Letters, September 2013

Softening the impact of welfare change

I read Jade Weston and Nic Horley's correspondence ('Can we be lobbyists for social change?', April 2013) with interest and was pleased to see the resulting discussion in the form of letters from Simon Stuart and an anonymous writer (May 2013), as well as 'From silence to a public voice' by Lizette Nolte (July, 2013). Many of us would not know where to start to be a 'lobbyist for social change', but there are small steps that we can take in our own practice to address the impact of the changes to the welfare system on our clients.
The welfare benefit system affects a huge range of the clinical psychologist's client groups. Nicola Barclay's project ('The impact of benefit reforms', 2013) is examining the impact of the Welfare Reform Act on clients known to mental health services and service delivery, but my colleagues across the North West have indicated that there are issues present amongst their clients in oncology, HIV, pain and other physical health settings.
I am fortunate to work in a Community Acquired Brain Injury Service that takes a person-centred and holistic approach to intervention and encourages interdisciplinary working. This means that if, for example, a client finds it difficult to engage in a session because they are worrying about a benefit application form, we will take the time to offer some advice about completing the form or check through what they have written. We take the view that to ignore such a worry when we are in a place to offer help is not only cruel but may impact on their willingness to engage with the service. Of course this has implications for our clinical time and stretches our limited knowledge of the benefit system. So we are running an evaluation of how frequently financial worries are raised by our clients and how much time we spend supporting them in such matters (as a clinical psychologist I am using my research knowledge to lead this).
We have also obtained a small amount of funding to commission a tailored benefits advice service for our brain-injured clients. We believe this is useful because for many of our clients visiting a Citizens Advice Bureau or another support service is an insurmountable task at what can be such an unsettled time in their lives. Again, I am running an evaluation of this service to determine whether it is valuable to our client group and to help secure further funding. Publication of this work will be another way in which clinical psychology is able to make moves towards social change.
Outside of work I have become involved with the local Trussell Trust foodbank, using experience gained through work to input into the management team. Likewise, the experience gained from the foodbank helps remind me to consider the social context of my clients.
These are just some examples of how I, as a clinical psychologist working in a very supportive and flexible team, have responded to the potential impact of the welfare changes on my clients.
Of course not every clinical psychologist will have the opportunity to respond in this way, or may feel they have other more pressing matters to advocate for on behalf of their clients.
Dr Hayley Entwistle
Chester

Reference
The impact of benefit reforms (2013, April). Clinical Psychology Forum, Issue 244, pp.2–3.

Peer feedback and the paradox of knowing

There has been much written about the benefits of peer-based learning on both professional and personal skills development (see e.g. Alpay et al., 2010). However, for the latter, the premise for such learning can be rather vague. The role of the peer group in facilitating effective learning communities and collaborative pedagogies are described in the literature, but its influence on genuine self-awareness, and subsequent personal development, is not always clear. As an educator
in higher education (engineering), I was therefore pleased to read David Dunning's article on 'the paradox of knowing' (June 2013) with its insights and implications on knowing others better than ourselves.
For me, the article provides a refreshing affirmation of the significance of peer feedback in student development. Specifically, Dunning's assertion of 'misguided exceptionalism' explains the challenges of curricula design for effective personal development, and the need for informed feedback during the course of such development. With all the good intentions behind learning activities for skills development (e.g. teamwork, leadership, and communication skills), without structured and explicit feedback from others the threshold mentality of the 'free agent…immune to the constraints that dictate other people's actions' might not be overcome.
Conceptual frameworks for such skills areas are important of course (and there is a plethora of models, approaches, books and tools on such issues!), as is self-reflection on personal attributes, but only if these consolidate the accurate observations from others. At university, we perhaps undervalue the student peer group as a critical resource
for such feedback and guidance.
E. Alpay
Imperial College London

Reference
Alpay, E., Cutler, P.S., Eisenbach, S. & Field, A.J. (2010). Changing the marks-based culture of learning through peer-assisted tutorials. European Journal of Engineering Education, 35, 17–32.

