Forum

The narrowing focus of UK psychology; US healthcare reform; bias in testing; clinical terminology; proposal for a Community Psychology Section; and more

The narrowing focus of UK psychology?
There is something insidious happening to British psychology that may be directly attributed to the RAE. The panel identified cognitive psychology and neuropsychology as most worthy of merit with the top 10 institutions publishing in these subject journals. Applied and professional psychological areas fared less well. How might we interpret this?

We could argue about who was rating papers and by what criteria and we might want to challenge the privileging of these areas of psychology, but we should certainly discuss the consequences. Given the present economic down turn and the redirecting of money following the RAE, the panel’s judgement gave a steer to my department at the University of Surrey in identifying where to retrench following a requirement to save money as well as fulfilling an aspiration for the university to be amongst the top 10 HE institutions nationally and the top 100 internationally.

Notwithstanding a 30-year history of pioneering forensic psychology, two out of the current four posts have been lost, and I fear Surrey’s contribution to this field is seriously depleted. I am aware of at least two other universities that will be losing some forensic psychology capability.

I have just returned from an international conference where colleagues were amazed at these losses and the implications for the research and knowledge base of not only forensic but other applied and professional areas of activity. Clinical courses have limited scope to be research productive given the heavy demands to support trainees and the interface with the NHS. Will these too be at risk?

There is in my view a serious danger in narrowing the focus of British psychology and relegating non experimental paradigms to the margins and in doing so minimise psychology’s contribution to our national life. Not every student wishes to pursue an academic postgraduate route, rather many wish to develop professional credentials and/or apply their psychological knowledge in areas other than psychology.
Do other colleagues share my concerns? I invite members of the Society to engage in a debate through The Psychologist to discuss these important questions so that we do not sleepwalk into a diminishing of our discipline.

Jennifer Brown
(until December) Professor of Forensic Psychology
University of Surrey

 

US healthcare reform – your support needed
Many readers will be aware of the debate currently raging in the United States concerning the proposed implementation of a government-backed health insurance scheme to provide coverage to the estimated 49 million uninsured Americans, and to provide choice for the under-insured. I, and many colleagues, have been surprised at the vehement resistance with which a proposal of nationalised health care has been met by some in the United States. For example, anti-reform protesters have taken such measures as bringing semi-automatic weapons to rallies, and have misrepresented the NHS by suggesting that we employ ‘death panels’ to judge the viability of life for elderly people. It is little wonder that in this fraught context, with the stakes so geographically distant and misrepresentations running rampant, British psychologists have thus far been reticent to comment on American healthcare reform.

Yet as psychologists, we are placed to provide great insight to those in America currently wrestling with healthcare reform, whatever our area of practice – clinical, forensic, research, and so on. Many of us work or have worked in the NHS; nearly all of us use it; and, crucially, we all enjoy the right to high-quality care free at the point of access, including the care of psychologists and psychological therapists. Even as we continue to address issues in our own service provision, we cannot but recognise that high-quality psychological support in Britain is much more freely available. The American debate has thus far neglected the immense benefit to society wrought from accessible psychological services; here, British psychologists can have a powerful voice. We are able to comment on some of those barriers with which millions of Americans struggle every day:

I    insurance coverage linked to employment: clearly a barrier for those with long-term illnesses and other vulnerable people;
I    expensive costs for prescription medication;
I    expensive co-payments for appointments;
I    appeals concerning care being handled within an insurance company focusing on economic cost–benefit analyses rather than individual well-being;
I    psychological issues caused or exacerbated by stressors and other factors emanating from under-treatment of medical conditions;
I    failure to include comprehensive psychological services within many basic insurance plans.

