BPS

Words Matter: Prejudice, progress and professional terminology

How we talk about things influences how we think about things. Whether you believe the people arriving in small boats after perilous journeys are “illegal immigrants” (who have come here to exploit the system and harm us) or “asylum seekers” (desperate people who are seeking better/safer lives for themselves and their families) frames how you treat them. If you believe people who have complex offshore tax arrangements are “legitimate successful business people” or “tax dodgers” frames how you treat them. If you believe that trans people are “men in a dress (who present a threat to women)” or vulnerable people who desire to live in a way that is aligned to their deepest sense of self frames how you treat them. Words matter because they set the Overton window – the range of discourse that is considered acceptable in a society – which frames the prevalent perception and accepted understanding of key issues.

That is why the “culture wars” in politics and social media is so dangerous. People are being swept up into bubbles where if you believe one misleading thing (eg that the difficulties young white men now face are not being recognised because all the focus is on uplifting women and people from the global south, or that immigrants get preference for housing or benefits or are taking away job opportunities from your community) you are suddenly exposed to more and more hideous things – from the incel mindset to vaccine misinformation, transphobia, racism, islamaphobia, antisemitism, sexism, and regressive views about reproductive rights or the value of people who don’t have children – until your understanding of the world can completely detatch from the reality. Once swept into a bubble like that people end up dividing the world into allies (who think like themselves) and enemies (who think differently). To align with the allies who defended you when you faced one area of legitimate criticism is to align with all their beliefs. So otherwise sensible and progressive people can end up defending the indefensible and entrenching into deeper and deeper prejudice and antagonism. Once it becomes about alliances and identity, it seems our ability to apply any critical thinking to evaluate claims is undermined.

Yet progress has made huge strides over the decades before this recent setback. The public are broadly supportive of gay marriage, of women’s rights, of a health service funded from taxes, of a social care safety net, of the need to take better care of the environment and avoid climate change. These have been positive changes over time. There is also less tolerance of prejudice. You can see it when you watch old TV shows, and hear their casual jokes that have a sexist, racist, homophobic or transphobic edge to them, and realise that such content wouldn’t be commissioned now (and rightly so) – although portrayal of people with disabilities by actors without them persists. Problems are most obvious when we look back 50 years or more, where the issue was overt in shows like the Black and White Mistrel Show and sitcoms contained overtly racist content. Disney have had to add content warnings to some of their old films and cartoons. However, shows that were not seen as problematic in my youth have also been reviewed. Episodes of Little Britain, League of Gentlemen and the Mighty Boosh have been withdrawn for blackface. But even relatively recent content can age badly. If you rewatch episodes of Scrubs or Psych (both still highly rated and available to stream) there is content that feels really uncomfortable now. The former has had three episodes pulled for blackface. Psych remains up in full, but has repeated caricatures of people of different nationalities, and lots of casual sexism, racism and transphobia, despite being made from 2006-2014. Times have changed for the better in this regard. The acceptable discourse changing is a sign that progress is being made to reduce inequalities. Frustratingly, as I wrote in my last blog post, the last government and various figures on the right have managed to reverse some of that progress, with inflamatory discourse about immigrants, islam and trans people. Thankfully there are signs that is being addressed by the new government and that the majority of people don’t share such toxic views.

Language also matters when it comes to the terminology people use about their skills and professional status. It might sound boring and pedantic, but it is super-important to use the right words to describe yourself – especially when it comes to the terms that identify your professional status or qualifications. When I go to my GP it matters whether I get seen by a qualified doctor with five or more years of training with signficant breadth and/or depth, or another form of clinician who may only have a year or two of training and a much lower level or narrower area of expertise. If I have stress and worries, it makes a difference if I see a “wellbeing worker” who only has administrative experience or a qualified mental health professional. At the hospital it matters if it is a or “physician’s assistant” or a doctor that examines you – it can be life or death.

So when I read a CV in which someone claims to be a “Chartered member of the BPS” when they only have GBC – the graduate basis that is the first step towards gaining a qualification that could lead to later Chartered Status* – that is a problem. Yet this mistake was made by more than one applicant for one of our recent vacancies. If I read that someone is a “clinical psychologist” but they are not on the HCPC register as a practitioner psychologist, that is misleading and unlawful – yet I’ve seen three examples this month alone (in applications, and on LinkedIn profiles). I suspect that people in the psychological career paths are being impacted by the lack of clarity in the legislation and professional bodies, just as the public are, because there is no clear single source of this information. It is particularly confusing for people entering the UK from countries with different training paths, terminology and regulatory frameworks. Someone who is legitimately a “clinical psychologist” in another country can’t continue to use that title when living or working here unless they gain HCPC registration. Yet it is interesting that it isn’t as obvious as someone not being allowed to practise as a medial doctor or dentist or social worker without the right regulatory status – perhaps because the regulatory framework for psychology is so weak that if they drop the word “clinical” they are free to claim to be a psychologist with impugnity**.

