The Psychologist Magazine January 2014

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psychologist vol 27 no 1

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Mid Staffordshire Hospital and the Francis Report Narinder Kapur asks what psychology has to offer

Incorporating Psychologist Appointments ÂŁ5 or free to members of The British Psychological Society

letters 2 news 6 careers 46 looking back 56

wishful seeing 22 interview with Chris French 26 the experience of homophobia 28 new voices: parental alienation 32

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Contact The British Psychological Society St Andrews House 48 Princess Road East Leicester LE1 7DR 0116 254 9568 mail@bps.org.uk www.bps.org.uk

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Wishful seeing Emily Balcetis outlines research on how desires and motivations change perceptions

December 2013 issue 48,875 dispatched Printed by Warners Midlands plc on 100 per cent recycled paper. Please re-use or recycle.

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New voices: Parental alienation – time to notice, time to intervene Sue Whitcombe looks at broken child–parent relationships and the damage they can cause

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...reports

ISSN 0952-8229

news 6 Typhoon Haiyan; event reports from the Psychology4Students and Psychology4Graduates days; and much more

Cover Memorial to the dead, produced by the campaign group Cure the NHS, at their HQ in Stafford.

Photo by John Harris at reportdigital.co.uk

© Copyright for all published material is held

by The British Psychological Society, unless specifically stated otherwise. Authors, illustrators and photographers may use their own material elsewhere after publication without permission. The Society asks that the following note be included in any such use: ‘First published in The Psychologist, vol. no. and date. Published by The British Psychological Society – see www.thepsychologist.org.uk.’ As the Society is a party to the Copyright Licensing Agency agreement, articles in The Psychologist may be photocopied by licensed institutional libraries for academic/teaching purposes. No permission is required. Permission is required and a reasonable fee charged for commercial use of articles by a third party: please apply in writing. The publishers have endeavoured to trace the copyright holders of all illustrations. If we have unwittingly infringed copyright, we will be pleased, on being satisfied as to the owner’s title, to pay an appropriate fee.

Mid Staffordshire Hospital and the Francis Report Narinder Kapur asks what psychology has to offer

society President’s column; journals report; and more

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careers 46 Alana James reports from a ‘Getting Published and Planning Your Career’ workshop The Psychologist is the monthly publication of The British Psychological Society. It provides a forum for communication, discussion and controversy among all members of the Society, and aims to fulfil the main object of the Royal Charter, ‘to promote the advancement and diffusion of a knowledge of psychology pure and applied’.

Managing Editor Jon Sutton Assistant Editor Peter Dillon-Hooper Production Mike Thompson

Staff journalist / Research Digest Christian Jarrett Editorial Assistant Debbie Gordon Occupational Digest Alex Fradera

Associate Editors Articles Michael Burnett, Paul Curran, Harriet Gross, Marc Jones, Rebecca Knibb, Charlie Lewis, Wendy Morgan, Paul Redford, Mark Wetherell, Jill Wilkinson Conferences Alana James History of Psychology Nathalie Chernoff Interviews Gail Kinman, Mark Sergeant Reviews Lucy Maddox Viewpoints Catherine Loveday International panel Vaughan Bell, Uta Frith, Alex Haslam, Elizabeth Loftus

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the issue The Francis Report into the treatment and care failings in Mid Staffordshire will, we all hope, lead to the kinds of changes to systems and practices that will ensure nothing of this sort can easily happen again. In our cover story article (p.16) Narinder Kapur outlines how psychological research can inform discussion of many key areas that the report from the public inquiry draws attention to. He calls on psychology as a profession to rise to the challenge and help bring about change for the better.

At the risk of seeming to indulge in bathos, I’d just like to mention the change (for the better, we hope you agree) to this contents page, now technically a contents spread.

It should be self-explanatory.

Readers’ views are welcome as ever.

Elsewhere in this issue we have an eclectic mix of articles – on wishful seeing, homophobia, parental alienation, and the surprising erstwhile popularity of lobotomy, not to mention hearing about Chris French’s fire-walking ambitions. Just glance to the left and you’ll see where to find it all.

Peter Dillon-Hooper Acting Editor

...debates letters 2 treating drug and alcohol dependency; finding a job; parallel texts and literacy; ‘Forum’ columns on stress in sport and the dangers of consumer crowds; and more

...digests 12

...meets

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An anomalistic psychologist Chris French tells Lance Workman about his journey into weird stuff

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careers we talk to health psychologist Vanessa Bogle

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one on one with Fehmidah Munir, Senior Lecturer at the School of Sport, Exercise & Health Sciences, Loughborough University

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...reviews 28

also 52 the usual mix of books and other media reviews, including the psychodynamics of film discussed in a review of Visible Mind: Movies, Modernity and the Unconscious

BIG PICTURE

Eye on fiction: Capturing the experience of homophobia Martin Milton on the coming-of-age novel Moffie set in apartheid South Africa

www.thepsychologist.org.uk

Macbeth effect; effectiveness of headlines; language and brain lateralisation

...looks back Interpreting lobotomy – the patients’ stories Physician and historian of medicine Mical Raz examines the reasons why the procedure was once so popular, with patients and physicians alike

The Psychologist and Digest Editorial Advisory Committee Chair (vacant), Phil Banyard, Nik Chmiel, Olivia Craig, Helen Galliard, Rowena Hill, Jeremy Horwood, Catherine Loveday, Peter Martin, Victoria Mason, Stephen McGlynn, Tony Wainwright, Peter Wright, and Associate Editors

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10 years ago Go to www.thepsychologist.org.uk for our archive, including Steve Newstead’s ‘Time to make our mark’ article on improving the reliability and validity of student assessment (January 2004)

read discuss contribute at www.thepsychologist.org.uk

This picture was taken at a community garden where researchers at Cardiff Metropolitan University have been investigating the benefits of gardening activity for physical and psychological health in later life. The Growing a Healthy Older Population in Wales (GHOP) project has found that allotments and community gardens are nurturing environments not only for plants but for humans too.

Over the course of a four-month prospective study, Jemma Hawkins, the research officer on the project, and her colleagues Debbie Clayton and Jenny Mercer found improvements in participants’ health and wellbeing on measures of body mass index, hand-grip strength, perceived stress levels and selfesteem that were not observed in a wait-list control group.

Harvest the benefits when growing older Photo by Nigel Pugh.

‘Big picture’ ideas? E-mail jon.sutton@bps.org.uk.

This sample of older gardeners also kept diaries that informed follow-up interviews exploring their experiences of being a newcomer to allotment gardening. Findings indicated that, even during the first couple of years, keeping an allotment can have significant benefits. For example, participants discussed the importance of regular social interaction at the site, and the sense of achievement and

satisfaction that arises from their activity. This has several parallels with the research team’s previous findings (published in the June 2013 issue of Ecopsychology) that both engaging in gardening activities and being in such a natural environment have the potential to reduce stress and enhance healthy ageing.

For further information on the GHOP project go to www.cardiffmet.ac.uk/ghop.

Big picture centre-page pull-out researchers at Cardiff Metropolitan University have been investigating the benefits of gardening activity for physical and psychological health in later life

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LETTERS

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Much to offer substance users treatments required to help people overcome their dependence.

There is a strong psychology presence within Public Health England’s Alcohol and Drugs Team, and psychologists are involved in a national initiative to produce clinical guidelines for the treatment of dependency on new psychoactive drugs.

Contrary to the pessimism implicit in the No Quick Fix report, the role of psychologists in the treatment system is helping to deliver a more recovery-orientated focus and supporting service users to overcome their dependence on drugs for the long term.

TIM SANDERS

The October issue contained a short news piece on a report from the Centre for Social Justice entitled No Quick Fix. This report is highly critical of the drug treatment system with an implied overreliance on medical interventions for people dependent on heroin and little to offer users of other substances, such as the new and emerging range of stimulant drugs.

We would like to highlight the important role psychologists can play in shaping the treatment system to be more recovery orientated. The recently published Division of Clinical Psychology document The Contribution of Clinical Psychologists to Recovery Orientated Drug and Alcohol Treatment Systems describes how the unique skillset of psychologists can be used to improve outcomes.

Two further documents (Day, 2013; Pilling et al., 2010) illustrate how psychologists are supporting the development of the alcohol and drug treatment workforce to be more competent in delivering psychologically informed interventions.

Psychological interventions are a central element in the range of

Ryan Kemp on behalf of the DCP Faculty of Addiction Committee References Day, E. (2013). Routes to recovery via the community: Mapping user manual. London: Public Health England.

Pilling, S., Hesketh, K. & Mitcheson, L. (2010). Psychosocial interventions for drug misuse: A framework and toolkit for implementing NICE-recommended treatment interventions. London: National Treatment Agency for Substance Misuse.

Gratitude to Sheila Chown

contribute

I was saddened to hear of the death of Sheila Chown, and warmly endorse what Elizabeth Valentine says in her excellent obituary (November 2013). I will not repeat what she has already expressed, but I should like to add two contexts in which I was

personally very grateful for Sheila’s contribution. I do not have the exact dates, but for two separate periods she chaired the Psychology Committee of the Associated Examining Board for whom I was leading the development of psychology as an A-level

THE PSYCHOLOGIST NEEDS YOU! Letters These pages are central to The Psychologist’s role as a forum for communication, discussion and controversy among all members of the Society, and we welcome your contributions.

Send e-mails marked ‘Letter for publication’ to psychologist@bps.org.uk; or write to the Leicester office.

Letters over 500 words are less likely to be published.

The editor reserves the right to edit or publish extracts from letters. Letters to the editor are not normally acknowledged, and space does not permit the publication of every letter received.

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subject; and she was a member of the Psychology Board of the Council for National Academic Awards (CNAA) when I was chairing it. The Board was responsible for psychology courses and qualifications in the so-called ‘public’ sector of higher education, that is

outside the universities, which was increasing very rapidly. In both roles her participation was invaluable.

I liked and respected her very much.

John Radford Emeritus Professor of Psychology University of East London

…and much more We rely on your submissions throughout the publication, and in return we help you to get your message across to a large and diverse audience.

‘Reach the largest, most diverse audience of psychologists in the UK (as well as many others around the world); work with a wonderfully supportive editorial team; submit thought pieces, reviews, interviews, analytic work, and a whole lot more. Start writing for The Psychologist now before you think of something else infinitely less important to do!’

Robert Sternberg, Oklahoma State University For details of all the available options, plus our policies and what to do if you feel these have not been followed, see www.thepsychologist.org.uk/contribute

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letters

Spread your net wider Several contributors have expressed upset and frustration about their inability to become psychologists. My advice is – spread your net much wider. I offer my own experience from 1968 to 1999.

My early career was spent mainly as an RAF navigator.

Then, as a mature undergraduate at Leicester University I read maths, English and psychology. The latter qualified me for BPS membership and later chartered status.

In 1968 I secured a research fellowship at Dundee University where I investigated visual and auditory signal detection. The outcome was an MPhil degree.

My next post was with the Air Transport and Travel Industry Training Board.

Projects were with airlines, airports, tour operators and travel agents. Travels included a visit to America and Canada to study training for customer service, air traffic control, supervisory and management roles. The most demanding assignment came from the British Airways Customer Service Training Manager to develop and run a one-week course for passenger service staff in customer contact skills.

This involved role-playing incidents using CCTV and a session on passenger anxiety.

The Training Board was closed and I was redundant at age 53. A post was found at Surrey University as research fellow for the Department of the Environment on ‘public attitudes to nuclear waste’.

My main contribution was a literature review: from scientific papers to polemic pamphlets.

My eventual successor became involved in the selection of waste sites and was harassed by nuclear protesters.

Next came a civil service post with the Manpower Services Commission (MSC) in Sheffield. There I administered grants for trainer development, mainly through

industry training organisations – about 40 projects in seven years, including wool textiles, fibreboard packaging, soft drinks, engineering and computing. I was also MSC representative to CEDEFOP, the European Centre for Vocational Training. This involved several visits to multinational meetings in Berlin and also Brussels, Eindhoven, Madrid and Lisbon. I also developed ideas and secured funding for two Video Arts films ‘Managing Learning’ and gained support for two master’s degrees in training and development.

Retiring from the civil service, I secured a lectureship for a further nine years in the Division of Adult Education, Sheffield University. An investigation into PICKUP – a government scheme providing funding for universities to mount short courses for industry – involved visits to several universities and an empirical report.

Next the Dean of Postgraduate Medicine asked for a study of ‘The Educational Value of Medical Audit’.

Attendance at various audit meetings including rheumatology, paediatrics and an inquest on a dead baby, resulted in a report presented by the Dean at a conference.

Then the Dean asked: ‘Nottingham offer a master’s degree in medical education, can we have one?’ An existing master’s in continuing education was modified for medicine. The course began with 15 hospital doctors and continued after my retirement until funding ceased.

Conclusion: Psychology applies in most areas of work and life. Several assignments were not directly psychological and I rarely presented myself as ‘A psychologist’. Yet the initial study and qualification provided the essential background.