The president of the American Psychological Association, James H. Bray, writes that ‘every American should have access to quality health care that includes mental and behavioral health promotion, screening and referral, prevention, early intervention, treatment and wellness services across the lifespan’. The APA is focusing upon the integration of psychological services into primary care, and has offered limited support for the so-called ‘public option’. However, given the inequitable nature of services under the current system, driven by private insurance companies with government support on offer only to the over-65s and the very poor, it is difficult to foresee how the aim of universal access to psychological services can be implemented without adopting a public option.

As an American resident in the UK, I am keenly aware both of the great advantages bestowed by the British system and of the struggles which my friends, family and fellow citizens fight every day back home. As we all know, access to psychological care is a matter of core well-being, and sometimes a matter of life and death. I invite colleagues who share my concern about the availability of psychological services to all peoples, to participate in the drafting of an open letter in support of a public option along the lines of the NHS, to be submitted to the Obama administration and major American media outlets. Anyone interested should please contact me at [email protected] for further information.

Rebecca Graber
Institute of Psychological Sciences
University of Leeds

 

Reducing bias in testing
I was interested to read the article by Jacob Hirsh, ‘Choosing the right tools to find the right people’, in the September issue – it is a very welcome change to have an article on occupational psychology in The Psychologist. While I congratulate Hirsh on the balance of his article and strongly endorse his emphasis on the importance of using the right tools in selection, I would take issue with his implied claim to have discovered the use of forced-choice item formats for controlling the response biases associated with Likert response formats in high stakes assessment. He states that ‘[b]ias-resistant questionnaires such as this may prove very useful for assessing personality in competitive environments’.

It is perhaps symptomatic of the Atlantic divide that those working in North America are just now ‘discovering’ the use of forced-choice as an alternative to Likert scales, when this approach was pioneered in the UK by my predecessors in SHL over 25 years ago (the OPQ Concept model was published in 1984). Not only did SHL develop parallel forced-choice and single-stimulus versions of OPQ but they took the radical step – at the time – of recommending forced-choice for use in high stakes settings, such as selection testing, and single-stimulus ratings for use in low stakes settings, such as personal development or career guidance. This was the complete reverse of conventional wisdom at the time. Subsequent research has proved this to be the right approach. Over the past three or four years we are beginning to see papers emerging at SIOP (the main US occupational psychology conference) on the potential merits of using forced-choice methods.

However, one issue with the use of forced-choice formats, which Hirsh does not raise in his article, is the fact that the scale scores produced are ipsative in nature if conventional scoring methods are used. This is not a practical issue for instruments like OPQ32, where the number of scales is sufficient to offset the effects of constraints on overall scale scores, but would be a serious issue for an instrument designed just to measure the Big Five.

Anna Brown and I have been leading developments in the application of multidimensional item response theory (IRT) models to the scoring of forced-choice instruments. We are now able to use IRT to get normative trait scores from forced-choice item data that in the past could only yield ipsative scale scores. This means that we are now able to get all the benefits of control over response bias that forced-choice formats provide without having the consequent disadvantages of ipsative scale scores.

Dave Bartram
Research Director, SHL Group Ltd

 

Jacob Hirsh stated that non-verbal tests of cognitive ability do not discriminate against respondents from different cultural backgrounds. Although this was the intention of such tests, empirical scrutiny has proven such assertion unjustified. IQ scores have been increasing with each generation and the effect is most profound on performance measures. Flynn (1987) has estimated that non-verbal IQ scores augment as much as 20 points within 30 years. This phenomenon is undoubtedly due to an environmental cause. Although efforts to address specific environmental factors remain predominantly speculative, it is likely that one’s culture is a strong determinant. Progressive generations experience societal changes that increment non-verbal IQ scores in particular.

Since non-verbal IQ scores have consistently been shown to be susceptible to environmental factors, their position as a culturally indifferent test of mental ability must be disputed. It is therefore surprising that the Society still provides space for declarations of the ‘culture-free’ nature of non-verbal IQ testing, as well as the assumption that such a psychometric tool will aid equality in selection procedures.
Alan William Gray
Durham University

Reference
Flynn, J. (1987) Massive IQ gains in 14 nations: What IQ tests really measure. Psychological Bulletin, 101, 171–191.

