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Clinical Psychology Blog



As I’m technically on holiday, I’m cheating very slightly this week, with an edited snippet from my book.

I commute to work by car and unfortunately drive for quite long distances on motorways. So my journey to work (like, I suppose, everything else in life) depends on the operation of the laws of physics.

When it rains, we often see collisions and other accidental tragedies; the roads are slippery, it is harder to see. When people have accidents, the police investigate the probable or likely cause of the incident for legal and insurance purposes. Their analysis includes human factors, but also includes complex physics.

To work out why a tragedy has occurred, the investigators will calculate things like the velocity of the vehicles involved, coefficients of friction between rubber and tarmac, reaction times calculated using equations of acceleration and deceleration, the role of centrifugal forces, tyre pressures and ‘footprint’, the role of aquaplaning, lift, etc.

They will measure elements of the physical world; the weight of the vehicles, radius of turns, the slope of ascents or descents, whether the conditions were wet or dry, the temperature, tyre pressures, the condition of brakes and the nature of the road surface.

All these aspects of physics are important; they explain why accidents happen. But road traffic investigators don’t use a special branch of physics called ‘abnormal physics’. We don’t expect scientists to apply one special branch of physics to car crashes and differentiate this from the laws of physics that apply to ‘normal life’.

There is not an ‘abnormal coefficient of friction’ that leads to car crashes and a ‘normal coefficient of friction’ that keeps us safe. Instead, and wisely, we recognise that it is important to understand the universal laws of physics – such as friction – and then use that understanding to help design safer roads and to drive more safely as individuals.

The laws of psychology are similarly universal. Psychological principles apply to health and wellbeing and to distress and problems. There simply isn’t an ‘abnormal psychology’ that applies to distress or explains ‘illnesses’ and a different ‘normal psychology’ that applies to everything else. There is just psychology.

Everybody makes sense of their world, and does so on the basis of the experiences that they have and the learning that occurs over their lifetime. We all use the same basic processes to understand the world, even if we come to very different conclusions.

The patterns and contingencies of reinforcement – rewards and punishments – shape us all: the basic psychology of behavioural learning is universal. We all learn to repeat those things that are reinforcing, and we all withdraw from things that cause us pain.

We all construct more or less useful frameworks for understanding the world, and we all use those frameworks to predict the future and guide our actions. We’re all using the same processes of learning and understanding, and those processes have similar effects on our behaviour and emotions.

However, because no one is exactly the same as anyone else, or has exactly the same experiences, we all make sense of the world in slightly different ways, with different consequences. But that’s entirely different from suggesting that there is some kind of ‘abnormal psychology’.

Instead, because applied psychologists use their understanding of psychology to solve real problems in the world, we could talk about clinical or educational or forensic psychology - if we must. Or about the psychology of psychological wellbeing, or even ‘mental health’ or offending, or parenting… just say what we mean without insulting people.

But not, in my opinion ‘abnormal psychology’. I’m afraid I just don’t think there is such a thing as ‘abnormal psychology’.

Wed, 24/08/2016 - 10:44

Yohohama skyline

I have been travelling a lot over the past week, representing the British Psychological Society at ‘scifoo’ in California and at the International Congress of Psychology (ICP2016) in Yokohama. The lurking plausibility of a Donald Trump Presidency, perplexity over the Brexit result have been common talking points. Our place as psychologists in an international network of scientist and practitioners is hugely important, but needs some nurturing and care… especially now.

Our international colleagues see UK psychology as world leading, especially in fields that require critical or idiosyncratic (or even iconoclastic) thinking. Major worldwide trends in psychology have leading thinkers from UK universities and our admired health and social care system. We need to be continually mindful of our position in major international discussions.

On the one hand, many of our international colleagues are on the cusp of overtaking us in terms of both ideas and delivery. I have liaised closely with Norwegian colleagues over the past few years on conceptual psychosocial models of mental health care.

Now we see an unashamed psychosocial focus in Norway, with a recent ministerial recommendation for universal provision of medication-free services. Norway is approaching a ratio of 1 clinical psychologist for every 500 members of the public; a ratio that would equate to 120,000 clinical psychologists in the UK. While I would proudly suggest that UK psychologists are offering world-leading ideas, some of our international colleagues have leapfrogged us.

