Letters, May 2013

He's just not that into you 

I'm moving on from a low period of my life. During that time I was a bit of an emotional self-harmer. Secretly scratching at hurtful memories instead of vocalising my feelings. Recently I've been talking to people who scarred me in the hope of healing those wounds. They're ex-boyfriends, a few old friends. All but one.

Someone suggested I write an open letter to Clinical Psychology. Crazy idea. But is it? Since graduating from university in 2008 I've tried and tried to engage in a relationship with Clinical. I chose it because I love working with people, am very interested in mental health, but also because my education gave me no advice on another route. That wild crush on Environmental Psychology? I had no idea even how to organise a date. 

Yeah, yeah, I know you're desirable, Clinical. I know you've got too many hopefuls waiting outside. That's not your fault. You're interesting with at least £25,000 a year to train. Who wouldn't want to chase you? You must be used to hearing from bitter exes. 

But realistically I think you've got to start taking some responsibility for the graduates, desperate to break in, unable to think of a way to gain experience except grindingly hard support work. Turning away from people working to catch your eye in these conditions, is as bad as if you sign the floating support worker contract yourself. 

I made excuses for you. I told my family, 'I'm fine, this is just what I have to do to get in.' I said to myself that years of you blowing hot and cold were worth it in order to build a lifelong partnership. 

I was overjoyed to get jobs, not the elusive five assistant posts advertised per year, but mental health support roles. Sometimes I thought I was getting somewhere. Sometimes on days off I would cry all day.

The psychology teams I've known did not engage with the support workers. I didn't have supervision for two years. On my first day in a PICU, I ended up trying to persuade the psychotic patient I was alone with, not to burn down the unit. Stamping out flames whilst cajoling the lighter from her hand.

She told me merrily that my alarm wouldn't work outside. It was half an hour before someone found us, and I never got a debrief. Another hospital had inexperienced support workers holding the hands of suicidal children for 12-hour shifts. We ate with them, went into the toilet and shower together, watched them sleep. One day a nurse told me to my face that I shouldn't expect a break.

That quietly became the norm. You took advantage of psychology graduates. Purposely employing us as you knew you would get ambitiously hard working, thoughtful staff. Yes, but every single one of us was crushed. We were in an abusive relationship. 

I assume that my experience isn't that of everyone. I was swooning reading Matt Butterworth's recent article in this magazine, in which he said he was training his HCAs in case formulation, over and above the case discussions and group supervision sessions on offer. Forgetting that I'd sworn off support work I wanted to turn up at his door. My compulsion to be noticed by Clinical Psychology is so engrained. Love me! 

Ahem. Moving on. I'm dumping you. I can't take the pain of the door hitting me in the face every day. I still want to work with people, research mental illness, and be in a caring role. So I applied to graduate medicine. I start this September. It was interesting, the difference at interviews.

At a pre interview (pre interview!) for one clinical course the candidates were edgy and tired. Their personalities formed from years of clawing at this opportunity. Chatting to some girls, I was appalled to hear them discuss how they would not give their friends tips, because they didn't want to throw away their advantages. At the graduate medicine interview I made instant friends. I went home and threw away the clinical interview letters I'd been flirting with. Enough. 

Part of me will always think of you. I can't help it. I am a psychologist, who will also be a doctor. And I know how I feel is not really your fault. I can't make someone love me, especially with so many contenders for your hand, but I suppose I just wanted to be treated with a little more care.

Frances Harkness
London E4 

Greening of psychology 

Dr Ian Walker (Forum: Going green, March 2013) talks about forming desirable habits around environmental issues. He asks if this is not a desirable goal for applied psychologists to aim for? The Division of Occupational Psychology's Going Green Working Group couldn't agree more. 

The working group was founded a few years ago to encourage change in attitudes and behaviours around environmental issues in the workplace, by bringing together academics and practitioners to better understand how to achieve this. Recognising that others may be better placed to source relevant theory and techniques, the group is open to all psychological disciplines and relevant professions. It holds regular seminars, the occasional conference, and even sponsors an MSc prize. For more information, visit the Division of Occupational Psychology webpage.

