Letters, December 2011

The most important problems

The Brain Mind Forum (BMF) is an offshoot of the Real Time Club (RTC), which was founded in 1967 by people interested in the then nascent science of computing, in order to hold controversial and iconoclastic debates; it is the oldest computing club in the country. The BMF aims to take this iconoclasm into the fields of neuroscientific and artificial intelligence research. BMF founder, Charles Ross, suggested that members of the RTC should try to do for the brain what David Hilbert achieved in 1900 with his famous list of the 23 most important problems in mathematics. This list is widely thought to have led directly to the development of computing. The BMF hopes that accurately specifying the most important problems to be solved in neuroscience may achieve similar success.

Many neuroscientists are worried about the increasing dominance of reductionism; scientists picking off the relatively easy tasks of working out how little bits of the brain work molecularly and hoping that knowing about these nuts and bolts will eventually tell us how this complex system works as a whole. However, there are no complex systems whose emergent properties can be deduced from their molecular structure alone. Even in physics the flow of explanation is usually in the other direction; theoreticians develop models of the system and use these to predict the properties of individual elements.

But such systems thinkers are becoming increasingly rare in neuroscience. Geneticists, molecular biologists, biophysicists, synaptologists pursue their own specialist areas and seldom have the time or skills to stop to think how all these things work together. So the BMF's version of Hilbert's questions for neuroscience are aimed to get them to think about why they're doing what they're doing, and to have the courage to ask questions that are currently almost forbidden, like what is consciousness, and what's the relationship between mind and brain.

We have published on the BMF website (www.brainmindforum.org/21questions.html) 21 short questions, together with a longer version in which they are broken down into more detail. Our idea is to make this an iterative process. Readers will say what they think is missing and how the list should be changed. The process will only end when there is a broad measure of agreement on the questions.

Remembering the commercial origins of the RTC and BMF, together with the mess that recent bad financial and political decisions have landed the world in, we think that currently the most urgent question that needs answering is how people make decisions. Unless we can understand this, how on earth are we going to solve the awful problems that face us like debt, increased population and climate change? Our minds are the only things that are going to get us out of all the holes we've landed ourselves in. I'm particularly interested in the 'hubris syndrome', when people in power tend to make silly decisions because they feel, often against all the evidence, that they have superior powers of prediction. There's a lot of literature on decision making, but not in relation to the kinds of decisions that hubristic leaders make.

I'm often asked, 'Why bother with these questions? There's a huge amount of neuroscience research going on. Let them get on with it.' Einstein once made the remark that if he had only an hour left to live and one question to answer, he'd spend 55 minutes deciding what the question should be, and only five minutes answering it. There's an awful lot about the brain that we don't really understand. Specifying precisely what this is should help people to begin to answer the questions and set the right priorities.

John Stein

Department of Physiology, Anatomy and Genetics

University of Oxford

Pitching tents and drawing swords

Science and Art: polar opposites? Or is this unproductive and unnecessary tension between scientific practice and the arts a result of the same supercilious academics and pretentious conventions that would not accept the world was round? But where does psychology lie within these two categories? Is psychology a science?

Psychology is such a compelling subject, one that has made many significant advances in understanding the most complex phenomena in existence: ourselves. I believe psychology demonstrates how scientific and non-scientific approaches can complement each other and provide an in-depth and diverse explanation of psychological causality: which is wonderfully subjective.

But despite this, many psychologists still strive to classify psychology as a hard science. Should we not celebrate what psychology is as a subject: a reflection of the complexity of the way we operate as humans; there is no black or white, more a spectrum of explanations that intrigue and provide insight. We should embrace our subjective nature, debatable paradigms, our multiple approaches and the exciting new discoveries and explanations that arise from them.

The complexity of our world cannot always be explained by an axiomatic cause-and-effect chain and should be explored by a variety of theories: this is what psychology provides. Does it not make more cognitive sense, especially when evaluating the research into psychological phenomena, that both scientific and social theories have significance? More often than not, contrasting psychological theories do not contradict each other but exist in harmony. And yet they are always presented as enemies, in conflict: psychologists identify with a specific field of psychology, pitch their tents and draw their swords.

