Forum

in defence of the flashmob; Down’s; medicalising pregnancy; and more

In defence of the flashmob

I was delighted to see that I’d been chosen as poster-boy for the flashmob extremist fringe within our profession (Forum, February 2010). I do however need to counter a number of the themes in Peter Rhodes’ comments accompanying the photo.

Far from being representative of the ‘failure of our profession’ as Peter describes it, I believe the flashmob is emblematic of the way occupational psychology needs to move with the times.

I found Peter’s arguments depressingly reactionary when harking back to some golden era of occupational psychology practice 35 years ago. The disparaging comments about the general knowledge of current MSc graduates also seemed characteristic of an elder member of our profession holding patronising and condescending attitudes towards ‘young people’.

I confess that I am a mere stripling of only 15 years’ experience but I do not recognise the picture Peter paints of where we are now. He complains that occupational psychology has ‘given it all away’. Right now we find ourselves in the time of ‘free’; anything that is currently being charged for can one day appear on the internet for free – this is certainly true of testing. This is not a new phenomenon, just one that has been accelerated by technology. The elements of our offering that are now provided by other professions were never given away, they were taken. Any practice that works and has value will be taken, whether by consent, stealth or deception. The ‘psychometric credentialing’ Peter criticises (Level A & B to you and me) offered by the BPS at least enabled many providers to generate revenue from this inevitable process of dissemination while setting standards of practice.

What Peter seems to be arguing for is a ‘closed-shop’ model of practice. Not only is it undesirable to retreat into an elite, it is also too late; the genie is out of the bottle. Rather than the flashmob underlining the failure of our profession it signals a way for us to build on our strengths. A key failure is the obsession with becoming a profession – this has led us to the farcical position of HPC registration, with the BPS having essentially painted itself into a corner.

We need to let go of the self-deluding view that we can be a profession and recognise ourselves for what we are – an industry, and a cottage industry at that. This is not a depressing picture, but an empowering one. We should be focusing our energies on becoming an excellent provider of the niche practice and services that our clients value.

And this is where I agree with Peter’s arguments – we do need to listen more to understand our clients’ needs. But we do need to shout as well to get ourselves heard above the cries of those who would steal our clothes. Nobody is seriously suggesting that flashmobs are the sole means of getting the attention of the wider world, but we do need to adopt modes of communication that are more congruent with contemporary media. This means social networking, interest groups, viral campaigns. It also means grinding on with the more traditional means of interacting that many in our industry are most at home with.

As Peter concludes, we must connect with modern society but this means taking part in the conversation that is going on using the methods that may get us heard. We need to stop looking backwards and inwards and start shouting about what we are.

Alan Redman
Criterion Partnership Ltd
Brighton

Peter Rhodes (Forum, February 2010) makes many interesting points on the challenges faced by occupational psychology and the profession more widely, but certainly this is not the death of a profession that he postulates. Nor is the profession a failure. Few would disagree that a touch of humility is always a noble quality in any professional. Similarly, the recent event served to highlight the need for occupational psychologists individuallyor collectively to accept the leadership roles we all have in promoting the benefits of our profession – both for the good of organisations and those who work in them.

The use of a flashmob was a genuine effort to highlight the contribution of occupational psychology to the UK’s economic, social and political agendas. It was the embodiment of the spirit of innovation for which the profession is known. It should be noted that flashmobs are right at the cutting edge of what is known as experiential PR – the new way of making brands real for people. It simply aimed at opening dialogue. Far from being introspective with preoccupations of self-grandiosity, it demonstrates the maturing of a profession coupled with a willingnessto be open, engaging and, above all, in listening mode.

Nonetheless, there is much we can take on board from Peter Rhodes’ observations to inspire the profession to operate in a sustainable way. We would welcome him, and other members of the Division, getting involved with current Divisional activities. We hope to create
a bright and inspiring future for the practitioners of tomorrow.
Antonia Dietmann
Chair, Division of Occupational Psychology
on behalf of the DOP Committee Executive


Support for whistle-blowers?

Where were the ‘professional’ whistle-blowers (including various psychologists) during the years of neglect of patients at the Mid Staffs NHS Trust? Even if they were personally afraid of ‘management action’, they could have reported matters to their professional organisation, the BPS for example, who could take action on their behalf – post-HPC shouldn’t that be one of the remaining jobs it is there for?

A few years ago I got a powerful indication of the pressure that can silence prospective whistle-blowers during a staff-training workshop I was running at a central London college.

During discussion one young teacher, early in his career and with
a new family, reported that under pressure from government financial and other targets the college had recruited, and was asking him to teach, many students who were simply unqualified in terms of requisite knowledge and skills to start the course, let alone learn from it. His comments came as no surprise to the other participants.

