PPN North West Blog
Across Lancashire and South Cumbria, 24 Trainee Associate Psychological Practitioners (TAPPs), at a band 4 level, have been recruited to general practice and community settings to deliver a mental health prevention and promotion service. Once qualified, they drop the ‘T’ and become APPs, at a band 5 level. Some of the TAPPs are based within one or two GP practices and some are spreading the service they provide across a whole primary care network (PCN), which in one case means up to 10 practices.
Medication prescribed by GPs for emotional difficulties is increasing at what is, perhaps, an alarming rate. One in three GP appointments has a mental health component to it and the reported rate of psychological need has increased as a result of the covid-19 pandemic and associated restrictions. With statistics such as these now well known, I think it’s time that psychological professionals focus their attention upon general practice and community settings. Your local GP, close by, familiar, lacking the stigma and sometimes complex access associated with mental health services seems an ideal place to start. With the average GP offering 10-minute appointments, and many GPs saying they don’t feel appropriately skilled to work with mental health and it’s varying presentations, it’s perhaps not surprising that ‘watchful waiting’ or a medication prescription are two overused tools.
Brendan J Dunlop, Clinical Psychologist in training
Health psychology is a rapidly growing discipline with increasing opportunities and career pathways. However, for trainees and prospective students it can sometimes be difficult to envisage what a future career in health psychology might look like. It’s not always easy to find examples of health psychologists working in areas outside of your respective work environment, or to fully understand the variety of contexts in which health psychology could be applied. Similarly, for organisations interested in commissioning health psychology expertise, it can also be challenging to find examples of the different settings in which we work, or to understand what we might bring to the table.
As we move into spring and a world with less lockdown restrictions, I wonder how many of us have mixed emotions about our new world. Perhaps it’s been like the weather (at least here in the North West) where we have had hail showers followed by brilliant sunshine over the past few weeks.
Prof Lucie Byrne-Davis PhD CPsychol PFHEA FEHPS, Health Psychologist, Division of Medical Education, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester
Saiqa Naz: CBT Therapist, Sheffield Specialist Psychotherapy Service, Co-author IAPT BAME Positive Practice Guide, & Chair, BABCP Equality and Culture Special Interest Group)
It’s an unfamiliar place and time we live in now. Probably very few of us have a plan or script for how we cope with this situation and the potential future. I’m sure most of us have found it unsettling to stop doing the things we take for granted in our lives. These may be the chores that we’re not so keen on – grocery shopping, paying bills or the activities we enjoy – films, live entertainment, eating out, exercising, socialising. For the former, we still have to do them but find different ways of doing them and the same is true of the latter. Online platforms are available but acoustics and connectivity may be a challenge.
This week I've been to Bristol for the launch of PPN in the South West. This is the result of the hard work by Catherine Gallup, Ken Laidlaw and Phil Self who have secured funding to develop the South West Psychological Professions Network.
The national conversation is due to start for Psychological Professions into Action. Some of you may have already heard of this, some of you may already signed up and some of you may have been at the conference and heard more about it there.
What’s the purpose of classifying things? We do this every day – we use it to make sense of our world. At its most basic, it is about pattern recognition and realising that some things are similar and some are not. This can be distinguishing between adults and children, birds and bees, stones and trees. These are not necessarily contentious but classification systems can be more contentious – describing ethnic background, gender preferences, diagnosis in healthcare. These systems are designed with a purpose and sometimes an underlying framework. Whether we agree with these or not, it is important to understand the system and its functions.
Yorkshire and Humber Psychological Practitioners Network
Why I do more homework than my clients
If you've learned anything about therapy before, especially something structured like CBT, you will know about therapy 'homework' or between session work where you tasks are set to complete before you next meet up. Clients often have mixed feelings about doing this, sometimes it reminds them of school, for example. There's a lot of emphasis put on the idea of homework, so it's supposed to show how motivated people are and can affect the outcome (the more you put in, the more you get out). For the most part homework is set up with the therapist to be completed by the client, but sometimes there is also a bit of between session work done by the therapist too (usually completing surveys). However, that's not what I'm talking about when I say that I do homework for my clients.....