On the other hand, some of the ideas that are common currency in the UK are rather unknown elsewhere. My views on psychiatric diagnosis and the nature of ‘disorder’ and psychological distress may not be universally accepted, but these debates are vibrant and active in the UK.

We have a number of BPS documents – on psychotic experiences and on the contested nature of diagnosis – and are having active discussions, not only within the BPS, but in such bodies as the Council for Evidence-based Psychiatry, the Critical Psychiatry Network and Mental Health Europe – Sante Mentale Europe.

We’re not at risk of being leapfrogged, but international colleagues seem to be unaware of these discussions, which is just as alarming.

Scifoo is a meeting of leading scientists, largely in the physical sciences. Here, the disputed notion of biomedical psychiatric illness was very positively received, but seemed entirely new and different.

Even at the purely psychological ICP2016, the idea that we need radically different approaches appeared difficult to integrate into colleagues’ views of the core purpose of their profession and discipline. The limitations of traditional psychiatric diagnoses, and the impact of such medicalised language on people’s understanding of the fundamental nature of their problems seemed new to many colleagues.

We need to be nimble and present to maintain our position in international debate. As individual academics and practitioners, we have a responsibility to speak with colleagues across the world. After the Brexit vote, that responsibility is particularly acute.

As President of the BPS, I have a particular responsibility to ensure that our links with the international scientific and professional communities are maintained. Our international profile is good  but it is not guaranteed. The effort involved in maintaining our international links is definitely worth it.

Wed, 27/07/2016 - 11:21

The British Psychological Society is actively engaged in several important policy issues, but two are particularly contentious. They are technically complex and they are personally challenging.

A recent government consultation asked how to implement the replacement of bursaries for nursing and other healthcare students with an expanded system of loans. This change raises complex issues for our discipline.

Our response stressed that “the proposed reform to healthcare education funding falls short of the long-term holistic workforce strategy necessary to achieve the government’s goal of delivering high quality integrated physical and mental health care.”

Given that clinical psychology trainees receive both fees and salaries from Health Education England, any move towards loans as opposed to bursaries would constitute a major threat to our profession. Thus we stated clearly that this support “is vital and must continue”. But this support does not cover all applied psychology, and, as we said in our response “is not sufficient to deliver the progress needed to achieve the government’s goal of significantly improving the psychological health and wellbeing of the population.”

We need to enter into substantive discussions with the Department of Health and Health Education England about the future shape of our professional training. We know that our profession is under review. There are many options – from the discussions held under the New Ways of Working programme, suggestions I have previously made and the opportunities offered by the existing Clinical Scientists route.

One thing that psychologists are good at – trained in – is grappling with difficult issues and forging coherent consensus. In this response we expressed a clear message on behalf of the whole profession that takes us forward with authority. But on a personal level, this was a difficult issue. It was challenging to balance the well-argued concerns of colleagues over the commissioning of clinical psychology training with the opportunity for other applied Divisions to boost the psychological workforce and begin to address structural inequity if they were at least able to access loans to meet their training costs.

One of the reasons I love my profession is that we didn’t just put our head in the sands. We took the bull by the horns, and developed a coherent and authoritative position, which we will develop further in the coming months. Armed with this, we are ready to sit down at the table and try to influence the course of events.

I had to confront a second personal and professional dilemma this past week as on Friday I met with colleagues in the Department for Work and Pensions. Many of my friends have aired grave concerns about DWP policies, arguing that they inappropriately ‘psychologise’ unemployment and locate the problem within the unemployed person.

The BPS and other organisations have also raised concerns that the DWP considers employment as a clinical outcome, and that the underpinning rationale for these policies was not improving health, but for ideological purposes. We are concerned that people would be coerced into therapy or face sanctions on their unemployment benefit payments if they refused consent.

We continue to scrutinise these policies and insist on the appropriate, ethical, use of psychological theory at all times. The British Psychological Society has argued that staff must not be involved in coercion and must maintain their professional independence as therapists. Claimants’ rights to autonomy and freely-given consent (to, for instance, participation in research trials or therapy) are non-negotiable.

Moreover, employment is not a universally positive outcome for everybody. There must be a clear commitment to appropriate work that includes long-term tailored support or there is a real risk of jeopardising recovery or worsening of mental health problems. Personally I’d go further and argue that employment should only be an outcome if that’s what the client wants.