Kenneth Nixon Walton-on-Thames, Surrey

read discuss contribute at www.thepsychologist.org.uk

FORUM SPORTING LIFE Jonathan Trott’s early return from England’s cricket tour to Australia with a stress-related illness in November spurred a raft of rhetoric about the well-being of our top athletes. Before exploring some wider issues it is worth paying tribute to the England and Wales Cricket Board (ECB) and the team management for their sensitive handling of the player’s departure. The ECB and the professional cricketers association (PCA) have done a great deal to raise the awareness of mental illness since 2006 when Marcus Trescothick, seemingly in his prime, also returned from a tour of Australia. Since this incident several high-profile cricketers have publicly revealed issues with depression thereby helping to de-stigmatise it and allowing others to seek assistance without fearing for their careers.

Other sporting governing bodies, notably football, are catching on that the statistics for depression are likely to be the same in their sport as they are in the general population. On average in a squad of 20, conservatively speaking, two players will be at risk. The bigger issue is whether professional athletes are more at risk than the general population. The PCA maintains that the level of depression in professional cricket is commensurate with that in the general population. But one wonders whether professional athletes, aware that their every move is being scrutinised, would ever admit (even anonymously) to a lack of energy or motivation, never mind worthlessness and suicidal ideation. Furthermore, there may be those who are in denial. My experience as a player and now as a psychologist leads me to think that the statistics in elite sport may be higher than many wish to acknowledge.

Elite athletes largely want success now and hang the future.

In some cases they will take banned substances that will shorten their lives to help this happen. Dr Tim Cantopher, the psychiatrist who treated Marcus Trescothick, argues that depressive symptoms arise from limbic system overload (Cantopher, 2012). Herein lies the problem for professional athletes – it is not easy for them to slow down. Indeed, many are perfectionists constantly striving for marginal technical or physical gains. Professional sport breeds insecurity and extra crumbs of confidence are like gold dust.

As psychologists, we have a key role to play in the prevention of physical and mental burnout. Many of the athletes I see feel they should be doing more. It is a fine line though, as stressing a system produces adaptation and athletes need to be battle-hardened. The boundary between performance issues and clinical issues becomes blurred. Clinical issues obviously warrant referral to other competent professionals, but how would you define someone who defies the coach’s wishes and trains on a day off or when injured? ‘Mentally tough’ or obsessive-compulsive? Over-training a little or exercise dependent? We may not always be able to prevent our athletes from pushing the boundaries of what is healthy but we can remain vigilant and objective, and get to work quickly if something looks amiss.

One cannot speculate about the circumstances in Jonathan Trott’s life but clearly he will not be the last athlete to take time out from sport to recover from a stress-related illness. Sport has had several warnings recently and, however unpalatable this may sound to performance directors, from now on it has to be athlete well-being first and winning second.

Reference Cantopher, T. (2012). Depressive illness: The curse of the strong (2nd edn). London: Sheldon Press.

Alastair Storie is a Chartered Psychologist with Performer Consulting and former professional cricketer with Northants, Warwickshire, and Free State. Share your views on this and other sport psychology issues by e-mailing psychologist@bps.org.uk.

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letters

A literacy experiment to try Most people do not accept that there is tremendous variation in beginners’ abilities to learn to read, although we take for granted there are tremendous differences in sporting ability. All children are expected to overcome the early barriers – even though some learn with no difficulty at all, but some others must struggle hard. A good teacher encourages them to struggle.

As a ‘community psychologist’ I had ample opportunity for seeing the range of learners' abilities to learn to read, and the many variables that influence this – family, environment, how they got on with their teacher, their first experiences trying to read and anxiety levels, as well as their ‘innate ability’ to learn to read.

My pilot experiments into what could help those at the bottom have never been tried by others. Simon Horobin’s book Why Spelling Matters (OUP, 2013)

explains teachers’ reluctance to go beyond teaching rote learning of phonics or words, neither of which helps failing learners to understand that these are not sufficient to learn spelling. We rely on spellcheckers.

A simple experiment can be tried by any professional – or on the puzzle page of a periodical intended for the general public.

‘Parallel texting’ gives a ‘spelling without traps’ version of a piece of text next to that text. Readers need not read the parallel text, but much can be learned about those who find it helpful and those who do not.

First, learners must be told that 36 common words (12 per cent of everyday text) must be recognised without phonic

prize crossword The winner will receive a £50 BPS Blackwell Book Token.

If it’s you, perhaps you’ll spend it on something like this...

Covering the breadth of contemporary research on language development, Language Development illustrates the methodological variety and multidisciplinary character of the field, presenting recent findings with reference to major theoretical discussions. In a clear and accessible style, readers are given an authentic flavour of the complexities of language development research.

Price £29.99 ISBN 978-1-4443-3146-2 Visit www.psychsource.bps.org.uk

decoding. For the rest of a text, ‘spelling traps’ are surplus letters, such as in guardian (6 per cent of everyday text) and unexpected letters such as in women (4 per cent of text).

To set a parallel text, teachers and psychologists must know more about spelling than rote learning and phonics.

They will find it illuminating.

Results could be sent in to me or a suitable centre. How many students benefited? What served best as a parallel text?

We spend far too much print bemoaning the state of literacy in English.

We cannot allow the 20 per cent of words in a spelling system that is 80 per cent phonic to wreck so many lives. (Test this claim with parallel texts.) Our literacy rates are still too low, set against the amounts spent on reading research and remediation.

Valerie Yule Mount Waverley, Victoria, Australia

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Send your entry (photocopies accepted) marked ‘prize crossword’, to the Leicester office (see inside front cover) deadline 10 february 2014. Winner of prize crossword no 72 Scott Smith, Nottingham no 72 solution Across 1 Transference, 9 Objective, 10 Owner, 11 Nausea, 12 Statutes, 13 Images, 15 Power nap, 18 Euphoria, 20 Advent, 22 Scruples, 23 Apollo, 26 Manse, 27 Oral stage, 28 Ostentatious. Down 1 Thorndike, 2 Anjou, 3 Secrete, 4 Epic, 5 Ejection, 6 Chortle, 7 Instance, 8 Eros, 14 Apparent, 16 Pathogens, 17 Tiresome, 19 Orpheus, 21 Deposit, 22 Soma, 24 Llano, 25 Tact.

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letters

Have we lost focus?

Many recent psychology and neuropsychology graduates I know believe they are at the forefront of pioneering research about the lived experienced. Yet, early 20th-century existential philosophers – Martin Heidegger, for example – discussed such matters, and were particularly insightful without the support of empirical ‘evidence’, way before current research was Martin Heidegger published.

What exactly is in the reading lists for many a misguided essentialist psychology and approach. I think it’s neuropsychology courses? important for the whole of I love psychology, people and psychology to reassess their their environment is incredibly ‘knowledge’.

Lloyd Cheng fascinating. I am sad that Craigavon, Co. Armagh psychologists have lost focus and are committed to

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Arsonist’s interrogator might ask it (7,8) Sale rep suffering setback (7) Weak yet popular drink I had contracted (7) Initially, Eysenck’s personality inventory note is grand in scale (4) Eager to move northern joint (4) Fish seen around lake still (4) Left to set fire to coal (7) Nitre unstable as krypton? (5) Bundle of fibres in cheek (5) Prickly pear auntie mashed shortly after work (7) Sailor posed around lake (4) Associate fully with psychology at last (4) A Catholic hospital’s principal (4) Greek character’s opponent is red (7) Copy combination of monetary systems that’s overdue (7) Outcome of fluttering chaos theory? (9,6)

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Personality disorder may be marginal (10) Continuous list popular with Goldstein, initially (7) One’s employing extremes of psychology for game (1-3) Teenager mixing drink (5,3) Together with university invested with title, say (6) Wary Scipio turns us both ways round (10) Drive up motorway to rhythmical beat (7) Green light to finally indicate anatomical protuberance (4) One dabbling with IT’s talented, surprisingly (10) Infant behaviour sent by e-mail (10) Pass position on course over lines - that’s mine (8) Pragmatic person making note on a menu (7) Caterer cooked for row of houses (7) Tax sailor if given fine (6) One who crosses the line in southern passenger vehicle (4) Channel hop, on board? (4)

read discuss contribute at www.thepsychologist.org.uk

FORUM THE REAL WORLD We generally try to avoid plugging our own work in this column.

So perhaps the reader will excuse us this one indulgence. After all, it does have some seasonal relevance...

In late November we published a paper with some colleagues – David Novelli, John Drury and Clifford Stott – in the journal PLoS One.* The paper addressed the way we experience different types of crowd. We drew a distinction between a physical crowd (simply a large number of people gathered together) and a psychological crowd (where people identify each other as belonging to a common group). We argued that physical crowds that have no such shared identity are experienced negatively, but physical crowds that are also psychological crowds are experienced positively. Far from people finding the proximity of others to be unpleasant in such circumstances, people actively search out the densest spots in such crowds. They want to be at the centre more than at the periphery.

So, to us, quite an interesting piece, but hardly the stuff of Daily Mail headlines… or so we thought. In the hands of the media this became a widely touted story about Christmas shopping crowds.

You know the sort of thing. Radio interviews would start with the interviewer proclaiming ‘I hate Christmas crowds. Rushing for those last-minute purchases, too many people in the way, buying the last “must-have” toy that you wanted for your child. But a recent study tells us that there are some people who actually like crowds. To explain we have…’. They would then ply us with questions about how we could make the shopping more enjoyable and get more people out to spend their money in the shops.

Our response was to try and turn the question around. The whole point about consumer crowds, we argued, is that they set people against each other as competitors. They don't simply lack, shared identity they disrupt it. A while back, again with John Drury and Chris Cocking as well, we did a number of studies about crowd emergencies and we found that, in general, when disaster strikes, the sense of shared fate leads to a sense of shared identity and that, far from running blindly for the exits, people tend to help each other.

The only exception was when the crowds were shoppers going to the sales. Then the lure of consumer heaven kept people apart and undermined a coordinated response.

So, rather than trying to create commonalities amongst consumer crowds, the larger message is to beware of the dangers of extending the shopping model to all walks of life – for example to the health service and to education. Whatever claims are made for the efficiency of the market, turning everyone (including our students) into consumers comes at the cost of disrupting the bonds between us and ensuring that masses don't become communities.

Perhaps there is another message for us as well, one that is also timely, given that universities have just been finishing their REF submissions in which 'impact' has figured prominently and will probably be yet more prominent next time round. If impact means serving our existing commercial and political masters more attentively (how can we get people to spend more) then this prominence is something to fear and to resist. If, however, it means speaking truth to power, then the more impact the better.

Enjoy the January sales! * Novelli, D., Drury, J., Reicher, S. & Stott, C. (2013). Crowdedness mediates the effect of social identification on positive emotion in a crowd: A survey of two crowd events. PLoS ONE 8(11), e78983.

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 psychologist@bps.org.uk.

An archive of columns can be found at www.bbcprisonstudy.org.

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NEWS

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Finding a way to respond to Typhoon Haiyan Over five thousand people died and several millions were adversely affected in November when Typhoon Haiyan blasted the Philippines with wind speeds of up to 200 mph. One of the most powerful storms on record, many towns and cities were left devastated.

Professor William Yule of the Institute of Psychiatry is chair of the Society’s recently inaugurated Crisis, Disaster and Trauma Psychology Section. He told us that although the first priority in mass disasters of this kind is always clean water, sanitation, food and shelter, ‘preparing the ground for psychological help starts immediately. There is support and advice for first responders.

Helping them pace themselves and not burn out. What to say, especially to children about deaths of loved ones, ensuring accurate lists of survivors, etc. Helping rudimentary schools to get back a rhythm of daily living. Psychological intervention should be available at the outset, but formal therapy in groups or for individuals comes a bit later.’

Aid organisations such as Médecins Sans Frontières (MSF) responded rapidly to Haiyan, including sending psychologists to the scene. Writing on the organisation’s website, MSF psychologist Ana Maria Tijerino explained that many people were not able to evacuate in time so they saw the destruction unfold before them.

‘After living through such a severe experience, it is almost impossible to come out mentally unscathed,’ she said.

‘Arguably, depression can be as much of a disability as blindness,’ she added. ‘Anxiety disorders and panic attacks prevent people from performing their daily routine. These are the kinds of long-term consequences that we are trying to prevent.’

The Red Cross also sent psychological support to the area.

Writing for the Canadian RedCrossTalks blog, volunteer Sandra Damota explained that her role was to provide psychological first aid (see box): ‘When a disaster happens, it’s easy to see the physical destruction and the physical wounds and injuries,’ she wrote. ‘But what we don’t see is the hurt people feel inside.

There has been incredible loss for the people affected by Typhoon

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Haiyan, in terms of losing family and friends, but also losing their homes, and everything they owned.’

Local psychologists have also played a vital part in the disaster aftermath. Importantly, they have the local knowledge to help understand victim reactions. For example, in her column for the Philippine paper MindaNews Gail Tan Ilagan, Director of the Center of Psychological Extension and Research Services at the Ateneo de Davao University, explained that for many people Haiyan (known locally as Typhoon Yolanda) would have stirred up memories of the deadly Typhoon Pablo that struck in December 2012. ‘Don’t forget the Pablo survivors,’ Ilagan wrote.

