The Development of Clinical Psychology Past and Future

Perspectives: Monte Shapiro’s Legacy

Professor Tony LavenderFriday 2 December 2011

BIRTH OF THE WELFARE STATE

No satisfactory scheme for social security can be devised [without the] following assumptions.

A) A national health service for prevention and comprehensive treatment available to all members of the community.

B) Universal children’s allowances for all children up to 14 or if in full-time education up to 16.

c) Full use of powers of the state to maintain employment and to reduce unemployment to seasonal, cyclical and interval unemployment, that is to say to unemployment suitable for treatment by cash allowances.

BIRTH OF THE NHS

(Tackle Disease)

“This is the biggest single experiment in social service that the world has ever seen or undertaken”

(Aneurin Bevan, 7 October 1948)

“It was the first health system in any Western society to offer free medical care to the entire population. It was, furthermore, the first comprehensive system to be based not on the insurance principle, with entitlement following contributions, but on the national provision of services available to everyone. It thus offered free and universal entitlement to State-provided medical care. At the time of its creation, it was a unique example of the collectivist provision of health care in a market society.” (Klein 1986)

BIRTH OF CLINICAL PSYCHOLOGY: UK/US CONTRAST

APA (1948)

“The need for clinical psychologists with a combination of applied and theoretical knowledge in three major areas: diagnosis, therapy and research.”

Eysenck (1949)

“Clinical Psychology demands competence in diagnosis and/or research”

Clinical Psychology should not involve a training in therapy “therapy is something essentially alien”

Personal Therapy

Eysenck was at his most strident in his response:

“It is proposed that the young and relatively defenceless student be imbued with the ‘premature crystallizations of spurious orthodoxy’ which

constitute Freudianism through the ‘transferences and counter-transferences’ developing during this training. Here, indeed, we have a fine soil on which to plant the seed of objective, methodologically sound,

impartial, and scientifically acceptable research”

APA, which advocated that:

“some kind of intense self-evaluation and that whenever possible that should be psychoanalysis”

BIRTH OF CLINICAL PSYCHOLOGY

APA (1948)

“Unmet social needs for more and better mental hygiene services, including research. The task before clinical

psychologists lies in adopting such policies in their training institutions that are best calculated to provide services that

can demonstrate social usefulness.”

  

Eysenck (1949)

  “Psychology can not go where social need requires. A science must follow more germane arguments than the

possibly erroneous conception of social need.”

CLINICAL PSYCHOLOGY & NHS – 1950-1960

• First NHS Whitley Council Circular 1952 recognises profession and publishes pay scales

• Three courses developed 1952-1957 (Maudsley, London; Tavistock, London; Crichton Royal, Edinburgh)

• Whitley Council Circular 1957 recognises three courses and allows entry ‘to pay scales’ for their students

• Queen’s University, Belfast, Course established 1959

• Whitley Council in 1960 uplifts clinical psychology pay scales to align with other Scientific Officers in NHS

CLINICAL PSYCHOLOGY & NHS – 1960-1979

• Embraces therapy

• Increases range of client groups

• 1965 – BPS secures Royal Charter – Privy Council

• 1966 Division of Clinical Psychology formed

• 1967 The NHS Zuckerman Committee Report

• 1960-1976 Training programmes grow by approximately one a year

TRETHOWAN REPORT 1976

Started in 1973: Report in 1976

Conclusions & Recommendations:

• Contribution potentially great but this was limited by numbers in service and training

• Clinical Psychologists should have full professional status – full responsibility for their work, also acknowledged continuing ‘medical responsibility’ of doctors

• Stressed the importance of multi-disciplinary team work

• All employed by the NHS required to have a Post Graduate Degree or BPS Diploma (end of independent route)

TRETHOWAN REPORT 1976

Started in 1973: Report in 1976

Conclusions & Recommendations:

• Psychology services organised into the tiers of the first (1974) NHS reorganisation– Regional Health Authorities manage training– Area HAs departments created with a base led by top grade– Principal psychologists head all specialties (mental illness,

mental and physical ‘handicap’, neurology, geriatrics, community, general practice)

• Clinical psychologists should have the opportunity to undertake research

• Clinical psychologists should be supported by psychology technicians

• Department of Health should carry a full ‘manpower’ review

PRECIPITANTS & CONTEXT OF MAS REVIEW

• Increasing demand for clinical psychologists in the service – Accelerated by move to community care– Reflected in growing vacancy rates