Gene Johnson
Division of Occupational Psychology Committee

Wot! A discussion on 'habit' (Forum: Going green, March 2013) and no mention of William James?

His view on habits could be paraphrased as 'if you really want to be sure of doing something, then you have to make it a habit' and in Chapter 4 of his Principles of Psychology (1890) he gives a lucid analysis of the formation of habits, and three maxims for developing habits.

These are broadly about constructing an appropriate supportive environment of antecedents and setting events, avoiding situations where lapses may occur, and using all opportunities to practise the behaviour (continuous reinforcement).

As for whether giving people information can change automatic habitual behaviour, perhaps not if one means consciously evaluated information; but information presented as antecedents and setting events (which must be processed somewhere, perhaps mostly without consciousness) may well have an effect on behaviour.

Pasco Ray
Strathdon, Aberdeenshire

I read with great interest Ian Walker's 'Green shoots' Forum piece, as encouraging pro-environmental behaviour through the formation of desirable habits is something I wholeheartedly agree with. Only recently Prince Charles publicly spoke of his concerns about the environmental legacy that will be passed on to future generations, calling for more long-term thinking regarding the damage being done. But thinking may not be what is required.

An emotional response to the environment and the value placed upon nature could be far more useful in increasing environmentally sustainable behaviours through the protection of what people care about. The challenge from a psychological perspective is to help society care for and engage more with nature and is something that nature connectedness may be able to achieve.

Nature connectedness includes the cognitive, personality, affective and learnt factors of a connection to nature (Zelenski & Nisbert, 2012) and receives a great deal of research interest as behaviour change is not brought about by knowledge alone. An increased connectedness to nature can also lead to the development of an environmental identity and greater natural place attachment.

This in turn encourages more pro-environmental behaviour as a desire to protect the natural world emerges as people identify with and place a high value on the natural environment leading to a greater protection of nature (Scannell & Gifford, 2010). Increasing this connection to nature then is an area that has the potential to encourage pro-environmental behaviour throughout society and is an area with real applied potential.

As a result, I have recently begun a PhD project at the University of Derby exploring the factors involved in increasing nature connectedness. The aim is to ascertain what factors are involved and incorporate them into interventions that make use of the local landscape. This will hopefully increase a connectedness to nature with the interventions targeted at specific populations to produce, in the long run desirable, pro-environmental habits.

Ryan Lumber
Psychology GTA, University of Derby

References

Scannell, L. & Gifford, R. (2010). The relations between natural and civic place attachment and pro-environmental behaviour. Journal of Environmental Psychology, 30, 289–297.
Zelenski, J.M. & Nisbet, E.K. (2012). Happiness and feeling connected: The distinct role of nature relatedness. Environment and Behaviour. Advance online publication.

Humour and The Psychologist – dying for laughs 

Simultaneously holding constructs of The Psychologist and humour would leave Leon Festinger with his work cut out, but April's issue resolved the conflict rather well. 

Larry Stern's article on the Worm-Runner's Digest ('Looking back', April 2013) reminded me of that journal's motivational value to 1960s undergraduates. ('When I have finished reading about Hubel and Wiesel's latest poking about of some unfortunate creature's cortex, I can have ten minutes with the denizens of the Digest.')

Stern does not mention that some of its most prescient articles were about behavioural therapy. I particularly remember an article on the treatment of death. It has long been known that mortal behaviour attracts a great deal of attention. If this were withdrawn, and replaced by the reinforcement of vital behaviour…

On second thoughts, I should not want the Improving Access to Psychological Therapies programme to hear about this.

David Hart
Chesterfield

It was refreshing to read the edition on humour (April 2013), which reminded me of a true story.

Ken Dodd was once asked, in an interview on what he thought constituted humour, if he had ever read Sigmund Freud's book on the subject. He replied that Freud had never had to play the boards of the Glasgow Empire Theatre on a wet Saturday night after Rangers had just lost a home game against Heart of Midlothian.