‘Yolanda awakened for some their dread and unspoken terror of a world gone mad. Like terrified children waking from a bloodcurdling nightmare, they too need soothing at this time.’

Chartered Psychologist and Associate Fellow of the Society Dr Debbie Hawker specialises in supporting humanitarian workers.

She echoed the importance of sensitivity to local ways of coping.

To ignore this can leave people feeling devalued and less confident about coping in the future. ‘As long as the practices are not harmful, it may be beneficial to encourage people to use the resources which are already available to them,’ she said, ‘offering any additional resources to supplement these rather than replace them.’

Another issue psychologists on the ground need to be aware of, according to Dr Hawker, is the increased risk of rape, domestic violence and even child abuse in the wake of a mass disaster.

David Miliband, President of the International Rescue Committee, also pressed home this point in an interview with BBC’s Newsnight programme. ‘To neglect [the risk of violence], to turn our minds away from that would be dangerous and wrong,’ he said.

Dr Hawker explained there are various reasons for the increased violence, from the lack of protective services, abuse of alcohol, to people’s desire to re-establish feelings of their own power. ‘It is important to find out about such problems and not to assume that the only “trauma” is the obvious one,’ she said. ‘The key is to spend time with local people, respect their views and listen carefully to their portrayal of what the major needs are.’ CJ

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AP/PRESS ASSOCIATION IMAGES

PSYCHOLOGICAL FIRST AID According to guidelines published by the World Health Organization (WHO; e.g. see tinyurl.com/nx9kuh5), humanitarian aid workers should consider offering ‘psychological first aid’ as a matter of routine to adults and children showing signs of acute traumatic stress symptoms after a traumatic event. Psychological first aid is defined as ‘basic, non-intrusive pragmatic care with a focus on listening but not forcing talk, assessing needs and concerns, ensuring that basic needs are met, encouraging social support from significant others and protecting from further harm’.

Psychological first aid has largely replaced ‘debriefing’ as the recommended intervention for people affected by disaster. Critical incident stress debriefing (CISD), to use its formal name, refers to a single session of therapy in which the traumatised person is encouraged to vent their feelings. The WHO, NICE and the Cochrane Collaboration have all published guidelines and analyses suggesting the routine practice of debriefing may do more harm than good.

However in 2011, a team of therapists and trauma consultants – Debbie Hawker, John Durkin and David Hawker – published a paper arguing that properly executed debriefing by trained personnel with a peer debriefer can be helpful for aid workers and emergency responders (Clinical Psychology and Psychotherapy: tinyurl.com/q9jqx3y).

Dr Debbie Hawker told us new research supports their case, such as a meta-analysis published this year showing lower alcohol use and better quality of life in emergency workers who had the benefit of CISD (Anxiety, Stress, and Coping: tinyurl.com/q7z3yk9). ‘Many aid workers want to receive psychological debriefing, and it appears to be beneficial, as long as correct procedures are followed,’ she said.

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Many labs make enlightened work A team of over 50 international researchers has published an ambitious attempt to replicate 13 existing findings in psychology (see tinyurl.com/kx3clvt).

Several questionnaires and tests were bundled into a single computer package that was completed by 6344 participants across the USA, Europe, South America and Malaysia – 27 of the samples were tested in a lab, nine online.

The ‘Many Labs Replication Project’ comes during what some have described as a ‘replication crisis’ in psychology, with high-profile failures to reproduce published results, especially in the field of social priming. Indeed, it is just over a year since Nobel-winner Daniel Kahneman wrote an open letter to the social priming community urging them to take bold action to address the doubts raised about their field (see tinyurl.com/8e72a5n and News, November 2012).

The 13 effects under investigation were selected from a wide time period.

The earliest ‘quote attribution’ effect (people are more likely to endorse quotes attributed to people they like) was first published in 1936. The most recently published ‘currency priming’ effect (after exposure to money, people are more likely to justify the current social system) was published in 2013.

Other effects tested included ‘anchoring’ (people’s judgements are swayed by initial irrelevant numbers), first documented by Daniel Kahneman and Karen Jacowitz; ‘gain versus loss framing’ (people’s tendency to take greater risks to avoid outcomes framed as a loss, also studied by Kahneman with Amos Tversky); ‘retrospective gambler’s fallacy’ (e.g. rarer outcomes on a dice throw, such as three sixes, are assumed to have been preceded by more throws of the dice); ‘flag priming’ (seeing the US flag increased agreement with conservative policies); and ‘imagined contact’ (imagining contact with religious outgroup members reduced prejudice towards them).

The results, submitted for publication in Social Psychology, provide some comfort for psychology as a whole, but not for the social priming field. Ten of the effects were replicated convincingly with similar or greater effect sizes than in the original research. It’s reassuring that Kahneman’s seminal work came out

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stronger in the replications. The imagined contact study replicated but with a weaker effect than found originally. The two priming studies, involving the effects of flags and currency, failed to replicate.

Chartered psychologist Dr Sharon Coen (University of Salford) is Secretary of the BPS Social Psychology Section.

She said: ‘The transparency with which the data, their origin and their analysis are shared with the public is commendable and should set the standard for future work.’ However, she also argued there is room for improvement – the effects under investigation were mostly very basic, and she noted that ‘of the 36 samples, only three were non-Western (Turkey, Malaysia and Brazil) and three from Eastern Europe (two in the Czech Republic and one in Poland), thus there are still issues to be addressed regarding the applicability of findings outside the Western world’.

The project was co-led by University of Virginia psychologist Brian Nosek of the Open Science Framework. He and his many collaborators said that the ‘primary contribution of this investigation is to establish a paradigm for testing replicability across samples and settings’.

Their hope is that Daniel Kahneman others will emulate their ‘crowdsourcing approach’ to explore other findings in psychology.

An interesting pattern to emerge from the new results is that the geographic location of the sample and the context of testing (lab or online) made little difference to the size of effects. The main determinant of effect size was the nature of the effect under investigation. Also intriguing was the fact that more robust experimental effects showed more variability in their size than weaker effects.

BPS Fellow Professor Richard Crisp (University of Sheffield), co-author of the original imagined contact research,

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described the project as ‘an exciting initiative for psychological science’, and he noted that the revised effect-size estimate for imagined contact with religious outgroups converges with the findings from a meta-analysis he’s co-authored looking at results from over 70 imagined contact studies (currently in press: see tinyurl.com/o5eqr4g).

However, Crisp added a note of caution. ‘There is an important distinction between replication of experiments, and replication of effects,’ he said. ‘Single-study replications provide important information about the replicability of

experimental findings carried out under very specific study conditions, but not about the conceptual replicability of the effect manifest using different task variants, different dependent measures, or focusing on different groups or issues.

To be truly confident about how robust a particular phenomenon is, we need both replications of specific studies, and replications of effects. In other words, we need both depth of replication (specific studies) and breadth of replication (meta-analyses).’ CJ I See our special issue on replication (May 2012): tinyurl.com/a6u8khw

STARTING YOUNG The Swiss publishers Frontiers have launched an online neuroscience journal for, and reviewed by, children: http://kids.frontiersin.org. Editor-inchief of Frontiers in Neuroscience for Young Minds is Robert Knight, a professor in the psychology department at the University of California Berkeley. Among the articles already published is one on why we sleep, reviewed by Eleanor, aged eight.

SEX DESIGNATION

APA criticised in detainee abuse report New details have emerged about the involvement of psychologists in the abuse of detainees at Guantanamo Bay and other US military sites.

The revelations appear in a task force report Ethics Abandoned: Medical Professionalism and Detainee Abuse in the War on Terror – which documents the results of a two-year long investigation supported by the Institute on Medicine as a Profession and the Open Society Foundations (tinyurl.com/loy9y57).

Based on a comprehensive review of military and other records in the public domain, the report describes how psychologists helped design and implement interrogation practices that included torture techniques such as waterboarding and sensory deprivation. Psychologists also advised interrogators on ways to exploit suspects’ psychological vulnerabilities. The US Department of Defense and the CIA recruited psychologists for this

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purpose into so-called Behavioral Science Consultation Teams.

Psychologists and medical professionals fulfilling these roles were described as ‘safety officers’, yet at the same time they were categorised as combatants, supposedly abrogating their usual professional ethical responsibilities.

The 20-strong task force, comprising medical, military and ethics experts, criticises the American Psychological Association (APA) for failing to prohibit psychologists from participating in

interrogation practices. ‘In the Task Force’s view, the APA incorrectly permits psychologists to balance professional obligations against national security interests and embraces the idea that psychologists can simultaneously and without conflict play the roles of aiding in intelligence gathering and safeguarding the well-being of detainees in interrogation.’

The APA has published various position statements and passed referendums outlining the practices it considers to be torture, and prohibiting psychologists from working where people are detained against international or US law.

However, unlike the American Medical Association and the American Psychiatric Association, the APA still permits its members to be involved in interrogation practices. CJ

Germany has become the first country in Europe to allow newborn children of indeterminate sex to be recognised officially as being neither male nor female. This is in contrast to the continuing situation in the UK and other countries where parents must immediately choose a sex designation for their child. It is widely accepted that this can have profound psychological implications for the developing intersex infant, who must adapt to the sex imposed on them.

I See our intersex special issue from August 2004: tinyurl.com/nevz5px

NEUROSCIENCE VIDEO CHANNEL A postdoc and research assistant at Duke University in the USA have launched http://Neuro.TV, a neuroscience and psychology online video channel. Co-founder Diana L. Xie told us: ‘Our mission is to remove the barrier between academia and the general public, by communicating fascinating aspects of science through the show.’ Pilot episodes feature psychologist Leanne Boucher, neurobiologist Nicholas C. Spitzer and others.

MORNING MORALITY People are more likely to cheat or engage in other immoral behaviour in the afternoon, compared with the morning. That’s according to researchers at Harvard University and the University of Utah who say the ‘morning morality effect’ is caused by the ‘gradual depletion of self-regulatory resources as a result of unremarkable daily activities’ (Psychological Science: tinyurl.com/p6rhj9t).

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From magic tricks to blue hair Christian Jarrett reports from the Psychology4Students day held in Sheffield in November ‘Attention is the number one thing,’ said Jim McKenna (Leeds Metropolitan University) during his lecture on the psychology and neuroscience of behaviour change. He practised what he preached, using magic tricks and dramatic YouTube clips to grab his audience’s attention, bringing to life his point that we need to jolt our inherently lazy, habitual brains into action with the power of rewards.

‘Dopamine lollipops is what we need,’ he said, to prompt our prefrontal cortex – the ‘Churchillian brain’ – into taking on new healthier ways of doing things.

This is an exciting time to go into health psychology, Professor McKenna also told us. For one thing, mobile phone health apps are an ‘astonishingly powerful’ public health intervention. ‘You could be the psychologist to help design these,’ he told the student audience.

‘Walking alone,’ began the next speaker Helen Fisher (Institute of Psychiatry, King’s College London) ‘have you ever felt you were being followed, only to look behind and see that no one is there?’ This was the first of several questions Dr Fisher asked us, her purpose

A DELEGATE’S VIEW

by Jen Tidman (Open University) This year, the British Psychological Society organised their popular ‘Psychology4Students’ days in Sheffield and London. These events give students a taste of the varied and fascinating field of psychology through a series of keynote presentations as well as an exhibition featuring careers advisers, university stalls, and representatives from the BPS and its member networks. Although aimed at A-level and first-year university students, as a recent graduate I still gained plenty from attending.

In Sheffield, the five speakers gave interesting talks about recent and ongoing state-of-the-art work, leaving behind the textbooks and bringing to life topics from cognitive, developmental, social and clinical psychology. This will have been an invaluable chance for some active learning for current students, hopefully boosting their memory (and recall!) of any topics within their curriculum. The lectures also gave those still in school a flavour of what they will experience at university, whilst those already in higher education gained a sense of the many places their degree has the potential to take them. As for myself, a former distance-learning student, it was a great opportunity to interact face-to-face with fellow students as well as practitioners, researchers and academics.

The speakers’ enthusiasm and passion for our discipline was unmistakeable and infectious. As well as presenting their work they also gave tips on how to progress within psychology, often based on their own experiences of getting into the subject. Although Helen Fisher and Stephen Kellett followed the more conventional path, pursuing the subject continuously from school to doctorate, others came to psychology as part of a career change (ads I did myself). Jim McKenna was once a PE teacher, Almuth McDowall worked as a dancer and fitness instructor, and Caspar Addyman was a financial trader. Although this shows it is never too late to start in psychology, if you are a teacher or tutor, please consider taking your students to a future event – it’s an opportunity I wish I’d had before applying to university the first time around.

Overall, the day highlighted the diverse ways psychological phenomena are investigated, and how findings not only increase our understanding, but also solve issues in the real world through their application. As such, I am sure ‘Psychology4Students’ encouraged many attendees to become a part of psychology’s exciting future. Even if you are already set on psychology, I’d still encourage a visit; the talks rekindled my interest in topics from the beginning of my course and inspired me to look into new areas for further study. After all, who could resist the idea of working with a lab full of laughing babies!I

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to illustrate there is a continuum of psychosis, from these kinds of everyday paranoid thoughts (nearly everyone raised their hand to that first question) to more outlandish beliefs, such as the feeling that one has turned into a tree. Other psychosis symptoms include catatonic behaviour, disorganised thought and hallucinations.

