Letters, August 2012

Engaging with the environmental crisis

In the current economic climate you would be forgiven for thinking that the economy is the most pressing issue facing UK and global governance. Yet despite the current overwhelming focus on our banks and the eurozone, the environment is also a pressing issue in contemporary society. For example, there is a general consensus within the scientific community that human actions are contributing to global climate change, ecosystem degradation and natural resource depletion. Yet despite being an issue of unprecedented importance, politicians, and more importantly for us, psychologists, have yet to adequately deal with it.

Yes, 'ecopsychology' is making steady progress in theoretically and empirically understanding human–environment relationships, but its focus is not on understanding and engaging with pro-environmental and conservational behaviours. Pockets of research in marketing/consumer psychology have attempted to profile the pro-environmental individual in terms of demographics such as gender, age, ethnicity, occupation and income (see Dolnicar et al., 2008 for a review), and by measuring attitudes to identify the pro-environmental individual (e.g. Singh et al., 2007). Both perspectives offer much to market research, but little is said about those who don't fit the profile or possess the correct 'attitudes'. This issue has been addressed to some extent through the emergence of 'conservation psychology' (for example see www.conservationpsychology.org), focusing on understanding how people behave toward and value nature . However, much of the research in this field is located in the USA.

In the UK there are a handful of academics attempting to address these issues, such as Chris Spencer, Mark van Vugt, David Uzzell, and Birgitta Gatersleben. I too have recently conducted research for a doctoral thesis looking into the emotional, reflexive and reciprocal experiences of engaging with pro-environmental behaviours.  Understanding this allows for a greater appreciation of the reciprocal and experiential elements of engaging with such practices and the positive impact this can have on well-being. This alternative focus appears crucial in facilitating greater levels of engagement for everyone, something fundamental in the context of the current crisis.

However, this type of research is scarce, and often does not filter through to the budding undergraduate or postgraduate student – the majority of institutions place more importance on traditional topics. So whilst psychology is constantly advancing knowledge in areas that are extremely relevant and important to contemporary societies (e.g. prejudice, development, health), what we have here is another contemporary issue of undeniable importance, yet one that remains largely unexplored by psychologists. Surely it is time for psychologists to 'come out of the woods', roll up our sleeves and fully engage with the environmental crisis facing all of humankind?
Dr Paul Hanna
University of Brighton

References
Dolnicar, S., Crouch, G. & Long, P. (2008). Environment-friendly tourists: What do we really know about them? Journal of Sustainable Tourism, 16, 197–210.
Singh, T., Slotkin, M. & Vamosi, A. (2007). Attitude towards ecotourism and environmental advocacy: Profiling the dimensions of sustainability. Journal of Vacation Marketing, 13, 119–134. 

Schizophrenia – routes to help

I was glad to see Dr Jerome Carson suggest a turn to organisations
like the Hearing Voices Network in supporting the former patient of his who's plagued by 'voices' ('Learning about asylums from inmates', Letters, June 2012). Researching my book on recovery from schizophrenia (D'Ombraine Hewitt, 2007) I gathered numerous firsthand accounts of the usefulness of sharing these experiences with fellow voice-hearers – 'worth a hundred therapy sessions', was one contributor's description. 

Killilea (1976) first suggested that the effectiveness of self-help groups may be partly attributable to 'the helped' gaining the empowering experience of being a 'helper', a finding from my own research into the effect of non-CBT, humanistic-integrative therapy with women on the schizophrenia/schizo-affective disorder spectrum (D'Ombraine Hewitt, in press). None of the study's participants sought therapy for their psychotic symptoms, though commonly reported an improvement in their mental health, evidenced by their 'voices' no longer being troublesome/being much more manageable. So viciously dominating had been one participant's 'voices' that she self-harmed and attempted suicide virtually on a daily basis. Eight years since the end of her two-year period of counselling the voices were 'hardly noticeable' and she has remained well.

This finding is in line with those of Tarrier et al. (2000), who reported an equivalence on all measures for CBT and supportive counselling, with both groups doing significantly better compared to participants who received routine care only.

