Forum, January 2010

Ensuring course standard

Like Marc Smith ('Take A-level psychology seriously', November 2009), I was pleased to see mention of the A-level results in the October issue. But it was only a small mention, and as Marc Smith points out, the wider issue of A-level recognition by universities was
not touched upon. Given the reported popularity of studying psychology, I was surprised to read that the last coverage of this issue was as long ago as 2007.

The BPS's role in education and its work with universities is hugely important for the discipline as a whole. I believe it should be given far more coverage so that its work in this area is more widely recognised – particularly now that the HPC has taken responsibility for regulation of psychologists.

We know that taking BPS-accredited courses is crucial for any undergraduate to step on the first rung of the career ladder that is Graduate Basis for Chartered Membership. But what does the BPS actually do to accredit courses? – or to 'dis-credit' them? As an examiner at both A-level and undergraduate level myself, I often face charges in the wider community of 'dumbing down' that fly thick and fast at exam results time. It would help to know more about how the BPS ensures assessment standards are met by those institutions that deliver courses bearing the BPS stamp of approval. Elizabeth Barnes
Plaistow, West Sussex

Lucy Kerry, BPS Quality Assurance Manager, replies: At both undergraduate and postgraduate levels, accreditation is gained and maintained by courses demonstrating that they meet the required standards, broadly comprising two components: content (e.g. learning outcomes, assessment standards) and resources (e.g. staffing, learning resources). Courses are reviewed against these standards every five years, normally by a panel of Society members conducting an onsite visit. The panel's role is to review the provision and to work with Society committees to agree a recommendation on the future accreditation of the course in question. Where our standards are not met in full, accreditation may be granted subject to the fulfilment of certain conditions. Where a course is operating at significant variance from the required standards, the Society will consider withdrawing or withholding accreditation. Such an outcome can be difficult for both staff and existing/potential students; nevertheless, it is an option that must be available if the Society is to ensure that accredited courses continue to meet students' needs.

Undergraduate and conversion courses, which are accredited against the content and resource requirements associated with the Graduate Basis for Chartered Membership (GBC), are reviewed every five years (with a visit taking place every ten years), and also undergo interim resource reviews. The content requirements for such courses are drawn from the Quality Assurance Agency's subject benchmark statement in psychology, which includes a set of core curriculum areas that must be covered in appropriate breadth and depth by all accredited courses at an appropriate level. In addition, the core areas must normally be separately assessed. In order to be eligible for the GBC, all students must pass an empirical project at honours level, and gain at least a 2ii overall.

See www.bps.org.uk/accredit for more. We are consulting on a new framework, accreditation through partnership: see www.bps.org.uk/partnership.  

Dying at work

People have often said that no one on their deathbed regrets not spending more time at the office, but this does not seem to be the case any more. More people are working to within days of their death. In the past two years in two offices I am associated with, three people with terminal illnesses have worked until they died. They said that they couldn't die alone at home in the suburbs where they had no connection to the neighbourhood. They came to work for companionship, distraction and a sense of contributing and being valued. It seems a sad sign that people are becoming more at home at work than in their own dwellings.

Unfortunately the workplace is not set up for the very ill. Colleagues have to shoulder an additional emotional workload as well as managing the practicalities of getting the work done when the sick person has to be taken to hospital from time to time or when they have to be sent home when they are having a really bad day. If a dying person has a task to do you cannot be sure they will be able to complete it, but if you do not give them work they are very unhappy. Two of the people I mentioned above were managers, which makes the situation more complex.

The hardest thing for everyone, including the sick person, is being positive. Everyone is reminded of their own mortality. In both offices there was a tacit agreement that no one would ever express their feelings about the additional work due to a recognition of the struggling colleague's bravery. This is very difficult as there is a lot of unspoken resentment which seems to be associated with increased absence rates because of the impact of the emotional burden on physical health.

