Pushing the electronic sealed envelope
We were delighted that our paper on electronic records in the NHS
(available via www.bps.org.uk/dcppubs) has created sufficient interest
to attract correspondence in The Psychologist (Forum, April 2010)
The thrust of Rowena Mattan’s letter was that our paper seemed ‘to be saying that our best tactic is to adapt gracefully to this new reality’ (her words), based on our comment about the introduction of electronic record systems: ‘Are we too accepting of what is happening? On the contrary we think not… future generations may well ask what all the fuss was about.’ Mattan’s primary concerns relate to the impact of electronic records on confidentiality, that these systems may force record-keeping practice against the way psychotherapy works and that consequently, psychologists ‘should make a fuss’.
To set the context, our paper was published (two years ago) so as to enable NHS clinical psychologists to be informed of developments in electronic record systems and to be prepared for the introduction of such systems in their services. Our basic position was, and remains, that such systems will be widely if not universally introduced in the NHS, irrespective of the views of psychologists or psychotherapists, and that practitioners must engage constructively with managers and system developers to try and ensure that such systems neither distort clinical practice nor compromise the needs of patients. This will be particularly important if, as is happening, systems are ‘paperless’.
To this end, our paper described briefly and referred to another (also available via www.bps.org.uk/dcppubs), which provides a systematic framework to enable psychologists and other professionals in mental health services to assess and evaluate the systems being introduced or already in use in their services. It is intended that the use of the assessment scheme will ensure that neither patient care nor professional practice is distorted as a consequence of the introduction of such systems. Further, the information it provides can be used both for staff education (about the features of good clinical systems) and, more importantly, to support constructive engagement with IT managers and system developers aimed at improving the clinical relevance of systems. The issue of confidentiality and effective controls for all sensitive patient materials, notes and special documents such as completed psychological test forms – both particularly pertinent to psychological and mental health services – are salient and central in both publications. Indeed, it is remarkable that our concerns seem to have been missed by Mattan and, contrary to her reading, we do recommend ‘making a fuss’, albeit in the form of informed, consensual and constructive engagement.
Mattan further criticises the paper by implying that we accept that all of the record will be shared. On the contrary, we propose the introduction of a mechanism, an electronic ‘sealed envelope’ as part of the record, originally suggested by the NHS for the Summary Care Record. This takes the form of a ‘sealed’ section that should be available in the Electronic Clinical Record, the detailed record of clinical care kept by those delivering services. Accompanying the ‘sealed’ system would be controlled-access protocols to ensure protection for information deemed sensitive by the client. Given that there are at least 14 references to the notion of ‘sealing’ in the document, we can’t understand how even a cursory reading of the document could fail to miss our concerns about, and suggested solutions to, the issues raised by Mattan.
We are concerned too that Mattan’s account of therapy professionals’
behaviour in the world of paper records (e.g. maintaining
confidentiality unless there is a risk issue), ignores the current
legal state of affairs. Within the NHS, every piece of paper, and
indeed every thought it contains, are the property of the Secretary of
State, and subject to potential access by NHS employees or a Court
Order. Electronic records make this easier – one of the reasons for our
papers and recommendations. Nevertheless, the issue of separate records
for sensitive information, paper or electronic, is one that exercises
practitioners, psychologists as managers and non-psychologist managers,
as well as service clients. With paper records, it is easy to
obfuscate. Electronic records have pushed the issues to the fore and
these are now being actively addressed by psychology service managers
and others in the Division of Clinical Psychology. Whether or not an
accepted, imposed or even no solution emerges, remains to be seen.
Department of Psychology
Royal Holloway, University of London
Department of Clinical Psychology
North Yorkshire & York PCT
The ‘shoulder shrug’ of religion
I would not dispute that ‘religion is a powerful human reality’ (Sara Savage, Careers, March 2010), but that does not necessarily make it a good thing. Racism is a powerful human reality too. Perhaps we need to confront the societal manifestations of our superstitious nature rather than finding ways to indulge them.
The claims for good made by the religious are always immodest and unwarranted, the proper credit belonging to people. The innumerable harms including paedophile priests, 9/11, the spread of AIDS in Africa and stopping the eradication of polio to name but a few outweigh any conceivable advantage. Savage cites Piaget’s idea that the first way we know ourselves and the world is through our bodies; is it too much of leap to suggest that we then experience it through our evolved minds? These are complete with many compromises not specifically aimed at ‘truth’ – we have developed tools to see further, that is what science is.