 

Reality TV – the problem of informed consent
Máire Messenger Davies (Forum, May 2009), followed by Helen Hughes and Rose Challenger (Forum, August 2009) have identified a problem which must concern psychologists. Broadcasts (over mass access channels and now, increasingly, via the internet) explore some human dramas that have occurred autonomously, and others that have been contrived by producers. The broadcast display of stress and distress, conflict and anxiety (which the press play a part in underlining, by publicising it as ‘stories’) is believed to draw in viewers. Before the 2003 Broadcasting Act, ushering in Ofcom’s apparent role of regulator of content quality, the BBC and the Independent Television Commission oversaw a market swelling with underfunded competitors; these were encouraged within an increasingly ‘light touch’ attitude to regulation; after 2003 the position
is now even more lax, so any sensibility and restraint with regard to treating those who appear in broadcasts, humanely, remains to be identified and if possible safeguarded by those with special interests, qualifications and competence.

Professor Messenger Davies hopes that informed consent is a crucial safeguard for proper treatment of those who appear in what are mistakenly labelled as ‘reality’ programmes. However, we presented a case based on evidence going back over two decades (McVey et al., 2001) that there are two limits to this notion; one lies in the phenomenon of ‘retrospective falsification of informed consent’ (which is where participants sometimes realise after the item has been shown, that they would not have consented to display, had they known its consequences); the other is the jeopardy to third parties of those who have agreed to publication of their own, ‘private’ lives and feelings (consider the husband and children of Jade Goody, or the small son of Alison Lapper whose nude statue stood for over a year on the Fourth Plinth in Trafalgar Square,for examples).

A very recent example of the problem for the third party is that of the footballer George Best’s sister; a televised play, well received by critics as a sensitive display of a human drama, was said (items in the Guardian, and Financial Times) to have particularly hurt her by the characterisation of her mother.

There may have been informed consent by parents and guardians of the children in the Channel 4 series, to which Messenger Davies referred, Boys and Girls Alone; but for the two reasons referred to above it is unlikely that such ‘consent’ validly absolves the consciences of the broadcasters.

To improve the plight of participants and of their third parties, there is scope for psychologists, at least, to influence the myriad ‘media studies’ courses so that future broadcasters become more careful of those whom they might (mis)use. This issue has been brought to the attention of the society quite long ago (Wober, 1978) and on a grander stage more recently (McVey et al., 2001)
J.M. Wober
London NW3

 
References
McVey, C., McKechnie, J. & Wober, J.M. (2001, March). Informed consent: The effect of the media on ‘documentary-soap’ participants, friends and families. Paper given at the Centenary Conference of the British Psychological Society, Glasgow.
Wober, J.M. (1978). Psychologists and the intrusion of broadcast ‘prygrammes’ on personal privacy. Bulletin of the British Psychological Society, 31, 1–2.

 

Policy on clinical terminology
Since most of the letters published in September’s Psychologist were supportive of David Pilgrim’s position, I felt it was important to redress the balance.Pilgrim states: ‘A diagnosis is a social negotiation with unequal power relationships determining the outcome [which] contributes to the stigmatisation of people labelled…’ (Forum, August 2009); while Anne Cooke refers to ‘phenomena traditionally seen as biological defects…rendering those affected somehow less than human’ (Forum, September 2009). I wonder if they would say the same about clearly medical diagnoses, such as diabetes or multiple sclerosis? The fact that medical conditions have a biological origin does not in itself confer any stigma on the sufferer: if people suffering from a chronic physical illness or disability do feel stigmatised, they do not blame their diagnosis for this, but attitudes to the condition itself. Yet for some reason psychological conditions are viewed differently.
The question of whether, or to what extent, psychoses have a biological origin is surely an empirical one, and despite what many psychologists claim, the issue is far from settled: interestingly the BPS document referred to by Cooke (www.bps.org.uk/3ndn) recognises the likely contribution of biological factors, stating that ‘[p]eople may have greater or lesser levels of vulnerability to this type of experience’ and that ‘[s]ocial, biological and psychological causes of psychotic experiences are all important, and interact with one another’. Similarly, the question of whether or not schizophrenia is a useful term is a theoretical one, vigorously debated within and outside psychiatry. But these issues should not be confused with political matters such as public attitudes towards those who suffer from psychoses. Theoretical conceptualisations of conditions are either helpful or unhelpful in understanding the condition, but not in themselves oppressive or stigmatising: if it does turn out that some people have a greater biological predisposition to develop specific psychological problems when faced with stressful life events (a conclusion that personally I find hard to avoid), why should this imply any more stigma than if their problems are entirely due to their life experiences?