Incidentally, I was surprised that of the 160-plus individuals with a diagnosis of schizophrenia whom I interviewed for my book only one reported finding CBT useful, and he had also had hypnotherapy and counselling at the same time. However, most interviewees spoke of the enduring benefits of the individual non-CBT counselling/psychotherapy they'd received through independent practitioners or charitable organisations such as Mind. Dr Rosalind D'Ombraine HewittLondon N6

References
D'Ombraine Hewitt, R. (2007). Moving on: A guide to good health and recovery for people with a diagnosis of schizophrenia. London: Karnac.
D'Ombraine Hewitt, R. (in press). Recovery and transformation – A humanistic-integrative approach to schizophrenia/schizo-affective disorder: The client's perspective. 
Killilea, M. (1976). Mutual help organisations: Interpretations in the literature. In G. Caplan & M. Killilea (Eds.) Support systems and mutual help: Multidisciplinary explorations (pp.37–93). New York: Grune & Stratton.
Tarrier, N., Kinnery, C., McCarthy, E. et al. (2000). Two-year follow-up of cognitive-behavioral therapy and supportive counseling in the treatment of persistent symptoms in chronic schizophrenia. Journal of Consulting and Clinical Psychology, 68(5), 917–922.

Being useful

The fundamental principles of effective applied psychology were refreshingly described in Paul Furey's article 'The brave psychologist' (June 2012); be clear, be concise, be challenging and ultimately, be useful. For educational psychologists working in local authority services, these are essential to daily working practice. Without them, we lack credibility and our value for money is justifiably held in question. Survival of our profession depends on our skills in translating knowledge into useful and accessible advice to clients.
Leisa Randall
Principal Educational Psychologist
Education & Children's Services
Haddington, East Lothian

Olympics and human behaviour challenges

We read with interest the July issue of The Psychologist and the different perspectives that the psychologists presented on the Olympics. We wanted to express a further perspective, which has its origins in occupational psychology, but is perhaps more accurately described as an interdisciplinary approach.

Here in the Socio-Technical Centre, at Leeds University Business School, the Olympics is proving to be a fascinating time for us too, as we are involved in a range of research activities that have application for this event. For example, our colleague Rose Challenger has been working with a range of organisations to better understand different crowd typologies, and the implications that these have on the way crowds behave at events like the Olympics, in order to facilitate better event preparation and crowd management. Other colleagues are working with architects to understand the effects that buildings and infrastructures have on people's behaviour, and we have worked with computer scientists to develop simulations of human behaviours such as team working.

Like many others in psychology, we believe that all of the challenges facing events like the Olympics are ultimately concerned with human behaviour. Yet when you present people from different disciplines with a practical problem – like 'How should crowds be managed at the Olympics?' – and ask for their ideas on how to solve it, you get a very different set of solutions, because people inevitably look at the problem from their own perspective. Sharing these solutions can be fascinating, because it can challenge everyone's assumptions, and triggers new ideas and ways of thinking.

For those like us in the Socio-Technical Centre who subscribe to a systems perspective, the challenges created by events such as the Olympics, require active collaboration between psychologists and other disciplines, most obviously including engineers, planners, architects, politicians and computing scientists, but there are many other groups too.

We are convinced that occupational psychology as a discipline is sometimes underexplored in relation to these challenges, and yet it has such a great deal to offer – we are certainly enjoying our involvement in these projects.

Helen Hughes
MSc Organizational Psychology Programme Director
on behalf of the Socio-Technical Centre,
University of Leeds

Unpaid psychology jobs – for and against

After reading Megan Down's letter 'We can't work for free' (June 2012) I was both saddened and deeply concerned about the potential effects of the campaign against unpaid internships. Having graduated in 2010 with a first class honours degree I have been in paid psychology-related work for only eight months since graduating, and know firsthand about the difficulties encountered with finding work in the field. In the past couple of years I have shadowed psychologists in a forensic ward for three months unpaid, worked as an honorary assistant psychologist in the NHS for eight months, and I am currently embarking on my fourth month as a research assistant intern in a psychological research centre. I acknowledge that I am very fortunate to be living at home with my parents, yet I have funded myself through the years by working part-time in retail, at the weekend in nightclubs, in temporary work as a receptionist and a wedding suit promoter, and have even started my own side company doing cooking demonstrations on occasional Sundays to earn extra money! There are definitely ways of self-funding internship positions, it just requires hard work.

Having experienced interning in this currently harsh economic climate, I have witnessed cuts of fully qualified staff in both public and private sectors in mental health and I am aware of limited funding in the research field. I very much doubt that there would be scope to fund graduates, and I am therefore concerned that many internship positions will cease to exist if these unpaid positions are opposed.