We are orbiting one of 200 billion stars in our galaxy. We have not
evolved to comprehend such vast size, but with imagination we can.
Religion represents the ultimate paucity of imagination and offers
no predictive or useful explanation of anything. At best it is a solipsistic shrug of the shoulders.
We seem to be expected to be ‘sensitive’ and not point this out, allowing superstition and oppression to carry on almost unchecked. I hope that readers, trained as they are in critical thought, will not be fooled by attempts to allow explanations (which understandably seemed satisfactory in the Bronze Age) along with their institutions built by man to divide us and get in the way of our capacity for progress and wonder.
I would go so far as to suggest that people connected with
psychology should not encourage the recourse to magic and fantasy in
some misguided attempt at ‘inclusiveness’.
Meaning of money
Stephen Lea discusses the role of money in his interview (‘Scams, squirrels and drug money’, February 2010) saying that money is not just a tool – as ‘lots of psychological theories’ seem to suggest. Instead he suggests it is a drug, as ‘a lot of behaviours towards money…are odd in many ways’. If Professor Lea had broadened his research to include philosophy, which used to be until recently a joint pursuit with psychology, he would have found a rich and fruitful source pertaining to the definition and meaning of money in society.
Karl Marx, philosopher and economist in the 19th century, analysed
the fascinating complexity of money, in greater detail than perhaps
anyone else, in his ‘theory of labour’ (Economic and Philosophic
Manuscript of 1844). He explains that money derives only from human
labour, it is for most people the ‘alienated ability of mankind’. The
profit derived by a company boss from the labour of its employees gives
the former an unparalleled freedom: As Marx says: ‘Money can turn one
thing into its opposite, if I am ugly, I can buy myself the most
beautiful of women. Therefore I am not ugly, for the effect of ugliness
– its deterrent power – is nullified by money.’
This makes apparent how deep and vital people’s feelings and motivations in relation to money – both for those who have it and for those who don’t – necessarily are. Strikes are a case in point. So is the whole history of labour struggles for an eight-hour day, paid holidays, etc.
Research into money without exploring what its origins are, namely human labour, is likely to remain shallow and vague. Those who study it ought not to forget the old masters who have done this over a century ago.
Institute of Education, London
Hard-wired to see purpose in life
I greeted Jesse Bering’s article on the ‘nonexistent purpose of people’ (April) with mixed views. On the positive side, he draws attention to the evidence that human minds are biased towards seeing purpose in their surroundings, and that this will lead to a natural tendency towards creationist ideas – that there must be a purposeful God creating the complex world we see before us. I believe it is important to be aware of this and work to address it, rather than to see it as a lack of reasoning or something that would simply be minimised by a scientific education.
On the negative side, I was surprised that Dr Bering regards
evolution by natural selection as purposeless. He seems to be looking
for purpose outside the organism. But the sense of purpose is within
the organism – its purpose across an evolutionary timescale is to
survive and reproduce. This also applies to an individual organism,
human or animal. They have their own intrinsic purposes – for example
to keep safe; to keep satiated; to maintain proximity to conspecifics.
There is no need to look to a creator, yet there is purposefulness
To many people the idea of ‘purpose’ indicates some kind of homunculus that is not explained. However this is also not the case. Purposeful cognitive systems can be modelled mathematically using networks of negative feedback loops, each with its own internal standard, or goal, that it seeks to achieve and maintain through the modification of behaviour. This is the essence of cybernetics, which is incorporated into contemporary control theories. Those interested in this blend of purposefulness and mechanism may wish to see demonstrations at www.pctweb.org.
Taken together, it is not surprising if we are hard-wired to see
purpose everywhere – it is part of life, and we don’t need a belief in
a grand creator to appreciate it.
School of Psychological Sciences
University of Manchester
Training for educational psychologists in England
We write as first year trainee educational psychologists from a variety of programmes in England. At the time of writing, we are currently unsure of whether we will be employed this time next year. Despite significant discussion before the restructuring of the educational psychology training scheme from a one-year master’s course to a three-year doctorate in 2006, there seems to be a widening gap between what was hoped for and what has been realised. By this we refer to the lack of planning, funding and the subsequent uncertainty in which we currently find ourselves.