Victim's choices

Tom Gaisford (Letters, July, 2013) raises an important issue for discussion: whether the choices of a victim, in a relationship characterised by coercive control, are actually independent. This is an important question because often victims' choices are used against them; such decisions appear irrational unless the ultimate goal is to stay in an abusive relationship. This is a central theme in the culture of victim blaming that often surrounds domestic abuse.
Mr Gaisford suggests that a model of deception might be used to understand such choices; that victims are deceived into thinking that they are in a consensual relationship and that they make independent choices within this relationship, when in fact they do not.
I appreciate that this proposal does take a step away from victim blaming. However, the notion of victims 'wanting to believe' and of perpetrators targeting those who particularly want to believe is still unhelpful in this context because of the word 'want'.
There are a range of alternative models (see Shurman & Rodriguez, 2006 for a concise review) but of note, when thinking about the specific topic of independent choice, is cognitive-behavioural theory (see Beck & Weishaar, 1995). This theory does not necessarily focus on whether a choice is independent or not (which potentially assigns blame). Rather it considers the victim's perception of a particular choice at a particular time.
In an oversimplified example: a choice may be independent, but the victim may not be choosing between an abusive relationship and something better, but rather between an abusive relationship and something worse. This insight helps to dispel the idea that an independent choice that is made can only be rational if the goal is abuse because the choice itself is not so straightforward (see Frische & MacKenzie, 1991 for further thought around this topic).
In sum, the same choice may look very different to the victim in
a particular situation than to the outside world or even to the same victim years later. This is potentially because of cognitive biases that may result from stress, and/or biases reinforced and manipulated by the perpetrator.
At crisis point, a cognitive shift may have been caused by a certain set of circumstances that allows for the perception of choices to change.
It is at this time that a professional with an understanding of such complex issues should be at the cornerstone of the response to domestic abuse. In the case of high-risk domestic abuse, this would be an Independent Domestic Violence Advocate (IDVA), IDVAs are able to provide clear practical support (and choices) to the victim to facilitate their own and their children's safety. Importantly, the victim can be confident that the IDVA certainly does not hold the view that the 'slave chooses their master'.
Laura Wilkinson
Senior Research Analyst
CAADA (Co-ordinated Action Against Domestic Abuse)
Bristol

References
Beck, A.T. & Weishaar, M. (1995). Cognitive therapy. In R.J. Corsini & D. Wedding (Eds.) Current psychotherapies. Itasca, IL: F.E. Peacock.
Frisch, M.B. & MacKenzie, C.J. (1991). A comparison of formerly and chronically battered women on cognitive and situational dimensions. Psychotherapy: Theory, Research, Practice, Training, 28(2), 339–344.
Shurman, L.A. & Rodriguez, C.M. (2006). Cognitive-affective predictors of women's readiness to end domestic violence relationships. Journal of Interpersonal Violence, 21(11), 1417–1439.

Forum column: The real world

It may be a little late to give recommendations for summer reading. But if it isn't, you could do worse than reading John Williams' recently reissued novel Stoner. It is the tale of the rich interiority of what seems to be a small life on the outside – that of an obscure academic. It isn't a campus novel in the narrow sense, but it does have trenchant things to say about academic life.
At one point, the characters discuss the nature of the University. One of the characters declares: 'it is an asylum or – what do they call them now? – a rest home, for the infirm, the aged, the discontent, and the otherwise incompetent'. While this may seem harsh and critical, as the novel unfolds, it becomes clear that the vision is affectionate and indeed inspirational.
Stoner is certainly an unworldly character. But that is because he has a sense of how the world should and could be rather than simply adapting to the world as it is. He has a sense of values and sticks to them, even if ultimately that is the cause of his worldly failure. And that, writ large, is how universities should be.
Our role is to challenge students and to challenge received wisdom. It is to create new ways of being which might seem absurd in the short term but which endure in the long term. It is to take intellectual risks, to explore alleys that might be blind and which are to the benefit of all rather than the commercial advantage of a few. It is about doing what the market cannot.
Yet the impact of austerity [considered in this issue from p.644] is to endanger all this. Although it hasn't always been acknowledged as such, universities have been subject to the most dramatic privatisation of recent years. Soon the State will only contribute 15 per cent of our funding and students will pay some 50 per cent. And the inevitable consequence of such privatisation is that we are increasingly ruled by short-term market forces and short-term market logic.
We are led to be wary of challenging students and making life difficult for them because we depend for our survival on their short-term ratings of us in the National Student Survey.
We are led to be wary of challenging received wisdoms in ways that might be ignored at the point of the next research 'excellence' exercise.
We are led to be wary of producing outputs whose impact will only be knowable in decades rather than months.
But even more profoundly, perhaps, we are led to see our own work in market terms. It is of value, not in itself but as a currency to purchase something else – career, fame or fortune. And so we are increasingly tempted to publish things even when we don't believe in them. We are seduced down the slippery slope from selective reporting to outright fraud – all those things over which we have been agonising in recent times. Things which make no sense if one's concerns are with the intrinsic value of universities and university research. Things which are unthinkable if one privileges unworldly values like curiosity and truth over market success.
In a world that is mad, we need more asylums.