It also bugs me when people self-adopt the term “consultant” because this is not protected by law and they think it will make them sound more impressive, when that title should reflect external validation of the level of responsibility of your role and expertise. I had to earn that title through a process involving a panel interview for a job with national assessors appointed by our professional body. I gained my consultant grading after many years of service gaining specialist skills with a particular client group, only when I gained a post with responsibility for a multidisciplinary team in a multi-agency context, working with highly complex presentations. Whilst the professional bodies haven’t yet resolved the issue of defining use of the consultant grade outside the NHS or large employing organisations, there are some professional recommendations and correspondence. Consultant is a term designed to mirror our medical colleagues in the NHS and is used to designate an individual who has been assessed as having attained a high level of specialist skill, doing a job with a high level of responsibility for leading a service and managing others, as well as having a deep expertise in a particular model of psychology and/or population. It isn’t obtained by time served or by specialist knowledge alone, it is a reflection of holding a post that scores above a particular threshold on the KSF – normally leading a substantial area of service delivery and being accountable for the outcomes and the team that deliver that service. For that reason, it makes me bristle to see self-employed sole practitioners who have claimed the title “consultant” either because they offer consultations or because they think they have earned it through time served or depth of knowledge of a model of therapy. That isn’t how it works. Not only was I judged to be the strongest candidate for the post and to have the required competencies to work at that level, my NHS role was judged to require consultant banding because of its level of responsibility. I have retained the title “consultant clinical psychologist” after leaving the NHS because I have continued to work in complex multi-agency contexts, leading teams and being accountable for their performance. But if individuals within my profession don’t understand and respect this differentiation, how can we expect the public (or the courts, or private service managers, or colleagues in social care or education) to understand what the terms mean, which of them are regulated and how to recognise when people are using them inappropriately and what to do about it?

I still hope that the government will grasp this nettle and regulate the title “psychologist”, require professional indemnity insurance for anyone offering therapy or mental health services to the public, and give the public much clearer information about how to find a suitably qualified practitioner who can meet their needs. I hope that this will then bring clarity for the terminology that people can use, and for public understanding of that terminology. But we are a long way from this happening. For now, I can only try to share clear information on the clinpsy forum, which continues to get millions of page views and to be one of the most accessible sources of information about the career path for clinical psychology in the UK.

*The BPS have lowered all the standards for what it takes to be a member, and how you can become chartered, so this is less and less meaningful, and they have encouraged members (even student and graduate members) to use letters after their name that I believe the public and non-psychologists would find misleading, so they are at least partly to blame.

**The issue of regulation of titles in psychology is something I feel passionately about and consider an important issue of public protection. The UK is the only country in the developed world not to regulate the term “psychologist” so this is a necessary first step. But I believe that absolutely everybody offering any form of wellbeing service to the public requires professional indemnity insurance and to be within the scope of a regulator. Otherwise people will continue to be preyed upon by unscrupulous, abusive and incompetent practitioners when they are at their most vulnerable.

My opinions about representing Clinical Psychology and the future of the British Psychological Society

I’ve probably been a member of the BPS for 20 years now, and with it the Division of Clinical Psychology and the Faculty for Children, Young People and their Families, and within that the network for Clinical Psychologists working with Looked After and Adopted Children (CPLAAC). I’ve been to the annual Faculty conference every year since I qualified, except for the one early in my maternity leave. I read some of the publications and I follow some of the social media. Over the last decade, I’ve done a long stint on the Faculty committee, and I’ve spent 5 years as chair of the CPLAAC network. I’ve responded to policy documents, represented them on committees, written papers and edited a periodical. So you’d think with all the energy and time I have put in that I am a great fan of the organisation.

Unfortunately, whilst I am hugely admiring of many of the individuals involved with the DCP and Faculty, and some of the recent Presidents of the Society, I’m pretty ambivalent about it as a whole. I think their website and social media suck. I spent ages looking at how to help them with that through the faculty, only to find out the scope for change was minimal and was within their user-unfriendly structure. Most of it was hard to navigate, and key documents were hard to find, the documents and information on the site were often out of date and much of the content was hidden behind walls for members and separated into silos by the Society structure that were impenetrable by topic. I was censored and then locked out of the BPS twitter account whilst live tweeting talks from a conference on behalf of the faculty because I quoted a speaker who was critical of the BPS’s communication with the media and public.

