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UK Clinical Psychology: Practice

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Title: UK Clinical Psychology: Practice


1
UK Clinical Psychology Practice Training
  • Professor Michael Wang Clinical Psychology
    Section School of Psychology University of
    Leicester
  • England UK

2
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

3
Outline
  • What is Clinical Psychology?
  • Employment pay
  • Training structure content

4
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

5
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.

6
The Hollywood Psychiatrist
7
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

8
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

9
(No Transcript)
10
Branches of Applied Psychology
  • Educational Psychology
  • Occupational Psychology
  • Forensic Psychology
  • Clinical Psychology
  • Counselling Psychology
  • Health Psychology
  • Neuropsychology
  • Sport and Exercise Psychology

11
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)

12
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

13
Range of Client Groups
  • Adults
  • Children
  • People with a Learning Disability
  • Older Adults
  • Brain injured patients
  • Forensic patients

14
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

15
Range of Settings
  • hospital in-patient ward
  • day hospital
  • out-patient clinic
  • community home visiting
  • primary care

16
Range of Types of Intervention
  • one-to-one therapy
  • couple family therapy
  • group therapy
  • carer nurse training or intervention
  • organisational intervention

17
Variety of Theoretical Orientations
  • Behavioural
  • Cognitive-behavioural
  • Psychoanalytic
  • Systemic
  • Pan-theoretical

18
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

19
Adult Mental Health Problems
  • anxiety e.g. phobias, PTSD, GAD, panic
  • obsessional-compulsive disorder
  • depression
  • eating disorders
  • CSA
  • Personality disorder
  • Psychosis

20
Child Problems
  • developmental or educational problems
  • conduct disorder, attention deficit disorder
  • anxiety depression
  • psychosomatic complaints
  • self-harm
  • sexual or physical abuse

21
Older Adult Problems
  • dementia stroke
  • depression anxiety
  • bereavement
  • challenging behaviour
  • physical illness

22
People with Learning Disability
  • Emotional problems
  • Challenging behaviour
  • Developmental problems
  • Trauma, abuse and bereavement issues
  • Behavioural intervention
  • Systemic intervention
  • Working through carers and staff

23
Other Specialisations
  • Clinical Forensic
  • Neuropsychology
  • Clinical Health Psychology
  • Psychosis and Personality Disorder
  • Addictions
  • Sexual health and HIV/AIDS

24
Case Management
  • intensive, detailed assessment
  • consideration of alternative hypotheses
  • hypothesis testing
  • problem formulation
  • individualised, multifaceted intervention
  • evaluation

25
  • Neuropsychological Examination

26
Case Example
  • ?Agoraphobia
  • ?Dog phobia
  • Obsessional Compulsive Disorder
  • Home visit, self-monitoring
  • Graded response prevention
  • Graded exposure
  • Marital intervention

27
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

28
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

29
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)

30
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

31
PG Clinical Psychology Training
  • 3 major strands
  • Teaching (20)
  • Clinical placements (50)
  • Doctoral research project (20)

32
Teaching
  • Phenomenology, epidemiology nature of
    Psychological disturbance
  • Theoretical bases for therapeutic intervention
  • Interview, assessment therapy skills
  • Research teaching
  • Professional ethics, NHS statutory
    organisational framework

33
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

34
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

35
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

36
Doctoral Research
  • Clinically relevant topic
  • PhD standard but not length
  • Commonly 2-year research period

37
Evaluation of Trainees
  • Exams vs Coursework essays
  • Case studies
  • Placement-based small-scale projects
  • Placement performance evaluation
  • Research thesis, journal article viva

38
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

39
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
40
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
41
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
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