I think that the more prominent issue within this debate is that companies are not only looking for candidates with experience, they are looking for those with additional postgraduate degrees. I walked out from one of the top universities thinking that with my first class degree I would fall straight into a job, but the reality is that I am competing with those that have masters' and PhDs; I rarely even get to an interview stage. After recently talking with professors I have further been advised to undertake a master's, which will require, at the bare minimum, £7500 and another year without a full-time psychology job. Unpaid internships aside, this is what will really prevent those from disadvantaged backgrounds gaining access into the field.

Yes, it is terrible that I and others have been unpaid in psychological work, but these placements have been my lifeline. What is worse than an unpaid internship is working full-time in exactly the same job you did when you were 16, pre-degree, never knowing when you will get your big break into the field of psychology. Having been accepted into a fantastic research centre a few months ago (still unpaid), I am so grateful for the opportunity, and it has changed my life for the better. I would hate to think that this would be taken away from me and others that I work with, knowing that we are thankful for every day that we have somewhere to go to, and that we are finally on a step in a very long ladder towards our dream.
Jodie Walman
Bushey Heath, Herts

Voluntary assistantships offered to the masses could put many of us 'non trust fund kids' at a disadvantage, and therefore I propose an idea. Perhaps psychologists and researchers should offer part-time voluntary posts. They could 'employ' two graduates per post (e.g. half the week one graduate, and the other half another graduate). This would double up our opportunities, give us the experience we so desperately need and allow us to work part-time in any job of our choice thus keeping us financially afloat. This may be hard on the researchers and psychologists, but with the right types of candidates it could work out as a great teamwork experience. After all three heads are better than two!
Name and address supplied

In a healthcare system providing community services based on
a recovery model, equipping services users with skills to better manage living with mental health problems, it would be a devastation for the psychology profession to not practise what it preaches by supporting and encouraging its younger counterparts who are so eager to be equipped with new skills, engage in the learning process and be recognised for the progress they make.
Helen Beckwith
Tees, Esk & Wear Valleys NHS Trust

With reference to Megan Down's letter, I agree that advertising so many unpaid jobs is creating a problem and will continue to grow. It creates a non-representative sample of students who can apply for clinical training; the financially fortunate students will be the only ones with a shot of getting onto a clinical course.

However, it would be a shame if this debate discourages students from doing placement years as part of their degrees. I am a third-year psychology undergraduate finishing an unpaid placement year and have absolutely valued my experience. Placement years are different to unpaid jobs, not only does it feel part of your degree but not being paid means you have the flexibility to choose your experience (to a certain extent) at the same time as making a real contribution to the team. My days were negotiable, depending on what needed to be done and what I wanted to do. My supervisor encouraged me to go and seek out other opportunities. It has given me numerous learning prospects and experiences and I am very grateful for it. As a result, I haven't felt frustrated for not being paid this year, but I have also been in a fortunate situation where I could live at home with my parents with the security of financial bailout if ever needed. Not everybody has this safety net.

Although placement schemes are commendable, I don't think universities should charge students half fees for the privilege. We write our letters, attend interviews and fight for each place. You have very little contact from them, there's no teaching, and I haven't used the university facilities all year.

To be met with the seemingly impossible task of finding an assistant psychology post after university is degrading. Without
a student loan, I won't be able to spend another year of my life working for free whilst also supporting myself. This is all the free labour I'm able to give, not out of stubbornness or a lack of commitment to psychology but out of a sheer necessity to live. But unfortunately, despite the fact that I work hard and have spent a year in an NHS setting, my chances of being a psychologist are compromised by that fact that I can't work for free. It is not good for the future of UK psychology to condone free labour. Psychology is all about representative samples of people, and yet, this will not be the case.
Laura Coote
Placement student
Beacon House
Gloucestershire Royal Hospital

In response to Claire Thompson (Letters, July 2012) I think it is useful to highlight why it is not valid to compare the experience of today's graduates to those of yesteryear as an argument as to why graduates should 'put up' with unpaid posts.

My main issue with the above argument is in temporal validity. The economic climate is different and some unpaid experience from yesteryear may have been more likely to lead to paid employment. It would surely be naive not to consider that there are some employers who, in this climate, think it better to take advantage of the conveyer belt of desperate graduates who will work for free. To those who think graduates are entitled – I believe that most psychology graduates endeavour to get experience, however they simply cannot live on air. I have worked and volunteered for many years in as many positions that were even vaguely to do with psychology as possible. Believe me, I have grafted hard, and have finally secured a new job as a paid assistant psychologist. So you may say 'Your volunteering paid off, the system works' – let me inform you that I still live with my parents and have been receiving financial help ever since I left university, without which I have no idea how I would have afforded to volunteer. I know how lucky I am. My experience may be a case study, but I feel it underscores the difficulty graduates have in working for free without a comfortable background.

