Beyond borders in applied psychology

Nick Hammond and Nikki Palmer ask whether we are united by commonality, or divided by difference.

The late, great, Wilfred Bion once said about psychoanalysis, ‘I get so sick and tired of hearing about the various different schools of psychoanalysis and their great superiority to the other one – whichever it is’ (Bion, 2005, p.39). Though not necessarily named, issues of hierarchy, division and specificity are embedded in the histories of applied psychology. They can be seen from frontline roles through to the policies and organisations that are concerned with governing the profession.

Yet professional applied psychology, like psychoanalysis, has much that unites the various areas of specialism. As Bion elegantly pointed out in respect of psychoanalysis, ‘the possibility of arguing about their various merits is simply endless – as long as you don’t anchor any of it to facts’ (Bion, 2005, p.39).

A divided profession
The British Psychological Society (BPS) has 10 divisions, 19 specialist sections and a further three special groups. This is not a criticism: the BPS and similar organisations play an important and complex role in maintaining excellence and ethicality in practice, as well the development and promotion of psychology. As others have said, such a domain focus demonstrates the diversity within psychology, but may also fragment it (Dias Neto et al., 2019). Indeed, it is in these extensive categorisations that we can see a focus shift from commonality to differences between psychologists.

Of course, this can bring benefits; for example, for psychologists seeking out appropriate context and domain specific CPD and supervision. However, in contrast, we must understand that these categorisations are socially constructed. They give meaning and shape to what a psychologist can and cannot do, and that meaning is implicitly or otherwise embraced by society. Importantly, this can be an inhibiting factor in recognising commonality, which in many cases is far greater than the differences.

Let us take a moment to provide a real-world example of what we mean. Clinical, counselling and educational psychology are three branches of applied practice. Of course, each branch is distinctive in its own right. Educational psychologists specialise entirely on working with children and young people, from assessing learning potential to mental health intervention, and they have extensive knowledge of education and allied systems. Clinical psychologists specialise in the assessment and intervention of complex and enduring mental illness across the lifespan and within families, and they also have extensive knowledge of the application of psychology to neurological and other physical health needs. Counselling psychologists have an unparalleled depth of knowledge in the delivery of therapy for both mental illness and life events, such as bereavement or domestic violence. Moreover, this specialism is the only branch of professional psychology where personal therapy is mandatory. Yet, the three also share many similarities. For example, all can be considered therapeutic practitioners by virtue of their training, and all offer forms of therapy to children and young people (Hammond & Palmer, 2021). Additionally, they all work in a range of settings, including schools, NHS community mental health teams, youth justice services, and voluntary sector organisations, to name but a few. You’ll also find many of these psychologists sharing wide and varied interests, including the impact of power, disability, social inequality and inclusion on mental wellbeing, across a range of community-based settings. And in 2021, we need applied psychologists to come together, more than ever.

Official statistics show that around 18 per cent (1 in 5) of those accessing mental health and learning disability services in 2018/19 were children and young people aged 0-19 (House of Commons, 2020). These figures, however, only capture the children and young people who are known to services. Researchers have found that 69 per cent of young people reported a decrease in their mental wellbeing after returning to school in September 2020 amidst a global pandemic. Yet only 15 per cent of children and young people felt there was enough information and support to meet their mental health needs. The pandemic has therefore seen a rise in mental health needs amongst children and young people (e.g., YoungMinds, 2020; Crawley et al., 2020), who are at significant risk of prolonged mental illness (e.g., Loades et al., 2020; Singh et al., 2020).

There is, therefore, a profound need for psychologists to provide mental health services throughout the UK. What we suggest is that commonality between branches of applied psychology has been lost amongst our differences and the merits of our own professional community. This can only be at the detriment of the society psychologists are here to serve.

For example, in the case of mental health, those psychologists with appropriate competencies and experience can offer various forms of therapy (see Hammond & Palmer, 2021). Whilst there may be differences in context, approach or, in some cases, type of need, it would be inaccurate to conclude that therapy is domain specific. The same can be said for a whole host of examples, from systemic development (e.g., training) to establishing learning profiles.

Moreover, psychologists work across settings: clinical in education contexts and educational in clinical or community contexts. The convergence of skills, knowledge and training as well as additional CPD and experience, allows this to be the case. By doing so, society benefits as a whole because psychological knowledge and support can be disseminated in the most efficient and effective way. It is through development of skills and knowledge alongside appropriate experience and supervision, the divergence between applied domains narrows and, in some cases, quite significantly.