I asked if he shouldn’t have reported this to his head of department, and he said that he had done so. I then asked what the response was and was told: ‘He said to me“I understand that you’ve got a mortgage”.’
Trevor Habeshaw
Bristol 


Aspects of Down’s syndrome 

I have a great deal of sympathy with Georgina Hutchinson’s complaint (Forum, February 2010), that autism has taken centre stage, the rest of intellectual disability, including Down’s syndrome, nowhere. The Psychologist is not the only professional publication to have gone down that path – I resigned from the Association for Child Psychology and Psychiatry years ago on the same grounds – although the specialist journals (Journal of Intellectual Disability Research, Journal of Applied Research in Intellectual Disabilities, and many others) go some way to redressing the balance.

 

I also agree with her statement, that people with Down’s syndrome have ‘a huge range of ability’; I have myself compared this with the range found in mainstream schools between ‘a potential university candidate and…a member of a remedial class’ (Carr, 1995). I agree too that it would be better to refer to ‘people with Down’s syndrome’ rather than to ‘Down’s syndrome participants’; let us at least be thankful that we no longer refer to ‘mongols’, as was the case until about the mid-1970s.

Other aspects of Ms Hutchinson’s argument are more problematic, beginning with her statement that not all people with Down’s syndrome have verbal mental age scores significantly lower than chronological age scores. I suppose it depends on what you mean by significant, but in the group of people I have been studying since they were six weeks old, even at four years old only a few of the most able children had verbal mental ages that amounted to just over half their chronological ages, and most were well below that. With increasing age the gap became progressively wider.

Elsewhere Ms Hutchinson says ‘We know people with Down’s Syndrome continue to learn at a greater pace well into their twenties’; I would be interested to know the evidence on which she bases that claim. Again, perhaps it depends on what aspect of learning is referred to. In my cohort, numbering 34 at age 30, for basic literacy skills (reading, writing, arithmetic), between age 21 and 30 seven people (20 per cent) made gains in reading, only three gaining by six months’ reading age or more; in writing 14 people made gains, three of three plus points (out of a possible 38); and, surprisingly perhaps as it is an known area of difficulty for people with Down’s syndrome, the largest number, 16 (47 per cent), made gains in arithmetic, although only eight gained six months’ arithmetic age or more. Looking at self-help skills (feeding, washing, dressing, toileting) eight gained four points or more out of a possible 58. Some learning then did take place, but by a minority, and most of it on a small scale.

Then, that ‘apostrophe s’. I am not sure which Down Syndrome Association Ms Hutchinson had in mind, the English Down’s Syndrome Association retains the apostrophe s, and so, as you may have been noticed, do I. Syndromes going by the name of whoever first identified them vary in their practice. Alzheimer’s retains it, Prader-Willi does not. My impression is that the fashion for omitting it is gaining ground, and I find myself increasingly having to omit it, especially when I am writing for a journal with transatlantic affiliations. My own position is that John Langdon Down, who in 1866 first identified the condition, and ran a remarkably humane and enlightened regime at his hospital for them and for others with intellectual disabilities, deserves the credit for what he did, even
if he did consider them related to the Mongol race. So where I can, I retain the apostrophe and the s.

One last concern. Of course we should delight in and celebrate those high-achieving people with Down’s syndrome who gain GCSEs, pass the driving test, and so on. My worry is that with so much focus on this group, the rest are in danger of being ignored – I have talked to mothers who felt that had been the case with their child. But ‘they too are important. They too deserve our attention and respect’ (Carr, 2009). It is true that there is, as Ms Hutchinson says, ‘a huge range of ability in those with Down Syndrome’. We should have as much consideration for those in the lower reaches of that range as for those in the upper levels.
Janet Carr
Bookham
Surrey

References
Carr, J. (1995). Down’s syndrome: Children growing up. Cambridge: Cambridge University Press.
Carr, J. (2009). 40 years of life with Down syndrome. Down Syndrome Quarterly, 11(1), 18–25.
Down, J.L.H. (1866). Observations on an ethnic classification of idiots. Clinical Lectures and Reports, London Hospital, 3, 259–262.



Over-medicalising pregnancy

Paula Nicolson, in the title of her article ‘What is “psychological” about “normal” pregnancy?’ (March 2010), raised a very important question. However, in the text she made a number of assumptions which indicate that her definition of ‘normal’ when it comes to pregnancy is very highly medicalised. Therefore, I think that without realising it she further subscribes to the medicalised policing of pregnancy and childbirth.