Longitudinal research has found that psychosis in childhood is usually transient, Fisher explained, but that children who show psychosis symptoms at age 11 are seven times more likely than other children to have them in adulthood, as well as being at heightened risk for other mental health problems. ‘It’s not fate,’ said Fisher ‘but it may be useful to screen children early on.’ She added that this is a new field of research, ‘with lots of opportunities you could get involved with’.

The next speaker, Stephen Kellett from nearby Sheffield University is a clinical psychologist who embodies the scientist/practitioner model of the profession, combining client work with related research. In particular he told us about his use of ‘single-case experimental design’ to investigate the benefits of using cognitive behavioural therapy with a client who has hoarding disorder.

Kellett assessed a 63-year-old woman (who began hoarding as a teenager) at baseline based on photographs of her home, then again during outpatient therapy, during outpatient therapy combined with home visits, and finally at follow-up after therapy had ended.

Encouragingly, her rates of throwing out her unneeded belongings increased sevenfold during therapy, whether that was outpatient only, or outpatient plus home visits. Unfortunately, this dropped to 3.8 per cent at follow-up.

We probably can’t generalise from this one case, Dr Kellett said, but ‘[insight into] the shape of change is completely new’. He also highlighted the research opportunities in this area – we need more lab research into hoarding disorder, he said, and more openness to other explanatory models for what drives the condition.

Next up was Dr Almuth McDowall (University of Surrey), Chair of the Society’s Division of Occupational Psychology, who spoke on the issue of work–life balance in the England and Wales police forces. ‘I’m a tart,’ she

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exclaimed, in reference to her use of both quantitative and qualitative research into the skills that are needed for police officers to achieve work–life balance.

She’s found they need a whole range of competencies including the ability to negotiate, to look after themselves, and to keep things in perspective. This research approach could be applied to other professions, she said, although getting her work published on this topic wasn’t easy because there is such a tradition in the field of focusing only on work–life conflict, not on the competencies needed for success.

The day ended on a cute note as blue-haired Caspar Addyman (Birkbeck Babylab) shared videos of babies with the giggles. Addyman studies babies’ laughter because it is an important form of early communication and gives us insight into their social understanding.

From an online survey of over 2000 parents, Addyman has discovered the game that is most likely to elicit baby laughter the world over is peekaboo, with chasing, funny noises, funny faces, tickling and (pretending to) eat the baby, also very popular. Notably all these games have in common that they

A baby’s laughter – an important form of early communication

involve social interaction.

Addyman and his colleagues plan to study whether laughter helps babies learn and whether it’s associated with faster vocabulary acquisition. As the afternoon drew to a close, someone in the audience

asked the question that was on all our lips: ‘Why is your hair blue?’ It’s an experiment that’s lasted for over five years, explained Addyman: ‘no child so far has ever reacted. The world is strange enough for them as it is.’

Be passionate, make a difference Alana James (Royal Holloway, University of London) reports from the first ever BPS Psychology4Graduates event, held in November at Regent’s College, London The inaugural Psychology4Graduates event aimed to equip current graduates, or those soon to finish their degree, with knowledge about the different chartership routes available to them.

In his welcome address, current BPS 20 201 13 President Richard Mallows spoke of how much he would have appreciated such advice. Once a chemistry teacher, his psychology career appeared to have come about largely from the chance opportunity to sit in on an evening class led by an engaging lecturer (who would also go on to become a BPS President).

By contrast, the graduates or final-year students present had reached a point where they knew they wanted a career within psychology. The big questions

The British Psychological Society

Promoting excellence in psychology

www.bps.org.uk/p4g2013

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were which route to choose and how to get there.

A straw poll in the first session indicated that, perhaps unsurprisingly, the majority were considering clinical psychology. Several of the day’s speakers spoke to this route. Estelle Moore, Lead Clinical and Forensic Psychologist at Broadmoor Hospital, receives many requests for work experience from those interested in clinical and forensic work.

Her top tip was to be persistent; chase up your enquiry and make your name stand out. David Dean, Clinical and Admissions Tutor at Oxford University/Amersham Hospital, told of his personal experience of being told by his tutors that it wasn’t worth applying as the competition was too great. His response had been to raise his game in his final year to get a top degree, get relevant experience, and then get even more and different experience.

Keynote speaker Abigael San, a private clinical psychologist, advised delegates that both paid and voluntary experience is worthwhile, and that they

should actively request opportunities by sending out CVs. San also said that current students should pick third-year options with a clinical focus and try to do a project with a clinical psychologist as supervisor to gain an ideal referee for doctorate applications. Following her own degree, San completed a master’s degree and would recommend picking one with a clear clinical focus. She subsequently worked in three short-term assistant psychologist posts, and ultimately applied for the ClinPsych doctorate four times. The key messages for aspiring clinical psychologists were therefore to gain as much and as wide experience as possible, to make undergraduate and master’s study as relevant as possible, and to be doggedly persistent in achieving their dream.

The event also provided insight into the other routes available, and in particular delegates seemed to also be considering educational, forensic and occupational psychology. Philip Wilson, Chief Psychologist at the Cabinet Office,

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BBC Radio 4’s All in the Mind psychology and mental health programme recently celebrated its 25th anniversary with a trio of programmes looking at the past and future of these topics.

To mark the occasion the presenter psychologist Claudia Hammond has also announced the All in the Mind 25th Anniversary Awards for people who’ve had mental health problems to thank those who have helped them.

‘Is there a person, project or group that has gone above and beyond the call of duty to offer the support or advice that made a real difference to your life?’ the programme

each of three categories (person, project, group)

by Claudia Hammond and her fellow judges Radio 1 DJ Scott Mills, Chartered Psychologist Guy Holmes, Marion Janner (founder of Star Wards), and MP Charles Walker.

To make a nomination visit the programme website at tinyurl.com/p566uko.

The deadline is the Scott Mills is one of the end of January and judges for the All in the Mind the winners will be 25th Anniversary Awards announced at a ceremony at the Wellcome Collection asks. ‘If so, this is your in June. ‘We want to chance to enter them for recognise those who really the new All in the Mind go the extra mile to help 25th Anniversary Awards.’ others,’ said Claudia Winners will be picked in Hammond on her blog. CJ

gave a keynote talk showing how diverse the work of an occupational psychologist can be. It encompasses not only psychometric testing but also understanding interpersonal dynamics within interviews, as well as stress management. Key attributes needed to succeed are general intelligence and emotional intelligence, technical knowledge, drive, and personal values.

Wilson recommended that graduates make use of social media as organisations share a lot of opportunities through sites such as LinkedIn, get a mentor, do a work placement and thoroughly research the assessment process.

Other speakers included Dilanthi Weerasinghe, Assistant Principal Educational Psychologist at Haringey Council, who again emphasised the need for relevant experience as educational psychology too can be highly competitive.

Barbara Douglas, a counselling psychologist in Edinburgh, showed how counselling psychology also involves varied experiences and shares many

aspects with clinical psychology. Juliette Lloyd, a freelance sport psychologist and coach, gave an inspiring talk about how her personal experience as a rower and national coach fed into her pursuit of a career in sport psychology. It still took time and perseverance to become accredited, but Lloyd’s passion for her work shone through.

Speaking to the delegates, it was clear that they valued hearing from speakers within a range of fields. The most eyeopening talk had perhaps come from Carolyn Mair, Reader in Psychology at the London College of Fashion. Mair initially studied applied psychology and computing and later completed a PhD in cognitive neuroscience. She is now working to promote an ethical fashion industry and is creating the first master’s courses in the psychology of fashion. This talk was the one that reminded graduates that a career in psychology is more than just the chartership routes. It is also about being passionate and trying to make a difference whatever field you choose to go into.

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FUNDING NEWS The Royal Society Research Professorship scheme is open for applications. The Professorships provide long-term support for world-class scientists to focus on research.

Applications can be made by researches from any of the natural and applied sciences, including medical science. Applicants can be of any nationality and applications are particularly welcome from scientists currently residing outside of the UK. Closing date for applications is 13 March 2014.

I tinyurl.com/6uw6ybw The European Association of Social Psychology (EASP) offers three schemes to support postgraduate and full members of the Association. The Postgraduate and Postdoctoral Travel Grants provide support of €800 for short visits to conduct new research, complete ongoing projects or undergo training elsewhere in the world. The Postdoctoral ‘Seed Corn’ Research Grants provide support to assist researchers in developing new research projects during the immediate postdoctoral period, which may facilitate the holder to subsequently obtain larger-scale funding from other sources.

Regional Activity Grants provide funding for any initiative that serves EASP members from regions where access to facilities and funding is scarce. The focus of the activity should be teaching, training and development. Applicants for all schemes must be members of the EASP. Full details of how to apply are available on the website.

The next closing date is 31 March 2014.

There are four application deadlines a year.

I tinyurl.com/ohsl49d The BA/Leverhulme Trust offers Small Research Grants to support primary research in the humanities and social sciences by UK-based postdoctoral scholars. Applications can be made by international groups of scholars, provided there is a UK-based scholar as lead applicant. Further details about international collaborations are available. Funding can be used for initial project planning; to support the direct costs of research; and to advance research through workshops, conferences or visits by partner scholars. The level of funding available is £500 to £10,000 over two years. The next closing date is 15 April 2014.

I tinyurl.com/bvsq7jx

info

All in the Mind awards

For more, see www.bps.org.uk/funds Funding bodies should e-mail news to Elizabeth Beech on elibee@bps.org.uk for possible inclusion

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Mid Staffordshire Hospital and the Francis Report Narinder Kapur asks what psychology has to offer

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The Mid Staffordshire Hospital scandal and the resultant Francis public inquiry caused major reverberations across the NHS. Psychology as a discipline can contribute to an understanding of key parts of this event and to ways in which change for the better can occur. In particular, psychology can inform discussion of nine salient issues – psychological aspects of patient safety, why inhumane behaviour occurs, the nature of moral dilemmas, the generation of clinical excellence, the discovery of truth in legal or quasi-legal settings, communication and its breakdown, the psychology of culture, target-driven behaviour, corporate memory and the implementation of intentions.

resources

Francis R. (2013). Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. Executive Summary.

London: The Stationery Office. www.abetternhs.com www.reallylearning.com

references

Agnew, C., Flin, R, & Mearns K. (2013).

Patient safety climate and worker safety behaviours in acute hospitals in Scotland. Journal of Safety Research, 45, 95–101.

Allan, J., Johnston, M., & Campbell, N. (2011). Missed by an inch or a mile?

Psychology and Health, 26, 635–650.

Ballatt, J. & Campling, P. (2011).

Intelligent kindness. London: Royal College of Psychiatrists.

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Can the distinction between conscious and unconscious cognitive and affective functioning be applied to the behaviour of staff in healthcare settings?

How can one accurately and reliably measure the quality of performance of healthcare professionals, whether they be clinicians or managers?

oor care in the Mid Staffordshire Foundation NHS Trust between 2005 and 2009 reportedly contributed to the avoidable deaths of many patients, possibly hundreds. The recent public inquiry into this calamity cost the taxpayer £13 million, interviewed more than 160 witnesses and sifted through one million pages of evidence.

Robert Francis QC produced 290 recommendations in a four-volume report that stretched over 1800 pages. Within two months of the publication of his report in February 2013, the government produced an initial response (Department of Health, 2013) and set up a number of further inquiries to bring about improvements to the NHS. This article considers what psychology has to offer in understanding some of the issues surrounding the Mid Staffordshire scandal, and how it can help to bring about changes for the better. Each section begins with a short quotation from the Francis Report.

with patient safety issues (Croskerry et al., 2009; Reason, 2008; Vincent, 2010).

Some applications of psychology can be found in research and publications under the rubric of ‘human factors research’ (e.g.

Flin et al., 2013; see also www.chfg.org).

Areas where psychology has made or can make a major contribution include: the use of checklists in medicine and surgery; team working in theatre and other settings; situational awareness; organisational culture; cognitive biases that can lead to medical misdiagnosis (Gaber et al., 2012) and surgical errors (Santry and Wren, 2012); the role of attentional lapses in patient safety (Li et al., 2012); stress management in healthcare staff; errors in communication; understanding bullying and whistleblowing; environmental design and labelling; safe medication delivery; preventing ‘Never Events’ (catastrophic clinical events); carrying out a ‘psychological post-mortem’ of such events; compliance with rules and standards; and the implementation of such guidance and other patient safety measures. There would seem to be a strong case for a ‘patient safety psychologist’ to be appointed in every major teaching hospital.

Inhumane behaviour ‘…it is clear…the system as a whole failed in its most essential duty – to protect patients from unacceptable risks of harm and from unacceptable, and in some cases inhumane, treatment.’

Patient safety ‘Organisational boundaries and cultures should not prevent the use by all of information and advice designed to enhance patient safety.’

