Forum, March 2009

Greening our practice and research
We were glad to see the February special issue of The Psychologist on how psychology can contribute towards dealing with environmental problems, and increasing 'green' (pro-environmental) behaviour. Anthropogenic climate change is generally accepted by climate change specialists internationally (Intergovernmental Panel on Climate Change, as referred to by Alexa Spence et al. in the February issue). Yet some people still completely reject the evidence, and a much larger number are uncertain and do not start changing their behaviour.

Psychologists could have a major role in addressing the second group by considering psychological phenomena relevant to acknowledgment of problems and taking responsibility. Confirmation bias, the tendency to selectively attend to information that confirms our opinion or preconceptions, mean that people may primarily attend to minority views, even those not from climate change specialists, and will reject or deny evidence from specialist bodies.

Psychologists can also be green-minded in their work, and psychology practitioners could incorporate a green approach directly with clients. Interactions with other professions can also be important (Patrick Devine-Wright made an excellent case in the February interview). For example, caring for the natural environment in adulthood is often a result of early experience. Educational psychologists could influence the extension of school-based provision of such experiences through classes or suitable play areas. Lecturers and teachers of psychology can address older groups by incorporating material on sustainability throughout the curriculum (e.g. see www.teachgreenpsych.com).

Health, clinical, and counselling psychologists can also contribute. For example, the restorative effect of nature for physical and psychological well-being, explained by Rosemary Wright (February issue) in connection with her work with people with learning disabilities, can be applied more widely.

As regards occupational and business psychologists, Matthew Davis and Rose Challenger (February issue) made an excellent case for them to encourage green behaviour in the workplace. The Appreciating Change website (www.appreciatingchange.co.uk/blog.html) gives guidance on how organisations can encourage green behaviour in the workplace.

In addition to practitioners, researchers in various areas of psychology can join in, by researching into underlying constructs, such as environmental concern (e.g. Snelgar, 2006). But a particular research challenge now is the psychological phenomena relevant to­ the problem of achieving behaviour change towards pro-environmental behaviours. Funding exists (e.g. ESRC).

Finally, the role of psychologists in the important crisis of climate change requires a central lead. As Alexa Spence et al. point out, other national psychological societies are much further ahead in engaging with it – will the British Psychological Society take up this role in the UK?
Rosemary Snelgar
Department of Psychology
University of Westminster
Sarah Lewis
Appreciating Change

Reference
Snelgar, R.S. (2006). Egoistic, altruistic, and biospheric environmental concerns: Measurement and structure. Journal of Environmental Psychology, 26, 87–99.

 
Integrating psychology,from all perspectives
Professor Lynne Segal ('One on one', January 2009) makes an important point, 'It would be useful for psychosocial studies…to incorporate the biological more successfully'; but, in her piece, a few lines before, she gave us her view of 'One great thing that psychology has achieved' by saying, 'Shown us, by its own multiple mistakes, the folly of dealing only with individual behaviour which is strictly quantifiable. Eysenck is no longer in fashion, and spent the last 20 years of his life pondering the merits of astrology.'

Hans Eysenck did much during the last 20 years of his life; 'pondering the merits of astrology' was only a very small part (see Corr, 2000). Eysenck is famous primarily for studying individual differences, not 'individual behaviour'; and he was one of the first to argue that psychology needs a truly biosocial approach – linking biological variables with social ones, which is the very approach seemingly favoured by Professor Segal. The inclusion of personality and individual differences in this biosocial model strengthens this approach – people do differ, and these differences have important consequences.

At this time, when the conceptual and philosophical bases of psychology are being debated (e.g. see John Campion's letter in the January issue), a balanced perspective is needed on the contributions of Hans Eysenck, as well as others, who far from being 'no longer in fashion' continues to be recognised as one of the pioneers of psychological research from
a multifaceted perspective. Indeed, Eysenck's perspective is enjoying a resurgence at present – for instance, the genetics and neuropsychological bases of personality and mental illness (e.g. as studied via cognitive neuroscience) is thriving – although this perspective was often met with strong opposition (e.g. from psychoanalysis). Psychosocial studies would be all the stronger by appreciating these lasting contributions.
Philip Corr
Swansea University

Reference
Corr, P.J. (2000). Reflections on the scientific life of Hans Eysenck. History and Philosophy of Psychology, 2, 18–35.
 

