Clinical Psychology Practice

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Clinical Psychology Practice Training

• Prof Michael Wang
• Clinical Psychology Section
• School of Psychology
• University of Leicester

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Who am I and what do I do?

• Director of the Doctorate in Clinical Psychology
  Training Course at the University of Leicester
• One clinical day per week anxiety, depression,
  post-traumatic stress disorder
• Research in anaesthesia
• Medico-legal expert in neuropsychology
• Former Chair, BPS Division of Clinical Psychology

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Outline

• What is Clinical Psychology?
• Employment pay
• Training structure content
• Getting on a course

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Branches of Applied Psychology

• Educational Psychology
• Occupational Psychology
• Forensic Psychology
• Clinical Psychology
• Counselling Psychology
• Health Psychology
• Neuropsychology
• Sport and Exercise Psychology

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Training

• 3-year undergraduate degree in Psychology
  (minimum 21 honours degree)
• Healthcare-related experience, e.g. assistant
  psychologist, clinical research (1-year )
• 3-year postgraduate clinical training (Doctor of
  Clinical Psychology - ClinPsyD)

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What do Clinical Psychologists do?

• Clinical Psychologists work with different
  patient groups
• Work includes assessment and treatment of
  psychological problems
• This includes one-to-one psychotherapy, group
  therapy, supervising nurses, working through
  parents, relatives, carers

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Range of Client Groups

• Adults
• Children
• People with a Learning Disability
• Older Adults
• Brain injured patients
• Forensic patients

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Range of Types of Problem

• minor mental health problems
• major mental health problems
• acute physical illness
• chronic physical illness
• substance abuse
• sexual problems
• personality disorder

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Range of Settings

• hospital in-patient ward
• day hospital
• out-patient clinic
• community home visiting
• primary care

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Range of Types of Intervention

• one-to-one therapy
• couple family therapy
• group therapy
• carer nurse training or intervention
• organisational intervention

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Variety of Theoretical Orientations

• Behavioural
• Cognitive-behavioural
• Psychoanalytic
• Systemic
• Pan-theoretical

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Organisation of Services

• Psychology Department
• unidisciplinary
• base clinic rooms
• CP head manager
• direct GP referrals
• professional support

• Community Team
• multidisciplinary
• shared office space
• nurse manager
• shared referrals
• professional isolation

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Adult Mental Health Problems

• anxiety e.g. phobias, PTSD, GAD, panic
• obsessional-compulsive disorder
• depression
• eating disorders
• CSA
• Personality disorder
• Psychosis

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Child Problems

• developmental or educational problems
• conduct disorder, attention deficit disorder
• anxiety depression
• psychosomatic complaints
• self-harm
• sexual or physical abuse

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Older Adult Problems

• dementia stroke
• depression anxiety
• bereavement
• challenging behaviour
• physical illness

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People with Learning Disability

• Emotional problems
• Challenging behaviour
• Developmental problems
• Trauma, abuse and bereavement issues
• Behavioural intervention
• Systemic intervention
• Working through carers and staff

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Other Specialisations

• Clinical Forensic
• Neuropsychology
• Clinical Health Psychology
• Psychosis and Personality Disorder
• Addictions
• Sexual health and HIV/AIDS

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Case Management

• intensive, detailed assessment
• consideration of alternative hypotheses
• hypothesis testing
• problem formulation
• individualised, multifaceted intervention
• evaluation

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Case Example

• ?Agoraphobia
• ?Dog phobia
• Obsessional Compulsive Disorder
• Home visit, self-monitoring
• Graded response prevention
• Graded exposure
• Marital intervention

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The MAS (1989) MPAG (1990) Reports

• In 1989 the Department of Health commissioned a
  report from an independent management consultancy
  into the activities of clinical psychologists in
  the NHS.
• The MAS MPAG reports described three levels of
  psychological intervention commonly employed in
  the NHS.

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The MAS (1989) MPAG (1990) Reports

• Level 1 supportive relationship basic
  counselling skills
• Level 2 specific, circumscribed therapeutic
  techniques, e.g. behaviour therapy
• Level 3 specialist psychological intervention,
  drawing on multiple psychological theories,
  involving individualised assessment, formulation
  treatment

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The MAS (1989) MPAG (1990) Reports

• Level 1 supportive relationship basic
  counselling skills - used by GPs, nurses, social
  workers, etc.
• Level 2 specific, circumscribed therapeutic
  techniques, e.g. behaviour therapy - used by
  psychiatric nurses with specialist training,
  assistant psychologists, etc.