A professional process of discovery and reflection
In 2018 we published a two-year study titled Personalizing Education: A person-centred approach for children with special educational needs. Whilst the book explored the use of a Person-Centred Review (PCR) process in the changing context of Special Educational Needs and Disabilities (SEND), it also lent itself to an unanticipated process of professional self-discovery and reflection. We showed that, for example, psychologists are well placed to deliver such interventions because of their added value of being able to use skills such as flexible problem-solving, facilitating complex group processes, redressing issues of power distribution and, importantly, applying evidence-based psychological theory (Hammond & Palmer, 2018).

This prompted us to explore these similarities further in relation to the use of therapy, specifically, but not exclusively, between clinical and educational psychologists (see Hammond & Palmer, 2021). These branches of applied psychology have arguably had their roles and skillset over-simplified, and this has led to specificity in their deployment to support people in a therapeutic capacity. A simplified example would be clinical psychologists are channelled into assessing and treating people with mental illness across the lifespan; educational psychologists are often faced with the traditional perception that they complete assessment of learning.

Whilst there are elements of reality in both assumptions, as we have discussed already, this is far from the whole picture. For example, clinical psychologists are more than able to undertake assessment of learning needs or deliver training to schools. Equally, educational psychologists have a statutory role in contributing to Education, Health, and Care Need Assessments (EHCNAs). But they also have the most extensive training in working with children and young people (see Hammond & Palmer, 2021) and deliver a broad range of therapy and therapeutic interventions to this client group (e.g. Hammond & Palmer, 2021; Simpson & Atkinson, 2019; Squires & Dunsmuir, 2011). This is why many educational psychologists, will often refer to themselves as educational and child psychologists (or a variation thereof).

The competence of a psychologist
Our initial discovery led us to pose a broader question: is what unites us as applied psychologists greater than what divides us? Or did we simply stumble upon some curious anomalies?

To explore this further, we turned to the Health Care Profession Council’s (HCPC) Standards of Proficiency for Practitioner Psychologists (HCPC, 2015). There are 227 individual Standards across seven protected titles, namely: clinical, counselling, educational, forensic, health, occupational and sports. One hundred and fourteen of these Standards (around half) are shared across all seven branches. Whilst our approaches may be different, driven by our client group or context, our skills do substantially overlap.

Perhaps more intriguing then, is the breakdown of the other half. Clinical has 17 additional standards; counselling 25; educational 20; forensic 17; health 17; occupational 7; sports 10. In other words, across all branches, the differences in registration Standards equate to no more than 11 per cent in any one branch of applied practice. Moreover, these differences often reflect specific contexts or nuanced specialist skills.

Whilst these differences are, of course, important, we do share many of the same competencies and, thus, may be suited to deployment in contexts beyond our specific specialist title (see Catherine Dooley and Hannah Farndon in the March issue, on the new BPS guidance on Best practice in psychology recruitment; tinyurl.com/bpsbppr). Indeed, the BPS issues a single set of Practice Guidelines (2017), developed by psychologists from across the profession.

It is of course important to respect these differences too. This is especially the case in respect of continued professional development, supervision and specialist knowledge of context, for example. Yet, overlap in competencies is likely to increase for many, depending on additional training and experience gained by the psychologist (see HCPC, 2015). Is it not time to see beyond the borders and respect the skills and experiences of individual psychologists, rather than assuming a skillset by title alone?

We suggest it is important to promote the interconnectivity of different applied branches, whilst appreciating different training routes as well as individual competence and experience. In doing so, we begin to move beyond boundaries, which are often misconstrued and misleading, to an arena of applying psychology to support the development and wellbeing of humanity as a whole.

This is not, however, the same as saying, for example, one can simply become a psychologist in a specialist field by undertaking CPD (e.g. clinical to educational or vice versa). Rather, additional training may well create a greater overlap of competencies – as we have argued in respect of therapy between clinical and educational psychologists.

Realities and opportunities
The role of domain-specific psychologists goes beyond competencies. Whilst, to some extent, overlap may occur through additional training, it cannot replace the nature of these initial training routes. Every domain has its specialised client group and context – each of these requires a different knowledge and approach in practice. But is it possible or, indeed, desirable, to bring together training for these different domains?

