Who looks and sounds like a psychologist

Khadija Rouf argues that there is 'a real, and as yet, unnamed form of prejudice and discrimination against people who are survivors'.

I am moved to write in response to the new briefing paper regarding clinical psychologists who have lived experience. I welcome this important development from the DCP, and hope that this will extend through the BPS and beyond. It is long overdue. I want to thank the lead authors and contributors for their vital work on this document. If anyone doubts whether such a document is really needed, then please read Dr Anna Chiara Sicilia’s courageous and powerful letter, which brings home the meaning and resonance that this document really has, and what its potential impact could be.

As part of wanting to support this important DCP Statement, I also want to share something of my own experience of coming into the world of Psychology. Like many, I have been reflecting during the pandemic, trying to make sense of so much happening and its impacts upon us and the public we serve. There have been searching and uncomfortable questions asked about why Psychology still isn’t as inclusive and diverse as it should be. In the 32 years since I started my Psychology degree, I think some things are improved, but many things are much too slow to change. There is still a problem with who ‘fits’ into the profession, and it has got to change. 

My interest and journey in to Psychology came through lived experience. I am now a consultant clinical psychologist. I am also a survivor of childhood sexual abuse. These two aspects of my identity have collided throughout most of my career. There are experiences which I have weathered all through my career, but particularly when I was training and newly qualified.

In my mid-teens, despite the real fears of what would happen to me, I disclosed that I had suffered many years of abuse. I cannot convey here how awful the abuse was, nor the aftermath of it. There were many low points, including not being believed by some, being plunged into financial adversity, being cut off from many Bangladeshi relatives, going through the trauma of police procedures (which at that time were not adapted for abuse victims) and a court case being in process whilst I was trying to sit my GCSEs. 

I was helped by social workers and psychologists. It changed the course of my life, and it sparked my desire to help others. That I was able to go on that journey, is directly due to the support of close family members, the belief and encouragement of those who worked with me and due to state supports and benefits. Heading into Psychology was hard work and so exciting, full of possibilities. It is a career that is richly varied, challenging, stimulating and which I value immensely. I’ve been privileged to work with many hugely talented colleagues and made many friends, some of whom know my history and have been so supportive. I am very thankful to them – the difference that kindness has made cannot be overstated.

It is also true that for periods, the journey has also taken huge amounts of emotional labour to survive. All along my path in Psychology, I have variously encountered classism, casual racism, sexism, but also something which concerned prejudice about mental health and survivorhood. I was very open that I was a survivor when I applied for training; at the time, it didn’t appear to be a barrier. Yet, I had some of the most corrosive experiences during training, and I seriously considered dropping out. Compared to fellow trainees, I was subject to an unhealthy and invasive level of scrutiny, and placement experiences which I requested were blocked, because of assumptions made about my past. This was silencing and shaming. I was effectively being told not to speak up or show interest in any areas which might personally resonate with my past. Just grateful to be training, I didn’t have the confidence or power to challenge it. It also rendered me vulnerable, as I felt I had to be very guarded. Thematically, some of this continued in my early career, with some colleagues (both psychologists and non-psychologists) questioning my professional judgment because of my survivor status. They never appeared to question whether they knew enough about victim and survivor experiences – and it is difficult for me to separate these experiences out from other, intersecting aspects of my identity. 

It’s a strange kind of binary, where a profession built on understanding the human psyche, cannot cope with a person who happens to be both a survivor and a clinician. It led to me being very closed down about my history for many years, despite trying to write and think about it over my life. It wasn’t until I was co-presenting at conferences about the BPS Guidelines on disclosures of non-recent abuse that I felt able to be authentic again, in speaking up about my survivor identity. It was really striking how several audience members approached me after those events to thank me for speaking up; some also said that they were survivor practitioners or aspiring clinical psychologists.

I think my experience – and I assume others – highlights that there is a real, and as yet, unnamed form of prejudice and discrimination against people who are survivors. It is a kind of prejudice which can lead to harm upon harm, and it is part of a wider, societal constellation of injustices which can happen to those who have suffered trauma (Taggart and Rouf, 2018; Taggart and Rouf, in press). I think this is evident in Psychology and who is considered to ‘fit’ into the profession. The profession needs to do better at being trauma informed, and to adopt practices which do not cause some sort of ‘iatrogenic’ harm to survivor practitioners.

I am now later in my career. Writers like Sara Ahmed, Audre Lorde, Kimberlé Crenshaw and bell hooks, have helped me – it is these thinkers who have had the insights and conversations which were missing for me, when I was developing as a psychologist. I recognise the important difference it can make to speak up. It is my personal choice to do so, but I understand that the social and professional space is simply not standardly safe enough for everyone to speak out. 