The constant grieving that goes on in the office is terrible. Each time the person gets bad news there is a great deal of distress. When people die at home, neighbours are able to visit and comfort them and then return home to deal with their feelings in private. There is no private space in an office, and colleagues have to deal with seeing someone slowly dying all day, every day.

An office in dealing with this issue needs a strategy developed by acknowledging what is happening and involving the ill person in coming up with a plan that is regularly revised.
I would be interested to read via The Psychologist if others are experiencing this issue and how they are managing it.

Name and address supplied

 

Psychology, philosophy and plumbing

I write with regard to Jennifer Brown's letter in the October issue and the subsequent discussion last month.

Mind–body dualism is a fiction that we as psychologists appear to be conceptually trapped in. Unless we can extricate ourselves from this trap, it is my belief that we will always remain second-class citizens within mental health provision as well health care generally. Richard Bentall in his book Doctoring the Mind forcefully documents why this is the case, namely that the apparent blinding simplicity of dualism makes it instantly appealing and readily graspable, but no less wrong-headed. Current problems that are emerging for the pharmaceutical industry around the use of antipsychotics with elderly dementing individuals, along with other failed claims for overhyped pharmacological interventions, should be clearing a path for us. However, we are failing to make our point that psychological interventions offer in many instances viable alternatives. A large part of that, I believe, boils down to the fact that we have not moved on this issue(so long as we believe that 'mind' is reducible to 'brain' pharmacological alternatives will always have ascendancy).

There are alternatives to Cartesian dualism. In 1949 Gilbert Ryle in his Concept of Mind provided what may be for us a very workable paradigm, but I think that as psychologists we don't have the conceptual tools within our training to tackle this by ourselves. This is one time when we will have to hold up our hands and say we need help, namely from our colleagues in philosophy, to extricate ourselves from this. This should not strike you as all that strange, since many chairs in psychology were held jointly with philosophy up until fairly recently (their separation came more from academic empire building than anything else).

Ryle tells us that dualism is a vestige of a world in transition from medieval ideas of an indivisible and non-corporeal soul and Galilean mechanics. Descartes' answer was conceived following his seeing water-garden automatons in the shape of water gods being powered by water: the spirit thus travels through the vessels of the brain and body.
Why in this day and age are we still adhering to this plumbing model of the mind?

Stephane Duckett
Royal Free Hospital
London

 

Community psychology

The only woman scientist among the founders of the BPS, was Dr Sophie Bryant, a distinction probably little known. Dr Bryant was very interested in communities as well as in education, and in combining the two. The school where she was headmistress (North London Collegiate School) has produced a number of psychologists. As a former pupil and current BPS member, I write to encourage these psychologists (I would love to know all their names and fields of work as well) and others to support the idea of a Community Psychology Section, as called for by David Fryer (Forum, October 2009).

Erica Brostoff
London WC1

 

Statutory regulation – jury is still out 

I read with interest Ray Miller's letter 'What the HPC won't do…the BPS will' (Forum, December 2009). It appears that all the HPC will deliver for their exorbitant fee will be 'to set and maintain standards that provide protection for the public who seek psychological services'. Both these functions the BPS were fulfilling very well, in my view. Well, the jury is still out on the first of these aims, but the HPC has conspicuously failed in its aim to protect the public by failing to make 'Psychologist' a protected title and establishing such a limited range of protected titles.The BPS over the last decade has been very successful in raising professional standards and establishing this in the minds of the public. The BPS can be justifiably proud of this achievement. They also did a magnificent job in protecting the public using internal disciplinary procedures, although these did not have the force of law, they did carry influence with the public as a consequence of the work the BPS had done in establishing Chartered Psychologist as a recognised standard in the public mind.