Without this, graduates are faced with obtaining paid employment alongside their honorary position. A weekend or evening job is difficult enough to get on its own when the employer takes one look at the degree written proudly on the CV and knows that the graduate will leave at the first chance. I was often advised to take it off! When recruitment is expensive, graduates are in no-man's land. Even if a graduate manages to get additional work, I question how easy it would be to survive today's living costs without further financial help, bearing in mind that honorary positions take up most of their time. That combined with new university fees and recent top-up fees that are tied around fresh graduates' necks, and the idea that you can compare like-for-like the experience of these graduates to the graduates of yesteryear is ludicrous.

Lastly there is the amount of competition. As an applicant during Labour's push for 50 per cent of school-leavers to go into higher education, I was told that university would help you obtain the career you wanted – this was in 2004, and the idea was still promoted. Then I left and my generation was told that to believe this idea made us 'entitled' as there aren't enough jobs. Excuse the young for believing what they were told.

So I implore anyone reading this page who believes that graduates should 'stop moaning' – please stop to think rather than jump on the proverbial bandwagon.
Catherine Lilley
Manchester

Defining learning disability

Jenny Webb and Simon Whitaker have provided a succinct and timely critique of the current definitions of intellectual disability as based upon IQ scores ('Defining learning disability', June 2012). In particular, they highlighted both the conceptual and practical limitations of defining intellectual disabilities in this manner, and their proposal to move towards a definition in part based on specific cognitive impairments and individual need is most welcome and one that should be supported by clinical psychologists working with this population.

However, their reference to intellectual disability as being 'bizarrely' included under the rubric of neurodevelopmental disorders in DSM-5 struck a rather odd note within the article, as this is surely an accurate overarching description of intellectual disabilities. Similarly, whilst Webb and Whitaker go on to quite rightly re-emphasise that intellectual disability is in part a social construction, they make no reference to the now incontestable fact that upwards of 75 per cent of cases of intellectual disability have a biological basis that is largely, but not exclusively, genetic. That these biological causes of intellectual disability are, with but a few obvious exceptions such as Down's syndrome, rarely considered when developing support and intervention for people with intellectual disabilities does not mean that aetiology is per se unimportant. On the contrary, it is now apparent that aetiology and the associated specific impairments in neurological functioning have, as Webb and Whitaker note, more prognostic value than IQ scores.

Therefore, the definition of intellectual disability could be further considered as involving two questions, the first regarding aetiology and identification and the second regarding individual need and support. As Webb and Whitaker demonstrate, neither of these questions can be adequately answered by the use of IQ testing. Given what is known about the aetiology of intellectual disability, the issue of identification of whether a person has intellectual disability could be in many cases already answered through the use of appropriate biomarkers, including genetic testing, whilst the assessment of what support a person thus identified will require could be done through appropriate cognitive, psychosocial, educational and occupational assessments, including those for risk. A re-conceptualisation of intellectual disability along these lines would, I contend, be both clinically and scientifically meaningful, thus satisfying both the demands of Webb and Whitaker, as well as those of the god Janus whom they invoke.

Given the evident limitations of the existing IQ-based concept of intellectual disability, this might be an appropriate moment for UK clinical psychologists working in this field to begin the admittedly difficult task of developing a more appropriate conceptualisation and definition of intellectual disability. Indeed, this might be issue on which the BPS could take a leading role.
Dr Dougal Julian Hare
University of Manchester

I read with great interest Webb and Whitaker's article, 'Defining learning disability'. Particularly striking was the main thrust of the piece, that the arbitrary application of standards based on fixed levels of IQ may deny some people appropriate support. While taking on board much of their argument, and noting that the authors are primarily concerned with those at the upper levels of IQ, I would like to enter a caution regarding their statement, quoting Sternberg (2001) that 'there is little evidence that it [IQ] can be used to predict performance in other areas of life'. In my own longitudinal study of a group of people with Down's syndrome, self-help skills (feeding washing, dressing and toileting) were significantly associated, at p = 0.0001 at every age from 11 years to 40 years and p = 0.01 at 45 and 47 years. So in this important area of life and with people at this level of disability IQ played a major role.