With regard to the policy that The Psychologist should adopt in relation to terminology, while we can accept that psychiatric terminology is problematic, could I suggest that as a profession we are in danger of isolating ourselves from other mental health professionals if we refuse to use terms that are in common usage? It is healthy to debate these issues with our non-psychologist colleagues, many of whom would share our doubts; it is not healthy, in my opinion, to ban certain terms, which merely closes down debate. Interestingly, distinguished clinical psychologists who work in the field are happy to continue using the term schizophrenia without quotation marks or qualifiers such as ‘people diagnosed with…’ (e.g. Kuipers et al., 2006), which implies that Pilgrim’s views by no means represent a consensus within the profession.
Stephen Bamford
Sheffield

 
Reference
Kuipers, E., Garety, P., Fowler, D. et al. (2006): Cognitive, emotional, and social processes in psychosis: Refining cognitive behavioral therapy for persistent positive symptoms. Schizophrenia Bulletin, 32(Supplement 1), S24–S31.

 

Where is the dignity?
I read with some concern the second headline on the front page of the Daily Mail (20 August), ‘Did a man win the women’s 800m?’, accompanied by a photo of the women’s 800m gold medal winner Caster Semenya. My immediate thought was of the psychological impact on Caster. An announcement was made a few hours before she ran, at the world championships in Berlin, by the International Association of Athletics Federations (IAAF) that ‘they had requested a gender test’. The distress that must have been felt when a very public suggestion was made that you might not be who you think you are, can only be imagined; and not only that it was just before the most significant race of her life.
The catalyst for the gender test was the phenomenal time Caster ran in the African junior championships and the physical changes the South African had experienced. It is without any surprise that certain elements of the media felt that this item of news was so significant that it should warrant a headline on the front page, and be covered in further detail inside. On a refreshing note, a more balanced reporting style was taken by the Evening Standard (20 August), which covered this as a small article deep inside its sport section.

There are two key issues here; the first, when, if at all has the IAAF considered the emotional well-being of Caster? Surely the tests should have been conducted and the results obtained before making an announcement? What of the ethical issues of publicly making a statement that Semenya may have both male and female chromosomes?

The psychological impact of waiting for these results on anybody would be intense, let alone in the glare of the world’s media. The IAAF offered little consolation by the way of stating that ‘their main priority is to see the athlete treated with the respect and sensitivity she deserves and uphold the standards of the sport’. There appears to be an amazing lack of insight into the emotional well-being of Caster. This is not a doping investigation but a question that some in the sport have that examines who Caster is. Her self-identity is being publicly challenged. If the IAAF wanted to treat her with dignity they claim, they would have been well advised to ask for advice from any psychologist about the emotional distress the situation would present.

The only mention of health professionals is with regard to the three doctors who will be examining her internally and externally.

