‘The impact we had as a discipline and profession in that time was off the scale’

Good to meet you David, thanks for your time.

Assalamu alaikum [peace be upon you] Fauzia, its lovely to meet you, thanks for inviting me, I've really enjoyed reading your previous interviews.

Can you tell me a bit about your background and clinical psychology career?

I often think of myself as the 'Forrest Gump' of Clinical Psychology as I just seem to have been in the right place at the right time and incredible things happened around me when I was, by chance, a bystander.

My initial academic background wasn't very distinguished. I didn't do well at school, and I didn't have any kind of clear career plan when I started my psychology journey. I did a joint degree in Psychology and Zoology at the University of Reading mainly because I couldn't really make my mind up what I wanted to do! However, at uni, I found that for the first time in my life I really enjoyed learning and ended up doing quite well. This was despite the fact that I became quite involved in the human rights movement and also spent most of my second and third year directing theatre plays! In fact, I almost went into a career as a director. I think that interest was an early sign of my fascination with leadership and teamworking… the miracle that is a group of people coming together to create something that none of them could ever do on their own.

After leaving uni I had two assistant psychologist jobs, one in Manchester – definitely the place to be in the late 1980's, although I spent more time in the university library than I did in the Hacienda! I came back down to London to do my clinical training at the Institute of Psychiatry, which was an incredible experience. I was so fortunate to learn from some of the real pioneers in clinical psychology: for instance my clinical tutor was the wonderful Padmal DeSilva, I did an intellectual disabilities placement with Glynis Murphy, a neuro placement with Robin Morris, and a placement in Chronic Pain with Amanda Williams in the then newly established INPUT pain service at St Thomas' Hospital.

After training, I started working at the Royal National Orthopaedic Hospital, with responsibility for all the inpatient wards but especially the regional Spinal Injury Unit. That was certainly an 'in at the deep end' experience; they hadn't had a psychologist for some time and on my first day they presented me with a list of referrals, including someone who had become quadriplegic as the result of a failed suicide attempt. There were no consulting rooms with comfy chairs and coffee tables, I had work at the bedside or find a quiet corner… I spent a lot of time in the sluice!

Although there were certainly times that were challenging, it was also an immensely valuable learning experience. I learned a lot from working as part of a team with other health professionals. I also learned a huge amount from the patients themselves. Once I'd got through the initial referrals, I would see every patient who came in, which is a rare experience in our profession, even in Health. We often end up seeing only a sample who have been identified, often by someone other than themselves, as requiring psychological input. There I was able to see the range of ways patients and their families cope with a life changing injury. It taught me that people have immense coping abilities, which often health professionals, and sometimes even the person themselves, don't know they have. I was, and still am, in awe of how normal people are able to cope with the most extreme challenges.

What came next?

After a while, I moved on to lead the clinical health psychology service at Charing Cross Hospital in West London, which was where I would end up staying for the next 20 years. When I say I 'led' the service, that's a bit misleading because when I started, I was the only member. Team meetings didn't too last long, although there could still be lively debates! However, it certainly wasn't lonely, I worked with wonderful colleagues in many different medical specialities. There had been an established psychology link with the diabetes team, and I worked closely with them at the start.

I was very fortunate that in the following years, there was substantial growth in the profession. When I trained, there were fewer than 2,000 qualified clinical psychologists in the UK, whereas today there is nearly twice that number just in clinical psychology training. Over the years, we were able to establish posts across a wide range of services and combined clinical health psychology and neuropsychology. Charing Cross became part of Imperial Healthcare Trust, so we covered three major hospitals; we established a cardiac rehabilitation programme, pain management programmes, stroke services, and as a trust we successfully bid to host a major trauma centre which had psychology input built in from the beginning. We also established posts in community services within several London boroughs. I had the privilege of working alongside some exceptional colleagues who were the driving force behind many of these developments including Elenor McLaren, Stephen Gunning, Joanna Livingstone, Michelle Lipton, Lynne Nutkins, Katie Murray, Anna Pullen, and Yvonne McCulloch and many others, also including many, many trainees contributed over the years.

It was quite a ride, but the thing I'm most proud of is that it continued to thrive and grow after I left. My favourite leadership quote is from Lau Tsu: 'A leader is best when people barely know he exists, when his work is done, his aim fulfilled, they will say: we did it ourselves'. I add to that 'and they will be right'. I don't think you can make any claim to effective leadership if things fall apart the minute you walk out the door.

It sounds like it must have been hard to leave that role, but you then moved into Clinical Psychology Training full time?