While we are in a position of excitement, enthusiasm and eagerness
as we embark on the first stage of developing careers as educational
psychologists, our position also creates uncertainty, stress and
frustration. Most trainees must secure their own posts for Years 2 and
3 with local authorities, and it is clear that the national situation
at present is patchy and incoherent to say the least – with some
courses running consortia associated with local authorities, whilst
have no allegiance to any single authority. With the added pressure on councils to make budget cuts due to the current economic climate, our survey of principal educational psychologists indicates that the numbers of available trainee vacancies is likely to fall significantly from last year’s levels. This puts huge amounts of pressure on trainees in terms of job procurement and possibilities of relocation, not to mention the financial pressure/loss of working rights for those who are funded by a bursary versus a salaried position. We hope that there will be enough posts for all 120 or so Year 1 candidates nationally to continue their training.
This is not the case for similar training courses; e.g. clinical psychology training, where the Strategic Health Authority funds trainees; or educational psychology training in Scotland, Wales and Northern Ireland, which is funded centrally. As these groups are funded by a central government scheme, we ask why this is not the case for educational psychologists in England? As an ageing profession, 6 per cent of the workforce is due to retire in the next three years, therefore there will clearly be a huge demand for educational psychologists if local authorities are to fulfil their statutory duties and truly improve outcomes for children and the people who care for and educate them. The current situation leads us to believe that this is not understood by central government, and the lack of agreement between professional organisations does not support our plight.
We propose a national scheme to fund educational psychology training in England, in which all government, either central or local, would subscribe to a single funding system that would not only more positively support trainees, but would also benefit local authorities by ensuring a steady stream of well-trained educational psychologists for children’s services.
Surely the current system is highly flawed and unsustainable. Without
a shared future in which training courses, professional organisations, local authorities and central government understand that a review of current processes is needed urgently for effective educational psychology training in England to continue, the road ahead for those entering the profession may be too uncertain to even take the first steps.
Norah Fry Research Centre
University of Bristol
and 80 other trainee EP signatories
Response from Harriet Martin, Chair of the Division of Educational Psychology (DECP): Currently all trainee educational psychologists (TEPs) receive a bursary during their first year of training. In their second and third years TEPs must apply to local authorities for positions. They are either employed and paid a salary or remain a full time student and receive a bursary. Fees for all three years are paid through the Children’s Workforce Development Council (CWDC), which has responsibility for administering the scheme and commissioning training places. Funds to pay for the first-year bursary and fees for all three years are raised by the CWDC through a voluntary subscription scheme. All local authorities are asked to pay a sum linked to the number of pupils in their schools. Local authorities have become increasingly unable and/or unwilling to pay their subscriptions. In the current climate of growing financial austerity they are also less able to employ/provide a bursary placement for second and third year TEPs.
The DECP, together with the other key organisations, the Association of Educational Psychologists (AEP) and the National Association of Principal Educational Psychologists (NAPEP), are all extremely concerned about the current situation. At a recent meeting of the three organisations, who meet regularly, we all agreed that educational psychology should become a fully doctorate profession and that the only viable, long-term solution to the funding difficulties is to establish a centralised system. The three organisations have also all repeatedly pointed out that the three-year doctorate is funded centrally in Wales and Northern Ireland and that clinical psychologists in training are funded centrally and employed by strategic health authorities.
The CWDC recognises these difficulties and inequities. It convenes the National Forum for Educational Psychology Training, where all interested parties are represented, including TEPs and the BPS, and has recently managed a working party to look at sustainable funding solutions for educational psychology training. However despite reports from these groups, lobbying, in particular by the AEP, and continuing discussion, central government (specifically the Department for Children, Schools and Families) is still maintaining that funding should come from individual local authorities rather than from a central pot. All organisations will continue to press for a national scheme in whatever ways they can, as they have done since the doctoral training was first conceived.
The DECP recognises that with every passing year the situation becomes more difficult and that the stress placed on TEPs by the uncertainty is not acceptable. It is partly because principal educational psychologists have been trying very hard to ensure places for all TEPs that the situation has become inconsistent. The same sum will provide for two TEPs on bursaries compared to one salaried position. Working together regionally can cut the number of applications and interviews TEPs may need to go through. None of these in themselves provide a long-term solution but are simply ways of trying to keep the current, inadequate system working so that we can continue to train educational psychologists for the benefit of children and their families.