The reduction in mortality rates, for both mothers and babies, did not result from increased medical intervention but from the events which led to improved health generally: clean water and good sanitation, and improved nutrition. Specifically with regard to pregnancy, the major reduction in mortality resulted from an understanding of asepsis, safe blood transfusions, antibiotic therapy and antenatal care that detected pre-eclampsia before it became dangerous. It is only the last of these that is specific to childbearing.

The fictionalised good old days she mentioned were those when wise women had much lower mortality rates than man-midwives who went straight from dissecting corpses to performing vaginal examinations on women without washing their hands. And women have been relating to their unborn babies since time immemorial, long before the invention of ultrasonography: in her reference to Joan Raphael Leff she seems astonished that women might relate to their fetuses without having seen them, and in her astonishment she reinforces the over-prioritisation of the visual in this society generally and in medicine specifically. The experience of pregnancy and the postnatal period is profoundly tactile.

The research of Klaus and Kennell does not recommend ways in which women should behave towards their babies. Rather, it shows how women, if left undisturbed, do relate spontaneously.

Her conclusion seems to be suggesting that what is psychological is heavily influenced by the social, and I maintain that it is this that changes over time, not the physiological. I believe she makes very good points about how unrealistic ideals are unhealthy. D.W. Winnicott said that ‘there is no such thing as a baby – only a nursing couple’, implying that without a caring relationship the baby will die. He also referred to ‘good enough mothers’, and I think that when it came to describing mother–infant relationships he was very wise.
Meg Taylor
London N16


Value of voluntary placements

I read with interest articles in February issue (Forum, Careers) written by undergraduates doing their psychology degree course, describing their experience of work placements in clinical psychology. I feel it is timely to describe my current experience as an honorary assistant clinical psychologist after having completed a master’s in health psychology.

My own experience began with receiving only one positive reply to 40 e-mails requesting a postgraduate work placement as an honorary assistant clinical psychologist. I wondered whether there was more demand for such placements from postgraduate candidates as compared to undergraduates. Having a year’s postgraduate experience to enhance my research skills and theoretical concepts has helped me, under the supervision of a clinical psychologist, to take on project work – audits, designing information leaflets, etc. – at the substance misuse service that I attend. Through observing treatment sessions with multidisciplinary team members, I have been able to ‘connect’ theoretical knowledge with practice at this stage more than would have been the case as an undergraduate. I co-facilitate a ‘crack/cocaine’ group, deliver guided self-help with clients, and the background of a postgraduate degree helps in reflective thinking. Contact with senior professionals, by virtue of my own ‘seniority’ of experience, is giving me a ‘realistic’ feel of the place of clinical psychology in healthcare systems and motivates me to pursue this career further.

In conclusion, I feel that undertaking a placement in clinical psychology at an undergraduate level may give a ‘bird’s eye’ view of the work involved by virtue of the ‘junior’ stage the students are at. Its advantage is in giving the person an idea of whether it would be beneficial to get more experience in that field later on. Experience at a postgraduate level, by contrast, bridges that knowledge gap, and provides the ability to experience clinical work more independently, and in depth to get a ‘realistic’ idea of the field. The disadvantages are the tremendous competition involved at this stage and the financial pressures that may limit the amount of time that can be spent in the placement.
Sanchia Biswas
Batley
West Yorkshire


Psychological reductionism
Stephane Duckett’s suggesting as ‘absurd’ my declaration that he might be falling into the trap of privileging psychological interventions does not seem to me to be a valid substitute for reasoned and balanced argument.

I always remember my first client in 1976 (as a trainee clinical psychologist) who was referred for the psychological treatment of blushing, who turned out to have been using steroid cream as a foundation (unbeknown to the GP making the referral). Similarly, the client referred for anxiety by a neurologist who on assessment showed very specific neuropsychological problems. The MRI scan carried out on my advice showed two small infarctions previously undetected by head CT scan. Need I give more examples?

The point I am making is that all psychologists have a duty of care to consider the wider context of behaviour including social, physical and biological factors. Certainly psychologists are right to be sceptical about medical diagnoses as a proxy for accurate understanding of underlying biological processes, but we should remind ourselves never to fall into trap of mirroring biological reductionism with our own particular brand of psychological reductionism.
Michael Church
Royal Leamington Spa Rehabilitation Hospital
Warwick 


Working through terminal illness

Like ‘anonymous’ (Forum, January 2010) I have recently been in a situation where a close colleague of mine who was in his 50s worked up until the last few weeks of his death. My colleague was a physician and academic. One year beforehand he had been diagnosed with mesothelioma. He actively chose to continue his academic work until his illness completely took over his physical and emotional energy, although he gave up his work as a physician immediately. He died on Christmas Eve 2009.