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The MAS (1989) MPAG (1990) Reports

• Clinical Psychologists are distinguished by their
  use of level 3 skills
• Level 3 specialist psychological intervention,
  drawing on multiple psychological theories,
  involving individualised assessment, formulation
  treatment

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Scientist-Practitioner Approach

• Review critical evaluation of empirical and
  qualitative literature relevant to presenting
  problem
• Clinical qualitative and quantitative assessment
  and analysis of problem
• Consideration of alternative hypotheses and
  clinical hypothesis testing
• Development of formulation, synthesising
  literature with clinical assessment data
• Development and implementation of intervention
  derived from formulation
• On-going monitoring and evaluation of effects of
  intervention review of formulation and
  intervention

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The Reflective Practitioner

• ill defined situations complex problems
  promptcreative approaches intuitive problem
  solving
• drawing on experience, intuitive approach
  on-going reflection
•  embedded in reflection-in-action thinking
  about thinking
• restructuring of strategies, on-the-spot
  experiments

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Psychological Formulation as alternative to
Psychiatric Diagnosis

• Deriving formulations of presenting problems or
  situations which integrate information from
  assessments within a coherent framework that
  draws upon psychological theory and evidence and
  which incorporates interpersonal, societal,
  cultural and biological factors
• Utilising formulations to plan appropriate
  interventions
• Revising formulations in the light of ongoing
  intervention and when necessary re-formulating
  the problem

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Unique skills in comparison with other applied
psychologists in healthcare

• Broad knowledge and experience base of client
  groups and types of problem within
  pre-qualification training
• Psychopathology and the assessment of mental
  state risk assessment
• Broad range of psychometric assessment in
  healthcare
• Formulation of problems from a wide range of
  perspectives including biopsychosocial
• Scientist-practitioner approach to individual
  clinical casework

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Employment Pay

• Clinical Psychologists work mainly in the NHS
• Some work in Private Practice
• Trainees are paid around 25k
• Qualified Clinical Psychologists start at around
  27k
• Consultant Clinical Psychologists earn 40 - 65k
• Heads of Service earn up to 85k

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Current developments

• NHS financial difficulties
• New Mental Health Act and Clinical Supervisor
  Role
• New Incapacity Act
• Redesigning the role of the Consultant
  Psychiatrist and implications for CPs
• New Ways of Working for Psychologists

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Traditional Clinical Model
Undergraduate Degree in Psychology
GBR
BSc (21)
210 years
Assistant Psychologist
Nursing or care assistant roles
Postgraduate Clinical research
Selection (Leeds Clearing House)
Postgraduate Clinical psychology training (3
years)
DClinPsy
Clinical Psychologist
CPD
Consultant Psychologist
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New Roles Model
Undergraduate Degree in Psychology (3-4 years)
BSc
Assistant Psychologist (1 year)
Certificate
A4C band 4
Associate Psychologist (1 year)
A4C band 5
Diploma
Senior Associate Psychologist (1 year)
A4C band 6
MSc
2-year Doctoral Training (clinical/counselling/hea
lth)
DPsy
Clinical Psychologist
Health Psychologist
Counselling Psychologist
Consultant Psychologist
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PG Clinical Psychology Training

• 3 major strands
• Teaching
• Clinical placements
• Doctoral research project

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Teaching

• Phenomenology, epidemiology nature of
  Psychological disturbance
• Theoretical bases for therapeutic intervention
• Interview, assessment therapy skills
• Research teaching
• Professional ethics, NHS statutory
  organisational framework

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Clinical Placements

• Commonly 6-month duration
• Supervisor for each placement
• Own cases
• Core client groups adult, children, people with
  a learning disability, older adults
• 3rd year elective specialist placements
• New emphasis on competencies

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Competency based Training Accreditation Criteria
(2002)

• Transferable skills
• Psychological assessment
• Psychological formulation
• Psychological intervention
• Evaluation
• Research
• Personal and professional skills
• Communication and teaching
• Service delivery

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Progressive Developmental Learning Model (Version
2)

• Basic one-to-one case skills
• Working through complex systems, carers,
  families, organisational interventions
• Advanced one-to-one skills, organisational and
  consultancy skills

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Doctoral Research

• Clinically relevant topic
• PhD standard but not length
• Commonly 2-year research period

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Evaluation of Trainees

• Exams vs Coursework essays
• Case studies
• Placement-based small-scale projects
• Placement performance evaluation
• Research thesis, journal article viva

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How to get on a course

• Work hard! 21 minimum
• Relevant experience
• Consider a higher research degree
• Write a paper or two!
• Observe a clinical psychologist
• Apply through the Clearing House
• Interview preparation

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References

• Marzillier, J Hall, J (1992) What is Clinical
  Psychology? Oxford Medical Publications Oxford
• Nierboer, R. (1994) From undergraduate to
  clinical psychology trainee a worms eye view.
  The Psychologist 7(3) 110-112
• Clearing House for Clinical Psychology, 15 Hyde
  Terrace, Leeds LS2 7LT