Coming of age at 25?

The Division of Health Psychology (DHP) turns 25 this year. Its emergence in 1986 occurred just months after I was born and marked a major advance in the study and application of psychological processes to physical health, illness and health care. This special edition of The Psychologist, celebrating the success of the DHP, coincides with my own most recent accomplishment – completing the Stage 2 Qualification in Health Psychology.

As a newly qualified health psychologist, I was asked to write about my path to qualification, my background and future career ambitions. In reflecting on this I began to wonder whether I, along with health psychology in the UK, have truly come of age.

I began my training in 2006 after completing my undergraduate degree at the University of Glasgow. Glasgow's psychology department is amongst the top 10 in the UK, with traditional research and teaching strengths including perception and cognition, language and communication and experimental neuroscience. During my time at Glasgow I developed a broad education in psychology but did not study 'health psychology' explicitly. In fact, I only heard about health psychology as a discipline in its own right from a friend and classmate, who mentioned hoping to pursue the area herself. Health psychology intuitively appealed due to the focus on promoting and maintaining health and well-being. It offered the opportunity to work with general and clinical populations, in addition to health professionals and students. My friend went on to occupational therapy in the end, but I decided to apply for the MSc in Health Psychology at the University of Stirling.

I chose Stirling primarily because it offered an experiential placement in a healthcare setting, and I was mindful of gaining as much experience as possible to help to secure a job upon leaving the course. The Stirling course exceeded my expectations. I found the course staff to be knowledgeable and welcoming; the course content to be interesting and challenging and the practical placement offered insight and learning. I got involved in undergraduate teaching in clinical and health psychology and undertook a placement in a health-visiting led service that facilitated peer breastfeeding support in deprived communities. Finally, my master's thesis investigated the utility of Karasek's job-strain model (Karasek & Theorell, 1990) in predicting the effects of caregiver stress on physical and psychological well-being.

However, at the end of my master's I entered a state of limbo. I aspired to undertake Stage 2 training in health psychology, but I was somewhat unsure what would be involved and the task of finding a suitable job and supervisor on my own seemed daunting. I suspect this is the case for many who are considering independent training in psychology. I was fortunate though, as soon after completing my master's three Trainee Health Psychologist posts were advertised in Scotland. Within six months I became one of the first cohort of fully funded NHS Stage 2 trainees. This innovative programme was developed via collaboration between DHP-Scotland, NHS Health Education for Scotland and NHS Boards. The programme places trainees directly within Boards (unified providers of primary and secondary care) and enables trainees to work towards their Stage 2 competencies (e.g. professional practice, research, consultancy, teaching and training and interventions) whilst employed on projects identified as health priorities by the Scottish Government. Trainees are supervised by NHS clinicians, a Stage 2 supervisor and a public health link. A description of this programme and an interim summary evaluation of its outputs was published last year (Gilinsky, Dombrowski et al., 2010).

Whilst training in health psychology, I worked under the supervision of Dr Vivien Swanson (now Chair of DHP-Scotland, and involved in setting up the Scottish Stage 2 programme). My projects included research and consultancy with NHS midwives regarding alcohol interventions (see Gilinsky, Swanson & Power, 2010). Furthermore, with input from workplace supervisors and clinical colleagues I successfully developed, implemented and evaluated an oral-health behaviour change intervention in a nursery setting (Gilinsky et al., in press). Other activities whilst in training included teaching and training for health professionals and master's students in health psychology and public health.

I also attended and presented successfully at conferences and at local and national forums. Conference attendees included psychologists, researchers, public health consultants and health service managers. All were very interested in how health psychology could 'add value' to existing approaches. By the end of my training, I had developed an almost exhaustive list of personal and professional abilities, in addition to attaining my Stage 2 competencies. Skills such as communication, perseverance and diplomacy are perhaps 'softer' but no less valuable in terms of my professional development.

There are many benefits of this model of training. Being employed directly by the NHS gave access to health professionals offering collaborations that facilitated and enhanced the quality of our projects. My training experience was successful because I was lucky enough to share my achievements and frustrations with other trainees as part of a Scotland-wide network (the programme has now employed a total of 10 THPs). This convinced me that having an easily accessible peer-group is vital to postgraduate training. So in 2009, when the DHP-Scotland committee was looking for a new postgraduate representative, I was keen to put myself forward. Since my appointment I've worked with colleagues throughout Scotland and the UK to offer networking and training opportunities for health psychology trainees.

