How does the next generation of clinical psychologists think about mental disorders?

To stereotype the mental health professions, psychiatrists tend to see mental health problems as being predominantly biological in nature, while clinical psychologists see them as caused more by social circumstances. This is a generalisation, of course, because individuals in each camp hold a variety of perspectives. But surveys do usually reveal average differences in perspective between psychiatrists and psychologists, likely related to the contrasting ways they are trained – psychiatrists begin studying general medicine, including learning a lot about physical diseases, whereas clinical psychologists start out as psychology undergrads. Times might be changing, however, as clinical psychologists and psychiatrists increasingly work together in interdisciplinary groups, and there have been efforts to broaden the training of both professional groups.

To get a sense of how the next generation of clinicians view mental health problems, researchers have conducted an online survey of hundreds of trainee clinical psychologists in the UK and compared their results with those from a similar survey of trainee psychiatrists published in 2009. Together the findings suggest the old stereotypes contain to contain a kernel of truth – while the survey of psychiatry trainees found they favoured biological approaches to mental health, the new survey of trainee psychologists shows that they most strongly favour social and psychological models.

Rebecca Read and her colleagues conducted their anonymous survey with 289 clinical psychology trainees in the UK, asking them to rate their agreement with 32 statements applying different conceptual models (biological, cognitive, behavioural, psychodynamic, social realist, social constructionist, nihilist, and spiritual) to four different psychiatric diagnoses: schizophrenia, major depression, generalised anxiety disorder and antisocial personality disorder.

An example of a social realist statement:

Social factors such as prejudice, poor housing and unemployment are the main causes of the disorder.

An example of a social constructionist statement:  

There is no universal classification of disorder, only culturally relative classifications.

And biological:  

The appropriate study of the disorder involves the discovery of biological markers and the effects of biological interventions.

The clinical psychology trainees most strongly endorsed social realist statements, followed by (in order of stronger to weaker endorsement): social constructionist, cognitive, psychodynamic, behavioural, biological, nihilist and spiritual. Their preferences varied somewhat depending on the diagnosis in question, so for example, they showed more endorsement of biological statements relating to schizophrenia than to anxiety or antisocial personality disorder, and less endorsement for cognitive statements related to schizophrenia and antisocial personality than to depression and anxiety.

Comparing the new survey results with the one involving trainee psychiatrists published in 2009, the trainee psychologists showed stronger endorsement than the psychiatrists of social constructionist statements (especially related to schizophrenia), and they showed less endorsement of biological statements related to all four diagnoses.

"Our findings suggest that the attitudes of psychologists and psychiatrists continue to sit at opposite ends of a biological / psychosocial spectrum," the researchers said. "This is the case despite the increase in interdisciplinary training and working, the evolution of the professions and the reconceptualisation of the medical model [as an approach based on what works rather than on exclusively biological explanation]".

Further reading

Read, R., Moberly, N., Salter, D., & Broome, M. (2016). Concepts of Mental Disorders in Trainee Clinical Psychologists Clinical Psychology & Psychotherapy DOI: 10.1002/cpp.2013