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of it was hard to navigate, and key documents were hard to find, the documents and information on the site were often out of date and much of the content was hidden behind walls for members and separated into silos by the Society structure that were impenetrable by topic.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.

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.

Giving psychology away – the positive ripples of training

When I left the NHS I wondered whether I would have enough work to keep me busy, and felt like the expert witness work I do the family court would probably be the main strand of my income for the foreseeable future. However, perhaps because of my book, I have increasingly been asked to speak at conferences, provide training to various groups of professionals, and consult to organisations – particularly on the topic of working with attachment, trauma and the impact of maltreatment on children. This has become an enjoyable sideline where I can cascade psychological thinking to a wider audience, meet lots of new people, learn from others, and earn a good daily rate without the same emotional weight as doing court work.

I also like any work that involves improving the quality of services, particularly for complex or marginalised client groups. It was therefore very interesting to me when I was asked to meet up with some of the directors of a children’s home company, Keys Childcare, about offering training and consultation to a 20 placement project they were running about an hour away from my base. After some initial meetings, we decided that I would offer some staff training sessions (on attachment, trauma and the impact of maltreatment on children’s development) to all the staff, and then help them to implement a more systematic program of care planning and outcome measurement. The aim was to make decisions about which young people needed therapy and what form of therapy they received more evidence-based, as well as to ensure that all of the staff were involved in making the care for each young person as therapeutic as possible.

This fitted in really well with an outcome measurement system I had been developing for several years, using my ‘BERRI’ checklist of Behaviour, Emotional well-being, Relationships, Risk and Indicators of something requiring further assessment (such as markers of neuro-developmental conditions, or more usual behaviours, perception or thinking which would merit more specialised interventions). I had already developed a system whereby data could be entered into the BERRI online and produce a feedback report, and scores could be compared to track progress over time. This could produce a visual representation of a young person’s needs across the five dimensions, and allow us to be more holistic in our thinking about how to support them to make optimum progress.

radar

After discussion with my friend and colleague on the BPS CYPF Faculty, Dr Andy Rogers, who had used the system in units he was consulting to, I had started to develop a system for targeting particular concerns to address in the care plan. This involves identifying around three specific concerns from the BERRI and tracking them with greater frequency, typically daily, whilst giving the staff various strategies to try to address them. The target behaviours can be entered into the online system, which can then produce graphs to show progress and to identify any triggers. For example, in the chart below I’d hope that staff would instantly wonder what triggered the big green spike of aggressive behaviour.

tracking

I spent a couple of days each month with Keys, completing the staff training and improving the online system so that it would meet their needs. We also developed a pathway in which there would be a psychological screening assessment when young people arrive in placement, and their paperwork would be properly digested to ensure we had all relevant information from their history as well as an initial BERRI checklist, and we would bring this together in a meeting where the professionals around the child, their care team, the therapist linked to the home and myself would put together a therapeutic care plan document and identify the targets to work on over the coming months. The care plan could contain a summary of the history, a formulation section giving insight into the meaning of the behaviours and concerns the child was showing, then the targets we had agreed to track, and the strategies we had identified to help work on those concerns.

This was seen as a refinement to the existing therapeutic plan the homes in the project were already using, and embraced very positively. We called the approach Psychologically Informed Care-planning and Intervention, with the acronym PICI (which Jonathan Stanley, Chair of ICHA, said was an acronym that led naturally to a marketing slogan: “if you want the best for your child, get PICI”).

After a few months of seeing the changes within the local project, and gathering feedback from staff, social workers and commissioners, Keys decided to expand my remit. They asked me to do training for staff outside of my local project, and then to do some consulting to the wider organisation. They subsequently offered me a job as Clinical Director of Keys, with a remit to train all of their staff and implement the pathway across the whole organisation. This will take me three days per week for the next two years! They have also agreed to employ a psychology team to implement the project in each region, and this week we appointed the first qualified clinical psychologists. In time this team will grow to cover all of Keys services across the UK. We will also be taking on 3.5 assistant psychologists and more therapist time, so that we have a consistent level of consultation to each home in the company (with additional therapy time in the attachment homes where every child placed gets direct therapeutic input). This is super exciting, and I hope that we are able to evaluate the impact on both staff and the young people we look after.

Keys have embraced the new pathway and outcome measurement system as part of a wider push to improve staff training (which now also includes a modular training program that every staff member will work through) and to be able to evidence the effectiveness of their care. This includes a desire to be more evidence-based in how they make decisions about placements and interventions. The changes also coincided with the tenth anniversary of the company moving into childcare and buying the initial ten Keys homes from their previous owners, and also with a rebranding exercise. When they revealed the new branding a few weeks ago in Belfast I was delighted to see that Keys now describe themselves as providing “psychologically informed care for children and young people” and see this as a way to improve the quality of their placements (and through this to gain better Ofsted inspection grades, and become the placement of choice when commissioners seek to place complex young people).

It seems like a natural progression from the kind of consultation I was doing in a CAMHS LAC team, but on an organisation wide scale. My small amount of time has the power to influence more children by working indirectly. By “giving psychology away” I hope I am giving increased insight to those doing the day to day care, and slightly changing their way of working with the young people. Instead of a child getting one hour per week with me, they are getting 38 hours per week with a slightly more psychologically minded caregiver, and my influence can reach 320+ children and nearly 1000 staff.

The staff within Keys have been really enthusiastic about the new pathway and have given me positive feedback for the training days, so the although there is a lot of travelling and a very ambitious timetable for implementation I am really enjoying the work so far. I also get surprisingly positive feedback from training elsewhere, which is so lovely to receive. I think it really stands out for me given how few positive feedback loops there are in most clinical roles nowadays (beyond the occasional client or colleague sending a thank you card). I get a real buzz from positive tweets about my training or keynotes, gaining high scores on conference feedback forms, positive reviews of my book, or complimentary endorsements on LinkedIn.

I went up to Glasgow last week to train some staff to run my group program for parents and carers of maltreated children (Managing Behaviour with Attachment in Mind) and really enjoyed that also. Glaswegians really are the friendliest people in the world, and the group I trained were clearly hugely empathic to the children they work with so they were a delight to train. As I was leaving someone said to me that “training is a way to change the lives of thousands of children”. I think I had made some comment to brush this off (perhaps that it was the clinicians working directly with the families whose relationships were vital, rather than a day from a person like me), but she wasn’t having any of it. She said “no I mean it. I will interact different with the families I see tomorrow and in the future because I spent the day with you, and each person who came to the training will do likewise”. She explained emphatically that she had literally meant that in one day I had done something that would ripple out and change huge numbers of lives. That was pretty humbling to think about.

I’ve also had some exciting discussions about research, service evaluation and different kinds of therapeutic work (for example, working in partnership with collaborative lawyers). So I have decided to have a break from doing expert witness work over the summer and really have a think about what I most want to do. I need to weigh up all the choices in front of me, prioritise the things that make the most impact and/or give me the most satisfaction, and put some energy into finding allies with shared goals (including seeing whether I can recruit another clinical psychologist to LifePsychol in Milton Keynes to pick up some of the therapy and court work). I also want to reclaim my life outside of working hours, and to consider where in the country it makes most sense to be located. But it feels like all the effort I have invested in various projects to date is finally nearing fruition, and there are lots of interesting things on the horizon.

Long ago, I had a task list written on the whiteboard in my office, and Gilly had made me laugh by adding to the bottom of this “build secret volcano base, take over the world”, to reflect my ambitions to change practise on a wide scale. Maybe it isn’t such an unrealistic aim after all.