Psychology has directly or indirectly made major contributions to patient safety research and practice. Three of the leading researchers in patient safety have trained in psychology (James Reason, Charles Vincent, Pat Croskerry) and authored or edited books that have dealt

Beck, A. (2013). Compassion care post Francis: How relevant is staff experience? Clinical Psychology Forum, 249, 10–12.

Bond, R. & Smith P. (1996). Culture and conformity. Psychological Bulletin, 119, 111–137.

British Psychological Society (2008).

Guidelines on memory and the law.

Leicester: Author.

Cohen, G., Erb, N. & Lemak, C. (2012).

One of the more astonishing and distressing facts to emerge from the Francis Report was the number of instances of not only poor care, but inhumane care. Patients were left lying in their own urine, or were left for hours without food or drink. Psychological studies have helped to shed light on the mechanisms underlying inhumane behaviour, such as ignoring distress and harm to an individual, although it is worth bearing in mind that none of the

Physician practice responses to financial incentive programs. Advances in Health Care Management, 13, 29–58.

Coiera, E. (2009). Communication in emergency medical teams. In P. Croskerry et al. (Eds). Patient safety in emergency medicine. Philadelphia: Lippincott, Williams and Wilkins.

Cosby, K. (2009). Authority gradients and communication. In P. Croskerry et al.

(Eds). Patient safety in emergency

medicine. Philadelphia: Lippincott, Williams and Wilkins.

Croskerry, P., Cosby, K., Schenkel, S. & Wears, R. (Eds.) (2009). Patient safety in emergency medicine. Philadelphia: Lippincott, Williams and Wilkins.

Cushman. F. & Greene, J. (2012). Finding faults: How moral dilemmas illuminate cognitive structure. Social Neuroscience, 7, 269–279.

Cushman, F.A., Young, L. & Greene, J.D.

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Francis Report

(2010). Our multi-system moral psychology: Towards a consensus view. In J. Doris (Ed.) The Oxford Handbook of Moral Psychology. Oxford: Oxford University Press.

Darley, J. & Batson, C. (1973). ‘From Jerusalem to Jericho’: A study of situational and dispositional variables in helping behaviour.

Journal of Personality and Social Psychology, 27, 100–108.

Dayton, E. & Henriksen, K. (2007).

Communication failure. Joint Commission Journal on Quality and Patient Safety, 33, 34–47.

Department of Health (2000). An organization with a memory. London: Stationery Office.

Department of Health (2013). Patients first and foremost: The initial government response to the report of the Mid Staffordshire NHS Foundation

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In situations where justifiable goals conflict, where risk to one set of patients has to be weighed against risk to another set of patients, where self-image and personal goals may be at stake, and where pain or suffering may be inflicted on others, moral dilemmas are bound to emerge. Relevant cognitive perspectives have been outlined by researchers such as Cushman and Greene (2012). Moral decisions may be intuitive, largely unconscious and influenced by affective responses, rather than being deliberate, conscious attempts to rationally solve a particular problem (Cushman et al., 2010).

Social norms also exert a strong influence.

Understanding how divergent feelings, norms and values in a particular healthcare-related moral dilemma can conflict with each other may make such dilemmas more tractable, and make easier the processes of adjudication and negotiation. Gandhian values might help in resolving such dilemmas (see Kapur, 2010). Such values include Truth and Compassion (Love), and the principle that the end rarely justifies the means.

A healthcare example of an end not being justified by the means is compromising patient safety to reduce waiting lists. In the case of the principles of Truth and Compassion, the latter is cited 16 times in the executive summary of the Francis Report, with lack of compassion being a key criticism of the NHS culture in question. ‘Truth’ can be seen in the calls from healthcare leaders for greater transparency and openness in the NHS. PHILIP WOLMUTH/REPORTDIGITAL.CO.UK

studies included samples where nurses 1996) are also relevant. The prototypical were caring for vulnerable patients. study showed how an individual can feel Particularly pertinent is the ‘bystander pressurised to agree with others who have effect’, in which individuals stand by and made an obviously erroneous judgement fail to help a victim in distress. Relevant about whether a line is the same length as variables (see Fischer et al, 2011) include three just-seen lines. This illustrates how the number of bystanders present (more difficult it can be to avoid conforming with means it is less likely that a victim will be prevailing opinions, however erroneous helped); the ambiguity of the situation they may be. In (more ambiguity leads to less help); and particular, Ballatt and the similarity of the victim to the Campling (2011, p.70) bystander (the greater the similarity, the refer to a parallel more likely that help will be offered). situation to the Mid Research has also shown that pressing Staffordshire clinical situational factors may readily override setting, where staff were explicitly enounced value systems and very unwilling to speak beliefs, such that a person in great distress out against the is ignored (Darley & Batson, 1973), prevailing view. A fear something that could find parallels in of being disloyal to busy clinical settings. their employer was Also relevant is Philip Zimbardo’s common amongst staff.

Stanford Prison Experiment (Haney & A positive step would Zimbardo, 1998) where those who were in be to encourage a put in charge of prisoners subjected them socially cohesive to inhumane treatment that seemed to network of like-minded transcend all moral boundaries. Relevant individuals who speak issues are discussed by Miller (2011) and out when they sense things are going

by Haslam and Reicher (2012). The latter’s wrong. findings indicate that a positive hospital culture of strong leadership in human Moral dilemmas values and appropriate peer support ‘it [is] morally wrong to put targets of should help to counteract any negative that sort ahead of the nursing needs tendencies. of patients’ In Mid Staffordshire, neglect rather than Moral dilemmas abound specific acts of violence “A fear of being disloyal in healthcare – should characterised the to their employer was the health of many be behaviour of some staff common amongst staff” sacrificed for the health – that is, there were of a few who may be errors of omission vulnerable and in great need? rather than errors of Should healthcare staff be judged by the commission. However, it would seem that outcome of their actions or primarily by psychological mechanisms may overlap their intentions? Is failure by a doctor or with those documented by Zimbardo – a manager to prevent harm to someone as deference to power or to what appear to blameworthy as actively causing it? In his be acceptable norms regardless of the commentary on professionalism in suffering that follows; lack of empathy medicine, Hafferty (2006) goes so far as towards those in distress; and a numbing to say ‘medicine is a moral community, of sensitivities. the practice of medicine a moral The Asch conformity experiments, first undertaking, and professionalism a moral carried out by Solomon Asch in 1951 and commitment’ (p.2152). replicated many times (Bond & Smith,

Clinical excellence ‘It is professionalism which encourages maximum performance, rather than reliance only on regulatory compliance.’

Trust public inquiry. London: Stationery Office.

Fennis, B., Adriaanse, M., Stroebe, W. & Pol, B. (2011). Bridging the intentionbehavior gap. Journal of Consumer Psychology, 21, 302–311.

Fischer, P., Krueger, J., Greitemeyer, T. et al. (2011). The bystander-effect: A meta-analytic review on bystander intervention in dangerous and nondangerous emergencies.

Psychological Bulletin, 137, 517–537.

Flin, R., Bromiley, M., Buckle, P. & Reid, J. (2013). Changing behaviour with a human factors approach. BMJ, 346, f1416.

Freund, A., Hennecke, M. & Riediger, M. (2010). Age-related differences in outcome and process goal focus.

European Journal of Developmental Psychology, 7, 198–222.

Freund, A. & Hennecke, M. (2012).

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Psychology can help to unpack some of the key components of clinical excellence.

In earlier articles I have outlined 15 ‘pillars’ of clinical excellence in medicine (Kapur, 2009), and applied psychology (Kapur and Wilson, 2010), which can be grouped into three domains – technical, personal and future-based. (Two pillars of excellence that may closely relate to events at Mid Staffordshire are the technical pillar of ‘learning and risk management’ and the personal pillar of ‘moral principles’.) Similar work has been carried out by Howard Gardner at Harvard University in his ‘Good Work Project’ (Gardner, 2007). He defines ‘Good Work’ as that which is excellent in quality, socially responsible and meaningful to its practitioners. Clinical excellence requires that professional standards are rigorously followed where possible, and professional bodies have a key role in ensuring that this occurs.

The British Psychological Society could be involved in hospital inspections to help ensure high standards of excellence for services relating to clinical and health psychology, and adherence to professional standards and guidelines. Implicit in most inspections is a form of ‘peer review’, whereby specialists in a particular field are more likely to detect shortcomings such as a failure to adhere to professional standards – a form of review that the Francis Report specifically supported.

Discovering the truth ’…the truth was uncovered in part by attention being paid to the true implications of its mortality rates, but mainly because of the persistent complaints made by a very determined group of patients and those close to them.’

During the Francis Inquiry many witnesses tried to recollect events that took place up to seven years previously.

There is a burgeoning literature on cognitive issues relating to eye-witness testimony in legal settings. Such

Changing eating behaviour vs. losing weight: The role of goal focus for weight loss in overweight women.

Psychology and Health, 27, 25–42.

Gaber, M., Kissam, S., Payne, V. et al.

(2012). Cognitive interventions to reduce diagnostic error. BMJ Quality & Safety, 21, 535–557.

Gardner, H. (2007). The ethical mind: A conversation with psychologist Howard Gardner. Harvard Business

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testimony can be subject to major distortion from the truth, with witnesses usually being unaware of such distortion, and in fact being very confident in their erroneous recollections. This research has been well summarised by Lilienfeld and Byron (2013), who have pointed out that there needs to be a greater recognition that the frailties of the human mind can lead to difficulties in discovering truth and implementing justice in judicial and semi-judicial settings.

Ozubko and Fugelsang (2010) reported that the act of retrieval itself can give rise to an illusion of truth for the person doing the recalling. Although the Francis Inquiry was not a specific legal exercise with the aim of attributing blame and bringing individuals to justice, there was a legal flavour to it, with a number of barristers playing a key role. It is therefore worth noting the observations of Morley (2009) that in legal settings issues other than the careful discovery of facts can influence the ascertainment and representation of truth.

Being aware of certain facts about human memory and about the nature of deception may help to guide judges and others to decide on the veracity of recollections (BPS, 2008; Schacter & Loftus, 2013; Vrij & Granhag, 2012).

These facts include: memory is reconstructive rather than the simple reproduction of a record of past experience; very detailed recollection of specific events from many years ago is unusual; a high degree of confidence or conviction in recollection of an event or fact is no guarantee that it is veridical; unconscious factors, deep-seated beliefs and strong feelings may lead to unintended distortions in memory of which an individual is unaware; the simple act of a statement being repeated can lead to an illusion that it is truthful (the ‘illusory truth’ effect); independent corroboration is a key way of knowing whether a statement is truthful; and deliberately telling lies involves additional cognitive effort, which is made evident after further increasing cognitive load on an individual by such

Review, 85, 51–56.

Gross, P. (2012). Process versus outcome measures: The end of the debate.

Medical Care, 50, 200–202.

Hafferty, F.W. (2006). Professionalism – The next wave. New England Journal of Medicine, 355, 2151–2152.

Haney, C. & Zimbardo, P. (1998). The past and the future of U.S. prison policy.

Twenty-five years after the Stanford Prison Experiment. American

means as asking unanticipated questions or asking for events to be recalled in reverse order.

Communication ‘This situation was exacerbated by a lack of effective communication across the healthcare system in sharing information and concerns.’

Coiera (2009) and Cosby (2009) have outlined the main types of communication failures in healthcare settings and ways these can be rectified.

Errors in communication are more likely to occur where there are distractions and interruptions; in situations of high information load, time pressure and multitasking; where there is ambiguity or duplication of roles; and where there are authority gradients – highly organised, hierarchical structures where a significant degree of control is exercised by authority figures. Although research in healthcare settings has traditionally been focused on these types of communications between health professionals or during doctor–patient interaction (e.g. Taran, 2010), there is also a recognition that failures in communication within and between organisations, such as those outlined by the Francis Report, are both widespread and amenable to analysis using psychological tools and concepts.

Thus, Dayton and Henriksen (2007) refer to a number of factors that can adversely influence organisational communication, such as cognitive workload, implicit assumptions, authority gradients, diffusion of responsibility and transitions in care. They called for more structured and explicitly designed forms of communication to help send unequivocal signals that a particular course of action is required.

Communication audits (such as those described by Hargie and Tourish, 1996), also show how failures in effective communication can emanate from a psychological culture where there tends to be suppression of bad news; where those

Psychologist, 53, 709–727.

Hargie, O. & Tourish, D. (1996). Auditing senior management communication practices in the NHS. Health Services Management Research, 9, 209–222.

Haslam, S.A. & Reicher, S. (2012).

Contesting the ‘nature’ of conformity: what Milgram and Zimbardo’s studies really show. PLoS Biology, 10, e1001426.

Kapur, N. (2009). On the pursuit of clinical

excellence. Clinical Governance, 14, 24–37.

Kapur, N. (2010). Bringing Gandhi to science and medicine. In R. Mashelkar (Ed.) Timeless inspirator: Reliving Gandhi. New Delhi: Gandhi National Memorial Society.

Kapur, N. & Wilson, B. (2010). Aiming for excellence as an applied psychologist.

The Psychologist, 23, 36–39.