Dyslexia – coping with the reality
I was scandalised this morning to see on BBC television Professor Julian Elliott, described as a professor of educational psychology at Durham University, associate himself with the proposition advanced by an MP that 'Dyslexia does not exist. It is only a defence for poor teaching.'

This extreme environmentalist view is tantamount to asserting that teaching can achieve anything, which is blatantly untrue. I accept his right to harbour this delusion; what horrified me was his criticism of the British Psychological Society for having such a wide definition of dyslexia as to render it meaningless. I consider this criticism unjustified.

In my 50 years as an occupational psychologist I have had as clients a number of highly successful senior executives who were dyslexic. Of its genetic origin there was absolutely no doubt. That they became millionaires was due to their developing effective coping strategies independently and in spite of the educational system.

These coping strategies can be taught. Rather than criticising the Society, Professor Elliott should address himself to the problems of accurate early diagnosis of a genetic condition that definitely exists and ensuring that the remedial action it necessitates is provided.
David C Duncan
Ruislip, Middlesex
 

Getting the message across
I recently received an e-mail alert from the London & Home Counties Branch of the BPS concerning what it describes as a 'major event called Psychology for All' on 14 March. It transpires that this 'major event' features a keynote address by Ruby Wax, who it transpires is apparently completing 'an MSc in Psychotherapy'. As this is the first time to my awareness in the 100-year plus history of psychology that a keynote address has been given by an MSc student, I can't help feeling that this has more to do with Ms Wax being a celebrity than a learned student of psychotherapy.A new low point in psychology's obsession with the trivial perhaps.

Can we sink any lower? As some psychologists somewhere are probably actively supporting the attack on Gaza, the answer is probably yes Sincerely not interested in celebrity psychology.
Ron Roberts
Faculty of Arts and Social Sciences
Kingston University
Surrey

Response from Gene Johnson and Karen Powell-Williams from the London & Home Counties Branch organising team for the event: We are grateful to Ron Roberts for giving us the opportunity to tell readers about our Psychology for All event in London on 14 March (wwww.bps.org.uk/psychology4all), featuring Ruby Wax and psychologist Richard Wiseman. The whole point of this event is to make serious psychology available to a wide audience. Ruby Wax is billed not as an MSc student, but as a 'comedienne' with connections and interest in psychotherapy; and while she is the 'attention-getter', giving a talk on 'How Ruby Found Psychology', the event also includes 40+ other sessions
of a serious academic and practical bent. Using celebrities to generate interest in and publicity for an event is a time-honoured practice, hardly a low point for psychology.

Undemocratic, unjustifiable and uneconomic?
We have recently become aware that, at their meeting on 5 December 2008, the BPS Board of Trustees decided that they would no longer be providing the Statement of Equivalence (SoE) in clinical psychology. The SoE is the BPS qualification issued to clinical psychologists trained abroad, or to UK-trained non-clinical applied psychologists seeking to work as chartered clinical psychologists in the UK (who make a 'lateral transfer'). This decision was taken by the Board of Trustees without any consultation whatsoever with any of the stakeholders involved in SoE, and in many cases, without even any direct communication of this decision.

None of the seven national SoE courses was consulted, nor the Strategic Health Authorities (SHAs) who commission places on those courses, nor the relevant BPS subsystems – not the Board of Assessors who assess the work of SoE candidates, not the Committee for the Scrutiny of Individual Clinical Qualifications, who process and assess applications, not the Committee on the Training of Clinical Psychology, not the Division of Clinical Psychology, not the Membership and Professional Training Board. This has been a totally undemocratic process.