Allan Dodds
Bramcote, Nottingham

The special issue on the psychology of humour (April 2013) had missing the humour which psychology itself can invoke (and provoke). I do so regret the demise of the 'Lighter side' format in The Psychologist, sometimes with accompanying cartoon. Apart from the amusement value, it gave the chance for non-academic psychologist like myself (but now long retired) to put forward offerings for possible publication.

I was proudly successful on a couple of occasions with 'The assessment of incompetence' (March 1998) a take- off of test design, content and procedure, and 'Proverbs' (October 1998). Would it not be in keeping with the repeated April message that humour is a very good thing indeed for The Psychologist to resurrect the 'Lighter side'? 

The special issue included articles about the Ig Nobel awards and the Worm Runner's Digest. I was disappointed that there was no reference to the Journal of Polymorphous Perversity, founded in 1984 by American psychologist Glenn C. Ellenbogen, with its spoof articles on psychology and psychiatry. I believe the journal continued into the early 1990s. Several books of the readings from the journal were published and I am the happy owner of one of these books, 

The Primal Whisper. It provides endless amusement at the expense of our discipline, with articles such as 'Animal movement on Rorschach cards: an empirical analysis of a deservedly neglected topic' (by B. Sorkin and T. Freylerp), 'On academic speech: Quick and easy guidelines to the disguise of ignorance' (J. Haskell), and 'The laws psychology (L. Calhoun, A.Cann and W. Terry), (e.g. 'Never give a rabbit to a child named Albert', 'Adults get older faster than children, and adults with children get older the fastest', 'You are more likely to remember something if you don't forgive it'). 

And, my favourite, 'Psychological evaluation of the dead' (J. Goldman). I have to admit that, in comparison, my 'Incompetence' write-up pales into insignificance. It is a truly comic take on a grave topic. The author clearly encountered no resistance whatsoever to a thorough direction of the subjects' intellectual, educational and emotional functioning. It is very much so laughter in the face of death and a rebuttal to the old proverb 'dead men tell no tales'. Far from being a dead-loss of an article, it should really liven you up. 

Michael Davis
Liverpool

Editor's note: Talking of death, old formats in The Psychologist never truly pass on, they just lie dormant. As I said in my editorial last month, the problem is that 

it seems to be rather difficult to be genuinely funny about psychology in print. But I would be more than happy to be proved wrong, and one of the aims of the special issue was to encourage more.

Retirement

I would like to add my own perspective to the recent correspondence about psychologists in retirement (Letters, February and March 3013). When I retired it was after a career based mainly in primary care which has turned out to be very relevant in retirement. I spent many hours helping my mother at her home before visiting her in a care home for those with dementia. For the organisation I then volunteered as an independent visitor making reports about their different homes.

I have been a school governor advising with responsibility for sex education and child protection. I have lost count of the number of times neighbours, friends and other people in my community have asked for advise for themselves or family members knowing that I understand confidentiality and have professional knowledge and experience from which they might benefit.

Of course I too have benefited from all this as it has helped me cope with the bereavement of loosing the time spent doing a job I loved.

Janie Penn-Barwell
Blisland, Bodmin

IAPT – a trainee PWP's perspective 

I would like to respond to a letter (April 2013) sent by a service user who had received therapy through the Improving Access to Psychological Therapies (IAPT) service and gave a somewhat uncomplimentary review, which was a difficult pill to swallow given that I am currently a trainee Psychological Wellbeing Practitioner. 

I must admit that whilst reading, I was taken aback but then I felt increasingly saddened that this was a true perspective and experience of somebody who had taken the courage to seek help for their difficulties, had expected recovery but instead encountered what appeared to be incompetence and dissatisfaction. 

Client feedback is extremely valuable and is something that informs my practice. However, I would like to address a few points which were mentioned and give a perspective from the other side of the therapeutic coin. 

Firstly, I think that the majority of people's views of psychology are formed by the media's portrayal of psychologists. The reality of Low-Intensity (LI) therapy is that instead of lying on a couch and offloading to a burly Freud lookalike, there's me: a 27-year-old female trainee. 