Yes, I experienced great emotions as he went through the process of diagnosis, prognosis, radiotherapy, chemotherapy and a constant search for new breakthroughs in medicine that might give him a few more days of life. Yes, analysis of data, report writing and grant applications were all affected by his illness as he could only work on his ‘good’ days. Yes, I took on additional workload too. And yes, yes, yes to the long list of additional emotional and practical factors that the letter writer highlighted as being part and parcel that working alongside a dying colleague brings...

Except in my experience we did not feel that we had to be positive. Indeed, we acknowledged our deep and utter sadness of his predicament. We also explored his reasons for wishing to continue working when he had a wife, children and many, many friends to spend time with. Essentially, being a physician and academic were intrinsic to his identity: without this he was dead already. While he didn’t have the emotional space to care for others, he still had the intellectual space to contribute to our work. Throughout 2009 we worked together whenever possible. But nothing was taboo. Yes, the first half of our meetings comprised catching up on how he was, and it was always extremely emotional, but his passionate and intellectual engagement with both this and with our subsequent ‘getting down to business’ was inspirational. We do not leave our emotions at home when we go into work. None of us do. Death and dying is part of life. Yet we’re so keen to ‘hide’ this: death is a taboo subject and we ‘shut away’ people who are dying. Perhaps we need to consider why ‘anonymous’and people like him/her feel so aggrieved at working alongside (and supporting) a dying colleague. Whilst it has been a profoundly deep emotional time for me, I have grown from my experience of working alongside my colleague in this way, and to deny him his identity at a time when he needed to hold on to as much normality as possible would have been unthinkable and inhumane.
Name and address supplied


Making a fuss about electronic record keeping

My response on reading the DCP publication Clinical Psychologists and Electronic Records: The New Reality [see www.bps.org.uk/dcppubs] was one of disappointment. This publication describes and discusses the impact of electronic record keeping for psychologists working within the NHS and seems to be saying that our best tactic is to adapt gracefully to this new reality. Berger and Skinner conclude: ‘Are we too accepting of what is happening? On the contrary we think not…future generations may well ask what the fuss was all about.’

I beg to differ. First and foremost there is the issue of confidentiality: clients see therapy as a safe space where they can talk about a range of deeply personal and intimate issues knowing that confidentiality is ‘shared’ with other professionals, they know that updates are relayed in a careful, respectful and confidential way regarding their progress in therapy, but without full disclosure of often very intimate details. Electronic record keeping, where this is the only record of client activity, systematically removes this safety.

It is often put forward that electronic records allow for more efficient communication between professionals sharing a client. While this is indeed the case in terms of risk issues, medication, etc., I propose that they also can be detrimental to team communication as they can be seen as a substitute for talking and discussing shared clients, something which, I believe, is a cornerstone of multidisciplinary teamwork.

This issue is further complicated by the fact that things written down can be easily misconstrued if not accompanied by a discussion. In therapy complicated and sensitive issues often arise (e.g. discussion around existential feelings of suicidality or abandonment or rage) without there being any intent to act on any of them. It is possible that a co-worker could read accounts of such emotional experiences and misconstrue them as concrete expressions of intent or evidence of real risk.

Furthermore, electronic record keeping takes away the client’s basic right to choose how to present themselves to different people. If a client decided to emphasise or de-emphasise a certain issue with one professional, then for that professional to hear a slightly different account of that issue through the records of a different team member would compromise this right. Two scenarios are possible here, both of them fairly dire in my opinion. In one scenario, the professional may challenge the client ‘knowing’ they have presented themselves differently elsewhere, or they will say nothing but will know something about the client that the client does not know that they know. Either way it is messy with potential real impacts on the
quality of the therapeutic relationship.

It is imperative for us, as psychologists, to ‘make a fuss’ over a system and culture that is so totally at odds with how psychotherapy works. It would be pointless and counterproductive to attempt to block or eradicate electronic record keeping altogether, as I can see that they clearly have many advantages, administrative and otherwise; and I recognise that it is important to acknowledge that record keeping will change as society and systems become more and more electronically led. However, ‘making a fuss’ is important so that we can generate and contribute to a dialogue, both within our workplaces and nationally, that will hopefully influence development of a form of electronic record keeping that is more in line with psychological thinking.
Rowena Mattan
Department of Healthcare Psychology
Airedale General Hospital

 

EI in schools – what’s missing?

The UK government is spending over £13 million in the coming year to embed the social and emotional aspects of learning (SEAL) into the curriculum and culture of primary and secondary schools. Are these emotional intelligence approaches based on sound research which support their methodology, or is there something missing? 