I therefore ask myself what has been the point of the years of protracted negotiations with regard to legal registrations? Very little in my view. I do not believe the HPC will do anything towards improving the professional standards of psychologists and will merely rely upon the BPS to do this for them by using them in an advisory capacity! Time will tell. Before the HPC took over registration, I do not think that the public were at much of a risk from those psychologists who are now covered by legal registration. The public are, however, still at risk from those unqualified practitioners who usurp psychology and offer various 'therapies' under a variety of titles and to which the public will still not have any protection in spite of registration.

I do not feel my professional standing with the public has been enhanced in any way by the introduction of legal registration. I do think that the role of the BPS has been diminished and is in danger of becoming an optional extra for most professional psychologists. I, however, do feel £120 poorer.
Chris Elshaw
Headley Down
Hampshire

 

The future of mental health training 

A recent monograph, 'Current status and future prospects of clinical psychology' (Baker et al., 2009) is a critical, in-depth analysis of clinical training in the USA. While some of the issues it raises are specific to that context, others have a wider resonance and immediate relevance for the training of all psychologists and practitioners who provide mental health and related services in the UK.

Baker et al. argue that training and practice are currently scientifically inadequate and unresponsive to the demands of the changing mental healthcare environment: increasing prevalence of mental health conditions; changing service demands; shifts in decision-making responsibility for the funding of mental healthcare; and the development and increasing availability of scientifically-robust and effective treatments. The failure of psychologists to engage with these developments in the USA has opened the way for the greater use of psychoactive medication as well as for others, for instance social workers, who are cheaper to employ, to provide the services funding agencies require. Clinical psychologists, even when they espouse evidence-based practice, opt for personal experience and dubious assessment procedures in their clinical work and have not made a convincing case to funders for their use of evidence-based interventions.

In proffering part of the solution, Baker et al. propose that there needs to be a different accreditation system for clinical psychology training, one which drives programmes to select applicants with a good background in science and mathematics and to then provide properly assessed, science-based training to PhD level. The appearance of the Baker et al. monograph links to the publication of the Psychological Clinical Science Accreditation System, designed specifically to encourage robust, science-based training programmes and produce practitioners who, through their research, will drive the development of further and more effective psychosocial treatments.

Many of the issues and solutions noted by Baker et al. are foreshadowed in the Kennedy and Llewellyn (2001) study of the prognostications of trainers, trainees and practitioners in the UK. Indeed, in some ways, clinical psychology in the UK appears more adapted to the changing mental healthcare environment. Competence in cognitive behaviour therapy is part of pre-qualification training requirements; clinical psychologists are involved in the specification of NICE guidelines; and greater involvement in supervision and consultancy for less skilled practitioners is developing. But are such developments grounds for complacency? Recent history says no. Mental health interventions are increasingly being provided more cheaply by other less intensively trained practitioners. Foundation Trusts, more competitive care funding and managed care models have other potentially negative consequences for clinical psychology, with resources directed to patient care and not to support research by practitioners. Baker et al. note the attendant loss of status and autonomy accompanying such service models in the USA. Partly for different reasons, similar 'losses' have occurred in the UK, for instance, through accreditation and professional registration moving from the control of the Society and profession to the HPC, most of whose members are non-psychologists. It is not surprising that the Baker et al. monograph excited the interest of prestigious science periodicals such as Nature and Science, as well as Newsweek and other news media. The provision of mental healthcare and effective interventions are clearly of wide concern. And with the involvement of all the applied psychologies in mental health provision in the UK, what Baker et al. have to say should be of interest, concern and subject to wider debate within the Society and its Divisions.
Michael Berger
Emeritus Professor of Clinical Psychology
Royal Holloway, University of London

References
Baker, T.B., McFall, R.M. & Shoham, V. (2009). Current status and future prospects
of clinical psychology: Toward a scientifically principled approach to mental and behavioral health care. Psychological Science in the Public Interest, 9(2), 67–103.
Kennedy, P. & Llewellyn, S. (2001). Does the future belong to the scientist practitioner? The Psychologist, 14, 74–78.