Steve Reicher is at the University of St Andrews. Alex Haslam is at the University of Queensland. Share your views on this and other 'real world' psychological issues – e-mail [email protected].
An archive of columns can be found at www.bbcprisonstudy.org.

NLP, psychology and avatars

I read with interest Dr Verrall's humorous caution about Google searching (Letters, August 2013) and agree with all he says. However even if we stick with the 3,060,000 hits he obtained for the search term 'neuro-linguistic programming', we are still left with a sufficient number of people using NLP professionally to support the findings of Tosey and Mathison (2009) that I referred to in my original letter (July, 2013).In defining NLP one part of their answer is: 'It is an internationally prominent practice in business, management development and professional education, a method used by facilitators of various kinds – coaches, trainers and consultants –who claim to offer some innovative and highly effective approaches to people development…' (p.3) . The warnings of Dr Verrall seem all the more appropriate when I typed in 'chartered occupational psychologist neurolinguistic programming' and obtained 2,710,000 hits. In looking at the websites of the first five pages, indeed there were Chartered Psychologists proudly telling us on their websites they were also Master Practitioners of NLP.
Despite the inappropriateness of using Google to do research, the
fact of the matter is that the informed predictions of Elich et al. (1985) have not eventuated. The researchers predicted: 'It is as if NLP has achieved something akin to cult status when it may be nothing more than another psychological fad that will go its merry way until it is replaced by the next fad.' As I rhetorically asked in my original letter, if NLP is a cult as some would have us believe, why are so many Chartered Psychologists associating themselves publically with the brand?
I welcomed the sympathy offered by Keith Rice (Letters, August 2013) and would like to offer my own explanation as to why so many Chartered Psychologists are consorting with what many of their peers regard as cargo cult psychology (Roderique-Davies, 2009).
Firstly, there are underpinning principles within NLP, and these find expression within the NLP Presuppositions. These Presuppositions are expressions of the underlying theories that support NLP. Even though Transformational Grammar (TG) is regarded by some as old hat (e.g. Jackendoff, 2002), John Grinder points to TG as 'the single most pervasive influence in NLP' (Bostic St Clair & Grinder, 2001, p.66). Systems theory is another supporting influence reaching back to the Macy conferences in the 1940s through Bateson, mentor to the NLP co-founders. Modelling of course is regarded as the core methodology of NLP and finds its theoretical expression through Albert Bandura. Finally, a radical constructivism is found in the supporting perspective
of general semantics from where NLP obtains the presupposition 'The map is not the territory'.
Whilst agreeing with Keith's other 'hard truths', and indeed his fine points regarding the current concerns of NLP and what NLP needs to do in the future, I would suggest the reason the NLP techniques are regarded by him as 'advanced and powerful' is that they do essentially draw from the above paradigms, and it is this that Chartered Psychologists tacitly recognise in developing their own brand of 'out-of-the-box thinking'.
Bruce Grimley
Achieving Lives Coaching
St Ives, Cambridgeshire

References
Bostic St Clair, C. & Grinder, J. (2001). Whispering in the wind. Scotts Valley, CA: J&C Enterprises.
Elich, M., Thompson, R.W. & Miller, L. (1985). Mental images as revealed by eye movements and spoken predicates. Journal of Counseling Psychology, 12, 622–625.
Jackendoff, R. (2002). Foundations of language. Oxford: Oxford University Press.
Roderique-Davies, G. (2009). Neuro-linguistic programming: Cargo cult psychology? Journal of Applied Research in Higher Education, 1(2), 57–63.
Tosey, P. & Mathison, J. (2009). Neuro-linguistic programming: A critical appreciation for managers and developers. Basingstoke: Palgrave Macmillan.