The second key issue is discrimination. Is Caster being discriminated against as a woman, on the basis that a woman’s body does not have the physical capacity to allow her to run such exceptional times? The ethical, discriminatory and psychological implications are very real and I am intrigued to see what fellow members of our profession think.
Phil Woods
University of East London

 

Support wanted for proposed Community Psychology Section
Community psychologists are found throughout Europe, North America, Central America, South America and Australasia, and community psychology is formally recognised by many national psychology professional organisations, including the American Psychological Association, the Australian Psychological Society and the New Zealand Psychological Society. In Europe the European Community Psychology Association is formally recognised by the European Federation of Psychologists’ Associations. Until now community psychology has not been formally recognised in the UK, and the purpose of this letter is to seek support from BPS members for the establishment of a Community Psychology Section.

Community psychologists: are concerned with the consequences for individuals, groups and communities of our social, organisational, cultural, socio-structural and politico-discursive arrangements; try to understand the interconnections between those arrangements and how people understand themselves and their social world; and use that understanding to promote well-being, health and social justice through non-individual intervention. Some UK psychologists work like this without recognising their work as encompassing community psychology approaches, and others may wish to extend their knowledge and skills to work in this way.

A proposal to form a Community Psychology Section of the British Psychological Society has been made to the Society. The requisite number of Fellows, Associate Fellows and Chartered Psychologists has written in support of the proposal, and the proposal has been approved by the Board of Trustees. For a Community Psychology Section of the Society to be established, it is a requirement that 1 per cent of the Society’s membership express a desire to become a Member of the proposed Section. If this happens, the proposal to form the Section will be put to a vote at a General Meeting of the Society. The aims of a BPS community psychology section would include:
I    promoting the study and understanding of community psychology at public, undergraduate and postgraduate levels;
I    raising awareness of issues, including government policies and global developments, affecting the psychological health, education,
and development of UK society;
I    fostering exchange of ideas through educational events such as workshops, conferences, symposia and training;
I    communicating the impact of inequalities on psychosocial functioning and challenging the dominance of individually focused models of psychosocial adjustment and intervention; and
I    facilitating community engagement, lobbying, advocacy and policy engagement.

Please contact the Society (e-mail: [email protected]) expressing an interest in becoming a Member of the proposed Community Psychology Section.
David Fryer
University of Stirling

Obituary
David McCarrell Campbell (1943–2009)


David Campbell, an inspiring clinical psychologist and one of the most respected and influential family therapists in the UK, has died, aged 65, of cancer. David was esteemed as a clinician of particular warmth and humanity, and as an exceptionally gifted trainer and supervisor. While he became best know for his writing and editing in the family therapy field, he remained strongly identified with the clinical psychology profession and taught a succession of clinical psychology trainees at the Tavistock in his 36 years working there.
Born in Chicago, the younger of two brothers, David came to Britain after qualifying as a clinical psychologist in Boston in the early 1970s. Initially trained in child psychotherapy, he quickly became aware of the need to address the contexts and relationships within which children live when they present with psychological difficulties. With colleagues he began to develop the family therapy service and trainings offered at the Tavistock Clinic in London, and, with his colleague Ros Draper, became the main proponent in the UK of what became known as the ‘Milan approach’.

Wearing lightly his great knowledge and breadth of experience, he brought a distinctive kind of grace and wisdom to all his activities. As a systemic thinker, he believed passionately in the generative potential of constructing ideas with others and he came to represent, personally and professionally, a commitment to helping people to see the ways in which they were connected to each other across apparent difference. Always calmly thoughtful and quietly spoken, he had a genuine and tenacious curiosity about, and respect for, other people’s perspectives, and this underpinned his striking modesty about his achievements and influence.
He constantly questioned and revised his own ideas, bringing new influences to bear.

His latest work drew on ‘positioning theory’, developed by Rom Harré, as a way of exploring conflict in both consultancy and clinical settings.

He was a workaholic, but also a devoted family man. He loved travel, especially to Scandinavian countries where the style of life and humour suited him, and water sports, which he pursued at his family house on a lake in northern Michigan.