 

FORUM guest column: Beyond boundaries

Argentina has more clinical psychologists per population than any other nation on earth. I'd long heard this claim in idle conversation but it turns out to be true. In a 2005 study published by the World Health Organization on proportion of psychologists working in mental health per capita, Argentina ranks first with the rest of the top 10 consisting entirely of European countries (if you're interested in the UK's position, we are 31, wedged between Cuba and Japan).

Argentina is not just an anomaly for its quantity of psychologists, but for the saturation of psychology, and particularly psychoanalysis, in the culture. Psychoanalytic language is used in all levels of public discourse, from the discussion of celebrities to the weighing up of political decisions. Earlier this year, the right-leaning paper La Nación ran an editorial critical of the country's successive presidents, husband-and-wife team Nechor and Cristina Kirchner, suggesting that their policies could be explained by an Oedipal struggle rooted in unresolved conflicts in their infantile sexual development. We can only await a similar analysis of Gordon Brown in the Daily Express.

In fact, clinical psychology in the whole of Latin America is heavily psychoanalytic, and there are good historical reasons for this. With Argentina to the south and the United States to the north the intellectual traffic of the 20th century favoured the influences of the two most developed countries, where Freudian and neo-Freudian thought dominated mental health. But since working on the continent, I've realised there are other structural reasons as well. Evidence-based scientific psychology is simply much more difficult here. It requires access to journals, which are priced out of the range of most universities, let alone smaller clinics or individual practitioners, and it requires training in experimental methods, which is often thin on the ground.

In contrast, a psychoanalytically oriented clinician can be considered fully versed in their profession through their own analysis, their work with patients, and discussions in a limited set of journals. From a psychodynamic perspective, in an environment with limited resources the desire to be considered a competent clinician is more easily satisfied by an approach that prioritises personal experience over experimental methods. While it is easy to trumpet the benefits of a scientific approach to treating patients, it is not a culturally neutral approach and there are strong social reasons why it may be eschewed by psychologists in other countries.

Vaughan Bell is a clinical psychologist and academic working in Medellín, Colombia. Share your views on this and similar cross-cultural, interdisciplinary or otherwise 'boundary related' issues – e-mail [email protected].

Obituary
Golda Zafer-Smith (1946–2009)

In July 2009 we lost a dear colleague and friend, Golda Zafer-Smith. Golda was someone who touched people's lives and hearts. She was a gifted listener and enabler who helped people articulate their feelings and thoughts. She had extraordinary skills in group facilitation. Above all, Golda was a profoundly compassionate and caring individual, with an abiding commitment to human rights and the protection of the more vulnerable members of society.

Prior to becoming an educational psychologist, Golda held a number of positions in education. She undertook professional training in educational psychology at the University of Birmingham (1991–1992). Over the next 10 years, Golda held various posts within social services, education and CAMHS in Birmingham, where she assumed leadership of the CAMHS Family Therapy Team. She also coordinated the psychological input to Birmingham's five Family Centres.

Following her move to London, Golda joined the Brent Educational Psychology Service as a Senior EP and became the team manager of the multidisciplinary Early Years Special Educational Needs (EYSEN) team in 2002. Golda worked tirelessly to promote inclusion and introduced systematic support for transition. The Early Years Transition working party, which Golda chaired, subsequently won a Brent Child Care Achievement Award for multi-agency working.
For Golda's colleagues.in the EYSEN Team she is remembered as 'an unforgettable manager, mentor, friend and treasured colleague. She has left an amazing legacy for all that worked with her in the Brent EYSEN Support Team. She nurtured us and embedded a team spirit and ethos which will never be lost. The goals of family-centred intervention, social inclusion and supported transitions were central to Golda's vision and she was always ahead of her time with key initiatives. She sought to support the most vulnerable children and their families by listening to their needs and acting as their advocate. Best of all, her work was always carried out with true humanity, kindness, generosity, smiles and laughter.'