We understand that there are currently about 120 psychologists enrolled on the SoE. In terms of numbers of trainees, this is equivalent to several doctoral clinical psychology programmes. In recent years, between 15 and 20 per cent of all new entrants to the profession of clinical psychology have come via the SoE, many of whom have become distinguished members of the profession and the BPS. The vast majority of places on national SoE courses are commissioned by SHAs, who fund these places because they see the SoE as delivering a cost-effective way of introducing greater numbers of often highly skilled and experienced clinical psychologists into the NHS.

Later this year, the Health Professions Council (HPC) will take on the statutory registration of all applied psychologists. However, since the Standards of Proficiency that have been developed by the HPC for registration are virtually identical to the current BPS core competencies in clinical psychology, we see no reason to believe that the numbers of overseas applicants requiring further academic, clinical and research measures would be any different to current levels. (We understand that over 90 per cent of the 150 applicants to the BPS each year require some further training.)

For overseas-qualified clinical psychologists who come from European Economic Area (EEA) countries, the HPC will have a legal requirement to set and assess adaptation requirements as the route to registration. However, the majority of SoE psychologists come from countries outside the EEA. Although these psychologists, together with those wanting to make a lateral transfer, may be set an adaptation period by the HPC, it is not clear that it will be subject to any detailed quality assurance mechanisms. If the Society, aided by national SoE programmes, were to continue to provide a SoE process (albeit under a different name), then overseas and lateral transfer applicants could undertake any further training required by HPC within a system that is tried and tested. This would give them confidence in the training and experience that they were receiving, and would give their future employers some confidence that their employees were gaining the required further training in a way that was subject to established quality assurance procedures.

The role of the SoE in enabling clinical psychologists trained abroad and psychologists qualified in other areas of applied psychology to undertake further training to develop competencies in the field of clinical psychology seems absolutely consonant with the stated aim of the BPS to develop a 'learning centre' within the Society. Other professional bodies representing professions regulated by the HPC do undertake this role. At a purely business level, this also hardly seems to be an apposite time for the BPS to reduce the number of its subscriptions. The costs of running the SoE to the BPS have consistently been well within the revenue generated, and it is one of the most easily economically justifiable of all the BPS qualifications.
The Board of Trustees needs to hear the voice of their constituents and think again.
Robert Marsh
Salomons, Canterbury Christ Church University
Malcolm Adams
University of East Anglia
Jan Burns
Salomons, Canterbury Christ Church University
Sue Watson
University College, London
Nigel King
University of Oxford
David Green
University of Leeds
Nan Holmes
University of Surrey

Peter Banister, Chair of the Membership and Professional Training Board, replies: As you know the Statement of Equivalence was introduced to provide
a mechanism for clinical psychologists trained overseas to achieve registration as a Chartered Clinical Psychologist. Once HPC becomes the regulator only that body will be able to formally and legally recognise equivalence across all the seven applied areas for EEA and non-EEA applicants. The Society will no longer have a Register of Chartered Psychologists and, although chartered membership will continue, it will not have specialist titles attached to it. Our accreditation of postgraduate programmes will be for the membership grade of Chartered Psychologist, not for any specialist titles.

The Society therefore is unable to offer any Statement of Equivalence in Clinical Psychology since we will no longer be the 'competent authority' in law when this function moves to the HPC. It has been clear since the first Department of Health consultation on regulation by the HPC in 2005 that this change of authority would be an inevitable consequence of statutory regulation. Those HEIs who have a route for overseas candidates to qualify will need to consider how such training will fit with the HPC processes and may wish to seek advice from the HPC on this issue Of course, there are a number of unknowns in relation to statutory regulation. At the moment we do not know the threshold level for entry to the HPC register or the Standards of Proficiency they will publish. This means that we cannot predict how many international applicants might be rejected by HPC in the future. However, this is something which could be considered further when examining potential new services that the Society might provide to its members. Obviously, we would need
to be sure that any activity in this area was sustainable, as well as being of benefit to members and the discipline and contributing to the development of the Society. All of these considerations would need to be addressed if new services in this area were proposed.
Over the next few months we expect to consult with members on various matters relating to the future of the Society, and as part of this process will welcome suggestions for services that we might offer.