I have my own opinions, which are guided by my understanding of psychological science, by my professional training and by my values, and which I know I share with my colleagues. Last year, I spoke out about the misuse of such policies but a principled stance is not necessarily the same as simple opposition.

The most important discussions are not easy. They aren't conceptually easy and they aren’t emotionally easy. But they are necessary - we have an obligation to engage and discuss such contentious and difficult issues, not avoid them.

Wed, 13/07/2016 - 13:51

We are always actively seeking members’ input to a great number of live consultations on policy issues related to psychology. Right now, two are particularly worthy of mention.

 In April, following the comprehensive spending review and significant further pressure on public spending in health and social care, the UK government announced that: “From 1 August 2017, new nursing, midwifery and allied health students will no longer receive NHS bursaries. Instead, they will have access to the same student loans system as other students.” That means  nursing and other healthcare students will soon be required to take out loans to fund their training.

The Department of Health has launched a consultation on how to implement this change and we are seeking our members’ views on how to respond. We are deeply concerned about the possible impact on these students, and therefore on the ability of the health and social care systems to deliver the services upon which we all rely.

Although student loans are now the norm in England and Wales, this is not the case across the UK as a whole. I remain committed to the idea that free, universal, education is an ideal of any civilised society. More importantly, for these particular students, the prospect of tens of thousands of pounds of additional debt at the end of training will have a negative impact on the future of these professionals and the patients in their care.

Our response is likely to stress the unwelcome nature of these changes for the overall delivery of psychological health care. Providing the best standards of care requires many different types of healthcare professionals working together in multi-disciplinary teams – any negative impact to one part of the system will have a knock on effect.

Currently, training for Clinical Psychology and some other mental health professions (including psychological therapists in the IAPT programme and child psychotherapists) that are funded indirectly by Health Education England are unaffected.

We are cautiously reassured that psychologists have been spared from the effects of these reforms for now. This move reflects the recognition that psychologists in training deliver invaluable services to the NHS… much like our junior doctor colleagues.

At the same time, a different arm of the political octopus – the House of Commons public accounts committee (not, technically, an arm of Government, but holding government to account) – has announced a call for evidence on the topic of ‘improving access to mental health services’.

The public accounts committee noted various positive steps taken (or announced) in this area: clear commitments from the prime minister and the Department of Health to improve mental health services, for ‘parity of esteem’ between physical and mental health, and, therefore clear access and waiting time standards.

The committee has raised concerns, following a rather sceptical report by the National Audit Office that said the cost of improving access to psychological therapies (IAPT), early intervention in psychosis and liaison psychiatry services could be 25 per cent higher than clinical commissioning groups have spent in the past and that their budgets may not stretch.

The British Psychological Society will be making a written submission to the Committee. Our view is likely to be that it is not only welcome but necessary, to follow through with these ‘Parity of Esteem’ commitments. People have a right to expect the NHS to provide NICE-recommended care whether in the field of physical or mental healthcare.

Investment in health and social care is not only a moral imperative and necessary for a well-functioning society, but it also represents value for money. Psychological health, particularly preventative and early intervention services, represents a clear net saving to the public purse in the avoidance of higher, future, costs.

The BPS has a stronger influence if we respond in one unified voice. If you wish to add to our discussions please contribute by emailing the Society consultations address or contact me directly. 

Find out more about my plans for next week.

Wed, 01/06/2016 - 15:07

The cliché is that we should fix our own oxygen masks before helping others. Working in a therapeutic profession is a privilege, but there are good, even self-serving, reasons to ensure that those professionals changed with helping others are properly protected.

Many of us have been concerned by apparent pressures on junior doctors and proposals to require young people entering nursing and other professions to take out loans to fund their training. And there are pressures on the ‘psych’ professions, too.

A short time ago, we reported on the findings from the joint British Psychological Society and New Savoy Partnership staff wellbeing survey. This revealed worrying apparent increases in staff stress since a similar survey in 2014, with 46 per cent of psychological professionals surveyed reporting depressed mood and 49 per cent reporting feeling they are a failure. Seventy per cent of the 1348 people surveyed said they were finding their job stressful. More details of the survey, and the results, can be found in a detailed paper.