When I started looking at adapted interventions for the young people I work with in Early Intervention we started looking at ways to engage people using their own interests (this eventually became part of a project I run called heavy metal therapy but this isn't about that specifically). I started using music, lyrics and other media in the session that clients had selected to describe their feelings or experiences. What started happening was that people asked me to listen to stuff or watch things in between the sessions so that we could use the session time to reflect on it. Now obviously there are some pitfalls in this, not having infinite time being one of them, and the joys of playing very sweary metalcore in the office displeasing your colleagues. But, over time, I have been converted to this approach for a few reasons:
Yorkshire and Humber Psychological Practitioners Network
Whiteness in Psychology: Starting a Conversation
By Tansy Warrilow, Third Year Trainee Clinical Psychologist, University of Sheffield
How often do we talk about diversity on clinical training? A reasonable amount I would say. We acknowledge our differences from our clients, we tick boxes on placement confirming we have discussed diversity and we recognise that clinical psychology programmes are pretty much dominated by middle class white women. So we talk about it, but how often do we really face the harsh reality that ‘Whiteness’ remains a persistent entrenched problem in clinical psychology and little appears to be changing. It’s taken me until my third year of clinical training and my fourteenth year of being a part of the psychology world to start talking about the white privilege that exists and is maintained within clinical psychology. Are we simply blind to white privilege? Do we ignore it because it’s uncomfortable? Or do we allow it to continue because it is beneficial to the most of us?
There’s no denying it, psychology is Eurocentric. In the main, our psychological assessments are developed and normed on and by white people, our theories were developed and re-tested by white people, our therapies are based on the norms of a Eurocentric society, almost all lecturers are white, our trainees are mainly white and the majority of qualified psychologists are white.
Yet when we talk about ethnicity, diversity or racism we look to our black peers to take over. Surely it is not the role of the very people who are marginalised by clinical psychology to address it? Should it not be the responsibility of those who are afforded power and privilege due to their whiteness to challenge it?
So why has it taken me to my fourteenth year in the psychology world to start talking about this? Well because for many years I was simply blind to it. I didn’t notice my skin gave me an advantage (which in itself defines privilege). I never had to worry about my whiteness, so I never did. I was always the norm especially in psychology. It didn’t occur to me that if others were oppressed then perhaps I was an oppressor. When it started coming into my consciousness I resisted it, I was too awkward to acknowledge it, too ashamed to admit I was part of any wrong doing. I kept quiet when I heard stereotypes at work, I thoughtlessly ticked the boxes agreeing I was reflecting on diversity and felt quietly pleased I had done my bit to understand others. I excused any part I had in systematic racism and colluded with the status quo. And as I write this, it remains awkward. I still don’t have the words, I talk clumsily and constantly worry I am getting it wrong or being offensive. The difference is, now I believe it is better to be clumsy and awkward than to collude with the racism.
Professor Nimisha Patel (2004) states:
“To develop and to demonstrate competence in empowerment, clinical psychologists need to be able to operationalise a social and political analysis of culture and racialism oppression in their psychological thinking, as well as in their assessment, intervention, training and research skills”
There is much more to say on this topic. But as a start, I encourage everyone within clinical psychology to take a step back and ask themselves what they do to challenge the status quo.
Some starting suggestions for exploring white privilege include:
- Read the book “Why I’m not Longer Talking to White People About Race” by Reni Eddo-Lodge.
- Read the (3 page) article “White Privilege: Unpacking the Invisible Knapsack” Peggy McIntosh.
- Check out Patel and Keval (2018) “Fifty ways to leave …… your racism”.
- Review and reflect on social media echo chambers. How much content is mindlessly absorbed that only reflects our own privilege. Follow pages representing; disabled, trans, cultural, Asian, black, and platforms that actively support and promote people of colour.
- Take an implicit bias test to reveal your hidden biases www.implicit.harvard.edu
Tansy’s article was published in the Sheffield University Clinical Psychology Unit Newsletter this month. She has kindly agreed for it to be circulated to the Yorkshire and Humber PPN members to encourage us all to reflect carefully about the above thinking points described.
@YH_PPN www.nwppn.nhs.uk Dr Paul Boyden