The Development of Clinical Psychology Past and Future Perspectives: - PowerPoint Presentation

1. The Development of Clinical Psychology Past and Future Perspectives: Monte Shapiro’s LegacyProfessor Tony LavenderFriday 2 December 2011

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4. BIRTH OF THE WELFARE STATENo satisfactory scheme for social security can be devised [without the] following assumptions.A national health service for prevention and comprehensive treatment available to all members of the community.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.

5. 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)

6. BIRTH OF CLINICAL PSYCHOLOGY: UK/US CONTRASTAPA (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”

7. Personal TherapyEysenck 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”

8. BIRTH OF CLINICAL PSYCHOLOGYAPA (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.”

9. CLINICAL PSYCHOLOGY & NHS – 1950-1960First NHS Whitley Council Circular 1952 recognises profession and publishes pay scalesThree 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 studentsQueen’s University, Belfast, Course established 1959Whitley Council in 1960 uplifts clinical psychology pay scales to align with other Scientific Officers in NHS

10. CLINICAL PSYCHOLOGY & NHS – 1960-1979Embraces therapyIncreases range of client groups1965 – BPS secures Royal Charter – Privy Council1966 Division of Clinical Psychology formed1967 The NHS Zuckerman Committee Report1960-1976 Training programmes grow by approximately one a year

11. TRETHOWAN REPORT 1976Started in 1973: Report in 1976Conclusions & Recommendations:Contribution potentially great but this was limited by numbers in service and trainingClinical Psychologists should have full professional status – full responsibility for their work, also acknowledged continuing ‘medical responsibility’ of doctorsStressed the importance of multi-disciplinary team workAll employed by the NHS required to have a Post Graduate Degree or BPS Diploma (end of independent route)

12. TRETHOWAN REPORT 1976Started in 1973: Report in 1976Conclusions & Recommendations: Psychology services organised into the tiers of the first (1974) NHS reorganisationRegional Health Authorities manage trainingArea HAs departments created with a base led by top gradePrincipal psychologists head all specialties (mental illness, mental and physical ‘handicap’, neurology, geriatrics, community, general practice)Clinical psychologists should have the opportunity to undertake researchClinical psychologists should be supported by psychology techniciansDepartment of Health should carry a full ‘manpower’ review

13. PRECIPITANTS & CONTEXT OF MAS REVIEWIncreasing demand for clinical psychologists in the service Accelerated by move to community careReflected in growing vacancy ratesThe plateau in numbers of training places – funding course capacity, government cynicisms with professions, fears of trainee loss

14. MAS REPORT 1989: LEVELS AND MODEL Identified a skills framework with three levels of activity:Level 1 Establishing and maintaining supportive relationshipsLevel 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 modelEqual status with medical practitionersOversee psychological component of care of all professionalsSupport doctors in assessment, diagnosis and treatmentOffer alternative psychological interventions

15. 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)

16. CLINICAL PSYCHOLOGY TRAINING PLACES 1980-2011

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

18. New Ways of Working for Applied Psychologists (2007) Organising, Managing and & Leading Psychological Services – Tim CateCareer Pathways – Tina BallTeamworking – Steve OnyettNew Roles – Tony Lavender and John TaylorImproving Access to Psychological Therapies – Graham Turpin & Roslyn HopeTraining Models – Jan Burns & Mike WangNew Ways of Working

19. 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

20. NEW WAYS OF WORKING:OUTPUTS & RECOMMENDATIONSDeveloped 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 levelPsychologists should be active in the design, operation and evaluation of teams – help crate effective teamsPsychologists should develop the role and improve the effectiveness of services through process consultancy at a systems level, peer consultation and supervisionPsychologists 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 servicesNew Ways of WorkingNew Ways of Working

21. NEW WAYS OF WORKING:OUTPUTS & RECOMMENDATIONSDevelop a broader base of prequalification training at three levels, Trainee Psychology Assistant, Psychology Assistant and Senior Psychology AssistantThe established three-year doctoral training model is robust and has a proven track record: alternatives should not be a substitute for doctoral trainingExisting applied psychology training courses should explore shared, common modules with other applied psychology training courses within their host institutionNew Ways of Working

22. CHALLENGES & WAY FORWARDEconomic downturn – ‘cold wind of debt’ – standing still we feel like cutsLead, think and work strategicallyKeep purpose and vision clearMaintain and enhance work with key partners, Department of Health, Centre for Workforce Intelligence, Health Professions Council, NHS Confederation, CommissionersDevelop and invest in current and future leadershipValue your work – its scientific base and demonstrate its utility to service users, service providers and commissioners, policy makers and research communityMaintain psychological stance in medicalised contextsPsychological (theory & research) formulation is keyApplying psychological theory and research (science) is the key to dealing with complexity – breadth of theories

23. CHALLENGES & WAY FORWARDEmbrace new rolesMental Health Act (responsible clinicians)Participate, lead in, Improving Access to Psychological TherapiesRe-visit Assistants roles in delivering psychological interventionsThink globally – foster development internationally (including in terms of recruitment)

24. MB SHAPIRO SMILEPsychological science is still at the coreNumbers in training and the workforceDoctorate – high quality training is the normPsychological formulation - key to embrace complexityInfluencing Government and policyMuch achieved but still much to do on our journey

25. Thank you for listeningandthe award