I’m delighted that the BPS, in collaboration with the New Savoy Partnership and with the support of Public Health England, launched a Charter for Psychological Staff Wellbeing and Resilience. But we also have a responsibility to act.

So, on 21 June, at the BPS London Offices, we’ll see the next stage in this process, when Jamie Hacker Hughes (Vice-President of the BPS) and Jeremy Clarke (Chair of the New Savoy Conference) will launch a Collaborative Learning Network to share best practice on practical measures to improve staff wellbeing.

We have an obligation to our colleagues and to those who use our services to ensure that our workplaces are compassionate and safe. We need to use our skills to facilitate accountable autonomy, reflective practice, participation in decision-making, staff engagement and creation of a non-discriminatory ethos, where difference and diversity are meaningfully sought alongside work-life balance. These are valuable for us as employees, but they are also vital if we are to have compassionate and empathic services.

Find out more about my plans for next week.

Wed, 25/05/2016 - 11:13

I had the great pleasure to be in York on Saturday, marching in support of colleagues calling for proper investment in mental health services in the city. It is ridiculous, in one of the wealthiest nations on earth, to be fighting for the most basic of social services. But the march and rally were great, and I am heartened by several elements of the day. 

The local people, and media, were welcoming and positive and there was strong support from local and national politicians. I was delighted to be shoulder-to-shoulder with colleagues from Psychologists Against Austerity and sharing the speakers’ platform with the local MP Rachel Maskell and Len McClusky from Unite.

Having been a clinical psychologist for 25 years, I was delighted to hear the message that psychological health is a matter for everyone -  one-in-one, not ‘one-in-four’ - and that our psychological health (and therefore mental health services) is intimately linked to social circumstances and the economic, political and material health of civic society. That message needs to be repeated and clarified - hence my visit to Channel 4 on Tuesday, to attend a meeting discussing media portrayals of mental health problems – but I think it’s getting across. I was delighted, for example, that Alistair Campbell has started talking about mental health as an issue that touches ‘one in one’, not just ‘one in four’ of us. For me, this is a welcome recognition of our shared humanity and common psychology.

Otherwise, issues around work and psychology have dominated my email inbox and Twitter account this week. We’ve seen reports of psychologists themselves issuing ‘zero-hours contracts’, and unpaid intern posts for people wanting to enter professional psychology careers. Is this a growing trend that BPS Members and other readers of the blog would like to share their views on?

We’ve also seen increasing discussion of the impact of Work Capability Assessments, the DWP’s in-work progression trial and sanctions in our benefits system. We’ve seen sexism in the workplace and we’ve seen further discussion of the importance of maintaining the psychological health of workers in the NHS.

So… two questions (for the comments section below, perhaps):

  1. What are readers’ views on psychologists issuing zero-hours contracts or contracts for unpaid interns?
  2. Is the time right for a British Psychological Society Presidential Taskforce on ‘Work and Psychology’?

Find out more about my plans for next week.

Wed, 18/05/2016 - 11:21

It’s been a busy week. I’ve attended meetings of the BPS Research Board, Education and Public Engagement Board, and had to give my apologies to the Membership and Standards Board (due to an unavoidable clash).

As well as other meetings with interesting colleagues, I’ve also chaired an All-Party Parliamentary Group on Prescription Drug Dependence and a celebration on the terrace of the House of Commons, celebrating the birthday of clinical psychology in the UK, because it was 50 years ago that the British Psychological Society was awarded its Royal Charter, and the profession of clinical psychology became an established part of British civic society. I’ve previously written about the charitable objects of the British Psychological Society (“to promote the advancement and diffusion of a knowledge of psychology pure and applied”).

And we were celebrating, in part, the fact that psychologists are also at the heart of the Government’s mental health strategy – we helped design and are spearheading the Improving Access to Psychological Therapies programme, and were key partners in the Mental Health Task Force. We’re part of the NHS Transformation Agenda, brining our skills in multi-professional, co-produced formulation to the heart of the skill set in mental health care.

We’re pioneers in working across health and social care – those of you who know my work will know that this is a passion of mine. And, as experts in the science of human behaviour, we’re leading on the drive to ensure that the NHS has the data it needs to deliver care. We look forward to supporting our colleagues in Government and Parliament as they work to make ‘parity of esteem’ a reality… and holding them to account!