Despite everything, graduate psychologists still want to work as educational psychologists. The quality and enthusiasm of current trainees and those who have recently qualified are very great. Evidence that educational psychologists can and do make a difference is clear and growing. The DECP, together with other organisations, will continue to do their best to ensure a long-term, sustainable solution to the funding of training.
Through my work with learning-disabled male offenders I have come to
realise the significance of education and knowledge to self-esteem and
motivation to change. A year ago I developed a literacy strategy to
enhance the communication skills of the clients with whom I was working
to improve access to and outcomes of therapy. Presently I am working
jointly with a social anthropologist and consultant clinical
psychologist to develop and teach an emotional literacy strategy for
learning-disabled offenders that addresses the need to recognise,
understand, communicate and predict the consequences of our own
emotions and those of others. There is very little research and even
less resource in this area that is appropriate for use with individuals
with varied offending and psychiatric history; hence, I am interested
in the work and views of other mental health professionals working with
offenders in a similar way.
Wanted: Spare neuropsychological tests for psychologists in Colombia, Latin America. Do you have a past edition of a psychological test, maybe an orphaned stimulus booklet or manual, one that’s too worn out to be used regularly, or simply one that’s going spare? Our department could make use of them for training, evaluation and test development. Anything considered.
Forum column: The real world
As we write this, the election has just been announced. As you read this, the result will be imminent. You will be enduring an endless stream of newsprint, of television debates, of opinion polls. Debate will soon turn to whether the media influenced our opinions significantly and whether the polls measured our opinions accurately.
But perhaps these are the wrong questions to ask – a phenomenon that we cannot attribute to politicians and journalists without looking closer to home. Herbert Blumer famously complained that we human scientists concentrate so exclusively on the process of producing answers (hypothesis testing) that we almost entirely neglect the process of producing worthwhile questions (hypothesis generation). And, as the novelist Thomas Pynchon remarked in his Proverbs for Paranoids, if you get people asking the wrong questions, you don’t need to worry about the answers.
To explain what we mean, consider the leadership debates. Like the election itself, these still lie in the future as we write. We can’t predict how the candidates will perform, but we can confidently predict that the key question that will dominate the press over the following days will be less about what Brown and Cameron said than about who came out on top. This is certainly true of the iconic Nixon–Kennedy debates. All we recall now is how Nixon looked shifty sweaty and swarthy, how Kennedy looked young, vigorous and open, and how Kennedy won the day – even though those who only heard the debate on radio as opposed to watching it on television adjudged Nixon the winner.
The point here is that what concerns us in such debates is not so much what we thought ourselves. It is rather what we think that others thought of them (which is not always the same as what others did think of them). In asking ‘who won’ we are dealing with meta-perceptions. And that matters, because in deciding what to think and – especially – what to do ourselves, we look to what other people, especially people like us, think and do. There is growing evidence, in a whole number of areas, that our sense of socially shared beliefs often impacts on people as much, if not more, than their own individual beliefs. Indeed, Julie Duck, Debbie Terry, Joanne Smith and Mike Hogg have shown us that individual attitudes only predict behaviour to the extent that one’s attitude reflects the perceived group norm. To give but one example, research conducted before the 2003 Gulf War showed that most Americans opposed armed intervention, but that most Americans believed that the majority supported armed intervention. It was the latter rather than the former which predicted their public actions.
Clearly, Fox News and its like must take much of the blame (or,
if you are George Bush/Dick Cheney/Donald Rumsfeld, the credit) for this. And there’s the rub. As recent research has established, mass media may not change a single person’s individual attitude but still have a massive impact on social affairs by changing our sense of what others think. This suggests that the question we ought to be asking after the election is not ‘did the media influence our opinions?’ but rather ‘did the media influence our sense of social norms?’. By the same token, we might move from asking ‘did the polls accurately measure our opinions?’ to ‘did the polls help form social norms?’.
That way, we might get a better understanding of what will happen in the merry month of May. New questions for a new Britain. After all, this election is supposed to be all about change. Let us, as psychologists, take that personally.
Steve Reicher is at the University of St Andrews. Alex Haslam is at
the University of Exeter. Share your views on this and other ‘real
world’ psychological issues – e-mail [email protected].
Self-harm and the internet
A 50 per cent increase over the last five years in hospital admissions of under-25s resulting from self-harm has quite rightly been widely reported in the media. However, I think it is unfortunate that much of the coverage has chosen to focus on the supposed role of the internet in this increase (e.g. Boseley, 2010). This has been justified with evidence suggesting one in five young people first heard about self-harm online. However, this means the vast majority of young people did not find out about self-harm via the internet, and those who did are unlikely to have stumbled across self-harm websites and videos by accident.