I read the July issue of The Psychologist with interest; not least, two seemingly unrelated pieces – one a letter from Bruce Grimley decrying 'all-or-nothing thinking about NLP', the other an article by Christian Jarrett on avatar therapy.
I'm one of relatively few psychologists trained in NLP. A few years back, I decided that far too many of my colleagues were content to sit on the outside criticising NLP from a position of relative ignorance. From my perspective, the only way I could have a robust opinion was to spend some time understanding NLP on its own terms. In my experience, some of its techniques work and some don't. Some work for some people and not for others. In that respect, it's similar to psychology. At a recent Psychology in the Pub event, we were told that there's a one in eight chance of success with any psychological treatment for pain for a given individual.
Irrespective of the evidence base, NLP seems similar to psychology in other respects, too. Most practitioners are honest, believe they're doing the right thing and see NLP as a means of helping others; a minority of practitioners are charlatans, over-selling what NLP can do (e.g. Jedi mind-tricks backed up by neuroscience).
But this letter isn't intended as a defence of NLP. I'm no zealot in that regard (far from it), and I'm happy for the two disciplines to fight it out amongst themselves. What struck me when I read those two articles was that avatar therapy is essentially the application of an NLP technique with the aid of computers (to replace the imagination). This itself reminds me of another Psychology in the Pub talk, on therapeutic responses to infidelity, in which one of the slides directly referenced material from NLP. Either NLP has infiltrated psychology, which is a bit like a prodigal son influencing his parents, or there's sufficient overlap between the two to support Grimley's call for an end to 'all-or-nothing thinking'.
Thanks for listening. Unfortunately, those were the droids you were looking for…
Richard Boston
Bristol

The ethics of working with the media
In response to Phil Boyes' letter ('Working with media agendas', July 2013), as Chair of the BPS Media Ethics Advisory Group, I would
like to expand a little on the important points he raised.
Phil is right to say that engaging with the media is an excellent opportunity to promote psychology and individual research. After all we hope our research will better inform society at large. However, as Phil has said, sometimes we also have to try to engage with the media (particularly programme makers) to resolve what we identify as ethics issues in how they treat topics and participants, or to cease our engagement because no common ground can be found.
The Society's Media Ethics Advisory Group was established just over three years ago to do just this. We are a small group of members with many years' media experience in a range of programmes. We were formed from members of the Ethics Committee and the former Media and Press Committee following an unprecedented number of concerns over the nature of some 'reality' television programmes. As well as engaging with programme makers and broadcast companies, we have also played a central role in developing and promoting proposals for new legislation to better safeguard children in performances.
When the Society's communications team is contacted by, in particular, television production companies, there is an initial discussion about what the programme makers are planning, and any ethics concerns are also raised. The communications team explains the ethics help that is available through our advisory group. We work on a rapid-response basis to get in touch with the production company as quickly as possible to help with more expert ethics advice on a one-to-one basis.
At this point I would like to thank my colleagues on the group for their work. These enquiries can come at any time, and overall colleagues have been able to respond quickly to point out problems, help find ethical solutions and in some cases even persuade the company not to pitch that programme idea to programme commissioners, or to explore alternative means of achieving the production aims.
Communications is about engaging and getting good evidence-based research out there, in ways that a broad public can understand. It is also about upholding the ethics standards of our profession, and communicating why a programme idea fails an ethics test, and indeed may be potentially harmful and distressing for participants and/or viewers.
Some of the evidence to the Leveson Inquiry reminds us how much distress can be caused by unethical media practices. Our advisory group works with and on behalf of the Society to intervene at the earliest possible stages in productions to minimise risks, and to promote the key ethics principles of respect for the autonomy and dignity of participants, scientific value, social responsibility and beneficence.
John Oates
Chair, Media Ethics Advisory Group

Noticeboard
-     Colleagues working in secondary schools in a teaching and/or management position are invited to participate in a study examining the ways in which teachers promote the value of GCSEs. Participation involves one of more Year 10/11 teachers of
any subject completing a series of questionnaires with a single class and does not require a whole school or year cohort. We intend
to finalise participating schools and teachers in September and start the first round of data collection at the beginning of October. Details of the project can be found at: www.edgehill.ac.uk/psychology/valueproject
Dave Putwain
[email protected]

-     From our direct and indirect experience and that of a number of colleagues, it would appear that the current systems for supporting clinical psychologists in NHS employment disputes are sometimes unsatisfactory and unhelpful. It would seem that there is a need for a body, similar to the Medical Defence Union for doctors, that would support and fund clinical psychologists who find themselves in distressing situations at work, and who face the possibility of losing their job or the prospect of legal proceedings. We would therefore like to gauge interest in the idea of forming a Psychologists Defence Union. Those who are interested, or who have any comments, are encouraged to e-mail one of us below.
Professor Narinder Kapur
[email protected]
Dr Steven Kemp
[email protected]
Dr Veronica Bradley
[email protected]

