Meeting a high flyer

Belsize Park is a beautiful London 'village' with a strong literary tradition (Keats' house is around the corner and you'll find two branches of the excellent Daunts bookshop there). The Royal Free Hospital is a short walk up the road from the underground station. In fact, all Belsize Park lacks to reflect Professor Robert Bor's career is an airport! Rob is a prolific author (25 books and counting) and psychologist who has worked for some years at the hospital.

He had been particularly keen to talk about work in aviation psychology, where he's something of a pioneer, to the extent that my background research for the interview largely consisted of reading papers and books by Rob.

The cockpit confessional

'If I wasn't a psychologist I'd be a professional pilot. I was born in South Africa, came to the UK when I was two, returning there when I was twelve. I studied to be a psychologist in South Africa, then trained to be a pilot. My first flight was round the stunningly beautiful Cape Peninsula.'

Are there similarities between the two disciplines? 'In one way not all. Psychology is, sometimes, an imprecise science involving judgement and creativity. Pilots have to nail processes exactly. But, in other ways, there are points of contact. You fly with another pilot and the cockpit becomes a sort of confessional for sharing stresses. Pilots are like medical doctors in that they often have issues but are reluctant to talk about them. The downside for both professions is huge: in the case of pilots they can be grounded or lose their licences.'

I'd never heard of aviation psychology. 'Yet the first writing on pilots was in 1919 for the Royal Air Force. One of the recommendations was that pilots should drink alcohol in order to overcome nervousness – something that would immediately disqualify a pilot these days.' Rob started looking at the work done on aviation mental health, mostly in North America and Europe, and ended up producing what is still the only textbook on the subject. 'I work with airlines. The old "stick and rudder" skills-based view of pilots has changed. We still use simulators, but leadership, communication and IT skills are now critical competencies. Pilots run medium-sized businesses, working with a team and co-pilot they may never have met before, in a stressful situation involving very strict rules and procedures.' Rob provides a counselling service for pilots among whom, worryingly, fear of flying is the most commonly presenting psychological symptom: 'But that's usually the surface manifestation of deeper issues.'

The rage for air rage

Rob's interest in pilot psychology soon extended to passenger behaviour. 'Before 9/11 air rage was all the rage. The relatively few instances received huge publicity, and I became interested in what triggered sometimes very aberrant behaviour. Of course, you find antisocial behaviour everywhere, but there seemed to be contextual factors in flying. For instance, there's a lack of space and privacy, and at average cruising heights passengers suffer from mild hypoxia.'

Rob's interest seems to have moved, in turn, from aberrant behaviour to the anxious passenger. 'The media sometimes report that as many as 10 per cent of passengers are flying phobic, but in fact, that statistic relates to passengers who are anxious, fretting or aroused but still manage to fly. This is obviously an issue for the individuals, but it's also one for airlines. It costs two to three thousand pounds to deplane a passenger, particularly if they have hold luggage, while dealing with a dissociated passenger at 35,000 feet takes the cabin crew's attention away from important duties, including those relating to safety. No one wants a passenger to fly in a state of increasing terror. So, you can train check-in staff to watch for significant signs of anxiety and also provide cabin crew with techniques to help passengers.

The airlines themselves run fear-of-flying programmes using a standard information/relaxation/flight experience curriculum, but some passengers find the effects wear off. Our programmes tend to pick up those people. There seem to be a lot of specific co-factors that affect fear of flying, so we tailor courses to individual issues like safety behaviours (including avoidance), alcohol, and drugs, and also to more pressing factors such as fear of dying and earlier bad flying experiences. One tip I'd give to readers is to watch the safety video at the beginning of flights and to check out the environment – the number of rows to the nearest exit, for instance. People who do this are much more likely to survive a crisis than those who read share prices in the FT while the cabin crew are pointing out the exits! Psychologists are looking at how to make safety information more compelling.'

Is this a new sort of psychology? 'No. Any psychologist can find a place within the field. It's an application of psychological knowledge and skills to a particular population and environment. In turn, aviation psychology is influencing other areas. In 1989 UA Flight 232 from Denver to Chicago crashed at Sioux Falls Indiana. A terrible event, but it started the Crew Resource Management (CRM) movement. The crew of the airliner communicated and worked together, saving about half the passengers. This emphasis on communication, leadership, operating procedures and safe or unsafe deviations from them is now embedded in all crew training. The approach is used in other contexts, operating theatres, for instance, to increase safety and reduce risk. You can argue that it has a place in financial services to mitigate the sort of disasters we've seen over the past few years.'

Aviation psychology also addresses cabin crews. 'The key issues here are to do with teamwork and lifestyle. Passengers and airlines demand more of their crews. Turnaround times and rest periods are shortening. There's much more stress in the role.' And aviation psychology is also involved in ergonomic and environmental issues. 'If you walk on to the brand new Boeing 787 you're in an atrium which makes you look upwards. The lighting lifts your mood. Psychologists have been involved in the design.'

Aviation psychology is beginning to create formal structures including a number of journals and associations. The European Association for Aviation Psychology is still small and Rob is one of only two UK-accredited aviation psychologists. 'It's a very good organisation which offers a lot of organisation which offers a lot of CPD and networking opportunities.'