The ‘embededness’ of psychology in public life was reflected not only in the business of our Education and Public Engagement Board (discussing our engagement with, and impact upon, education policy, but also our public out-reach activities such with the Big Bang science festival), in the work of our Research Board (liaising with HEFCE about the REF assessment of research quality, organising an event on ‘replicability’ with the Royal Society and publication of a range of research reports) and the Membership and Standards Board (discussing issues as diverse as our relationship with the statutory regulator, HEFCE, and our quality control on the use of psychometric testing), but also in some of my other meetings – with film-makers, theatre directors and colleagues from other charities.

All of this can be seen to have culminated in the fantastic announcement by Lisa Cameron MP, at our celebration on the terrace of the House of Commons, that we will soon have an All Party Parliamentary ‘Psychology’ Group. I believe that – if we step up to the mark – this will offer us a valuable new opportunity to point out the value that psychology ‘pure and applied’ brings to policy-makers and civic society.

My hero, Albert Camus, wrote in his private notebook for May 1937: “Psychology is action, not thinking about oneself.” I think it’s pretty clear that we’re being active… and it’s worth taking half an hour out of a busy week to stand on the terrace of the House of Commons and raise a glass of prosecco in celebration.

Wed, 11/05/2016 - 16:38

Lisa Cameron MP and Norman Lamb MP at the launch event

 

On 15 March  I was delighted, both as BPS President and a new Fellow of the Academy for Social Sciences, to introduce an event sponsored by the BPS in conjunction with the British Society of Gerontology, Age UK, Alzheimer's Society and the University of Bradford to launch a new booklet on Dementia in the Academy for Social Sciences' series Making the Case for the Social Sciences .

The event was introduced by Professor Bob Woods FBPsS FAcSS and the keynote speech was given by former Health Minister Rt Hon Norman Lamb MP. Other speakers and panellists were the clinical psychologist MP, Dr Lisa Cameron, Colin Capper of the Alzheimer's Society, Baroness Sally Greengross, Dr Jo Moriarty of Kings College London, Professor Murna Downs of the University of Bradford and Professor Jane Fossey of the  British Society of Gerontology.

"There is insufficient recognition of the critical importance of the social sciences" - Rt Hon Norman Lamb MP.

Tue, 22/03/2016 - 11:13

The conference programme and a delegate's badge

Last Friday I was with the DCP Prequalification Group (assistant psychologists, research assistants and clinical psychologists in training) for their one-day conference in Birmingham entitled 'Thinking more, Saying more, Doing more'.

Our very own clinical psychologist MP, Dr Lisa Cameron MP, opened the day followed by me, clinical psychologist blogger Dr Masuma Rahim, Nina Browne and Kat Alcock on psychologists and policy and Dr Ste Weatherhead and the Walk the Talk team.

In the afternoon were Playback Theatre, Peter Kinderman, Anne Cooke and Glenn Williams on competences in clinical psychologists, and Psychologists against Austerity.

Exciting things are happening in psychology and it's great to be a part of it.

Tue, 15/03/2016 - 15:17

Following the recent New Savoy Conference there has rightly been a lot of press coverage of stress experienced by those working on the front line of psychological health services.

A notable example of this was an article for the Guardian website by Anne Cooke and Jay Watts, both Chartered members of the Society.

In an article that has attracted many comments and considerable attention on social media they write:

"When psychologists and therapists meet nowadays, the talk is often less about work and more about who’s just resigned, the latest edict about time limits and targets, and the pernicious market culture that is eroding what we do …

"The current focus is on producing figures that can win and keep contracts. Staff are often asked to see huge numbers of clients, for ever shorter time periods. What everyone wants from a therapist is someone who listens. But increasingly, listening has to compete with a demand to get to the next person on the list, to fill in outcome measures and assign diagnoses for accounting purposes or to enter in flowcharts that determine the help people get."

What is being done about this?

In addition to the Charter for Staff Wellbeing launched at the conference, the BPS is now leading on a collaborative network to work on promoting staff well-being through maximising self-care, reducing stigma and the barriers to disclosure and care seeking in staff, and working with employers to build psychologically healthy workplaces.

Fri, 19/02/2016 - 12:25

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