Psychology should be proud to be what it is: not wholly scientific, not wholly artistic but definitely revolutionary.

Helena Jarman

Peterborough

NHS not the only way

Jim Orford (Letters, October 2011) asks the Society to take a stance against 'privatisation by stealth' in the NHS. He is mistaken however in equating the principle of universal health care, free at the point of delivery, with the large monopolistic bureaucracy known as the NHS. This is only one means by which free universal health care might be provided. It matters not who provides the care, only that it is universally available, of sufficient quality and free at the point of delivery. (We all pay for it anyway, through taxes and National Insurance.)

There are many instances where private or non-NHS providers might be of higher quality and/or lower cost than the NHS. There are also many instances of the NHS failing to provide sufficient resources in 'unpopular' fields such as podiatry, psychology and physiotherapy, to name but a few. Large bureaucracies are seldom efficient disbursers of resources, and are often slow to respond to changing circumstances. They are prone to government by excessive rule-making, complex procedures and excessive committee work.

There would seem to be a good case for contracting out certain services, as is already policy in many healthcare fields. There is no reason for psychological services to be made an exception.

As a psychologist who has worked both in the public sector and sold my services on the open market, I would oppose any move by the Society to take the stance that Jim Orford demands.

Jonathan Pincus

London NW10

Psychology magazines in France

After living in France for six years I had become rather used to the rows of psychology-related magazines in our local Tabac. I had been unaware that this was not the case in the UK until reading Lucy Maddox's article in The Psychologist (Media, November 2011).

Chatting to French friends here and to other professionals it seems no surprise that this genre has taken off in France. There seem to be a number of reasons. Firstly, historically, there is a great importance placed on 'psycho-analysis' in France. The French public like to understand any subject up for discussion from a psychological and philosophical viewpoint. Very few important news articles would be broadcast without offering the opinion of a psychotherapist or philosopher. The general view is that people are 'curious' and want to understand the behaviour of themselves and others. Professionals from these fields are held in high regard.

Secondly, despite this emphasis, psychological therapy in France is not reimbursable through the national healthcare system. Most people needing therapy, whether this is psychoanalysis or CBT, must seek a private practitioner. There are few 'counselling' type services either – in fact the term counselling is not understand in the context of therapy. There are some exceptions of course, and psychologists do work in teams, but this is mostly in clinical services, for example palliative care and drug addiction.

If individuals are depressed or anxious and consult their GPs they will most likely be prescribed psychotropic medication. If this isn't enough they will be referred to a psychiatrist, who often practises psychotherapy. For most people this is seen as an 'extreme' route and unfortunately carries a certain stigma.

A clinical psychologist in a local hospital told me that 'French people like to keep their therapy a private matter; they are willing to pay for this as they consider it a personal choice'. But what of those who cannot afford this luxury? Perhaps one answer to the question as to why these magazines are so popular is that, due to the lack of access to psychological services, the French are seeking self-help solutions to their problems

To my surprise when I asked a French psychiatrist what she thought about these magazines (I anticipated she would brush them off as pop psychology), she said she thought they were very good. Browsing some of the seven November editions of psychology magazines in our local village shop the articles seemed, for the most part, to be of good quality. However, I couldn't help but think what a useful marketing ploy it must be for the skincare company, whose advert featured on the page across from the 'Petits Rituels de Demaquillage' (Little rituals of make-up removal). Oh cynical me!

Christine Haworth-Staines

Aux-Aussat, Gers

France

Interpreting our developing history

We cannot yet know what events in 2011 will prove to have been significant in the history of psychology. However, some of the issues raised by Derek Mowbray and Bernard Kat (Letters, November 2011) relate to ongoing trends that historians could illuminate.

Historians of British psychology, including myself, have tended to concentrate on the earlier years of the subject or the biographies of individual psychologists. These are perhaps relatively tractable topics, using well-defined archival material. Specialist historians could do more to investigate the contemporary history of psychology. This requires techniques to synthesise and interpret from the plethora of information generated by a community of tens of thousands, rather than tens or hundreds.

