UK Clinical Psychology: Practice

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UK Clinical Psychology Practice Training

• Professor Michael WangClinical Psychology
  SectionSchool of PsychologyUniversity of
  Leicester
• England UK

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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

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What is a clinical psychologist?

• Clinical Psychologists are the experts in
  psychological assessment and treatment in mental
  health, physical health, hospital, clinic and
  community settings
• This is because clinical psychology is the only
  profession that spends more than 6 years training
  in psychological approaches at University level
• About 6,000 clinical psychologists in the UK

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Do psychological approaches matter?

• Cochrane and other evidence-based reviews
• National Institute for Clinical Effectiveness
  (NICE) - Depression guidelines- Anxiety
  guidelines- Schizophrenia guidelines-
  Personality disorder guidelines
• National Service Frameworks (NSFs)
• Lord Layards initiative to reduce long-term
  incapacity using Cognitive Behaviour Therapy
• Importance of psychological interventions in
  cancer and cardiovascular disease and
  rehabilitation, brain injury rehabilitation, etc.

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The Hollywood Psychiatrist
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But dont psychiatrists do psychological therapy?

• No! not usually
• Training doesnt equip them
• Emphasis on medical model 7 years training in
  medicine, surgery and biological aspects of
  health
• In practice, psychiatric treatment is mainly
  drugs and ECT and the evidence is now
  suggesting that in many cases psychological
  treatments are superior

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The Hallmarks of Clinical Psychology activity

• Detailed and often quantitative assessment (using
  questionnaires, psychometric tests or behavioural
  observations)
• Synthesis of assessment data with theoretical
  models and evidence from the scientific and
  clinical literature to produce testable
  hypotheses and a formulation
• Intervention/treatment that is driven by the
  formulation
• Evaluation of the impact of the intervention by
  repetition of baseline assessment

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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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• Neuropsychological Examination

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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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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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Employment Pay

• Clinical Psychologists work mainly in the NHS
• Some work in Private Practice
• Trainees are paid 23k to 25k
• Qualified Clinical Psychologists start at around
  27k
• Consultant Clinical Psychologists earn 40 - 65k
  
• Heads of Service earn up to 90k

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Clinical Psychology 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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PG Clinical Psychology Training

• All are 3-year doctoral postgraduate courses
• 33 Courses in UK
• Heavily regulated by the BPS
• 550 places each year but typically 2,500
  applicants
• Trainees are simultaneously full-time
  postgraduate students and full-time NHS employees

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PG Clinical Psychology Training

• 3 major strands
• Teaching (20)
• Clinical placements (50)
• Doctoral research project (20)

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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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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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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