• The plateau in numbers of training places – funding course capacity, government cynicisms with professions, fears of trainee loss

MAS REPORT 1989: LEVELS AND MODELIdentified a skills framework with three levels of activity:• Level 1 Establishing and maintaining supportive relationships

• Level 2 Protocol driven circumscribed psychological interventions (simple BM and manualised therapy)

• Level 3 Use of multiple theory and evidential analysis to tackle complex problems – individually tailored solutions (characteristic of CPs)

Shared care model• Equal status with medical practitioners• Oversee psychological component of care of all professionals• Support doctors in assessment, diagnosis and treatment• Offer alternative psychological interventions

MAS REPORT 1989: WORKFORCE

Recommend increase in psychologists including training place from 173 to 300 by 2000 (actually hit 450)

Recommended enlarging clinical psychology workforce from just under 2500 to 4000 by 2000 (actually hit 4052 fte)

Should move to statutory registration (BPS granted power to set up voluntary register in 1987)

CLINICAL PSYCHOLOGY TRAINING PLACES 1980-2011

19801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011

0 100 200 300 400 500 600

Number of Training Places

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

5500

6000

6500

7000

7500

28593108

33763660

37634052

4399

4846

53315518 5562 5463

57886056

6706

6901

FTE

Year

FTE

Clinical Psychology: FTE in the NHS (1995-2010)

NEW WAYS OF WORKING FOR APPLIED PSYCHOLOGISTS (2007)

 

Organising, Managing and & Leading Psychological Services – Tim Cate

Career Pathways – Tina Ball

Teamworking – Steve Onyett

New Roles – Tony Lavender and John Taylor

Improving Access to Psychological Therapies – Graham Turpin & Roslyn Hope

Training Models – Jan Burns & Mike Wang

New Ways of Working

NEW WAYS OF WORKING FOR

APPLIED PSYCHOLOGISTS (2007)

PURPOSE OF THE APPLIED PSYCHOLOGIES

“to improve the psychological well being of the population through working with individuals, teams,

organisations and communities.”

New Ways of Working

NEW WAYS OF WORKING:OUTPUTS & RECOMMENDATIONS

• Developed leadership competencies based on NHS leadership Qualities Framework (training to Band 9)

• NHS Trusts should have a named lead for psychological services, ideally at Board level

• Psychologists should be active in the design, operation and evaluation of teams – help crate effective teams

• Psychologists should develop the role and improve the effectiveness of services through process consultancy at a systems level, peer consultation and supervision

• Psychologists should become involved in service redesign and in IAPT take up active roles in the commissioning and quality monitoring of training as well as leading and delivering those services

New Ways of Working

New Ways of Working

NEW WAYS OF WORKING:OUTPUTS & RECOMMENDATIONS

• Develop a broader base of prequalification training at three levels, Trainee Psychology Assistant, Psychology Assistant and Senior Psychology Assistant

• The established three-year doctoral training model is robust and has a proven track record: alternatives should not be a substitute for doctoral training

• Existing applied psychology training courses should explore shared, common modules with other applied psychology training courses within their host institution

New Ways of Working

CHALLENGES & WAY FORWARDEconomic downturn – ‘cold wind of debt’ – standing still we feel like cuts

• Lead, think and work strategically– Keep purpose and vision clear– Maintain and enhance work with key partners, Department of Health,

Centre for Workforce Intelligence, Health Professions Council, NHS Confederation, Commissioners

– Develop and invest in current and future leadership

• Value your work – its scientific base and demonstrate its utility to service users, service providers and commissioners, policy makers and research community

• Maintain psychological stance in medicalised contexts– Psychological (theory & research) formulation is key– Applying psychological theory and research (science) is the key to

dealing with complexity – breadth of theories

CHALLENGES & WAY FORWARD

• Embrace new roles– Mental Health Act (responsible clinicians)– Participate, lead in, Improving Access to

Psychological Therapies– Re-visit Assistants roles in delivering

psychological interventions

• Think globally – foster development internationally (including in terms of recruitment)

MB SHAPIRO SMILE• Psychological science is still at the core

• Numbers in training and the workforce

• Doctorate – high quality training is the norm

• Psychological formulation - key to embrace complexity

• Influencing Government and policy

• Much achieved but still much to do on our journey

Thank you for listening

and

the award