Firstly, in relation to scientific discoveries and professional innovation, historians need to disentangle the plethora of publications, conference papers and online material to identify major trends. These include not just intellectual discoveries but also technical developments, such as advances in IT support, changing methods of data analysis, the use of neuropsychological techniques and genetic analysis.

Secondly, historians need to investigate the organisational growth of psychology in universities and schools. Shifts in the delivery of professional services from the public sector to private business, and from large organisations to small consultancies, need to be interpreted. Mowbray and Kat describe issues arising from the privatisation of clinical psychology that might be more effectively addressed if earlier developments in other subdisciplines, notably occupational psychology, were better understood. Relationships with government, for instance in relation to statutory registration, are an especially important issue in the organisational history of psychology. Not least, there is a need to analyse the implications of a long-term shift in government oversight of psychology from departments such as Defence and the Cabinet Office (in relation to the Civil Service Selection Board) to the designation of a service department, Health, as the lead.

Thirdly, we need to address the recent social history of psychology. Mowbray and Kat refer to issues concerning the prestige of psychology and its identification as a separate profession. But there is a conflicting trend, raising needs that Mowbray and Kat perhaps fail to appreciate, to diffuse psychology within the community, not least through the large number of psychology graduates who have perforce to find, hopefully relevant, employment outside the profession.

The contemporary history of psychology should not be divorced from other areas of the history of science or indeed history generally. Not least, it is important to evaluate fairly the boundaries between psychology, emergent disciplines such as neuroscience and competing professions such as personnel management.

Better understanding of the recent history of psychology would highlight important issues. In particular, my impression is that there have been too few developments in the scope of academic syllabi and in the identification of areas for professional activity. Mowbray and Kat comment that things have moved on. I have an uncomfortable feeling that historians will tell us psychology needs to catch up with other sciences and professions.

Frederic Stansfield

Canterbury

Context of therapy

We are grateful to Miles Thompson for raising some important issues about the HPC's standards of proficiency for the various practitioner psychologist professions (Letters, October 2011). Although Miles was at pains to make clear that his letter was not only about health psychology, members of the Division of Health Psychology, Division of Health Psychology Training Committee and the Health Psychology Qualifications Board all agree that it is very important that the competencies described in the HPC's standards of proficiency match up with the competencies that are provided by training.

Part of the difficulty here, we think, may be due to the word 'therapy' having many potential meanings. Therapy, in its broadest sense, is a term that can be applied to any form of treatment for any illness or disorder. To illustrate, antacid is a form of therapy for heartburn, rehabilitation is a form of therapy for addiction, and exercise is a form of therapy for obesity. However, among applied psychologists the term has probably been most often understood as an intervention provided one to one or in groups to a client or clients in a clinical or hospital setting. While some health psychologists are indeed involved in such work (for example, helping clients with symptom management in long-term physical health conditions) other health psychologists may interpret 'implement psychological therapy or other interventions' (see p. 23, Standards of Proficiency – Practitioner Psychologists, HPC) in different ways. That is to say, the issue is not about the level (as Miles suggests) but about the context in which we operate. For example, a health psychologist may undertake a range of therapeutic interventions in order to improve or safeguard health at an individual, community or population level.

Furthermore, Miles suggests that the advanced qualification in health psychology syllabus does not include therapeutic work as a compulsory unit. However, the recent revision to the Stage 2 health psychology syllabus resulted in the inclusion of health psychology interventions as a mandatory competence and in so doing recognised the different therapeutic techniques that health psychologists may use. So, in conclusion, our view is clear – the issue is about the interpretation of the terms therapy and therapeutic without reference to the context within which health psychologists are trained to practise.