The forensic/clinical divide, continued 
I write in response to Moira Potier de la Morandière's comment that she has 'been shocked by the lack of any sense, from some forensic psychologists I have encountered, that there might be important gaps in their knowledge and skills base and that they ought to be very concerned about how they represent themselves to patients' (Forum, February 2009).

Would it be fair to suggest that she has experienced a similar sense of shock in response to some clinical psychologists? As Carol Ireland and Jenny Taylor point out (Forum, February 2009), clinical psychology training does not necessarily equip one with the knowledge and skills base to work in forensic settings, just as forensic training does not necessarily equip one with the knowledge and skills base to work in clinical settings. For both aspects of the profession it surely is about developing expertise and we will do this far better if we collaborate rather than set up straw divides that become stone walls. Perhaps Adrian West's suggestion would be a suitable roadmap to peace.
Simon Duff
University of Liverpool

In the February issue of The Psychologist, Carol Ireland and Jenny Taylor, Chairs of the Division of Forensic Psychology and the Division of Clinical Psychology respectively, provided a joint response to a recent query about the enmeshing of clinical and forensic psychology. In concluding their letter, they expressed the hope that their response addressed satisfactorily the concerns raised (initially, by Denis McVey, published in the November issue). As a member of both Divisions and holding Chartership in both areas – and sharing many of the concerns expressed by Mr McVey – I must inform them that I am not satisfied with their response.

Dr Ireland and Dr Taylor sought to dismiss Mr McVey's concerns on the basis that they revealed his lack of awareness about the training undergone by both clinical and forensic practitioners. He did not reveal any such ignorance. He did, however, pose very specific questions about the competencies of forensic and clinical psychologists to do the various tasks for which they are increasingly being held equally responsible, as if there was no difference in their professional backgrounds. His questions remain unanswered.
Caroline Logan
Liverpool

IAPT and our skills
Is it not the time for chartered applied psychologists who specialise in cognitive behavior therapy to be recognised for our training, work experience and CPD?

Under the new Improving Access to Psychological Therapies (IAPT) framework we are increasingly being pressurised to apply for British Association for Behavioural and Cognitive Psychotherapies (BABCP) accreditation and are being told (by the BABCP and IAPT) that our skill base is inadequate. Our practising certificates are becoming increasingly redundant, particularly within the NHS.

Isn't it time that the BPS stood up for the fee-paying members? How about creating a subdivision of CBT specialists that are recognised by IAPT as psychologists who are sufficiently trained and experienced to be high-intensity therapists in the new framework?

Let's not allow our skill and expertise to be dismissed and for highly qualified, respected psychologists to be marginalised purely because the BABCP has appointed itself as the only organisation equipped to judge whether a therapist can apply CBT in the therapeutic arena.

Valerie Halbinger
Jo Gresham-Ord
Thetford Community Healthy Living Centre
Thetford

FORUM beyond boundaries
Cultural sensitivity is an important part of any psychologist's toolkit, but it may not be enough: madness does not speak a universal language. We assume that words are but tools to express the inner turbulence of mental illness, but a growing literature documents the fact that hallucinations and delusions can be language-specific. In a landmark study, psychiatrist R.E. Hempill reported on 30 multilingual South African patients, all diagnosed with schizophrenia, who heard auditory hallucinations in only one or some of their languages. More surprising was a case where the patient had extensive delusions when speaking one language but was insightful and non-psychotic when speaking another. Although pioneering, the 1971 study now makes for uncomfortable reading. As a self-described study of 'White and Coloured schizophrenic patients', it is dusted with the language of apartheid South Africa and clearly demonstrates that cultural and linguistic sensitivity are not nearly the same.