Yes, it was 11 years ago now, and it was really hard to leave… a piece of my soul will always remain at Charing Cross. If I hadn't left at that point I would have definitely stayed there until I retired. However, the joint programme director job came up at Oxford, which was a dream opportunity to move into clinical psychology training. I didn't tell anyone I was going to the interview as I was so sure I wouldn't get it, but to my great surprise I did. I always think that all of us involved in clinical psychology training, staff, and trainees, are hugely privileged, to have the time and resources over three years to focus on developing qualified clinical psychologists. It was also lovely to work alongside Paul Kennedy who was the other Joint Director as he had been a mentor to me when I was in my first job, which had actually been his first job some years before I was there. I also became a fellow of Harris Manchester College, which is a hugely inspiring place, it's the smallest Oxbridge colleges, and the only one that takes only mature students. A wonderful inscription on the clock tower reads 'It's later than you think… but it's never too late'.

I guess it was a new experience for me to go into such a well-established programme with a team who were all very experienced trainers. All clinical psychology training programmes, but especially long-established ones, are complex ecosystems, their network of connections with supervisors, service users and carers, local services, visiting teachers and the university are what gives it life. These connections need to be cultivated and maintained, and I remember the challenge of the first few years was trying to get to understand the local services and learn who was who.

It was when I got to Oxford that I first started looking in detail at leadership development and how we could bring this into training more. We were incredibly fortunate that some of the experts within the Said Business School, particularly Profs Sue Dopson and Tim Morris, were willing to help as well as amazing colleagues from NHS Horizons, Helen Bevan and Katherine Pereira. Together we developed a leadership development strand through within the programme, and trying to identify and measure outcomes of this led me up to link up with experts at Edinburgh University and developing a UK wide study of leadership development in clinical psychology trainees and doing a PhD in leadership… but that's another story.

Sadly, the Oxford training community experienced a trauma in September 2016 when Paul died suddenly, and completely unexpectedly. He suffered a cardiac arrest during a Board of Examiners meeting. The night before we had all gone out for dinner, and as usual, Paul was the life and soul of the party, telling anecdotes like the true Irish raconteur he was. Paul's death was a very difficult time for everyone, primarily of course for his wife and children… Paul was only 56 when he died and just starting to think about his retirement. However, it also was a significant trauma for trainees and also for staff, many of whom had known him since they were trainees themselves. Many of us experienced flashbacks of the events afterwards. A few days afterwards, I was speaking to David Clark, who had also been present when Paul died, and he said he had been having flashbacks, that was actually a big help. I thought 'if one of the authors of the cognitive model of PTSD is having flashbacks then I shouldn't feel bad that I am too'!

As a result of an organisational restructure, I was made redundant 18 months after Paul's death, and that was undoubtedly the lowest point in my life so far, and I very much hope, ever. However, as many patients have taught me over the years, although you may go through a traumatic experience, and would give anything for it not to have happened, something positive can still come out of it if you look for it. If I hadn't had to leave Oxford, I would never have put myself forward for election for BPS president and I wouldn't have had my current job in Plymouth.

Over the years, you've held a number of different roles within the British Psychological Society, including the presidential role; can you talk me through the varied work you carried out as part of those roles?

I held different roles in the BPS for about 25 years continuously. My first role was in the late 90's on the committee that assessed applications from clinical psychologists who had trained overseas. I applied as I thought it would be interesting to learn about training in other countries and it certainly was, although it was also a lot of work. Each application included pages and pages of documents, and in the pre-email days it was all sent by post. They actually came in boxes which the poor postman had to struggle with! I definitely wasn't in his good books, especially after I became chair and got sent copies of all the papers!

If you thought I was exaggerating with my Forrest Gump comment earlier, you'll see what I mean. That role led on to becoming Director of the DCP Professional Standards Unit, which was just in the run up to statutory regulation. The BPS were still strongly resisting the idea that anyone other than a special psychologist's organisation could regulate psychology, but a few of us recognized that we were going to end up going into the Health and Care Professions Council, and that they would effectively be taking the training standards on from the BPS. However, at that time the training standards weren't really up to the job. People don't believe me when I say it now, but before 2007 the training standards didn't mention a single type of psychological difficulty or a single form of psychological intervention. This was because there were a lot of tacit assumptions, which is ok within the BPS where everyone more or less shared those assumptions, but when you go outside our professional bubble… then not so much.