In academic circles an emotion is generally accepted as consisting of several components: physiological arousal, cognitive processing, conscious feelings and action tendencies/motor expression. All of these components interact to produce an episodic experience – an emotion. So by definition emotional intelligence is the management of one’s emotions and the emotions of other people by understanding all of the components of an emotion and their consequences.

The emotional intelligence agenda in schools seems to be based around a James-Lange model of emotions, where the vast majority of resources for all of the key stages in the SEAL project, for example, focus on the behaviours associated with emotional intelligence, perhaps with the assumption that changing behaviour will change the emotions experienced. Where is the evidence supporting this approach to emotional intelligence in school? Would it make sense to pay more attention to the cognitive role in emotional intelligence projects, considering the success of the rational emotive therapy of Albert Ellis and others?

Interestingly, section 5.1 of the Department for Children, Schools and Families’ guidance booklet on social and emotional aspects of learning for secondary schools states that it is of particular importance to ‘Make sure learners believe they can learn and that it is within their reach and capability’. If a belief system is so important (which is what Ellis has found), then why don’t the resources reflect the importance of thoughts and belief systems in shaping behaviour and emotional intelligence? In the key stage 4 resources of SEAL there are only two resources that focus on the role of cognitions: they examine the link between thinking (belief systems), behaviour and feelings (Resource sheet 3.7.3: Positive self-talk) but do not appear in other resources or underpin the learning of how an emotion is created.

Although the evidence around the study of emotions is inconclusive, the evidence supporting the effect of cognitions changing behaviour is extensive. Therefore I believe the methodology for a national project on emotional intelligence be supported by evidence of ‘what works’, by paying equal attention to the cognitive element of an emotion. I would be interested to hear other professional opinions on the methodology used in emotional intelligence programmes in schools and how these programmes should be measured and assessed.
Will Calver
University of Greenwich


Obituary
W. Bryan Dockrell (1929–2010)

Always keen to be at the frontiers of research, Bryan took wry pleasure in being diagnosed with a condition that had first appeared in the literature only two years before. With degrees from Manchester, Edinburgh, Trinity Dublin and his PhD from New York and Chicago, he headed literally to the frontiers of educational research first to Northwest Canada and much later to Sri Lanka, Jordan, Pakistan and finally Nepal. His love of frontiers is illustrated by tales of taking his family riding elephants to chase tigers in the Himalayas and, with his guide and friend Rajesh, building an igloo to survive a snow storm.

This pioneer’s appetite for adversity, while getting on with what called out to be done, seems somehow characteristic. Bryan was, from 1971 to 1986, Director of the Scottish Council for Research in Education (SCRE). But that bald statement reveals little. Set up by the Scottish teachers union (the EIS), SCRE was just one year older than Bryan. At first teachers did most of the research including a remarkable survey of Scottish intelligence, which is now approaching its 80th birthday and currently yielding a stream of publications from Ian Deary and his colleagues. By the 1970s, in the face of the surge in government control of research, SCRE received a block grant, its own building and a new Director with a mission. Unfortunately, the Council’s control of its research programme was soon eroded by the emerging ‘customer-contractor’ principle.

Managing a research institute is always a difficult enterprise. Researchers must feel free to explore questions as yet unclear, while Directors give sponsors the impression all is tightly controlled. What Bryan did was let the bureaucrats have their say but take little notice. He got money for one purpose and used it for another. Naturally, this infuriated some of the bureaucrats. In the end, they found a way to get rid of him. But not before he had kept alive work on the, by now unfashionable, topic of ‘intelligence’ and simultaneously promoted work on the assessment of wider aspects of competence.

His pursuit of the unconventional but important went with him to Newcastle. With his son and daughter he raised funds for an inventive evaluation of an educational programme designed to reduce the risks of HIV infection. I vividly recall him summarising the results by saying that he had never before given an attainment test in which 95 per cent of those tested knew the correct answers. They knew what they should do – use condoms etc. – but just didn’t do it! Once more, it was the wrong solution to the wrong problem.

So now you have the picture… Bryan was someone who, under adverse conditions, found ways of facilitating the important. His mark is left through On Intelligence, Parlett and Hamilton’s Beyond the Numbers Game, Dockrell and Broadfoot’s Pupils in Profile, Dockrell & Hamilton’s Rethinking Educational Research, Hope’s As Others See Us and my own Managing Education for Effective Schooling [see www.psychforum.org.uk, under the ‘Obituaries / recollections’ thread, for a list of Dockrell’s publications]. More than this, he leaves a devoted wife and family and many, many, friends.
John Raven
Edinburgh


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