From cure to prevention

Early in our conversation, Angel Chater confesses to being 'passionate about health psychology'.

She traces her long-standing links with her local community. 'I grew up between Luton and Dunstable. I went to a notoriously tough school and did really well but was teased no end.' This form of bullying to some extent related to her family. 'My mum was an accountant and my dad worked as a buyer in an electronics company. A fairly ordinary background, but my dad's job got lots of perks: high performance cars, tickets to Wimbledon, trips to F1 racing pits for instance. Maybe we were seen as "posh". I certainly got bullied for how I spoke: Lutonians don't pronounce their 't's in words – I did.'

'When I was young I promised my dad that I'd get the word "Doctor" in front of my name or pay his bills for the rest of his life. I was too squeamish to become a medical doctor – I was a vegetarian at high school and refused to do dissection in biology. I knew I wanted to study psychology from the age of 15, and I became the first person in my family to go to university.'

Family constantly threads Angel's conversation. When I pose questions, she thinks hard about how deeply she wants to talk about her mother and father. What's clear, as is so often the case in these interviews, is that her choice to study psychology stemmed, in part, from personal experience.

'My size was always an issue for me at high school, I was tiny and a very fussy eater: in fact I'm now the heaviest I've ever been! My parents, like many others, had health problems, which I knew about at the time, but only realised their extent after they had died, when I read their diaries, and the letters they had written to each other whilst one or the other were in hospital. So, my decision to become a psychologist related to those issues – in a sense a desire to "cure" my parents was the root of it. I also had a very close friend who suffered with an eating disorder and self-harming. My undergraduate dissertation on dietary restraint and binge eating, which formed the basis of my MSc, was certainly influenced by personal experiences.'

But other factors also influenced her choice. 'I cringe to say it but Cracker and Silence of the Lambs were really influential to me at the age of 15! And I really wanted to work in forensic or clinical psychology, but as my knowledge grew, these desires changed.'

Angel is someone who plans her life very carefully, who is organised and sets out to achieve her objectives. 'Perhaps that's because of the uncertain aspects of my home life. Anyway, I moved out of home when I was quite young, I wanted my own family and was pregnant for my first year of A-levels, having my baby in the summer holidays to return for my final year and then on to university. At this time I was still intent on becoming a clinical psychologist. I didn't know much about health psychology; many students still don't understand it. But at 49, my dad died… right at the end of my undergraduate degree, and it could be that this caused a switch from my interest in curing conditions to my current passion for preventing them.'

An upstream approach

Angel's first application for a clinical course after completing her BA (Hons) was rejected. Her MSc director David Stewart suggested she look at health psychology as a way of working in clinical areas.

'Once I learned what health psychology could offer I totally fell in love with the area: it had everything I was interested in. It addressed issues like eating behaviours and addiction and had that focus on prevention that I wanted to move towards. A concern with prevention led to an interest in children: my PhD was on children's perceptions and engagement with healthy eating, physical activity, smoking and alcohol use, using an intervention approach.' The second phrase is important. 'At the time I was absolutely committed to being a practitioner not a lecturer or an academic. I often told my boss in my staff review that I wanted to practise and not to teach. That's changed!'

Angel started her PhD in 2002 and graduated in 2007. 'My mum was ill and I wanted to complete it before she died. I'd already started working at the university part time in 2004 and was heavily involved with the MSc programme as well as managing a level 1 unit by 2006, so work was overwhelming. My PhD had been sidelined, since I spent as much time as I could with Mum outside of work. In March, she told me she was improving, so I began to work on the PhD again. Sadly she died in the June; I submitted that December, hating my PhD and the time it took away from my family.'

It becomes clear that Angel has an ulterior motive in agreeing to this interview. 'I love health psychology and too few people know what it is. That's why I wanted to be Chair of the Publicity and Liaison Sub-Committee of the Division of Health Psychology (DHP). I've actually been involved in BPS activities since 2003. I began with PsyPAG and loved the time I spent on this committee and the people I met along the way: being a PhD student can be so lonely, and PsyPAG really buffered that. I began on the DHP committee as the postgrad rep in 2006 and then stayed on, representing consultations and specialist knowledge and then publicity and liaison. Wide communication is so important to our Division. We are currently trying to engage more with sixth forms, at student events and with the public and other health professionals. I'd love to see health psychology included in the national curriculum from an early age.

'Health psychology ultimately addresses the health of the nation. It's not just about behaviour, but about reasons for behaviour. In my area of interest we draw from, to use a great analogy from the ABC of Behavior Change, an upstream approach. Prevention is in the river at the top of a waterfall, stopping people from falling to the dangerous waters beneath. It has real, tangible outcomes. It improves lives.

'Health psychology gathers ideas from other disciplines – clinical, coaching, counselling, sport and exercise – and applies them to a particular problem or population. I think it's naive to think you can practise psychology without drawing from different applications and therapeutic approaches. I'm actually a registered sport and exercise psychologist and trained health coach as well.'

Angel feels that concepts central to health psychology are control, risk, motivation and self-image. 'There's a lot to be leant from positive psychology here. You could say I come from a positive perspective, and I am currently focusing my research attention on enhancing levels of happiness and control to assist health behaviour change for weight management.'  

'It's a huge simplification to say this, but when students ask me how health psychology differs from clinical, I say that clinical psychology looks at mental health while health psychology looks at physical health. I truly feel the two are complementary not competing, and both have massive population and policy impact.'

Fruitful contradictions

Angel is Senior Lecturer in Health Psychology at the University of Bedfordshire as well as course director for both the BSc and MSc in Health Psychology and the Deputy Course Director for an MSc in Physical Activity, Nutrition and Health Promotion. I raise these facts with Angel since she had earlier in the interview stated she had never wanted to be an academic. 'Up until two years ago I worked part-time as a health psychologist in Specialist Obesity Services at Luton and Dunstable Hospital, but in the end the increased workload and shortening of clinic time with my clients led to my decision to leave. It was important for me to work one-to-one with my clients and have a short follow-up period for behavioural homework, but sadly by the time I left, my follow-up appointments were months in advance.'

'I love supervision. So much of the research I'm involved in now is applied and this, to some extent, makes up for my move away from a direct practitioner role. I'm hoping to get further funding to extend my research in weight management and I'd love to set up a clinic that can take GP referrals for health behaviour modification and an East of England Health Psychology Group. I'm also focusing on getting more published, so the next two years are going to be focused on more high-quality research. I plan to write a book on applied health psychology as well, really highlighting where we work and what we do. The ultimate aim of it all is to gain a professorship.' I wouldn't bet against it!

But there are interesting contradictions here. Angel is someone devoted to practical tangible change who works in an academic role. She's organised and goal-oriented but tells me about recent events including a flooded house which had to be rebuilt, a fiancé who accidentally set himself on fire while repairing the house and, therefore, a postponed wedding: a long story which suggests chaos rather than organisation.

Angel has an international view of health psychology's importance (she's national delegate to the European Health Psychology Society), yet stays where she grew up: 'It's important for me not to disrupt my children's education by moving away.'

However, there's no contradiction between her hugely honest and thoughtful conversation and her passionate advocacy of psychology as a public discourse; that psychologists should reach out and communicate what they know to help the lives of others.