Throughout the 20 months with which David lived and struggled with his cancer, he demonstrated an impressive openness to talking and writing about his illness. This was the last way in which he was able to touch, unforgettably, the lives of the very many people to whom he is irreplaceable.
Bernadette Wren
Tavistock and Portman NHS Foundation Trust

 

Am I OK?
I was pleased to see the note about the ‘Am I Normal?’ website briefly described in your August issue (p.660). In the light of this I would like to introduce you to our www.am-i-ok.co.uk site.The site has been up and running since March 2007 and has been drawing up to 16,000 hits per month. It took several years to be developed and has been vetted by solicitors, and the prototype content by the NHS Litigation Authority.
It is a signpost site that provides young people with a description of psychological risk resulting from critical incidents in their lives, plus a checklist of early warning signs. It effectively gives them tools and guidance to self-refer, directing them to their GPs and to our service.

Apart from the above core functions of the site, it also contains ‘Others’ stories’, a list of useful websites, a list of whom else the person can talk to and how to contact their GP (in the UK). It also has an e-mail feedback option to help us to keep the design and the process within the thinking of the age group.
Keith Butler
Buckinghamshire Early Intervention Service

 

Take your PIC
Having read Benjamin Gardner’s article (‘Incentivised snowballing’, September 2009) it was interesting to see that in line with general population trends, psychology appears to becoming gradually more technologically proficient. Acutely, this could be attributed to the continued dissemination of technology into our everyday lives. Chronically, such trends may continue due to cohort effects. It is my view that such effects, alongside the continued assimilation of information and communications technologies (ICT) into our everyday lives, should encourage reflections about how ICT can be integrated into different stages of the research process.

This reflection was something reinforced to me by during my doctoral research. This research sought to encourage vulnerable adolescents to record a series of vlogs (a form of video dairies) in their own homes. Understandably, ethical and safeguarding issues were a clear priority for all stakeholders, with each adding their own requirements in terms of what information needed to be communicated to this vulnerable population.
Following a pilot meeting with a group demographically similar to that of the target population, it became clear that despite my best efforts to synthesise this into accessible information, the young people were not able to fully understand what they would be needed to do. For this reason Participant Information Clips (PIC) were created. These short movie clips (for examples, see www.simon-hammond.co.uk/contact.php) were shown to participants, outlining the wide variety of information deemed vital in an accessible way. Conversing with the participants in this manner provided inherent flexibility and a non-authoritarian medium of information delivery.

Of course the effectiveness of PIC does need to be explored. However, beyond this process, future applications could see PIC being used to supplement or replace standardised instructions and debriefing in some internet-mediated research or face-to-face environments as appropriate. Alternatively, as in my own research, PIC could be used to communicate information to young people in an accessible and participant friendly manner. The use of PIC could not only improve participant experience but also promote the dissemination of the aims and implications of the studies to participants in an accessible and informative manner.
Simon P. Hammond
University of East Anglia

 

Recovery Research Network
There is an opportunity to join a network of recovery-focused mental health researchers in England. The NHS National Institute for Health Research (NIHR) has funded a five-year (2009 to 2014) programme of research around recovery in adult mental health service, called REFOCUS.

This provides an infrastructure to create a new informal network to support recovery-focused research relevant to mental health services. The agreed aims of the network are:

To create new robust research around recovery. This will involve conceptual and empirical work, importing critical tools from other disciplines (e.g. anthropological, historical, philosophical, sociological) and perspectives. Preliminary topics include conceptual understandings of recovery, methodological approaches, empirical studies, and approaches to changing organisation culture and professional practice. Specific tasks may include collaborations to produce new grant applications, holding events with international speakers, providing a meeting-point for researchers from different scientific areas (e.g. health services, research, well-being, social inclusion, identity) to develop collaborative links, or co-supervising PhD students.

A particular, but not exclusive, focus will be on developing ev

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