I realised how much of our view of what makes a psychologist is culturally constructed when I was the BPS rep to the international psychology competencies project some years ago. I spent several days in a hotel in Stockholm with psychologists from around the world trying to agree on what the core competencies of a psychologist were, and it was fascinating to see the diversity of viewpoints. For instance, in the UK we see formulation as being one of our most distinct and important competencies, it's almost like our Desert Island Discs competency, the one we would keep if we could only have one. However, there I remember saying 'what about formulation?' and everyone looked at me blankly, until someone from the American Psychological Association said 'oh I know what you mean, you mean diagnosis'!.

Anyway, we managed to persuade the training community that it was time to be a bit more explicit, obviously no one would have agreed if I, or anyone else, were to say what the content should be, so we just did an analysis of what the courses were actually teaching. An assistant psychologist working with me at the time, Helen Wain, helped me to basically do a thematic synthesis of the training and, sure enough, there was much more in commonalities than there were differences. We found all courses did at least some training in CBT, Systemic, and Psychodynamic therapy, and originally we proposed that for the revision, but that was felt to be overly restrictive so it ended up as the current 'CBT + 1' requirement.

When HCPC came along, BPS was then able to pass over standards that were actually workable by people who didn't have all the tacit assumptions. Malcolm Adams and I were very involved in working with HCPC to develop the Standards of Proficiency for Practitioner Psychologists. HCPC asked me to stay on as an advisor, which I did for five years until the end of the grandparenting period. In 2011, I was appointed as Chair of the BPS Professional Practice Board and, by complete chance, the NHS had the biggest overhaul in its history the following year! NHS England, Health Education England, and Public Health England were all formed at that point, and given my NHS background I was in a good position to try and help the BPS build links. I'm pretty sure I was the first psychologist to meet with each of those organisations. I remember going into my first meeting at NHS England when the builders were still there! We did end up with psychologists involved in a lot of the national commissioning structures though and that was an important outcome.

My term as President started smoothly enough in 2019, and it was such a joy to meet all types of psychologists and psychology students across the whole of the UK and to participate in international work. I also established a presidential taskforce on diversity and inclusion, which brought together people from across the Society, to look at how we could tackle the serious problems in psychology as a profession and discipline. I had done a bit to highlight the continuing disparity in selection outcomes for people from different ethnic backgrounds when I was Chair of the Clinical Psychology Clearing House but the problem is certainly not specific to clinical psychology, it's just that there is good data there. There's much less data about other career routes such as academic careers but many of the same issues are there. We were able to assemble an incredible taskforce initially chaired by Binna Kandola and then by Nasreen Fazal-Short. I was, and still am, in awe of all of the members of that group. They each bought different perspectives. Some were currently students, others many years into their careers.

We were all thrown a bit of a curve ball in early 2020 when the pandemic struck. The inaugural meeting of the taskforce had to be switched to an online event at the last moment, but they didn't let the pandemic slow them down. In fact, they continued their own work and also contributed to the Society's Covid work as well. I won't go into too much detail about the BPS Covid response as I've talked about it at length elsewhere, including in my presidential address. However, one, of the many, things I'm proud of is that although we did move very quickly. We published our first guidance and held our first webinar within a week of the Covid Coordinating group being set up, we spent time identifying the core values that would guide us and one of these was being inclusive. One of the first acts of the Covid Coordinating group was to appoint a diversity and inclusion champion, and we were so lucky that Layne Whittaker put herself forward to do that as well as her role on the taskforce.

The pandemic was yet another 'Forrest Gump' moment for me. It was chance that I was president at that time, but I had worked in physical healthcare for 25 years, been chair of the professional practice board, knew the chairs of all the practitioner divisions well, and also had quite a few national links in the NHS as well. The Society made such a positive contribution to the national response to the pandemic, and chairing the Covid Coordinating group was a great privilege. I also got to go back to my roots when I was asked to join the multidisciplinary group designing the NHS England post-covid rehab programme. In terms of size of impact of things I've been involved in, that tops the list.

What do you enjoy most about your role and what do you find most challenging?

What I enjoy most is an easy one, seeing trainees develop through across the three years of their training and going off to do incredible things as qualified clinical psychologists. At Plymouth, we have the most different types of health profession trainings of any UK university so I also have the opportunity to be involved in training of many other types of health professionals too.

In terms of challenges, a lot of people assume that travelling back and forth between London and Plymouth every week is challenging, but I actually quite enjoy the travelling itself and I probably get more work done on the train than I do at other times. Even staying in a bedsit during the week isn't really a hardship as I can see the sea from my window and have a 10-minute walk to work. I wouldn't have considered this lifestyle when my kids were growing up, but they've left home now and actually love to use my flat as a free Air B&B! However, some of the financial pressures on universities at the moment, particularly those like Plymouth that rely heavily on undergraduate student income, can be challenging.