We must also hold that people have identities which are multitudinous and intersecting; the impacts of speaking safely will be mediated by factors such as classism, racism, sexism, homophobia, transphobia, ableism and religious discrimination. This is not ‘woke’, it is just reality. Psychology is a discipline which needs to recognise internal and external worlds, and also understand that it has historically under-served people whose voices have been systemically ignored or silenced in the field of science and practice.  

It is important to change the shape of social spaces, and to ensure that the template of ‘who looks and sounds like a psychologist’ radically expands. Psychologist allies in leadership positions really need to step up in numbers, and to listen to clinicians with lived experience and work in true partnerships with survivors and the organisations who are speaking with and for them. And for everyone, it’s really important to know your legal rights, to seek allies, advocates and to belong to a trade union, who can offer support and advice if needed. We cannot leave this Statement on the value of Lived Experience resting on a website, and congratulate ourselves that we have done the work. We need to move to a space where talking, accepting and celebrating lived experience in the profession is safe and is the norm. It is also part of our rights to dignity at work, and to health and safety at work.

Some of the conversations in Psychology at the moment are painful and difficult. I’ve been in my career long enough to feel sceptical, to see that we have been here before. Despite that, I am also hopeful. In this time of grief and masks and silence and a rising tide of knowing and speaking, there is a change in tone and momentum. We simply must not lose the opportunity to all play a part in making Psychology a place where all people can be welcomed and claim rightful spaces as who they really are. 

- Dr Khadija Rouf, Consultant Clinical Psychologist 

If you have been affected by the issues in this article, please see sources of support:

NSPCC - https://www.nspcc.org.uk/keeping-children-safe/our-services/nspcc-helpline/

National Association for People Abused in Childhood (NAPAC) - https://napac.org.uk/calling-our-support-line/

The Truth Project - https://www.truthproject.org.uk/getting-in-touch

Rape Crisis England - https://rapecrisis.org.uk/

The Samaritans - https://www.samaritans.org/how-we-can-help/contact-samaritan/talk-us-phone/

References

BPS (2016) Guidance on the Management of Disclosures of Non-Recent (Historic) Child Sexual Abuse

Rouf, K. & Taggart, D. (2018) Is there Justice for Trauma Survivors? The Cost of Living blog.

Rouf, K. & Taggart, D. (in press) `Do No Harm’? Hearing and responding to victims and survivors. In Trauma and Memory: The science and the silenced.

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Comments

Thank you for writing this. I am pleased that these conversations are happening in psychology and that people are gradually feeling more able to share their experiences. I hope that one day, talking about our lived experience, whatever that might be, will be part of common practice in our profession. Until then, thank you for your brave article Khadja. 

all the best, Anna 

Thank you Khadija for this very insightful article and for publicly sharing your own experiences in advocating change. I like to think that the points made are being recognised in more and more quarters, within applied psychology, among our colleagues within the Royal Colleges of Psychiatry and Nursing, as well as the funders of health professional training. As someone who's worked in clinical psychology training for 20 years, I know that for many the journey to being heard, respected and supported by colleagues and seniors who should be listening attentively and valuing what those with lived experience can teach them has been a painful one. Too often have our colleagues and trainees with lived experience felt silenced, shamed and had their competence and professionalism questioned, something that we all have a responsibility to put an end to. 

Khadija asks that those of us in leadership positions step up. On this note, we're pleased to share the new guidance just published by the BPS: Supporting and valuing lived experience of mental health difficulties in clinical psychology training. www.bps.org.uk/sites/www.bps.org.uk/files/Member%20Networks/Divisions/DCP/Lived%20experience%20of%20mental%20health%20difficulties%20in%20clinical%20psychology%20training.pdf

This guidance was produced by the UCL Unit for Stigma Research (UCLUS) with input from many in the clinical psychology training community and with support from both the BPS who funded the work, and ACP-UK. The journey to publishing this guidance, which we hope promotes a change in discourse around mental health professionals with lived experience, was co-ordinated by Natalie Kemp, then Research Fellow at UCL and also Founder of in2gr8mentalhealth, demonstrating what working in true partnerships can accomplish. We warmly thank Natalie for her passion and staying power at many points when the going got tough, and also all the colleagues and trainees who generously gave of their time and personal experiences to help us arrive at these guidelines.

Katrina Scior

Professor of Clinical Psychology and Stigma Studies

Joint Director, UCL Doctorate in Clinical Psychology

University College London