A rider to this must be that the test I used was neither the WISC nor WAIS, as discussed by Webb and Whitaker. I have not attempted either with my group, but did try using some part of the WPPSI when they were 21 years old and only five of the 44 were able to make a score on it. From age 21 onwards I have used the Leiter International Performance Scale, which is non-verbal and whose range makes it feasible for use with all but those with the most profound intellectual disability. With that proviso IQ can be seen to give good prediction of these people's ability to perform these essential self-care tasks.
Janet Carr PhD
Bookham, Surrey

We are two clinical psychologists working in social services,
in an integrated, multidisciplinary community team for people with learning disabilities. We also regularly receive referrals that request cognitive assessments, for parents in the same position as Sophie, the young lady described by Webb and Whitaker. We commend Webb and Whitaker for highlighting the issue of flawed eligibility criteria, for services for people with learning disabilities. We agree that learning disability is a social construct, in keeping with many of the presenting issues that clients who work with clinical psychologists present with, such as depression, schizophrenia and personality disorder.

However, we feel that a viable alternative to the current system has not been presented, in that clinical judgement, and societal norms cannot provide a platform for evidence-based practice. The definition of learning disability suggested in the article seems over-inclusive, as any of us may reach a stage in our lives when we are in need of additional support due to 'a failure to cope with the intellectual demands of our environment and are suffering significant distress'. Furthermore, the inability to take care of oneself/dependants, or to protect oneself/dependants from harm or exploitation may be a direct result of an individual's social circumstances, rather than having any correlation with learning disability. Examples would include victims of domestic violence, self- neglect due to drug or alcohol abuse, or deliberate self-harm due to mental health problems.

Webb and Whitaker provide an 'either-or' construction as an alternative to the current definition of learning disability, whereas we would argue that assessment of need, in order to allocate admittedly scarce resources, must be based on both intellectual capacity and social support.

Webb and Whitaker appear to make the assumption that a diagnosis of learning disability brings benefits to an individual that outweigh the costs of this label. We would question this assumption, as societal norms still include negative attitudes towards people with various types of disability. Many of our clients experience abuse, neglect,
hate crime, stigma and social exclusion.

In addition, the example used by Webb and Whitaker of a young woman becoming pregnant and requiring specialist support, overlooks the fact that such parenting support could be provided by child and family services, regardless of whether or not the young woman had a learning disability. BPS (2000) guidance, cautions against sharing information in a way that could potentially 'restrict or exclude people from the most appropriate services available'.

Webb and Whitaker question the utility of intelligence testing in parenting cases. Good practice guidance in this area has been provided by the BPS (Baum et al., 2011) and notes that people with an IQ below 60 have generally been found to be more unlikely to be able to provide adequate and safe parenting. However, in our experience, most referrals of this nature result in an outcome that places people on the borderline of having and not having a learning disability (IQ between 65 and 80). The guidance further asserts: 'Perhaps one of the most critical factors in supporting parents with learning disabilities in being "good enough" parents is what support is available to them on a long-term basis' (p.24). This social support could come from an individual's informal circle as well as children's services.

Therefore to adhere to best practice and an ethical approach, learning disability services could potentially advise about how to make information accessible and memorable for Sophie. This guidance could be contained in the assessment report, in terms of recommendations by the clinical psychologist and/or speech and language therapist, for the referrer. The learning disability services could also potentially provide advice to other service providers in order to maximise the effectiveness of the help they provide. However to diagnose learning disability based on need only may result in the support provided not being the best type of support available to meet that individual's needs.

We believe that although the IQ is not a perfect tool to measure intellectual abilities, used in conjunction with clinical judgement it does provide a useful set of boundaries to guide the appropriate direction of scarce resources.
Liz Marlow
Vicky Lauté
Merton Team for People with Learning Disabilities
Morden

References
Baum, S., Gray, G. & Stevens, S. (2011). Good practice guidance for clinical psychologists when assessing parents with learning disabilities.Leicester: British Psychological Society.
British Psychological Society (2000). Learning disability: Definitions and contexts. Leicester: Author.
 

For full version, please see PDF version. This includes: 'Copenhagen – not so wonderful'; 'Ignorant about religion'; 'Daryl Madeleine Foot (1946–2012)'; 'Can anybody be a BME therapist?'; and Professor Jane Ogden's first 'Forum' column, 'Health matters'