Neil S. Coulson

On behalf of the Division of Health Psychology, Division of Health Psychology Training Committee and the Health Psychology Qualifications Board

Our 'crazy cousin'

During his clinical hypnosis workshop in Nottingham, American psychologist Michael Yapko asked us 'Why is hypnosis still the crazy cousin that nobody wants to invite to the party?' Nobody had an answer. All I could say was that hypnosis, here defined as systematic attention training, had not formed part of my original clinical psychology training. It is a shame, because hypnosis has contributed much to our understandings of neuroscience, therapeutic intervention, psychophysiology, placebo effects, and various other factors affecting treatment response.

Clinical hypnosis, the application of hypnosis as clinical tool, can be used for symptom reduction (e.g. pain) or as an adjunct to other forms of psychotherapy (e.g. CBT). The terms clinical hypnosis and hypnotherapy are often used interchangeably, although the latter term seems to be preferred in the UK.

In 2001, the British Psychological Society recognised 'Hypnosis [as] a valid subject for scientific study and research and a proven therapeutic medium'. However, we do not have a section of 'psychological hypnosis' like the American Psychological Association (Division 30). Despite empirical evidence that hypnosis enhances treatment outcome, for example in depression (see Alladin & Alibhai, 2007), hypnosis has not made its way into mainstream psychology.

When training in clinical hypnosis, I found myself predominantly amongst complementary healthcare professionals. Unsurprisingly, my view that hypnotherapists should have a core professional training (e.g. nursing, medicine, psychology) was not well received. But hypnosis can cause very serious harm when used inappropriately (e.g. inducing false memories of sexual abuse).

Many complementary healthcare professionals have limited experience in psychotherapy or knowledge of memory research. Memory is only superficially covered in the Hypnotherapy Diploma. Also, hypnosis remains unregulated, although the National Council for Hypnotherapy is now trying to improve the quality and practice of hypnotherapy training in the UK. Having encountered the aftermath of 'false memory syndrome', I believe it is high time things changed. A client, who had privately sought hypnotherapy for blushing, had undergone age regression (a process where the person had been returned to an earlier stage of life in order to retrieve memories). The discovered memory of sexual abuse caused distress and family fall-out. Additionally, the client had been traumatised by the hypnotherapy experience. Could this be prevented if hypnosis became integrated in clinical psychology training programmes and was delivered by more qualified professionals in the NHS?

Peter Naish, President-elect of the Hypnosis and Psychosomatic Medicine Section of the Royal Society of Medicine, argues (see tinyurl.com/cu2woee) that hypnosis should become a standard part of the NHS toolbox (NICE recognises hypnosis as a possible intervention for IBS). If it became integrated in our practice, the public would not only be protected but also become better informed about hypnosis. But is it just the public, who needs better information, I wonder? Thanks to stage hypnosis, myths surrounding hypnosis linger on (e.g. people lose control in hypnosis and can be made to say or do what the hypnotherapist wants; people may not come out of hypnosis). Interestingly, I have not heard the same myths about mindfulness, although it uses guided meditations that are structurally identical to hypnosis sessions (see Yapko, 2011). Is it, therefore, time we invited the crazy cousin to our party?

Susanne Vosmer

Biggleswade, Bedfordshire

References

Alladin, A. & Alibhai, A. (2007). Cognitive hypnotherapy for depression. International Journal of Clinical and Experimental Hypnosis, 55, 147–166.

Yapko, M. (2011). Mindfulness and hypnosis. New York: Norton.

Forum: beyond boundaries

Jonathan Shedler is recounting an anecdote. 'So when the patient says "I'm frustrated", you say "Tell me more about that" and then you shut up!' We've just bustled in from a crisp Manhattan evening and the story gets an appreciative laugh. City University of New York is home to one of the most psychodynamically oriented clinical psychology courses in the US, and Shedler is here to fire up the audience. He's presenting his research on the effectiveness of psychodynamic therapy, but the underlying message heralds a fight back. His data is mixed with tales of naive cognitive therapy trainees and disdain for 'manualised CBT' (there is, it seems, no other sort) and the audience are firmly behind him.