In September 2004 Golda undertook a doctorate programme in educational psychology at the Tavistock Clinic. A personal recollection from Dr Fox and Dr Mathews follows: 'Golda was a valued course member of the Professional Doctorate at the Tavistock Clinic. The course quickly learnt to appreciate and value her wise comments reflecting her diverse and passionate interest in psychology. She was the students' representative on the course's Stakeholders' Group and articulated her colleagues' interests with commitment and energy. She is remembered as someone prepared to give of her time and insights to colleagues. She was always able to use her gentle humour and compassion to help others contain and manage difficult and challenging situations on the course. She will be remembered fondly by her friends and colleagues at the Tavistock.'

Golda also had many interests outside work and was actively involved with Jewish Renaissance magazine as a feature writer and member of the editorial board. She sat on the British Psychological Society's Standing Committee for the Promotion of Equal Opportunities and was a guest editor for the International Journal of Human Rights.
Whilst Golda will be deeply missed by the many people whose lives she touched, her vision will continue. As her colleagues from Brent reflected, 'Golda was and always will be right at the heart of a special team, we miss her so much, but her work will go on in everything we do.'
Karen Budow
Liza Manoochehri
Camden Educational Psychology Service

 

Forum guest column: psychology at work
What are the major causes of stress? Workload and the environment are well-documented mechanisms, but are these the only factors? Have you ever felt that life would be a lot less stressful if your boss behaved differently? Or perhaps a new manager has made your life much easier? In the high-pressure recession-hit workplace, line management behaviour could make all the difference as to whether employees and employers suffer fallout from work-related stress.

Health and Safety Executive statistics for 2008/09 suggest that 11.4 million working days were lost in Britain due to work-related stress, depression or anxiety and that 415,000 individuals believed that they were experiencing work-related stress at a level that was making them ill. The individual and organisational cost of this is enormous, and then there is 'presenteeism' (attending work but not performing), which may cost employers nearly twice as much as absence (Sainsbury Centre for Mental Health). This may be a particular problem during a recession, as individuals struggle with performance and health problems amidst fears for the security of their job.

There is evidence to suggest that the line manager–employee relationship is the most commonly reported cause of stress in the workplace; studies have also shown a link between management behaviour and the well-being of those being managed. Research by Emma Donaldson-Feilder and the team at Affinity at Work, identified four broad behavioural competencies that managers need to show in order to prevent and reduce stress for their staff:
I    Respectful and responsible: managing emotions and having integrity;
I    Managing and communicating existing and future work;
I    Managing the individual in the team; and
I    Reasoning and managing difficult situations.
This research casts new light on the role of 'the boss' and the behaviours that increase or decrease stress levels for employees.

In the current economic environment, with a strong focus on cost-cutting, senior management often recognise and value task completion over people management skills. The agenda is to get the job done and the people dimension is often lost. Employees feel that the organisation does not value them as an individual. They feel pressurised to achieve more with fewer resources and consequently can disengage from their work. There is an impact on health and well-being, but also productivity. People will not go the extra mile for a business that does not support and understand them. It is often the simple gestures that make a difference; actively listening to others, respecting them and saying thank you for good work. Psychologists need to support employees and organisations once stress has been identified, but there is also a need to better communicate the importance of managers' behaviour in determining stress levels. It is vital to reinforce the business case for best practice management development and to incentivise employers to enhance people-management skills at all levels.

Some organisations may think that people cannot change or develop these people skills, but managers can enhance their competencies when given the right training and incentives to change. Effective behaviours prevent and reduce stress, whilst upward feedback by staff to managers supports this change process.

So the next time you feel stressed or you see it in others, explore the manager relationship and think about the behaviours that have a significant impact. Sometimes the answer is close at hand and can be applied to improve things for all of us.

Hazel Stevenson, Division of Occupational Psychology, with Emma Donaldson-Fielder, Affinity at Work. Share your views on this and other workplace-related issues via [email protected].