Do you still fly? 'Yes, mainly around the Cotswolds. I have a cottage near Kemble where the Red Arrows used to train. One of my most memorable flying experiences was as a passenger on an RAF refuelling flight from Brize Norton. We refuelled two Tornadoes then a message came through that a Russian air force plane was approaching and a two-hour flight ended up taking six hours as we refuelled planes north of Scotland to enable them to guard UK airspace.'

Career progress is changing

To quote a few highlights from his CV, Rob is a chartered psychologist in the areas of clinical, counselling and health; visiting professor at City University; a consultant at the Royal Free Hospital and school counsellor at the Royal Ballet and St Paul's schools. This variety of work, prolific authorship and his interest in new applications inform strong views about psychology as a profession and a discipline. We'd started discussing these at the beginning of our interview and Rob had warned me 'I like to talk and you'll have to stop me if I ramble.' He didn't and I wanted to investigate his views further.

How did he get into psychology? 'My father was a dermatologist. I think I was seven when I was helping him organise a slide deck for his medical students and it struck me that a skin disease must affect people mentally as well as physically. Returning to South Africa, you couldn't but be aware of the society-emphasised difference which posed the question "Why aren't we looking at our similarities?".'

Rob went to a liberal, multiracial school and, after a short stint in the army, studied psychology at the University of the Witwatersrand. 'My course involved sociology and social anthropology – the emphasis on context, on wider systems of thinking and on considering issues of power and ideology has influenced me hugely.' Doing an MA in Clinical Psychology at the University of South Africa, 'another liberal institution', deepened his commitment to this systemic approach.

His family had emigrated and he came to London, taking advanced family therapy training at the Tavistock. 'At the Tavistock, you practised therapy with a bug in your ear. Experts observed you and prompted and commented in real-time. It taught me that therapy is about detail.' Rob moved on to the Royal Free Hospital, where he worked with families affected by acute illnesses. He's still working at the Royal Free in acute medicine and has developed counselling courses at City University, 'which was where I first came across aviation psychology'.

Rob has written a number of academic textbooks but more recently has been concentrating on the self-help area. 'Self-help underpins therapy and I've written with colleagues on issues such as fear of flying, cancer, coping with panic attacks and shyness.' Another change is a stronger emphasis on his private practice.

'I do clinical work as well as counselling with high-achieving people.' What's different about private practice? 'Every day and every client is different. Clients self-select so, with increased motivation, there is more chance of a positive outcome. And they won't be fobbed off. They demand honesty and rapid results. I've become more interested in brief approaches to therapy partly because of this. It's useful sometimes to think of each session as the only one, even if your relationship with a client lasts for years, or even decades. Of course, I'm committed to NHS work, but private practice allows you to learn and grow, rather than be constrained by one process or technique. It introduces you to contemporary issues such as stress and newer sorts of addiction, such as to pornography.'

Rob sees this in a wider context. 'The traditional specialist psychological career path can be constraining, but that is changing. Career progress is becoming more stochastic, and I think the BPS recognises this. You can probably tell I'm interested in applying core psychological knowledge and skills to a wide variety of clients and situations. This helps society; it also helps the psychologist who stays fresh, up to date and enthusiastic. Running your own small business is in itself challenging and fascinating. You have to balance commercial issues with quality and professional ethics.'

A sequence of relationships

'Training at the Tavistock started me thinking about the best way to approach psychological problems. Yes, you need to know ICD and DSM typologies, but psychological practice increasingly favours clinical formulation. There are good reasons for this, not least resource constraints, but there are three important issues here. One is the contextual one. You can't divorce the person facing you from their wider societal context and you can't ignore the therapeutic context in which you, as the psychologist, are an active element. Secondly, the emphasis on diagnosis for protocol-driven therapies – and on the bureaucracy that goes with this – sometimes drowns out the critical question "What do we do about this problem?". The third is the issue of the psychologist him- or herself. In independent practice, you have to think about how you differ from each other. This is partly for marketing reasons but you quickly realise you don't just differ because you use CBT as opposed to other approaches. Emphasis on a set way of doing things perhaps undervalues psychologists' presence and charisma within the therapeutic context. Psychology is a sequence of unique relationships and psychologists are unique individuals. To go back to my Tavistock experience, psychology is more than a series of grand theories. The practice of psychology depends on detail.'

Leaving personality at the door

Rob comments that he's noticed lower levels of job satisfaction among practitioner psychologists in the last three to five years, 'Which is sad, given how exciting the field is and what's at stake. You increasingly find psychological thinking everywhere – in households, companies, the government, the military and the financial sector. The rather proscriptive way of working we are falling into seems to ask psychologists to leave personality at the door, to act as the means of applying an external process. That can't be healthy or very rewarding.'

Rob's own career is embracing new areas. 'Living part of the time in the country has interested me in agriculture. I've just taken a tractor-driving course and am beginning to get interested in the psychology of agricultural workers.'

Has he any tips for people starting their career? 'It's become obvious to me that stamina is critical. You need to keep healthy. That's why my transition from work to personal life is half an hour in the gym. And secondly. practitioner psychology must be reflective. You need to make time to think about what you're doing even if, as an independent, your income depends on billing hours.'

This issue had arisen early in the interview. He commented, 'Being a passenger on a flight is, to me, what going on a retreat seems to be to you. It's a chance to cast off all the day-to-day worries and think deeply about what I do.' And that's what this interview felt like: the opportunity to listen to someone who is still enormously enthusiastic and optimistic about the ability of psychological thinking to genuinely affect the lives of ordinary people as he thought through his practice in a critical but constructive way.