In more enlightened times, a 2004 case series by De Zulueta and colleagues reported on three bilingual patients who were formally assessed in both languages by the same researcher. All three were found to report language-specific psychotic symptoms, two seemed emotionally more insightful in one language rather than the other, and one patient was a higher suicide risk – but only when speaking Portuguese rather than English. Contrary to what we might expect, the native language was not always the tongue in which powerful experiences were more readily apparent. In a wide-ranging review published in 2008, psychologist Michel Paradis quotes studies suggesting that there may be a linguistic effect across the range of neuropsychiatric disorders, although curiously, psychosis seems the most likely to be differentially expressed.

The implications of these studies are clearly spelt out by the authors. Cultural sensitivity is necessary but not sufficient to address the mental health needs of people who regularly speak more than one language and who make up the majority of the world's population. In multicultural Britain these studies also question our reliance on interpreters as 'universal translators' through which we assume we can do our work adequately, even if it is not as well as we would like. It is clear that translators are still an essential service, but for bilingual clients we really need bilingual psychologists, because we may be missing and misunderstanding the experiences of the people we meet if we rely on only one channel of communication.
We assume psychologists will be gifted communicators but it may be time to include the appreciation of another language as part of our development.

Vaughan Bell is visiting professor at the University of Antioquia, Colombia. This column aims to prompt discussion surrounding cross-cultural and interdisciplinary issues.

A blooming mistake
As a keen gardener as well as a neuropsychologist, I enjoyed the picture of spring snowflakes (Leucojum vernum) on the cover of the February issue. I was a bit disappointed to see the implied reference to these as snowdrops (Galanthus spp.) overleaf. While this distinction is not, I imagine, a majority concern, aspirations for scientific accuracy should extend beyond the boundaries of psychology.
Richard Warburg
Stourport on Severn

Editor Jon Sutton responds: I quite agree, so apologies for the error. On this occasion our in-house botanical expertise was not up to spotting the mistake made by the commercial picture library that supplied us with the photograph, which they had catalogued as of snowdrops.

Biophilia – who was first?
In her interesting article 'Conservation work – a therapeutic intervention?' (February 2009), Rosemary Wright claims that the word biophilia 'was first used by zoologist Edward Wilson in 1984'. Not so, though Rosemary can hardly be blamed for repeating a myth contained in authoritative sources that she cites.

When Wilson's book, Biophilia, was published in 1984, the word was already decades old. It is not in the Oxford English Dictionary, but it is in the third edition of the Oxford Dictionary of Psychology (published in February 2009). According to my researches for that entry, the German psychoanalyst and Holocaust refugee Erich Fromm used it first in The Saturday Review (4 January, 1964): 'There is an orientation which we may call love of life (biophilia); it is the normal orientation among healthy persons' (p.22); and he goes on to contrast it with necrophilia. I think we should give the credit back to Fromm.
Andrew M. Colman
School of Psychology
University of Leicester

 

Obituary
Laurie Worsley (1925–2008)
James Lawrence Worsley, known as Laurie, previously Head of Clinical Psychology Services at the North Wales Psychiatric Hospital, died on Saturday 6 December aged 83 years. Laurie was one of the pioneer generation of psychologists who started his professional life at the very beginning of the emergence of a truly independent profession of clinical psychology.

He started his adult life in the RAF training to fly fighter planes. This was in the latter stages of the war, which ended before he could fly for long on active service. After the war he enrolled at Manchester University to study psychology. There he met his wife-to-be Jean, and thus started a loving relationship which lasted the rest of his life. Following qualifying as a clinical psychologist, he worked for a time in London before moving back to Manchester. Then a position became available as 'Principal Psychologist' at the then North Wales Psychiatric Service. Many colleagues were baffled as to why he would want to leave the energy of Manchester to go the backwoods of Wales with a non-existent service, but Laurie could see fertile ground when it was there for the taking. By the time he retired a large department of clinical psychologists had been established, covering all the major clinical specialisms,
and he was instrumental in setting up the North Wales Training Course in Clinical Psychology.