New York City was famous for its Freudian émigrés and became a leading centre for psychoanalysis during the 20th century, but the rising influence of drug treatment began to erode both the popularity of the couch and the therapeutic eminence of the Big Apple. Shorter therapies, validated using the techniques of academic research, have pressured both psychodynamic therapy, the younger relation of psychoanalysis, and its community of practice, who traditionally eschewed the systematic collection of data for the introspective gaze.

Psychoanalysis never gripped the UK's psychology and psychiatry departments as it did in the US, and so the division between clinicians and researchers has traditionally been much less acute. In the New York lecture hall, this divide is reflected in the post-presentation discussion, driven by the split rhetoric of 'practitioners' and 'researchers' and how the latter don't understand the former, despite the fact that we're here to discuss research evidence. But most striking is the sense of revolt against the perceived oppression towards the psychodynamic approach, which, in the US, is additionally fuelled by the insurance companies desire for the most evidence-based bang for their buck.

The audience speak out. Person after person stands up, vociferously thanking the speaker, decrying the lack of respect afforded to psychodynamic treatment and promising to spread the word about this new evidence to colleagues, managers and patients. But beyond the fight back, there is a distinct culture change in the air. In an area famously divided by internecine feuding and bitter theoretical differences there is unity. And perhaps more significantly, the tools of clinical trials, systematic data collection and evidence-based practice are now being taken up as essential allies. New York City may yet be home to psychodynamic revolutionaries once more.

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

Forum: Psychology at work

In these economically uncertain times, we need talented workers more than ever. Yet a recent global survey of CEOs by PricewaterhouseCoopers identified a key challenge to business as 'limited supply of candidates with the right skills'. How can psychology help to put the right individuals in the driving seat and ensure they are performing to the best of their ability?

Research indicates that organisational effectiveness is enhanced by identifying and managing top performance. Companies that implement formal and systematic systems for identifying and managing top performance outperform others by more than 50 per cent regarding financial outcomes and more than 40 per cent with respect to outcomes such as customer satisfaction. Yet, appraising performance, a process at the heart of effective performance management and enjoying great popularity with organisations, is a job managers love to hate. Indeed, a CIPD survey found that 75 per cent of managers view it as a waste of time.

So what impact can psychology have in shaping this agenda, and could we be doing more? The first step is to identify excellent performance: only then can we measure and manage it. Occupational and organisational psychology research in this area has a long tradition, but it is now time to move research and practice forward. For example, research by Saville Consulting suggests that performance at work can be captured through a hierarchical framework with an overall effectiveness factor at the top. Performance can be assessed by the use of innovative online tools to enable a review at the individual, team and organisational level, with multiple stakeholder perspectives.

Psychology, as a discipline, must link academic research to practical organisational needs. For example, current doctoral research at the University of Surrey by Céline Rojon, supervised by Dr Almuth McDowall and Professor Mark Saunders, aims to untangle the performance construct by answering questions such as 'are there factors underlying performance that are important and common to most or all jobs?' and 'if there is a set of underlying performance factors common to most or all jobs: how can we measure these best in the workplace?'. Céline has developed a generic hierarchical model of individual workplace performance that is based on interview research, the results of a systematic literature review and a meta-analysis. She is now looking for organisations to support her research by using her performance measure with their workforce: contact her on [email protected].

Psychology is providing evidence based information on what makes for success in roles, how to compare, how best to identify and how to develop and manage talent. We have objective and growing databanks that enable organisations to identify success factors, to accurately predict performance and to focus scarce resources in the most effective way; thus growing talent and driving business success. But we can do more. We must focus on good science and excellent data, so that psychology can illuminate the road ahead and encourage a brighter future.

Obituary: Leonard Patrick Curran (1946–2011)

Len Curran was an extraordinary man. Born in Belfast and educated at St Mary's Christian Brothers School and Queen's University Belfast he moved to England as a young psychology graduate and worked in a number of prisons and in Prison Service Headquarters for most of his career. He was a wonderful, sensitive and completely non-judgemental counsellor, which stood him in good stead not only for the prisoners whom he helped and supported o