-term time limited context, including NICE guidelines and other evidence bases, our customers' requirements and the scope of the services they contract VHG to provide, and the specialisms and capacity we have within our internal and wider network teams. We also need to take into account that much of the therapy we offer is time limited and is delivered remotely, which impacts the level of complexity, need, and risk we can reasonably expect practitioners to hold. The decision to refuse or end therapy early is never taken lightly and we always endeavour to keep clients' best interests at the centre of these decisions.  

IMPORTANT: If you receive a referral that you feel is unsuitable because it meets one or more of the criteria below, or you are concerned about a client's suitability at any point during their therapy, please flag this to our clinical team and discuss with us before taking any action to discharge the client. It may be that we can offer the client a pathway change or reallocation, and we can advise and support regarding onward referral/signposting where required. 

1.    Exclusion criteria for all therapies (including psychology)

  1. Neurodevelopmental assessment and treatment (e.g. assessment and/or medication for autism or ADHD) - on some contracts these can be referred through psychiatry pathway, otherwise through client's GP. 
  2. Other specialist psychological assessment/diagnosis including assessment for personality disorders (see above)
  3. Specialist treatment or therapies for diagnosed personality disorders (where this is the main presenting issue - see above)
  4. If medication management is the main presenting issue (see above)
  5. Active psychosis, schizophrenia, bipolar disorder
  6. Moderate to severe eating disorders (e.g. anorexia nervosa, bulimia nervosa, binge eating disorder) that would require MDT support
  7. Under secondary care/CMHT, a MDT, or receiving therapy via another service
  8. Chronic, severe and treatment resistant depression
  9. Moderate to severe cognitive impairment (e.g. dementia, brain injury, Alzheimer's, learning disabilities, autism or other neurodevelopmental conditions with moderate to severe co-occurring LD/cognitive impairment)
  10. Moderate to severe gender dysphoria/gender reassignment
  11. Moderate to severe risk to self or others/under Crisis Team or equivalent care
  12. Admitted to inpatient care
  13. Severe substance misuse/physical dependency (we can work with substance use/misuse as a coping strategy without dependency or significant impairment in daily functioning)
  14. Children cannot be present during adult therapy sessions (except for family therapy where offered) 
Note: If a client is receiving therapy funded by their employer or an employer-funded insurance policy and they resign or leave their employment, therapy will not be able to continue beyond the end of their employment contract. 

2.    Exclusion criteria for counselling

  1. All in section 1
  2. Eating disorders
  3. Moderate to severe self-neglect
  4. Chronic Fatigue Syndrome (where this is the main presenting issue)
  5. Moderate to severe self-injury within the last 7 days
  6. Recent hospital stay for suicide attempts or severe self-injury
  7. Long-term enduring anxiety disorder that is not directly related to current life circumstances/stresses

3.    Exclusion criteria for CBT

  1. All in section 1
  2. Unable/unwilling to engage in active change work 
  3. Multiple previous episodes of unsuccessful treatment
  4. PTSD symptoms less than 1 month after a traumatic event
  5. Complex PTSD with multiple traumatic events (would be referred to EMDR/psychology if pathway available, or referred through GP)
  6. Moderate to severe self-injury within the last 7 days
  7. Recent hospital stay for suicide attempt or self-injury 

4. Support with decisions about inclusion/continuation and exclusion

As therapists, we need to make nuanced and sensitive decisions based on clients' individual circumstances, and our clinical team is here to support with that, along with the supervision you access as part of your own practice. If you are unsure about a referral you receive, or have concerns about a client's appropriateness for therapy or the treatment pathway they have been placed on, please raise a ticket for our clinical support team to review the case here: Vita Health Group | My Area | Submit a Ticket