But I am not a 'two-bit counsellor' who makes wild claims about therapy and lacks experience and qualifications, as stated in the letter. All trainees have past experience of working with people with mental health problems, all are above graduate level, are trained one day per week with four days supervised practice. We do not work in isolation from our colleagues, we receive supervision; meaning that all work with clients is approved and reviewed. We never administer interventions that have not been evidenced to be effective. 

I guide clients to use CBT-based workbooks that have been written and devised by reputable clinical psychologists and therapists. The workbooks are the therapy. I guide clients through them and work collaboratively, using my expertise and the clients' expertise to foster self-efficacy and recovery. And it works. Is this not wonderful? 

No one should be under the impression that LI CBT is a cure for all. We do not force people to receive therapy; it is based on the stepped-care model, which requires people to have the most effective but least intrusive therapy first. If recovery does not occur then they are 'stepped up' for further and more involved therapy. I deem this to be a win-win situation for clients. 

I noted cynicism from the writer about sessions held over the telephone. We are breaking boundaries and changing people's perspectives about psychotherapy. There is research evidence that telephone working is just as clinically effective as face-to-face working (Hammond et al., 2012). Many clients have remarked at its convenience and benefit. I see this as an incredible feature and testimony to the adaptability of LI working.

I have learnt that clarity, transparency and clear setting of expectancy with clients are needed. The IAPT service is still developing and there are imperfections. But it is a free service with great intentions and results. When a client sits in front of me, it becomes the most important 30–45 minutes of my life where every ounce of my being is invested into helping them.

Christabel Anomelechi
Croydon

Reference

Hammond, G.C., Croudace, T.J., Radhakrishnan, M. et al. (2012). Comparative effectiveness of cognitive therapies delivered face-to-face or over the telephone: An observational study using propensity methods. PLoS ONE, 7(9): e42916.

The psychology of rape in India 

Sindy Banga (Letters, March 2013) has done a service by drawing psychologists' attention to the horrific Delhi gang rape. However, she selectively quotes some statements briefly or out of context, in her discourse analysis (see Bhalla, 2013 for an Indian analysis of the case and Wikipedia for a disturbing chronology of events).

The alleged worst offender of the six men (alcohol was involved) – a teenager, ripped out the intestines of the victim and apparently would have to be released in June when he is 18 years. The negative effects of media and Bollywood portrayal of women as sex objects has also been implicated as contributory factors.

Rape is a terrible crime against womankind – the only person responsible for a rape is the rapist – but I fear political correctness prevents frank discussion. To understand 'rape myths' which have universal currency (even amongst some women) requires an understanding of the psychology of rapists (for a typology that distinguishes date rape and stranger rape, see Taylor & Alladin, 1994) and controversially, evolutionary psychology (Thornhill & Palmer, 2000) can explain why women have been discouraged from 'displaying their attractiveness' to men in traditional societies and chaperoned as opposed to the 'if you have got it, flaunt it' modern attitude.

Because rape myths are normative in non-offender populations, they are not predictive. Contrary to Sindy Banga's assertion, belief in fate and self-efficacy ('heaven helps those who help themselves') are not necessarily mutually exclusive. Further, Rotter's unidimensional locus of control is a flawed, often applied naively to non-Western cultures (Hammer & Alladin, 2010) where locus of control and responsibility should be differentiated.

Skinner encouraged that we focus on changing behaviour, not attitudes. Misogyny and male chauvinism may simply go underground. But in India, police incompetence with botched investigations and corrupt politicians often collude and fail to uphold the law to defend the wronged citizen, particularly if she is a woman.

Some 5,000 years ago the epic Mahabharat war was triggered by the attempted disrobing and sexual assault of Queen Draupadi, in the presence of her in-laws and husbands (she had five!), who were complicit when they watched in silent impotence. Lord Krsna who prevented the disrobing, warned that if the Queen is not safe, then no woman is safe and that this heinous crime will increase in the modern era.