Well, this is not a new concept. The Australian pathway for training psychologist works in this spirit. For example, the first six years of training is to become a general psychologist. The Australian Psychological Society (APS) estimates that over 60 per cent of psychologists are registered for ‘general practice’. These psychologist work across many different settings, undertaking the same range of duties as a qualified psychologist in the UK. These psychologists may then wish to work towards what is known as a practice endorsement. This involves an additional two years of supervised practice in one of nine named areas of endorsement, including clinical, counselling, educational and developmental and community psychology, amongst others. Across Europe, the picture is variable, but there are pathways including generalised training to become a psychologist (Dias Neto et al., 2019).

Given the similarities in competencies across the branches of applied psychology, would it be plausible, and indeed, desirable to establish a similar approach in the UK? It has in fact already been debated – many times, in some fields of applied psychology. For example, the Department for Education (DfE) proposed a combined professional psychology training programme at doctorate level, for both clinical and educational psychologists. The proposed programme would combine the specialisms of educational psychology (working with children and young people) with the specialisms of clinical psychology (working with families) (DfE, 2011). This would be an initial generic training, followed by the trainee choosing their specialisation later into the programme. Whichever the trainee chooses, they would graduate as a qualified family psychologist, but would simply be more accustomed to either a ‘clinical’ or ‘educational’ system, orientation and practice customs.

Why, then, has this idea not caught on – not only for clinical and educational psychologists, but rather in the way Australia develop their psychology workforce? The answer is perhaps rather complex. One may be tempted to oversimplify the issues, for example, to pigeon-hole applied psychologists into a specialised domain, or lean on the social constructs of each protected title which dictates context and approach. But, as we have seen, there is much diversity between individual psychologists let alone different domains. Moreover, to remove specialisation altogether overlooks the importance of nuanced skills and approaches. Could we, for example, expect an occupational psychologist to offer therapy or assessment of a child? Probably not, unless of course, they can demonstrate appropriate competencies to do so through experience and training. Further, psychology sits within wider social constructs. For example, although the DfE (2011) found merit in the proposed new combined programme, they noted several structural issues that prevented this from happening. These included inequality and organisation of existing funding arrangements between the two branches, training structures, and wider social structures (such as the way these two branches of applied psychology are commissioned).

The reality then has been provided quite succinctly by others, ‘…it is important to maintain the unity of psychology while respecting professional and scientific diversity’ (Dias Neto et al., 2019, p.6). In order to achieve this successfully, there must be concerted effort to appreciate not only differences in initial training, but also competencies accrued after qualifying.

Where next?
The publication of Catherine Dooley and Hannah Farndon’s article in the March issue of The Psychologist is timely. They suggest that progress will be made through a gradual culture shift amongst those employing psychologists. In this article, we have argued for the many benefits of domain generalisation, whilst respecting domain-specificity to some extent – somewhat of a stalemate, perhaps.

However, we do agree with Catherine and Hannah, and we further suggest that perceptions and narratives surrounding applied domains are, largely, misleading, misunderstood and misplaced. These have been socially constructed and over time, have become embedded in our culture, history, traditions, discourse and, perhaps to some extent, territoriality between domains. We do not claim to have avoided these traps ourselves, in fact.

And so, we conclude by appealing to applied psychologists and the wider audience with an interest in psychology, to re-consider how the language we use may well misrepresent and create much misunderstanding amongst the people we are here to serve. This is not an argument of competencies; in that respect, there is evidently far more that unites than divides us. Rather, it is in the narrative we have come to use in relation to applied branches of psychology. We must recognise differences, of course, but also place a far greater focus on commonality in order to remove borders, and move towards a shared interest (and competence) in applying psychology to make a constructive difference to human beings.

What this look likes, perhaps, is not so much about the branch of applied psychology to which one belongs, but more to do with individual psychologists who build up competencies both within and across borders, as the HCPC states:

Your scope of practice is the area or areas of your profession in which you have the knowledge, skills and experience to practise lawfully, safely and effectively, in a way that meets our standards and does not pose any danger to the public or to yourself (HCPC, 2015, p.4).