Klopper-Kes, A., Meerdink, N., van

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expressing concerns are stereotyped as ‘lobbying’, ‘misfits’ or ‘troublemakers’; where hierarchical management systems impede the sharing of information or concerns; where territorial behaviours and ‘turf wars’ predominate; and where the reputation of an employer is considered more important than patient safety concerns. Mutual stereotyping can also contribute to poor communication between clinicians and managers (KlopperKes et al., 2009).

Psychology of culture ‘Aspects of a negative culture have emerged at all levels of the NHS system.’

Psychological studies have helped to tease apart some of the key factors and variables that pertain to institutional culture and its impact on the performance of individuals within an organisation.

Schneider et al. (2013) note the existence of several tools to measure culture in organisations, such as the Organizational Culture Inventory, the Denison Organizational Culture Survey and the Organizational Culture Profile. Leaders play in an important role in directly articulating values and policies, and taking indirect measures to support them.

Schneider et al. note that a particular framework, the Competing Values Framework, is useful in distinguishing various types of culture and associated behaviours. This framework contrasts and combines Flexibility versus Stability, and an Internal versus External focus. This can result in four sets of cultures with a distinct set of values, beliefs, behaviours and criteria for effectiveness, each focused either on human affiliation, change, achievement or stability. The idea that particular values, beliefs and behaviours will contribute to certain culture features, such as well-being or innovation, opens up the possibility of planned interventions.

Harten, W. & Wilderom, C. (2009).

Stereotypical images between physicians and managers in hospitals.

Journal of Health Organization and Management, 23, 216–224.

Kransdorff, A. (1998). Corporate amnesia.

London: Butterworth-Heineman.

Lahaie D. (2005). The impact of corporate memory loss. International Journal of Health Care Quality Assurance, 18, xxxv–xlvii.

Newdick and Danbury (2013) have outlined how cognitive biases in reasoning may influence interactions between managers and clinicians, and thus contribute towards harmonious or conflictladen cultures in healthcare organisations.

Specific areas of culture, such as patient safety, have been subject to a psychometric analysis. Thus, Sarac et al. (2011) examined a measure of culture, the Hospital Survey on Patient Safety Culture, and found evidence to confirm a 12-factor structure in respect of patient safety culture. These factors included openness of communication, non-punitive response to error, and frequency of incident reporting. A further study from the same group found a relationship between safety climate and safer patient care by NHS staff (Agnew et al., 2013).

been subject to criticisms, with a view that they tend to distract from more important aspects of patient care (Rawlinson, 2008). In the area of delivery of healthcare, there has been debate on the relative value of process versus outcome measures, with a general consensus that both approaches have their value in certain settings. To the extent that quality of care and a focus on errors are regarded as more processdriven, the latter approach may tend to be more beneficial (e.g. Gross, 2012; McClimans & Browne, 2012).

This discussion of process versus outcome has its parallels in certain areas of psychology research. Compared to cognitive behaviour therapy, dynamic psychotherapy has traditionally placed a greater emphasis on processes rather than outcomes, for example intrapersonal and interpersonal reflections rather than symptom remission (Shedler, 2010). In other health-related applications, Freund and Hennecke (2012) reported that in the field of weight control, a focus on process (dietary behaviours) was more likely to achieve difficult health-related goals and enhance self-regulation rather than a focus on outcome (weight loss). Freund et al.

(2010) found that older individuals were more likely than younger participants to adopt a process rather than an outcome focus when considering the attainment of goals. These examples from psychology research support the idea that the NHS should focus on process rather than outcome measures.

Corporate memory ‘Recommendation 126 – Preserve corporate memory.’

Target-driven behaviour ‘Finances and targets were often given priority without considering the impact on the quality of care.’

In general, while recognising that targets may have their value, target-driven approaches to healthcare delivery have

Li, S., Magrabi, F. & Coiera, E. (2012). A systematic review of the psychological literature on interruption and its patient safety implications. Journal of the American Medical Informatics Association, 19, 6–12.

Lilienfeld, S. & Byron, R. (2013). Your brain on trial. Scientific American, 23, 45–53.

McClimans, L. & Browne, J. (2012).

Quality of life is a process not an outcome. Theoretical Medicine and

read discuss contribute at www.thepsychologist.org.uk

The study of organisational memory, corporate memory and corporate amnesia (e.g. Kransdorff, 1998; Lahaie, 2005) has addressed questions such as How can key sets of knowledge be preserved in organisations, especially those with a high turnover? Which representations of

Bioethics, 33, 279–292.

Michie, S. & Lester, K. (2005). Words matter: Increasing the implementation of clinical guidelines. Quality and Safety in Health Care, 14, 367–370.

Miller, G. (1969). Psychology as a means of promoting human welfare.

American Psychologist, 24, 1063–1075.

Miller, G. (2011). Using the psychology of evil to do good. Science, 332, 530–532.

Morley, I. (2009). The devil’s advocate (2nd

edn). London: Sweet & Maxwell.

Newdick, C. & Danbury, C. (2013).

Culture, compassion and clinical neglect. Journal of Medical Ethics. [23 May, EPub, ahead of print] Nickerson, D. & Rogers, T. (2010). Do you have a voting plan? Implementation intentions, voter turnout, and organic plan making. Psychological Science, 21, 194–99.

Ozubko, J. & Fugelsang, J. (2010).

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Remembering makes evidence compelling. Journal of Experimental Psychology, 37, 270–276.

Rawlinson, N. (2008). Harms of target driven care. BMJ, 337, 237.

Reason, J. (2008). The human contribution.

Farnham: Ashgate Press.

Santry, H. & Wren, S. (2012). The role of unconscious bias in surgical safety and outcomes. Surgical Clinics of North America, 92, 137–151.

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intentions may not be implemented for a variety of reasons: the person may completely forget the intention and related knowledge; they may retain this information but forget to carry it out; they may lack motivation, be distracted or distressed by other events; or circumstances may have changed and it may now be too costly to implement the intention. Most of these obstacles to intention implementation find parallels in the behaviour of organisations. Recent studies with individuals have shown that such problems can sometimes be overcome by techniques such as ‘if-then’ plans; that is to specify in advance particular situations where the intention should be carried out, and picturing such implementation taking place. Areas of application have included voting (Nickerson and Rogers, 2010), shopping (Fennis et al, 2011) and healthy eating (Allan et al., 2011). At an organisational level, this technique could be implemented by being as precise as possible about the time and the setting when implementation of, for example, a safety recommendation should take place.

Conclusions It is over 40 years since George Miller delivered his memorable and moving presidential address to the American Psychological Association, where he called for psychology to be ‘given away’, so as to help promote human welfare (Miller, 1969). I was a fledgling undergraduate student at the time, but his address moved me then, and it moves me still. In the past 40 years, there have arguably been two revolutions in psychology – the ‘splendiferous revolution’ in cognitive neuroscience by which advances in brain imaging and related procedures have brought new insights into our understanding of human behaviour, and also a (perhaps more

Sarac, C., Flin, R., Mearns, K. & Jackson, J. (2011). Hospital survey on patient safety culture. BMJ Quality and Safety, 20, 842–848.

Schacter, D. & Loftus, E. (2013). Memory and law: What can cognitive neuroscience contribute? Nature Neuroscience, 16, 119–123.

Schneider, B. Ehrhart, M. & Macey, W. (2013). Organizational climate and culture. Annual Review of Psychology,

important) ‘silent revolution’, whereby advances in our understanding of behaviour and of related cognitive processes have enabled new approaches to the assessment and management of human behaviour. This silent revolution has brought the field of applied cognitive psychology to the fore, contributed to at least one Nobel Prize (Daniel Kahneman, in 2002) and to an influence at the heart of government in the form of the Behavioural Insights Team.

Although it is clear that psychology as a discipline has a key role to play in patient care, it has perhaps not promoted itself in the best possible ways. One way forward could be for a Special Interest Group in Patient Safety to be formed within the British Psychological Society.

Other ways include research collaborations in patient safety between psychologists and medical professionals; psychologists taking up advisory roles in regulatory and other healthcare bodies, and working directly with health trusts on the provision of psychology services or indirectly by having a place on the board of governors.

Psychology now has the knowledge and tools to tackle real-life problems, such as those highlighted by the Francis Report.

As others have also pointed out (Beck, 2013; Whitby and Gracias, 2013), psychology as a profession now needs to take up the challenge, and to gain the respect of society by using such knowledge and tools to bring about change for the better.

64, 361–388.

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy.

American Psychologist, 65, 98–109.

Sheeran, P., Harris, P. & Epton, T. (2013).

Does heightening risk appraisals change people’s intentions and behavior? Psychological Bulletin. [June 3, Epub ahead of print] Taran, S. (2010). An examination of factors contributing to poor communication

JOHN HARRIS REPORTDIGITAL.CO.UK

knowledge and experience should be formalised and used? What is the best way to integrate such knowledge and experience with current and future needs of an organisation? How do we motivate key former employees to pass on knowledge and experience? And how do we similarly motivate key current and future individuals in an organisation to avail themselves of such knowledge and experience.

An Organization with a Memory was the unusual name given to a report published by the UK Department of Health in 2000.

It highlighted ways in which lessons should be learned from adverse clinical events occurring in hospitals and other healthcare settings. Its author, the chief medical officer at the time, Sir Liam Donaldson, noted: ‘If an organisation focuses intensively on a problem for a short period of time but forgets about it when new priorities emerge or key personnel move on, effective learning has not taken place’ (pp.29–30).

Many good intentions have been documented in reports into healthcare failings, but the real task is how to ensure their effective implementation (Cohen et al., 2012). In experimental and health psychology, the study of implementation of intentions has seen a resurgence in recent years, and some of the findings of these studies may be worth considering at an organisational level. Michie and Lester (2005) found that improving the style and behavioural specificity of mental health guidelines resulted in stronger intentions to implement the guidelines, more positive attitudes towards them, and greater perceived behavioural control over using them. In a meta-analysis of experimental studies, Sheeran et al. (2013) noted that greater implementation of intentions followed when situations were appraised as being particularly risky, and that this effect was stronger when individuals felt that a particular behaviour would change the situation, and when they were confident about being able to execute the particular behaviour.

At the level of the individual,

Narinder Kapur is a Consultant Neuropsychologist and Visiting Professor of Neuropsychology, University College London n.kapur@ucl.ac.uk

outside the physician-patient sphere.

McGill Journal of Medicine, 13, 86–91.

Vincent, C. (2010). Patient safety (2nd edn).

Chichester: Wiley-Blackwell.

Vrij, A. & Granhag, P. (2012). Eliciting cues to deception and truth. Journal of Applied Research in Memory and Cognition, 1, 110–117.

Whitby, P. & Gracias, S. (2013). Reflecting on the Francis Report. Clinical Psychology Forum, 249, 13–17.

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Calling out for new voices When someone is making waves in psychology in years to come, we want to be able to say they published their first piece in The Psychologist. Our ’new voices’ section will give space to new talent and original perspectives.

We are looking for sole-authored pieces by those who have not had a full article published in The Psychologist before. The only other criteria will be that the articles should engage and inform our large and diverse audience, be written exclusively for The Psychologist, and be no more than 1800 words. The emphasis is on unearthing new writing talent, within and about psychology.

The successful authors will reach an audience of 48,000 psychologists in print, and many more online.

So get writing! Discuss ideas or submit your work to jon.sutton@bps.org.uk. And if you are one of our more senior readers, perhaps you know of someone who would be ideal for ‘new voices’: do let us know.

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Capturing the experience of homophobia Martin Milton on André Carl van der Merwe’s novel Moffie

sychologists have to navigate a tension. We are positioned as having special knowledge that we deploy in service of people’s well-being. Yet in the consulting room we recognise the limits to that expertise and, like the rest of the population, engage with intuition, gutfeeling, hunch and experience. It is the managing of this tension that makes all the difference when providing a therapeutic encounter. Similarly, when trying to understand a phenomenon we don’t just have one set of documents to consider. We consider professional guidelines and are informed by the available research. As practitioners, we also want to understand what clients have tried to educate us about.

This is the case with any client’s presenting concerns. But there are particular difficulties when trying to meet the needs of LGBT clients. Some of our empirical evidence has been coloured by heterosexist assumptions and therefore offers very little knowledge about people’s experiences. More worryingly, this body of knowledge has offered a pathologising perspective and led to poor practice and inappropriate treatment (see Garnets et

references

P

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Bidell, M. (2012). Addressing disparities: The impact of a lesbian, gay, bisexual and transgender graduate counselling course. Counselling and Psychotherapy Research: Linking Research with Practice, 1, 8.

Coyle, A. & Kitzinger, C. (2002). Lesbian and gay psychology: New perspectives.

Oxford: BPS Blackwell.

Garnets, L., Hancock, K.A., Cochran, S.D. et al. (1991) Issues in psychotherapy

al., 1991; Milton, 1998). But, even for the psychologist who mines the literature and finds the more appropriate seams (see Coyle and Kitzinger, 2002 for a review), there are limits to what that material can offer. These bodies of knowledge cannot always help us get that elusive ‘feel’ of an experience. To know abuse has happened is one thing, to know what that abuse feels like and the impact it has on one’s sense of self is another. In our efforts to understand people and their situations as fully as possible, we must not underestimate good literature.

with lesbians and gay men: A survey of psychologists. American Psychologist, 46(9), 964–972.