My experience of running clinpsy.org.uk is that we make everything accessible, searchable and google indexed (apart from the qualified peer consultation forum that is a closed group, and the archive of livechats and other member content that can only be seen when logged in). We are also able to respond to things immediately, and often talk about current affairs. So it is quite a contrast. The view of the BPS on the forum is fairly negative, despite myself and several other qualified members trying to put the advantages of having a professional body.

One theme comes up across both spaces – that lots of people like to moan, but very few are prepared to take the actions that help to change things for the better. So, when a document is put out to consultation, or members are canvassed for views by BPS Divisions or Faculties it may be that no clinical psychologists respond at all, or perhaps just one or two nominated by the committee, someone with a vested interest, or the same old voices who feel a greater sense of responsibility for the group. I’m sure the same would be true on the forum, as lots of people like to read the content, some like to ask questions but few actually write up content for the wiki, or help with the maintenance tasks like checking and updating links. However, people pay quite a lot for their BPS memberships, whilst the forum is entirely free and run by volunteers, so it is perhaps fair to have different expectations of service. The difficulty being that the BPS expect the few members who do contribute to do so for free, in their own time, over and over again. I worked out that one eighth of my working time as a self-employed person was being spent on unpaid committee and policy work, and I don’t think that this was unusual. Certainly the chairs of networks and faculties give up a large amount of their own time, and although higher up the tree some days are paid, these are not paid sufficiently to reflect the amount of time that is spent on the job.

So when the DCP sent me a link to a survey recently, I had to reflect my views and tell them that I don’t think that the BPS works for clinical psychologists in the UK, and this is predominantly because of the nature of the larger organisation.

I have witnessed time and time again that clinical psychologists, including those on faculty committees and in the DCP committees, are inhibited rather than facilitated in responding to topical issues, speaking to the media, expressing opinions or taking action by the slow, conservative and censorial wider organisation of the BPS. Even sending representatives to sit on government fora, guidance or policy making organisations involves an overly bureaucratic process of formal invitations and nominations that often means the window has closed to have our voice heard. Likewise the process for agreeing documents for publication is onerous and slow and means months of delay. The Royal Colleges and bodies for other health professions make responses to news items in a timely way, but we don’t. We are constantly told not to be political by expressing any opinion, when, as I understand them, the charity rules are not to be party political rather than not to express opinions that affect political policy at all. I would argue that our role as powerful professionals, effective clinicians, supporters for our clients and compassionate human beings requires that we are political in the wider sense, because we should be advocating for the psychological wellbeing of the population and putting the case for provision of adequate mental health services. I would consider that this includes an obligation to argue against policies that cause hardship and emotional distress, and to put forward a psychological understanding of events and individuals in the news.

Whilst there are great people involved in the committees and a lot of good will and energy, the BPS itself makes contributors impotent. It inhibits rather than amplifies the messages we should be sending outwards and it fails also to represent us as a professional group. It is not effective at representing our interests in government policy, national or regional workforce issues, professional negotiations, disputes about funding or other professional matters.

The structure of the BPS also drowns out the fact that the majority of practitioner members are clinical psychologists by giving equal weight to tiny factions and much too much weight to academics and students – the focus on the latter two groups means that the BPS failed to address issues of regulation properly and has left us with a legacy of problems with the remit and standards of the HCPC (including who is included and excluded in the scope of regulation and the criteria for equivalence of international psychologists, which I will no doubt blog about another time). In these areas it has not only failed to promote the profession, but also to protect the public.

Unlike other professional bodies, the BPS does not offer much by way of professional advice and representation for its members (eg about workforce and pay issues, disputes with employers). It doesn’t act like a union to defend individual members or the interests of the profession, or provide us with insurance or collective bargaining. It doesn’t show our value to the public or those in power through media statements, responses to news and current events and policies, representation on government and policy bodies. It is ineffective in building the status and public awareness of the profession. I believe our professional body should constantly articulate the need for proper mental health services and highlight the useful role the profession can play in meeting those needs. Likewise it should constantly express opinions about government policy and other issues that may be harmful to the psychological health of the population, and highlight what we think would help and the role we as a profession can play in systemic changes and in planning strategies at the population level that prevent or reduce distress.

So I think radical change is needed. If that isn’t possible as a program of reform from within, and Jamie Hacker Hughes’ Presidency suggests it wasn’t, then we need to split the DCP away from the BPS and/or build something new that is fit for purpose.

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If you also have an opinion about the BPS and/or DCP, whether or not you are a member, please answer their survey here. Feel free to cut and paste any part of this blog into your response if you wish to do so. Likewise feel free to share a link to this page, and if you are an aspiring or practising clinical psychologist you are welcome to join in the discussion about the BPS on the clinpsy forum.