We in the West should not be smug, as rape and gang rape is a crime without borders but the statistics are difficult to compare because of differential rates of underreporting and methods of rape classification. Rather than individualistic psychology, we need a systemic intervention aimed at the police and politicians. So, why does rape and gang rape happen? 

A simplistic answer would be because the perpetrators know they can get away with murder (no pun intended). Until every man respectfully treats every woman as if she were his mother, spouse, sister or daughter, rape will continue. 

A life of dignity, respect and freedom from molestation – all women deserve no less.

Waseem Alladin
University of Leicester

References

Bhalla, N. (2013, 16 January) Analysis: How India's police and judiciary fail rape victims. Retrieved from TrustLaw, www.reutersreprints.com
Hammer, M. & Alladin, W. (2010). Transcending East/West boundaries: Pittu Laungani and cross-cultural counselling. In R. Moodley, A. Rai & W. Alladin (Eds.) Bridging East-West psychology and counseling. New Delhi: Sage.
Taylor, L. & Alladin, W. (1994). A multidimensional framework of rapists: Implications for victim counselling. Counselling Psychology Review, 9(2) 7–11.
Thornhill, R. & Palmer, C.T. (2000). A natural history of rape: Biological bases of sexual coercion. Cambridge, MA: MIT Press.

Lobbying for social change 

I was delighted and encouraged to read the letter from Jade Weston and Nic Horley 'Can we be lobbyists for social change?'(April 2013). This is, I believe, a vital discussion for clinical and other practitioner psychologists to have.

Regardless of our personal politics, we can presumably agree that the changes applied by the Westminster government to the UK welfare system are likely to have a major effect at both a societal and individual level. My own experiences as a trainee and previously as an assistant psychologist are by definition limited, yet I can immediately identify several clients and families for whom there will be a marked impact.

The key question raised by Ms Weston and Ms Horley is what clinical psychology, as a profession, can do about this. It could be argued that scientific impartiality precludes practitioner psychologists from engaging too deeply with such issues. However, my response would be that clinical psychology is an applied science that is heavily informed by the society in which it is practised – and which also informs that society.

Like it or not, clinical psychologists are at the sharp end! On an individual level, we would surely never offer a formulation that did not acknowledge someone's social circumstances, particularly an abrupt change in those circumstances. Surely, then, as socially informed practitioners, we have at the very least a duty to acknowledge and discuss what is happening more generally?

I would echo the call by Ms Weston and Ms Horley for an active dialogue. To this end, this letter has also been posted on The Psychologist's online forum. Perhaps a summary of any online discussion can be published in a subsequent edition of the magazine? I very much look forward to hearing what other members think.  

Simon Stuart
Trainee Clinical Psychologist
University of Edinburgh

It is important that those embarking on a career in psychology are motivated by the desire to minimise disadvantage and promote social justice ('Can we be lobbyists for social change?', Letters, April 2013), but it is necessary to do so from a perspective of realism if we are to be effective in the longer term.

The example given of the parent of a child in 'long-term foster care' losing a percentage of their housing benefit is of course emotive, but I would want to reassure the authors that a child in 'long term foster care' will not be returning home. Long-term foster care is a decision of the Court based on the assessed inability of the parent to provide a safe and nurturing environment for the child for the remainder of their childhood.

There may be contact at some level, often indirect and often supervised, but not, in my experience as a practising psychologist, involving overnight stays with a view to rehabilitation. If this were an option the child would not be in long-term foster care. And of course foster care, and the services around it, is costly to the state.

Might it then be argued that it is reasonable, in principle, for a very modest recoupment of the very considerable amount expended on fostering that child via a reduction in the housing allowance payable to the mother? After all she will have a reduced expenditure now that her child is looked after. 

The above scenario leads me to a broader point regarding the dangers of simplistic thinking over welfare reforms. We are not clear who we are referring to when we talk about the poor, the disadvantaged, the vulnerable, the needy, and nor are politicians. Within that poorly defined group, many of whom receive welfare benefits, some are trying hard, doing their best, striving to improve things for their children. I know because I have met them and work with them. There are also those who view their children as a means to fund their lifestyle. I detect a sharp intake of breath, but I know because I have met and worked with them also. 