Laurie's particular interest in clinical problems was that of obsessionality. Reared in the days of frank behaviourism, he anticipated much of contemporary cognitive psychology with his counselling about the fruitlessness of obsessional worry, or, adopting his wife's Lancashire, 'worriting', and the need instead for effective action and thought.

There was an earthy no-nonsense character to his dealings with both patients and colleagues, leavened with a twinkle in his eye. To use an old-fashioned term of endearment he was in the best senses of the word a gentleman. A man who raised his hat to his secretary when passing her in the street.A patient I inherited from him remarked with some astonishment how he had stopped and chatted to her when chancing upon her in a supermarket when all other professional staff she had contact with seemed to need to look straight through her in such a context.

Fearful about how he would cope with retirement, his wife Jean bought him some flying lessons, and with his previous RAF experience he quickly secured his pilot's licence and treated all and sundry to joyrides over the Welsh landscape.

Many psychologists leave a legacy of multiple books and publication papers; Laurie wrote one slim volume but left countless grateful patients who remember him with warm affectionate regard and a generation of psychologists enriched by his teaching and management.

At his funeral, Laurie teased us with his lack of any particular religious faith when a poem by James Leigh Hunt was read out. In this, a man is visited by an angel 'writing in a book of gold' the names of all those who love the Lord. Abou Ben Adhem cannot count himself among them, but asks to be recorded as 'one who loves his fellow man'.
It was enough for God, and a fitting epitaph for Laurie.
Richard Corney
Royal Alexandra Hospital
Rhyl
 

Help-seeking and stigma – a broader view
We read David Vogel and Nathaniel Wade's article on the impact of stigma on seeking psychological help with great interest ('Stigma and help-seeking', January 2009) and would like to contribute some reflections to broaden the discussion.

Our current research focuses on access to mental health care more generally and on how stigma and discrimination may act as barriers to access. Concerns about the self-stigma relating to seeking psychological help are certainly part of the picture, and receiving psychological help can usefully be viewed as stigma marker. There are a number of other potent stigma markers including seeing a GP for a mental health problem, being on psychoactive mediation, receiving a mental illness diagnosis, seeing a psychiatrist, being hospitalised, and being treated under the Mental Health Act. Individuals may vary in their sensitivityto stigma markers, and we need to understand more about how this impacts on help-seeking.

Vogel and Wade's article focused on common mental illness and limited itself to discussion of the individual as help-seeker. When considering access to mental health care more generally it is useful to expand the focus to include the role of the family as help-seekers. In psychotic disorders and other severe mental illnesses the nature of the symptoms can deter the affected individual from seeking help and family members may seek help on their behalf. However, family members may anticipate stigma against themselves (sometimes known as courtesy stigma or stigma by association) or may have concerns about the stigma or discrimination their family member is likely to face (which may be termed vicarious stigma). We therefore need to learn more about the complex ways in which family stigma and help-seeking interact.

Vogel and Wade briefly mention how stigma may contribute to drop out from treatment. We believe that it is helpful to conceptualise help-seeking and engagement (with services and treatment) as two key components of access to mental health care. The relationship between stigma and engagement is under-researched and is as a vital area for further exploration. Also, it was clear from our previous work that both anticipated and experienced discrimination have a negative impact on many areas of life (Thornicroft et al., in press), and our current research will explore how these two processes affect access to mental heath care. We conjecture that experiencing discrimination after seeking help is likely to negatively influence future help-seeking behaviour.

Lastly, we would like to draw readers' attention to the literature in health psychology, medical sociology and anthropology about how many different health problems, from cancer to heart disease, may threaten or compromise an individual's self-identity, which may deter help-seeking and engagement. Self-identity and self-stigma are overlapping concepts, and we may have much to learn about help-seeking for mental health problems from this wider vantage point.

Our research will begin later this year, and we would be very pleased to hear from others working in this important area ([email protected]).
Sarah Clement
Elaine Brohan