Thus, a psychologist, with registration within any domain, who can demonstrate competence which is otherwise specific to a different domain, may wish to use a more generic protected title, that is, Practitioner Psychologist (Dooley & Farndon, 2021). For example, if a psychologist undertook additional training in a different domain, perhaps in psychotherapy, they may well be able to demonstrate counselling psychologist specific competences, such as understand how empathic understanding can be helped by creativity and artistry in the use of language and metaphor (HCPC, 8.17) or be able to critically reflect on the use of self in the therapeutic process (HCPC, 11.5). Of course, this is not the same as being a counselling psychologist or using the title. Rather, it becomes another shared competence and adds credence to us being united as applied psychologists both by our initial training routes, to some extent, and additional post-qualification training and specialism.

We recognise that the complexities argued here are likely to be emotive. But, as painful as it may feel, we suggest the way forward is to name what it is that makes us feel uncomfortable. From here, we can reflect on the opportunities these discussions offer in an honest and respectful way. We will end, as we began, with some words from Bion as a cautionary note to us all as we move forward in considering what this all means for us, as individuals and as groups of professional psychologists:

‘… the curious thing is that as soon as we are contained in a group, it seems to be very difficult indeed to go in the direction of developing thoughts or ideas or feelings of our own; we are dominated by a need to be like everybody else and to think what everybody else thinks and feels – although how to tell what everybody else thinks or feels may be something we would find very difficult to formulate’ (Bion, 2005, p.74).

- Nick Hammond
Practitioner Psychologist (Education & Child)
[email protected]

- Nikki Palmer Trainee Practitioner Psych (Education & Child)
[email protected]

Twitter: @PP_Psychology

References

Bion, W. (2005). The Tavistock seminars. Routledge.

Crawley, E., Loades, M., Feder, G. et al. (2020). Wider collateral damage to children in the UK because of the social distancing measures designed to reduce the impact of COVID-19 in adults. British Medical Journal Paediatrics Open, 4. DOI: 10.1136/bmjpo-2020-000701.

Department for Education. (2011). Developing sustainable arrangements for the initial training of educational psychologists: Final report. Crown.

Dias Neto, D., Figueiredo, S., Biscaia, C., et al. (2019). Routes for specialization in psychology throughout Europe. Behavioral Sciences, 10(7), 1-13.

Dooley, C. & Farndon, H. (2021). We’ve got vacancies, and we’re missing out on the right people: New advice on best practice in Psychology recruitment. The Psychologist. Leicester, UK: BPS.

Dunsmuir, S. and Hardy, J. (2016). Delivering psychological therapies in schools and communities. Leicester, UK: The British Psychological Society.

Hammond, N. & Palmer, N. (2021). Between Therapeutics and Therapy: The continuum of therapeutic practice and the role of ethical blind spots in decision-making. Educational Psychology in Practice, in print.

Hammond, N. & Palmer, N. (2018). Personalizing Education: A person-centred approach for children with special educational needs. Trentham Books / UCL-IOE Press

Health and Care Professions Council. (2015). Standards of Proficiency: Practitioner Psychologists. London, UK: HCPC.

House of Commons. (2020). Mental health statistics for England: Prevalence, services and funding. Briefing Paper, 6988. UK, London: Crown.

Loades, M., Chatburn, E., Higson-Sweeney, N. et al. (2020). Rapid systematic review: The impact of social isolation and loneliness on the mental health of children and adolescents in the context of COVID-19. Journal of the American Academy of Child and Adolescent Psychiatry, 59(11), 1218-1239.

Simpson, J. & Atkinson, C. (2019). The role of school psychologists in therapeutic interventions. A systematic literature review. International Journal of School and Educational Psychology. DOI: 10.1080/21683603.2019.1689876

Singh, S., Roy, D., Sinha, K. et al. (2020). Impact of Covid-19 and lockdown on mental health of children and adolescents: A narrative review with recommendations. Psychiatry Research, 293. DOI: 10.1016/j.psychres.2020.113429

Squires, G. & Dunsmuir, S. (2011). Embedding Cognitive Behavioural Therapy training in practice: Facilitators and barriers for trainee educational psychologists (TEPs). Educational Psychology in Practice, 27(2), 117-132.

YoungMinds. (2020). Coronavirus: Impact on young people with mental health needs - Survey 3: Autumn 2020 – return to school. London, UK: YoungMinds.

 

BPS Members can discuss this article

Already a member? Or Create an account

Not a member? Find out about becoming a member or subscriber