Can you share a piece of work or research that has really changed or shaped your practice?

If its ok, I will mention an experience rather than a piece of work, I would say it has changed my approach more than anything I've read. That is the year I spent on secondment to the Commission for Health Improvement, what went on to become the Care Quality Commission (CQC). When it was first set up, I spent a year as a project manager helping to develop the review methods, that in itself was a challenge as no one had ever gone in to evaluate a whole NHS trust before. However, what really changed my perspective was doing a dozen or so clinical governance reviews all across England. We had a unique perspective, far different to anything I had had as a clinical psychologist. We spoke to patients, relatives, junior doctors, consultants, nurses, cleaners, porters, managers, chief executives and chairs. What it made me realise is that, whilst it's important for people to do a good job, patients' lives literally depend on it, in a way what's even more important is how the different parts of the system work together. When they do things can be great, when they don't patient, and staff, experience can be really lousy.

This perspective led me on to doing an MBA which included quite a lot on system dynamics, and I think that has really shaped the way I approach things. I deliberately chose to do my MBA at a business school that didn't have a health service focus, most of the other students worked in the City, and I think it was really beneficial to be learning alongside people who had a very different perspective and context to my own. I did feel a bit guilty because of the main ways in which MBA programmes are judged by how much more people earn after doing them, so they kept ringing up for a while asking me how much more I was earning than I was before, and I had to keep saying nothing! In fact, now I'm in a university I earn less than I did when I was in the NHS, although fortunately they gave up ringing me many years ago. I think I definitely did benefit though!

What change do you hope to see within Clinical Psychology in the future?

I feel like I'm being a very difficult interviewee because I keep rephrasing your questions! However, for me what's more important than a change within Clinical Psychology is change in how Clinical Psychology engages with other disciplines and professions. One of the things I think that our work in the Covid pandemic taught us is just how much of an impact psychologists can have when we work together. The sheer breadth of the BPS is a challenge, and indeed has been since the very first meeting in 1901 which was attended by a neuropathologist, a philosopher, an anthropologist, and a head teacher among others. However, I think during the pandemic we managed somehow to align the different specialisms within the BPS towards a common purpose, and that was really like nuclear fusion! The impact we had as a discipline and profession in that time was off the scale. The NHS in all four nations were basing a lot of their policies on BPS guidance. My cousin, who is a medic, sent me an email that President of the Royal College of Physicians had sent to all their members which recommended they all read our BPS guidance. Now that doesn't happen everyday!

What advice would you give to those earlier on in their psychology career journeys, that you wish you'd known back then?

That's a wonderful question to finish on. I regularly get asked for advice by people who are just beginning their journey. I would say that it's important to not focus so much on the destination of your career that you miss out on the benefits of the journey. A quote that is attributed to the Buddha goes 'It is better to travel well than to arrive'. Really make the most of all the opportunities that are around you to learn, develop and enjoy. If you are currently doing an undergraduate degree, the priority is to do your best in all of your modules because your academic transcript will be important later on and it's difficult to go back and do that part again. However, that doesn't mean you need to stress out. I actually stressed out much more, and did more 'studying', when I was at school than I did when I got to uni but ended up getting a C and two D's at A-levels but a double first at uni. The way to do your best at uni is just the same: make the most of all the opportunities around you to learn, develop, and enjoy!

The final piece of advice is seek out people who you admire and whose commitments you share, then look for ways you can contribute to their work. Any positive impact I have had has been because I've been able to work alongside amazing people. In my BPS presidential address, I talked about how giant redwood trees, which are the largest and longest-living organisms on the planet, only thrive when they are surrounded by other redwood trees. Each tree relies on the others for support and nutrition. If they are grown on their own, they only reach a fraction of their normal height and have a pale colour. Look at the 'trees' around you. Are they helping you to grow, can you make more of this? But also, how are you helping them to grow, can you do more? Unlike giant redwoods, we have the ability to move to a different part of the forest… maybe it's time to pick up your roots.

Photo: 'This is from one of the highlights of my time as BPS president, when I represented the BPS at the 25^th anniversary congress, of the Psychological Society of South Africa (PsySSA). In the photo are Arthur Evans, Chief Executive of the American Psychological Association, Garth Stevens, 2019-21 president of the PsySSA, Shahnaaz Suffla, 2021-22 PsySSA President, Anne Kramers-Olen PsySSA Executive member and Fatima Seedat, PsySSA Executive Director.'