Some people who use self-harm websites do report an increase in their self-harming behaviours (Baker & Fortune, 2008). The websites can trigger painful and upsetting memories, and they can validate self-harm as a legitimate way of coping with distress. Using such sites can also lead people to feel negatively about themselves when they either fail to respond to the help of fellow website users or feel unable to be of help others. However, using self-harm websites can also lead to a reduction of self-harming behaviours by providing users with an important source of empathy and understanding as well as a sense of belonging and community. Ultimately, using the sites can replace self-harming behaviours as a way of coping with social and psychological distress.
The effects of using self-harm websites is an interesting and
complex question that is worthy of debate and further research.
However, there is a much more important, fundamental and potentially
difficult question, which the role of the internet appears to distract
us from. What is it about our society that large numbers of our young
people find so unbearable that they feel compelled to cut and burn
their own bodies just to cope with their everyday lives?
East London Foundation NHS Trust
Baker, D. & Fortune, S. (2008). Understanding self-harm and suicide websites. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 29, 118–122.
Boseley, S. (2010, 13 March). Doctors ask websites to monitor self-harm images as cases increase. The Guardian, p.5.
Do you work with gifted children?
The National Association for Gifted Children (NAGC) is a charity supporting the social, emotional and learning needs of gifted children and their parents and carers. It has been in existence for 43 years and takes 3500 enquiries each year through its Information and Advice Service. One of the most frequent questions we are asked is how parents can get their child assessed. NAGC refers families to a fact sheet on the website www.nagcbritain.org.uk entitled ‘Educational Psychologists – Advice for Parents’ and to the BPS website to search for an educational psychologist. However, many parents still have difficulty finding someone who specialises in the assessment of ‘gifted’ children. If you work with ‘gifted’ children I would like to encourage you to add this to your key words on the BPS Directory.
At the same time NAGC is happy to place a list of educational psychologists working with gifted children on its website with a link through to the BPS website. If you would like to be included on this list, please contact [email protected] by 31 May 2010.
Please note that this will not be a recommendation by NAGC.
Hopefully we will be able to ease the search for a suitable professional for parents and carers.
Julie Taplin Deputy Chief Executive National Association for Gifted Children
Given your special edition focusing on social inclusion (January), it seems somewhat ironic that many of these articles and other contributions to The Psychologist are not inclusive. I refer to the discriminatory omission of references to counselling psychology (and other applied psychologies) in many articles addressing applied psychological work.
Not one of the contributions to the special edition mentioned counselling psychology. Even in the article on applied psychology there was no explanation of what an applied psychologist was or that it meant more than just clinical psychology. On a quick search I could only find one mention of any other applied psychology in the body of the articles: occupational psychologists were mentioned once. Take these examples:
‘Also encouraging is her wish to confront the very real dilemma of
how to use expensively trained, scarce professionals – the specialist
versus generalist debate long wrestled with by clinical psychologists.’
‘To what extent are key developments in the organisation and practice of clinical psychologists in the community relevant to the problems of delivering effective mental health services in prison?’
‘Given the high levels of unmet need in the prisons, clinical psychologists also need to try to be involved with others in the screening processes used on reception and induction.’
I do not believe that this omission is intentional. Those who do it may not understand that like other discriminations which are institutional and embedded in the culture of an organisation, there needs to be a positive effort and policies put in place to make change happen. To this end, I am requesting that the policy committee of The Psychologist put policies in place to overcome this exclusivity.
I would suggest a policy that says: All contributors to The
Psychologist are obliged to consider when submitting material for
publication that their contribution does not, either consciously or
unconsciously, promote one form of psychological endeavour or applied
psychology over another where this cannot be justified. They are also
obliged to consider the inclusivity of material submitted to The
Psychologist. Material that promotes exclusivity and/ or
discrimination, and that therefore leaves The Psychologist open to
accusations of institutional discrimination if published, will not be
I would encourage members to comment on this proposal via these pages.
Lead for Promoting Counselling Psychology
Down(’s) syndrome learning curve
Having hoped to provoke discussion in a neglected area, I was delighted to read Janet Carr’s response (Forum, April 2010) to my letter about Down syndrome, given her acclaimed and long-standing reputation in this area.
To clarify, when I referred
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