Kitzinger, C. (1987) The social construction of lesbianism. London: Sage.

Milton, M. (1998). Issues in psychotherapy with lesbians and gay men: A survey of British psychologists. BPS Division of Counselling Psychology Occasional Papers: Vol 4. Leicester: British Psychological Society.

For those wanting to better understand the impact of homophobia, there are not many better books than André Carl van der Merwe’s novel, Moffie.

‘Moffie’ is a horribly pejorative, originally Afrikaans, term for a gay man. The novel is set in apartheid South Africa and narrated by Nicholas van der Swart: as a young child, ‘different’ to others; as a high school student, secretly starting to establish a sexualised existence; and as a conscript, aware that only by keeping his sexuality secret will he survive. All of these positions offer us the starkest, most visceral understanding of living with homophobia. So while this novel offers readers insight into many different aspects of apartheid South Africa, it is in relation to homophobia that this novel has a lot to offer the psychologist.

Nicholas’s account helps the reader feel what it is like to be born into a world of non-stop pressure to not be who – or what – you experience yourself to be.

Heterosexuality training starts very early and Nicholas’s experiences helps us recognise that no opportunity is missed to ‘train’ this young boy out of being gay.

As a four-year-old (after his older brother dies), when thinking about his mother’s sadness Nicholas is aware that ‘[h]er one son is gone and the other is “different”’.

As a nine-year-old the sense of difference is beginning to be understood and he writes: I am gay. Gay – this word and everything it stands for – is what I am at the age of nine, although I have not even heard of it yet. I know it, I feel it and, in secret, I start living it.

This awareness is ever-present. As a teenager, he notes: And through it all runs the cord of sexual discovery. How mortified would he [his father] be if he knew about the sex, his son’s exploration of the unmentionable, the other races. Yes, to him that would be the ultimate evil.

The novel gives us an insight into the ‘unknown knowns’ that many LGBT

Rivers, I. (1997) Lesbian, gay and bisexual development: Theory, research and social issues. Journal of Community and Applied Social Psychology, 7, 329–343.

Stonewall (2012). The school report: The experiences of gay young people in Britain’s schools in 2012. London: Author.

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people report. People tolerate the difference but only on condition that it is not acknowledged. This lack of acknowledgement can be through silence or, for Nicholas, by threat.

so I only pose masked questions to Mr Davids.

I stop sleeping. In the darkness, I am haunted even more, and by the time morning comes, I am more confused than ever. Eventually my school work starts suffering. My parents have no idea why their son is so introverted and spends all his time behind locked doors.

[Nicholas’s father] changes his tone to a sound I have not heard before as he turns to me. ‘If I find out that you are a moffie, that is the end.’ He waits for the gravity of the words to sink in, looking at me, looking through me.

Later on in the novel, Nicholas reflects ‘That will be the end,’ he says in back on these difficulties and says: a measured way, stepping slowly When I eventually come out on the from one word to the next. other side, systematically I am paralysed, shedding the scabs, because that means I realise that all this “We need to empathise it is already the end anguish hinged around and there is with trauma but not my being gay. Being the absolutely nothing I overlook resilience and talents as people unmentionable, the can do about it. navigate the world” worst, the utterly sinful, [...] I know that to irredeemable, and survive I have to hide carrying it all on my the inescapable own – a secret too large to bear, too feelings I carry around inside me. devastating to share and too dreadful What does he mean by, ‘That will be not to. My mother’s Catholic Church, the end’? I dare not ask him. I am my father’s Dutch Reformed Church, walking on a knife edge and my only all our friends and family, my entire defence against catastrophe is my world, it feels to me, regard one thing ability to deceive. more heinous than anything else, and that is what I am. Hell is guaranteed; Pejoratives proliferate in the policing of at the end of a living hell I did not sexual identity, and it isn’t only parents or choose. authority figures who use such language.

Like Nicholas, those being policed are very sensitive to language.

Poofter, queer, moffie, sissy, homo, pansy, fairy, trassie – how those words scare me. I’m so terrified of being ‘discovered’ that I obsess about it. Being a homo gives everybody the licence to persecute one. If I’m found out my life will be ruined. I MUST AT ALL COST, KEEP THIS A SECRET.

Despite knowing that negative ruminations or ‘obsessing’ is seldom psychologically useful, there is little point simply encouraging clients to rely on positive thinking. Nicholas does this and it’s clear that it is his way of keeping safe, but it comes at significant cost. Such pressure exerts a toll and those experiencing discrimination can suffer psychologically (Bidell, 2012, Rivers, 1997, Stonewall, 2012). Nicholas struggles and seeks comfort in different ways.

I search for my Creator with exaggerated fervour. I read books on religion and spirituality in every spare moment and establish even stronger ties with the one man I trust – a mentor whose patience I test with my delirious perplexities. I don’t tell him about the root of my problems, for fear that even he won’t understand,

This is a powerful way of illustrating the concept of ‘compulsory heterosexuality’ (Kitzinger, 1987). All the resources of the community amass to privilege one way of being and to create numerous sanctions against anything vaguely different.

The accounts of Nicholas’s conscription into the South African Defence Force are numerous and painful to read. Physical and verbal abuse are the norm, and so is the pathologising and demonising of same-sex sexuality. As the novel puts it: The Defence Force distinctly forbids homosexuality, regarding it as an unpardonable offence against God and country, so perverse that it is socially acceptable to mete out punishment to anyone found to be of such orientation. If you are caught, you are sent to the psychiatric ward for shock, hormone, and aversion therapy – you are as good as eliminated

Through this multi-layered account of homophobia, Moffie gives us insight into the power of secrets and an understanding as to why the recipients of long-term discrimination and rejection may not be able to talk to anyone about their experience. This is important for

read discuss contribute at www.thepsychologist.org.uk

therapists to consider as it follows that clients may not be able to discuss their core concerns, certainly not immediately.

Even with one’s friends opening up may be difficult.

I want to look at Malcom but I can’t.

I want to talk to him. I want to tell him how I feel, but sharing my fear could prove too much, could make me lose control, and all I have left is this thin line of restraint. Nothing else is within my power.

As well as the painful account of homophobia and an understanding of the trauma this incurs, the reader is also offered moments of hope, strength and optimism in this novel. We need to empathise with trauma but not overlook resilience and talents as people navigate the world. The novel also gives us a sense of the excitement and joy of falling in love.

Ethan is my first army friend, and for the first week my only friend. Ethan is whom I want; Ethan is the drug to see me through – my medication. We are reshuffled [in platoons], and by the grace of God we are put in the same tent. For the first time I believe I am going to get through it all.

Reflexivity is probably important. I too grew up in apartheid South Africa and know this never-ending preoccupation with compulsory heterosexuality by way of misogyny, homophobia and racism.

While delighted to say that my family life bears no resemblance to Nicholas’s, I too had to don the brown cadet uniform and march many an hour away in an absurd pretence at becoming a better soldier (read ‘man’). I was not spared fear and anxiety as I could not escape the exposure to the Church, school and wider culture’s insistence that nothing other than macho, somewhat misogynistc, heterosexuality would suffice. So I know this story in my bones and this is a realistic and well-crafted novel. A story of family violence, school and cultural oppression, racism, sexism and homophobia, could have been treated with sensationalism. Van der Merwe avoids this and captures above all else the subtle, yet crucial experience of needing to keep a secret. It’s because of this that Moffie is now on the reading list for my module in ‘Working with difference and discrimination’.

I Martin Milton is Principal Lecturer and Programme Director at Regent’s School of Psychotherapy and Psychology and Regent’s University London miltonm@regents.ac.uk

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2014 CPD Workshops Professional development opportunities from your learned Society Academic, Teaching & Research Psychology Researching your psychology teaching practice: An action research approach Clinical Psychology

4 April

Setting up and running a social enterprise providing child clinical psychology services (MIlton Keynes) Trauma focussed CBT to work with PTSD An introduction to sleep: Psychobehavioural assessment and treatment strategies for people with insomnia Developing services for common mental health problems in the age of austerity Cognitive Analytic Therapy in a forensic setting Cognitive assessments with children and young people in CAMHS and other non-specialist settings What’s the story? Using metaphor and stories in therapy, counselling and coaching Exploring terrorism and extremist behaviour Understanding childhood feeding disorders: Causes, diagnosis and interventions Running groups in schools based on CBT principles – Sharing practical issues (Birmingham) Leadership, commissioning and current drivers in service development Essential knowledge of psychometric measures and neuropsychology for applied psychologists Making better use of a psychological resilience paradigm in health and well-being services Using formulation in teams Working with suicidal patients: A reflective workshop From ‘ice-breakers’ to creating connections to farewells: Group facilitation Facilitating preferred changes using narrative approaches for those with physical health problems Coaching Psychology

23 January 30-31 January 24 February 4 March 14 March 20 March 9 April 17 April 28 April 8 May 14 May 28-29 May 30 June 4 July 10 September 7 October 17 October

Get Productive Wheel: Using systemic thinking to support clients What’s the story? Using metaphor and stories in therapy, counselling and coaching Changing the effects of procrastination, self-sabotage and disorganisation on solo / small business owners Cognitive Psychology

5 March 9 April 14 July

Strategies for improving decision-making Community Psychology

19 February

Developing services for common mental health problems in the age of austerity Community psychology for applied psychologists From ‘ice-breakers’ to creating connections to farewells: Group facilitation Counselling Psychology

4 March 24 July 7 October

Trauma focussed CBT to work with PTSD Planning and implementing psychological treatment for eating disorders Solution-Focused Therapy with children, families and schools Essential knowledge of psychometric measures and neuropsychology for applied psychologists Mindfulness: Compassion, choice and gratitude Adaption-based Process Therapy (APT) for personality disorders Developmental Psychology

30-31 January 29 April 21 May 28-29 May 30 September 31 October

Understanding childhood feeding disorders: Causes, diagnosis and interventions Educational & Child Psychology

28 April

The practice of educational psychology in an increasingly diverse society Understanding childhood feeding disorders: Causes, diagnosis and interventions Running groups in schools based on CBT principles – Sharing practical issues

24 March 28 April 8 May

www.bps.org.uk/findcpd

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Ethical trading: Guidelines and issues for EP services offering traded services Post-16 educational psychology Developing mindfulness in schools From ‘ice-breakers’ to creating connections to farewells: Group facilitation Implementation Science: Leading evidence-based practice in psychology Forensic Psychology

10 June 23 July 29 September 7 October 13 October

Cognitive Analytic Therapy in a forensic setting Advanced Interpretative Phenomenological Analysis (IPA) Exploring terrorism and extremist behaviour Understanding qualitative analysis Understanding violence and aggression: Theory and therapeutic techniques Assessment, formulation and therapy with women who commit offences within the family Health Psychology

14 March 31 March 17 April 20 June 18 September 1 October

Using therapeutic skills to engage individuals with physical and long-term conditions to manage their health The Behaviour Change Wheel Guide to intervention development, evaluation and evidence synthesis Advanced Interpretative Phenomenological Analysis (IPA) Planning and implementing psychological treatment for eating disorders Vocational Rehabilitation: What is it and what role can health psychologists play?

From ‘ice-breakers’ to creating connections to farewells: Group facilitation Facilitating preferred changes using narrative approaches for those with physical health problems Neuropsychology

21 February 13 March 31 March 29 April 25 June 7 October 17 October

The neuropsychological management of Multiple Sclerosis (Liverpool) Essential knowledge of psychometric measures and neuropsychology for applied psychologists Mild traumatic brain injury and stress: The influence of trauma and prolonged stress on cognitive functioning Occupational Psychology

13 February 28-29 May 9 October

Refresher course on repertory grids Developing evidence-based approaches to practice in organisational psychology The creative spark: Fanning the innovative flame in everyone (Bristol) Leading culture change Sharing best practice of diagnosing and assessing adults with Neuro-Diversity in the workplace High performance team development Mental health at work: Improving well-being in the workplace Psychology of Women

27 February 28 March 16 May 5 June 16 June 25 September 15 October

Planning and implementing psychological treatment for eating disorders Psychotherapy

29 April

Planning and implementing psychological treatment for eating disorders An introduction to working therapeutically with couples Qualitative Methods in Psychology

29 April 30-31 October

Advanced Interpretative Phenomenological Analysis (IPA) Understanding qualitative analysis Sport & Exercise Psychology

31 March 20 June

Developing mental strength: Applying positive psychology in sport Transpersonal Psychology

25 April

What do meditation and mindfulness have to offer to the 21st Century practitioner?

Making better use of a psychological resilience paradigm in health and well-being services Playful revolution: Creative approaches to well-being, health and growth

2 May 30 June 30 July

For more information on these CPD events and many more that will take place in 2014, including the popular supervision, expert witness and private practice workshops visit www.bps.org.uk/findcpd.

read discuss contribute at www.thepsychologist.org.uk

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CAREERS

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Advice and inspiration for postgraduates Alana James reports on the advice given to PhD students at a workshop organised

by PsyPAG, held at the CogDev 2013 conference, University of Reading

ver 30 postgraduate students attended the pre-conference workshop on ‘Getting Published and Planning your Career’, organised by Beth Law (University of Reading), Samantha Reeves (Canterbury Christ Church University) and Katie Rix (University of Greenwich). For those who couldn’t attend, here are some of the key points.