One such mother whose four children were admitted into the care system was receiving £36,000 a year in benefits (more than some of the professionals supporting her were earning and a figure inflated by the cluster of pathologies diagnosed in each child courtesy of psychologists amongst others – but that's another story). This mother was openly more concerned about how she would manage without the money than without her children. She has since resumed her procreation. There is a very big social problem here. 

I quote this case only to illustrate that lack of money is not always the problem, and we must not be naive enough to think that giving money, although it is nice and easy, will always solve the problem. I do not have an answer to the situation we have created in which some people have enough money but lead impoverished lives whilst others are indeed poor and suffering. Welfare is an incredibly complex issue requiring sophisticated thinking and intelligent, informed debate, not knee-jerk, undifferentiated and polarised reactions from the government or the well-meaning rest of us, most of whom are inadequately informed. 

As psychologists we know that the most workable solutions generally lie in the middle ground between extremes so perhaps that is the ground we can most helpfully inhabit over issues of social welfare. 

Name and address supplied

Beginnings of occupational psychology

I share Pauline Willis' sadness at the death of J. Richard Hackman (Letters, April 2013). Building on the ground-breaking work of Vroom (Work and Motivation, 1964) and joining Porter and Lawler he helped cultivate the field of work motivation, a field woefully barren before their work, unless you count Maslow and his needs or McGregor's Theory X and Theory Y.

But I must take issue with her description of Hackman as 'one of the founding fathers of occupational psychology'. 

If you take the American use of the term, occupational psychology has a history going back at least to Strong and his Vocational Interest Blank in the 1920s; the field was summarised by Donald Super in his 1957 book The Psychology of Careers. In Britain, though, the history of 'occ psych' goes back at least to C.S. Myers and the work of the National Institute for Industrial Psychology, which flourished in the 1930s, with its landmark Imperial Airways study – before Hackman was born. The NIIP continued to flourish post-war.

If it died in the 1970s, it was not due to any lapse in quality of its work. During WW2 all three of the British armed forces employed occ psychs (see Vernon & Parry: Personnel Selection in the British Forces, 1949). And as we know the BPS had an Occupational Psychology Section long before Hackman graduated, and there was a postgraduate course in occ psych at Birkbeck before that.

So yes, Hackman was a significant figure in our field, a valuable contributor, but founding father he was not.

David Nelson
Founder member of the Division of Occupational Psychology, retired
Burntisland
Fife

Chronocentrism

Michael Davis notes the recent date of most citations in The Psychologist (Letters, April 2013). He speculates that current researchers must be seen to be 'bang up to date' and thus are led to neglect the true 'onlie begetters' of advances in the field. 

A letter of mine in The Psychologist (October 2011) pointed out that a phenomenon hailed as new in The Psychologist had been first identified in 1934. The process whereby new work is privileged over old is known as chronocentrism and has been analysed in some detail in respect of British criminology by Paul Rock (Rock, 2005). Criminology is not a discipline replete with new insights, so chronocentrism there is particularly depressing, but psychologists are prone to chronocentrism too, as Michael Davis points out. 

Neglect of relevant past research is a form of chrono-hubris.

The opposite form of chrono-hubris was evident to me early in my career, when offprints from a Journal (I think Perceptual and Motor Skills or Psychological Reports) contained a flyer assuring contributors that the paper on which the journal was printed would last for (from fallible memory) two thousand years.

Ken Pease
Stockport

Reference

Rock P. (2005). Chronocentrism and British criminology. British Journal of Sociology,   British Journal of Sociology, 56, 473–491.

Obituary 

Brendan Geraghty (1942–2012)

On 28 June 2012 my friend and erstwhile colleague Brendan Geraghty was knocked down and killed. He was 70 and recently retired. Brendan was one of the early pioneers of clinical psychology in Scotland.