‘Psychology is a young subject… even early in your career, you can contribute to its development’

In June 2020, a letter from Liam Myles was published by The Psychologist. It argued that pharmacists would be in a good position to identify those at risk of suicide, and therefore could be trained in suicide prevention techniques. Liam signed off as 'Assistant Psychologist, Surrey and Borders Partnership NHS Foundation Trust'. This seemed a good opportunity to talk with someone working in the role of Assistant Psychologist – one which is often mentioned in these interviews – and how his experience fed into his proposal.

I expected a fairly brief, focused discussion but Liam's CV comprises almost five pages of practical experience, research, and publications – despite the fact that he only received his first degree in psychology one year ago. He did, however, find time to talk over Zoom despite his busy schedule.

A gateway

Assistant Psychologist roles are often seen as a gateway to clinical, forensic, health and counselling training. I asked him what his role entailed.

'I work for a community mental health team in West Molesey, taking referrals from primary care, such as local GP practices. I have three remits in my clinical work. The first is one-to-one CBT for difficulties like anxiety and low mood. Then I run psychoeducational groups. The third element involves shadowing clinical and counselling psychologists in the team. That is fascinating and, I think, helps people in assistant roles to decide if they want to train further and which direction they might want to go in. But I also undertake service-based research and service improvement initiatives.'  

What's Liam's goal? 'To become a clinical psychologist, maintaining a role in both practice and research. In recent years I've become fascinated by an approach to clinical psychology called "computational psychopathology" [If you are interested in this approach to clinical psychology, please see Liam's recent paper, 'The Emerging Role of Computational Psychopathology in Clinical Psychology', published in the Mediterranean Journal of Clinical Psychology]. I believe this to be the future of clinical psychology, but it is an almost entirely neglected field (in terms of clinical psychology). This is the direction I am taking my current research and I hope it will lead to the development of novel interventions for those who may not benefit from traditional therapies.'

I asked Liam about the Society's Assistant Psychologists Task and Finish Group to which he provides input. I hadn't heard of the group. 'Well it's new and we're still discussing our remit. But there are reports of exploitation of assistant psychologists – being asked to do things they are not trained to do, thus raising real ethical issues. Then there is the use of honorary contracts which require people to self-fund in some way. These preclude certain people from taking assistant roles, affecting the diversity of the cohorts accepted onto further training and therefore of the profession as a whole. At the moment there is a real mismatch between the characteristics of the clinical psychology profession and the clients they tend to work with.' This is something that has been mentioned by a number of Psychologist interviewees over the last few years. 'We're aiming to provide clear guidelines on what Assistant Psychologists are, what they can do and other areas.'

Losses and gains

The impact of Covid-19 on Assistant Psychologists' work has influenced Liam's thinking on the involvement of other professions in secondary health care. 'We're trying to meet greater numbers of referrals with the same number of clinicians. We now have some statistics in our area on how people are coping during the pandemic; for instance, one in ten people reported suicidal thoughts over lockdown. These figures are heart-breaking and demonstrate the necessity for much more to be done. People are feeling a real sense of loss for not seeing friends and family or even missing out on particular events. It's almost like grieving.'

How has the pandemic affected how you do this work? 'Increased use of Zoom and phones means you have to be very mindful of the risks of discussing triggering material, particularly for those with emotional regulation difficulties. But there are positives in how we've reacted to the pandemic. Face-to-face therapy might be easier, but the situation has shown how we can use technology to reach out to people – particularly younger people, as some research is suggesting that they prefer technology as a way of accessing therapy.'

This situation contributed to Liam's letter, asking the question whether 'others in the community,' are '…capable of identifying individuals at risk of suicide', and suggesting pharmacists as one group. I asked him to explain his reasons. 'As I've said, incidence of mental health problems is growing. There are many reasons advanced for this apart from the pandemic: social acceptability and societal pressures are two. But the fact is we're not doing well and one of the most devastating outcomes of poor psychological welfare is suicide. At the moment the approach to this issue is about putting out the fire: can we make interventions before it's too late, by identifying people at risk much earlier than we do now. In the letter I quote statistics that a pharmacist will see mental health service users 31 times more than primary care providers will annually. They get to know people who come in to pick up prescriptions regularly.'

Liam's point mirrored my experience when picking up medication from a local chemist. The person serving me would note the make up of the prescription and comment on how I was doing. 'The primary obstacle to this is pharmacists' confidence and the need to train them.' Liam's letter also points out that, with pharmacies open during the pandemic, and with the certainty that Covid's effects on mental health will last long after a vaccine has been developed, training for pharmacists could have a huge effect. This idea raises questions about other people in the community who may be in a position to help here and, if some are identified, how they could be trained.

The beauty of psychology

Our discussion moved on to the difficulty of gaining relevant experience to get accepted on clinical training. This is a well-known phenomenon. Liam's CV records experience covering his later years at school and his degree: they include a large number of research internships as well as publications and conference presentations. He has worked in student welfare and care homes, advised Oxford University Press, and taken a variety of volunteer roles. I assumed he was driven from an early age to become a psychologist and had focused hugely on getting experience.

'No, my first loves were music and skateboarding! At 16 I combined music and psychology. That said, I always had an interest in psychology and an intense fascination with why people behaved the way they did – I just didn't know it was called psychology! I have always been fascinated by music theory but when I started studying psychology at A-level, I became completely obsessed. During my psychology degree I got fascinated by almost every topic I studied: Durham University academic staff were incredibly supportive. Professor Anthony McGregor and Dr Matthew Buckley, now working at the University of Leicester, really took me under their wing and gave me research opportunities I couldn't have dreamed of. I found research incredibly stimulating and without their support, I wouldn't be where I am today.'

Liam says that the beauty of psychology is that, unlike something such as chemistry or physics, 'it's a young subject… even early in your career, you can contribute to its development. And research and application support each other – psychologists are scientist practitioners, meaning that they reciprocally integrate theory and practice. If I am fortunate enough to become a clinical psychologist, I would hope to balance clinical practice and work in research.'

Finally I asked Liam if the British Psychological Society had helped him. 'I'm not just saying this, but I wouldn't have got this far without BPS events, conferences and resources. Psychology is very networked and the society provides a way into that network. Everyone I have met has been so kind and members are always keen to help each other grow as psychologists. It is these connections that have helped me to develop my own voice in psychology. In fact, I think it is these connections that make psychology such a special field to work in.'

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