O

Getting published Margaret Harris (Oxford Brookes University, Editor of the British Journal of Developmental Psychology) and Robert

Johnson (University of Kent, previous Editor of Visual Cognition) gave advice on the what, where, how and when of getting your work published.

Choosing what to publish The first step is to choose which study to publish. This means remembering that not everything is worth publishing, and focusing on publishing something that will make a significant contribution.

It may be tempting to try to publish as much as possible, but it is better to publish fewer papers of higher quality than many papers that will not get

citations. One suggestion made during the workshop was to ask supervisors or other senior colleagues if they have any research waiting to be analysed or written up that you could help with, in return for being included in the authorship. Being third author on a good paper may be more worthwhile than being first author on a poor one.

Choosing where to publish Once you have identified the study you want to publish, find the most appropriate journal to submit it to. The trick is to balance finding a high-impact journal with one where your research will be read by your target audience. Looking at journal impact factors (an average of how many citations each article published in the journal receives) and other bibliometrics (such as journal rankings) can help identify high-quality journals.

However, a paper on a specific topic may get more citations if it is published in a specialist journal with a low impact factor than a more general journal with a high impact factor. A tip is to look at your references list to see where other research in your area has been published.

Writing well Writing journal articles can be very different from writing a PhD thesis.

The readership is much larger, and the number of pages cannot be as many.

Thinking about what the article’s ‘big idea’ is and how this will draw readers in can be a good starting point; remember that the title and abstract may be the only chance you get to convince someone to read the paper. To make sure that it is well written, ask as many people as possible to comment on drafts. Finally, make absolutely sure that you don’t make simple spelling and grammatical errors, and that you follow the journal’s instructions for authors. It is better to be critiqued for what you have to say than the way you have said it.

jobs online

Looking at journal impact factors can help identify high-quality journals

www.psychapp.co.uk is now open to all.

Advertisers can now reach beyond the prime audience of Society members that they reach in print, to include the many other suitably qualified individuals online.

Society members have the added benefit of being able to sign up for suitable e-mail and RSS alerts, and we are looking to add more

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Possible outcomes Once you have submitted your article,

member-only benefits as the site develops over the coming years. Please let the Managing Editor know what features you would appreciate, on jon.sutton@bps.org.uk.

Please help us to spread the word. Recruiters can post online from just £750, and at no extra cost when placing an ad in print.

For more information, see p.50.

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don’t hold your breath, because the reviewing process can take some time.

Don’t immediately crumple if you receive a rejection as this can just mean that the article wasn’t right for that journal at this time. The holy grail is to have an article accepted as it is, but more likely options are to have a conditional acceptance dependent upon minor revisions or to be asked to revise and resubmit. If you are asked to make revisions, consider them carefully and don’t feel that you have to make every change requested by the reviewers. It is more important to be clear about any changes you have made or have not made, giving thorough explanations rather than being argumentative.

When to publish The sooner the better! Try to start publishing your work as soon as possible.

However, it is still worth waiting to make sure your first publications are high quality. In some research areas where studies tend to be longitudinal, particularly in developmental psychology, publishing before the end of a PhD may not be possible.

Whilst these don’t offer stability, they will broaden your experience and could lead to opportunities for longer-term work.

A relatively new development is the creation of teaching promotion streams, with an increasing number of teachingonly or teaching-focused roles; this could be a better option for those who enjoy teaching and an alternative way of securing a longer-term contract.

to offer and don’t feel that you can only apply for roles directly related to your PhD topic.

Take advantage of all opportunities A theme that came through in the different presentations was the need to be flexible and make the most out of what is available. This could mean taking up work abroad even though you planned to settle down, taking on extra work to gain experience and losing precious free time, or doing research in an area you weren’t planning to. Your academic career path is unlikely to be a straight road, but the diversions could be interesting.

Remember all of your skills and experience As well as gaining research experience, a PhD involves developing a range of skills such as self-confidence, resilience, and determination. You may also have acquired experience of teaching or public engagement. It is just possible that you will have had a life outside of the PhD, or at least before the PhD, where you developed other skills. When applying for positions, remember everything you have

* The speakers were: Daniel Lamport, Bhismadev Chakrabarti, Nicholas Holmes (all University of Reading), Claire Monks (University of Greenwich) and Alana James (Royal Holloway, University of London).

Planning your academic career Any delegate hoping to pick up a step-bystep plan to developing their academic career would have been sadly disappointed. Instead the workshop provided a look at the real world of academic careers. Five speakers* at different stages of their career, ranging from postdocs to associate professor, gave an insight into how they got to where they are today. Each speaker had taken a unique path, but there were some common threads in the advice they gave for postgraduates looking to make the next step into academia.

Don’t ‘panic apply’ It is a tough job market out there, but don’t make the application process even harder by applying for everything and anything. No matter how desperate you feel, don’t be tempted to apply for a role you wouldn’t realistically be willing to accept. It will only give you less time to spend crafting strong applications for the jobs you really want (and add extra work for the people having to sift the applications). Make sure all the applications you submit are tailored to the particular position, and clearly address all of the advertised criteria.

Be aware of all the possibilities To get ahead it may well be necessary to take up short, fixed-term positions.

seek and advertise at www.psychapp.co.uk

2 Positions: Lecturer/Senior L Lecturer/Associate Professor Overseas Competitive salary

Clinical Psychologist (Part-time) South East Competitive salary

Principal Human Factors (HF) Practitioner Technical Partner/Consultant

Salisbury Wiltshire Circa £42,500 PA

To check the latest jobs please go to

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Making the most of our unique skillset Beatrice Chapman talks to health psychologist Vanessa Bogle

r Vanessa Bogle is an experienced health psychologist who has worked in a range of applied roles.

She works part-time as a Senior Public Health Strategist in the public health department of a local authority in London. She has over 13 years experience of NHS experience. She is also currently the Acting Programme Director of the Health Psychology Doctorate at City

D

for a private healthcare company, I was particularly interested in the role of health psychologists in applied settings. So I wanted to ask Dr Bogle to share her thoughts on her varied career and experience.

Tell be about your experience as a public health strategist?

Within my role as Senior Public Health

developing new service models. I am also responsible for the development of the infrastructure of the NHS Health Check programme, a national programme that aims to prevent cardiovascular disease amongst people aged 40–74 years. My key areas of work include men’s health, obesity, physical activity, cancer prevention and brief intervention training.

Health psychology is very much ingrained in the work of health trainers, and the national core training was developed in collaboration with a team of health psychologists. Further examples of work include conducting an evaluation of the NHS Health Check programme and developing service models to increase physical activity levels amongst sedentary populations. On an ongoing basis I roll out motivational interviewing training to a range of healthcare professionals to support the delivery of the NHS Health Check programme. Those eligible for a check, irrespective of their risk of CVD, should receive a brief intervention to support health behaviour change.

The training is designed to enhance the quality of the interventions delivered.

You are saying this is very much a health psychology role; however, your title at work is not Health Psychologist.

Yes. Although my title does not reflect that I am a health Dr Vanessa Bogle and Eddie Nestor (BBC Radio London presenter) at the Men’s Comedy Health psychologist, I use my skills and Check event, November 2013 knowledge in applying health psychology theory and evidence to address major public health concerns, such as obesity and University London. In addition, she is a Strategist I provide expert psychological physical activity, and to address health member of the Motivational Interviewing advice and leadership on behaviour inequalities. This contributes towards Network of Trainers (MINT) and regularly change interventions and training. changing and understanding health delivers training to a range of health Examples include the commissioning of behaviours and in developing more professionals and students. behaviour change interventions – for effective interventions and services.

As a psychology doctoral student example, social marketing, Health One of my key areas of work is at City University and a trainee health Trainer/Champion service and physical physical activity. I sat on a physical psychologist and research/project manager activity programmes, which often involve activity steering group where we were

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looking to develop a physical activity care pathway. The initiation and complexities of behaviour change were overlooked and simplified, so with my health psychology expertise I was well placed to support this piece of work. I introduced motivational interviewing as an approach to facilitate behaviour change; and as a result this now underpins the approach used within the physical activity care pathway, namely ‘Let’s Get Moving’. I delivered the motivational interviewing and physical activity promotion training for healthcare professionals for the London pilot, which supports health professionals to deliver brief interventions.

Have you got any examples of novel projects you have used your health psychology skills in?

It is necessary to used targeted approaches in health promotion as we know that one size does not fit all. There is the need to use theory and evidence base when delivering health promotion; however, I strongly feel that we should be innovative and creative and think outside the box, particularly if we want to engage with clients who tend not to utilise healthcare services. For example, we know men use healthcare services less frequently than women, and tend to present late with symptoms of ill health, or when the disease has progressed, which can negatively influence health outcomes. Having reviewed the evidence for using the performing arts as part of a health promotion strategy, for the past few years I have been looking for an opportunity to use this approach. An opportunity arose in June 2013 in my role within public health to address the men’s health agenda. I developed an initiative aimed at black African Caribbean men aged 40+ living in a deprived area of a London borough that was run during national Men’s Health Week.

The rationale for targeting this population was that black men are three times more likely to develop prostate cancer, and due to ethnicity are at increased risk of developing certain longterm conditions, such as diabetes, stroke and hypertension. The event used comedy as the vehicle to raise awareness about serious health issues. The line-up included a BBC London radio presenter (cancer survivor), a four-time Olympian, a prostate cancer specialist nurse from

Prostate Cancer UK, and a range of standjobs solely using the term ‘health up comedians who were very credible psychologist’ they are few and far between with the target audience. A well-known and they may be disappointed. Look at DJ and some high-profile singers also the job description/specification, and if helped to attract the target audience. The you meet the competencies, apply for aim was to raise those roles. It is really difficult topics and to about health psychologists challenge hegemonic broadening their minds and “we should be innovative masculinity – for thinking about their skillset example, erectile and competence and then and creative and think dysfunction – and looking for jobs. You might outside the box” linking it to health need to spell out to behaviours such as potential employers what you healthy eating, can bring that is over and above physical activity and not drinking alcohol other applicants. Our skillset is unique! to excess. The use of comedy was effective in delivering these messages in Do you think there is more that can a way that may be more challenging using be done to inform up-and-coming a traditional approach such as leaflets. psychologists of the opportunities The event sold out; extra seating was that are out there? added, which sold out a second time.

A lot of health psychologists naturally It was a somewhat risky project as it was enter into teaching and research not scripted; I gave the cast key messages positions, which is obviously important. that I wanted to be communicated, which However, I think it is also important they did ‘free style’. Feedback from the to highlight applied areas that health audience was extremely positive. psychologists can work in as there are Due to its success, I put on a further many opportunities out there. event independently in November – during ‘Movember’ month. The event was How do you see health psychology video recorded and was evaluated using developing in the next five to ten years? three methods (1) direct observation, Given the rise in long-term conditions, (2) questionnaires and (3) semiI think there is a clear role for health structured interviews. psychologists. We need to raise our profile as we are well placed to address Do you think there are many other these issues. If we look at help-seeking health psychologists in roles such as behaviours and primary prevention, this yours? is an important area in terms of helping No. However, I believe that health people to stay well. Informing policy is psychologists are very well placed to offer also crucial important. Health skills to complement and support public psychologists need to have a voice, and health, given that much morbidity and it is pleasing to see that we are making mortality associated with long-term inroads within this area. conditions has a behavioural aetiology.

Unlike clinical psychology we have It is important for health psychologists to self-fund our training, which may be to promote the discipline and our unique a limiting factor, and in addition fees are skillset so that potential employers on the increase. If we do more to raise understand what we do and what we the profile of health psychology and make have to offer. organisations aware of our unique skillset, this could result in more organisations One of the things people might not funding or part-funding trainee health realise, especially those who are psychologists. looking for jobs in applied settings, is that you might need to look for jobs What advice would you give to someone that are not necessarily advertised as who is looking to start a career in Health Psychologist posts. health psychology and would like to Absolutely! I always encourage trainee work in an applied setting? health psychologists who are coming to Do not restrict yourself to looking for the end of their training to look beyond jobs within the NHS or those with a the title, because if they just search for ‘Health Psychologist’ title. Think broadly!

seek and advertise at www.psychapp.co.uk

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Research. Digested.

The British Psychological Society’s free Research Digest Blog, email, Twitter and Facebook

www.researchdigest.org.uk/blog ‘Easy to access and free, and a mine of useful information for my work: what more could I want?

I only wish I’d found this years ago!’

Dr Jennifer Wild, Consultant Clinical Psychologist & Senior Lecturer, Institute of Psychiatry ‘The selection of papers suits my eclectic mind perfectly, and the quality and clarity of the synopses is uniformly excellent.’

Professor Guy Claxton, University of Bristol

read discuss contribute at www.thepsychologist.org.uk

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