In the past 12 months in The Psychologist many graduates have written about how they have 'fallen out of love' with psychology and have given up in their 'dream' to become fully qualified psychologists. Each contribution I read disappoints me further. I do not understand how only completing an undergraduate course you thought that you could then walk into a ClinPsyD course? Most other disciplines require a master's why should psychology be any different?
Realistically what did you learn as an undergrad? I graduated in 2010 and remember learning a little of everything to do with the discipline, which covers a vast array of different specialities. I understand that an MSc is expensive, but surely if you want to work in your 'dream' job then it is worth it? I worked full-time for two years after graduating to save up for the course and I am a mature student, who has a house, partner and dog who rely on my financial contributions. I quit a relatively well-paid job to return to university for the second time (although due to financial commitments I only go part-time, travelling 85 miles to Nottingham for my classes).
I now work part-time in three different pubs to cover expenses and bills, I also volunteer with a charity and have recently started working as an (unpaid) assistant psychologist one day a week. This position was not handed to me, as many of the letters have suggested, it was not even advertised; instead I barraged every single psychologist that I could find in a 70-mile radius of my home listing my current qualifications, what I wanted to achieve and also attached a copy of my most recent piece of work from my MSc. I was ignored by 98 per cent of the psychologists, rejected by 1 per cent and invited for an informal chat by one, which ultimately led to my internship. I am not suggesting that you do the same, I am just showing that by taking the initiative, not relying on others, I am at present 'on my way' to the next step.
I also resent the constant demand for monetary internships. Every day that I spend as an assistant psychologist I gain experience in the field, and it is this experience that will enable me to move forward. This opportunity would not be available on a paid basis, and in the current economic climate this is unlikely to change. I am under no illusions that I will be accepted on my first try, but as the saying goes 'if at first you don't succeed, try again', and I will continue to try until I am accepted. I am writing this for those who need hope; there is a way – you just need to fight for it, which I will do even if it takes a further 10 years…
Katie Woodland
Telford

Philosophical underpinnings of DSM-5

Professor Chris Brewin (Letters, August 2013) argues that even
if we concede the existence of faults in the DSM, we should be wary of rejecting it if no better alternative is available. However, it is not clear what could motivate the search for a better alternative other than the recognition that the DSM is fundamentally flawed. It is not enough just to identify specific limitations, since this merely motivates an iterative approach to gradually refining the existing manual. Moreover, it is plausible that any problematic conceptions about the nature of human psychopathology that were built into DSM-III will continue into subsequent editions, such that no future edition will ever be an optimal taxonomy (Cooper, 2013).
I am also not clear about Professor Brewin's views on the medicalisation of disorders in the DSM. In referring to DSM-III, he states that the manual 'undoubtedly introduced an explicitly medical rather than psychosocial focus', but he then adds 'there was no necessary implication that mental disturbances are a subset of physical diseases'. To avoid the apparent contradiction, this must presumably mean that the authors of the DSM intend that some disorders, despite supposedly being psychosocial in essence, are nevertheless best understood within a medical paradigm (whatever that is about if not physical illnesses). If so, this view is continued in DSM-5. Interestingly, the classification of mental disorders in ICD-10 is actually just one chapter of a comprehensive taxonomy of known physical diseases. So this apparently assumes that mental disorders are diseases of some sort.
It is frequently stated that the DSM is atheoretical and makes no assumptions about a biological model of disease. However, this seems disingenuous, since many psychiatrists maintain consistently that the main psychoses, such as schizophrenia and bipolar disorder, must have a basis in brain dysfunction, which further research is bound eventually to clarify (e.g. Andreasen, 1997). Moreover, the DSM makes the implicit theoretical assumption that there are 'syndromes with unity' (Poland et al., 1994) underlying the range of symptoms in disorders defined by polythetic criteria (e.g. schizophrenia). Indeed, the editors of DSM-5 expect eventually 'to carve nature at its joints' by identifying clear syndromes with 'dimensional discontinuities' (Regier et al., 2009). One can legitimately ask what is expected to be the nature of these distinct unitary syndromes if not ultimately biological.
Richard Hassall
Leeds

References
Andreasen, N.C. (1997). Linking mind and brain in the study of mental illnesses: A project for a scientific psychopathology. Science, 275, 1586–1593.
Cooper, R. (2013). Natural kinds. In K.W.M. Fulford, M. Davies, R.G. Gipps et al. (Eds.) The Oxford Handbook of Philosophy and Psychiatry. Oxford: Oxford University Press.
Poland, J., Von Eckardt, B. & Spaulding, W. (1994). Problems with the DSM approach to classifying psychopathology. In G. Graham & G.L. Stephens (Eds.) Philosophical psychopathology. Cambridge, MA: MIT Press.
Regier, D.A., Narrow, W.E., Kuhl, E.A. & Kupfer, D.J. (2009). The conceptual development of DSM-V. American Journal of Psychiatry, 166, 645–650.