Having completed my training I've now gone full circle and rejoined the University of Stirling. I'm currently completing a PhD in the area of postnatal physical activity, jointly funded by the School of Sport and School of Nursing, Midwifery and Health. My PhD primarily involves a randomised controlled trial of an intervention to increase physical activity participation amongst this group. As a health psychologist, I am specifically qualified to undertake research involved in understanding health behaviours and implementing a health behaviour change intervention. In addition to what I bring to the mix, my supervisors and colleagues bring other important expertise and resources. For example, through the Exercise and Health Sciences Research Group I have access to physical activity monitoring equipment. This method of measuring physical activity change will improve my research output and publications as my main outcome will be measured objectively. Similarly, being part of the Maternal and Child Health Research Programme has focused my mind on how best to demonstrate meaningful improvements in the health and well-being of mothers. We will now include a qualitative phase of research, to help us identify whether the intervention has been responsive to the needs of postnatal women, as well as being theoretically sound and evidenced-based.

However, I am mindful of the need to retain and cultivate networks that were built up during my training. I continue to collaborate with health psychologists and am writing publications based on my previous work. I'm also engaged in new challenges (for example through applied work with chronic pain patients). Most importantly, I use my psychological skills and experience on a daily basis to improve my research, interventions and teaching outputs. Looking to the future, my career ambitions are to be successful both academically and as an applied practitioner. In the long term I'd like to contribute towards shaping health policy and the healthcare system in Scotland and to improve opportunities for training in health psychology amongst postgraduates. These ambitions mirror the broader aims of the DHP, so I feel safe in the knowledge that we have the same goals.

To conclude, the breadth of applicability of its models and methods is one of the strengths of health psychology.

I myself have had a diverse range of experiences during my training and I continue to add new strings to my bow. My experience also demonstrates a 'catch-22' facing many growing disciplines – how to retain our widespread teaching, research and practice interests whilst simultaneously carving out a professional 'niche'. Indeed, how many of us have been asked by colleagues: 'What is it that health psychologists actually do?' Educating our applied and academic colleagues as to the value of collaborating with health psychologists remains a significant challenge. Since its origins 25 years ago, the DHP has progressed remarkably in this area, demonstrating the added value of a psychological approach to understanding and improving health and illness outcomes.

Personally, turning 25 ended a year of transitions for me. Having completed my training and having bought my first home, I feel like a proper grown-up. As the DHP moves into its late twenties and beyond, I feel there is the same positive sense of transition amongst our discipline. Since I began my training, the science, application and influence of health psychology has moved on considerably. Our focus on interventions to improve health and our multidisciplinary approach allows us to utilise our explanatory frameworks and models to address real-life problems. Health psychologists are also firmly involved in policy formation, such as providing input to the House of Lords inquiry into the effectiveness of behaviour change interventions. Despite this progress we continue to require sustainable, funded models or training for postgraduates and greater opportunities for posts and collaborations, particularly in applied settings. As the minds of our colleagues throughout academia and the health service turn increasingly to funding cuts this becomes all the more challenging. But health psychologists do have a lot to offer potential employers. And, although it is a cliché, as I've shown, our skills are definitely transferable, suggesting a bright path ahead, with the potential to input into many different organisations and roles. So here's to health psychology 'in the round' as I'm calling it. I'm looking forward to this future, and I believe the next generation of health psychologists should be too.

- Alyssa Gilinsky is with the Exercise and Health Sciences Research Group, University of Stirling

References

Gilinsky A.S., Dombrowski S.U., Dale H. et al. (2010). Partnership work between public health and health psychology. BMC Public Health, 10, 69.
Gilinsky, A.S., Swanson, V., Merrett, M. et al. (in press). Development and testing of a theory-based behavioural change intervention. Community Dental Health.
Gilinsky A.S., Swanson, V. & Power, K. (2010). A systematic review of interventions delivered during antenatal care to reduce alcohol use during pregnancy. Addiction, Research & Theory. doi: 10.3109/16066359.2010.507894
Karasek R.A. & Theorell T. (1990). Healthy Work. New York: Basic Books.