Table Of ContentA SHORT INTRODUCTION TO
CLINICAL
PSYCHOLOGY
CHESHIRE_&_PILGRIM-PRELIMS.QXD 3/12/04 3:54 PM Page i
Short Introductions to the Therapy Professions
Series Editor:Colin Feltham
Books in this series examine the different professions which provide
help for people experiencing emotional or psychological problems.
Written by leading practitioners and trainers in each field, the
books are a source of up-to-date information about
•
the nature of the work
•
training, continuing professional development and career path-
ways
•
the structure and development of the profession
•
client populations and consumer views
•
research and debates surrounding the profession.
Short Introductions to the Therapy Professions are ideal for anyone
thinking about a career in one of the therapy professions or in the
early stages of training. The books will also be of interest to mental
health professionals needing to understand allied professions and
also to patients, clients and relatives of service users.
Books in the series:
A Short Introduction to Clinical Psychology
Katherine Cheshire and David Pilgrim
A Short Introduction to Psychoanalysis
Jane Milton, Caroline Polmear and Julia Fabricius
A Short Introduction to Psychiatry
Linda Gask
CHESHIRE_&_PILGRIM-PRELIMS.QXD 3/12/04 3:54 PM Page ii
A SHORT INTRODUCTION TO
CLINICAL
PSYCHOLOGY
Katherine Cheshire and David Pilgrim
SAGE Publications
London • Thousand Oaks • New Delhi
A SHORT INTRODUCTION TO THE THERAPY PROFESSIONS
CHESHIRE_&_PILGRIM-PRELIMS.QXD 3/12/04 3:54 PM Page iii
© Katherine Cheshire and David Pilgrim 2004
First published 2004
Apart from any fair dealing for the purposes of research
or private study, or criticism or review, as permitted under
the Copyright, Designs and Patents Act, 1988, this
publication may be reproduced, stored or transmitted in
any form, or by any means, only with the prior permission
in writing of the publishers, or in the case of reprographic
reproduction, in accordance with the terms of licences
issued by the Copyright Licensing Agency. Inquiries
concerning reproduction outside those terms should be
sent to the publishers.
SAGE Publications Ltd
1 Oliver’s Yard
55 City Road
London EC1Y 1SP
SAGE Publications Inc.
2455 Teller Road
Thousand Oaks, California 91320
SAGE Publications India Pvt Ltd
B-42, Panchsheel Enclave
Post Box 4109
New Delhi 100 017
British Library Cataloguing in Publication data
A catalogue record for this book is available
from the British Library
ISBN 0 7619 4768 X
ISBN 0 7619 4769 8 (pbk)
Library of Congress Control Number: 2003115330
Typeset by C&M Digitals (P) Ltd., Chennai, India
Printed in Great Britain by TJ International Ltd, Padstow, Cornwall
CHESHIRE_&_PILGRIM-PRELIMS.QXD 3/12/04 3:54 PM Page iv
CONTENTS
Preface
vi
Acknowledgements
viii
1
The Social and Historical Context of the Profession
1
2
The Knowledge Base of Clinical Psychology
24
3
Clinical Psychology Training
42
4
Careers in Clinical Psychology
64
5
Changing Practice and Changing Roles
85
6
Experts and Expertise
103
7
Internal and External Relationships
119
Glossary of Therapeutic Approaches
136
Further Reading
143
Appendix
144
References
145
Index
156
CHESHIRE_&_PILGRIM-PRELIMS.QXD 3/12/04 3:54 PM Page v
PREFACE
This book aims to provide an account of British clinical psychology
that is both descriptive and critical. We have sought to give the
reader an understanding of the profession’s history, nature and
function, while avoiding the self-serving public relations view that
characterises much professional rhetoric. In order to facilitate our
examination of these issues, we adopt a sociological framework that
allows us to locate clinical psychology within the network that post-
structuralists refer to as the psy complex: psychiatry, psychiatric
social work, mental health nursing, counselling, psychotherapy and
psychology. We argue that the contested knowledge base of British
clinical psychology and its history (particularly its evolution within
the National Health Service) are responsible for many of the pro-
fession’s distinguishing features. At the same time, clinical psycho-
logy shares a number of characteristics with other members of the
psy complex.
In the first two chapters of the book we provide the background to
our subsequent exploration of contemporary British clinical psychol-
ogy. In Chapter 1 we examine the social and historical context from
which the profession emerged. Chapter 2 focuses on the knowledge
base of the profession: its relationship with the academic discipline
of psychology and its reliance on the scientist-practitioner model.
Chapters 3, 4 and 5 describe how prospective members gain entry
to the profession and give an account of the work that we do, fol-
lowed by a discussion of likely developments in our role. Chapter 3
begins with a view of clinical psychology training from the trainees’
perspective, followed by an outline of current training arrangements
and recent proposals to expand training provisions in order to meet
the growing demand for our services. Chapter 4 contains a collec-
tion of accounts written by us and some of our colleagues, describ-
ing the current role of clinical psychologists with a range of client
groups. In Chapter 5 we look more broadly at some of the emerg-
ing trends in clinical psychology and suggest some of the ways in
which our role might evolve in the near future.
The last third of the book, Chapters 6 and 7, continues the critical
appraisal of the profession that we began in Chapter 1. Chapter 6
extends the discussion of professional expertise, begun in Chapter 2,
and examines how clinical psychology’s credibility and marketability
CHESHIRE_&_PILGRIM-PRELIMS.QXD 3/12/04 3:54 PM Page vi
have developed on the basis of its claim to specific expertise within
the psy complex. Finally, in Chapter 7, we assess both the internal
and external relationships that define our profession. We start by
discussing the divisions and co-dependencies within the profession,
and then examine how clinical psychology continues to negotiate its
boundaries with the NHS, central government, other professionals
and service users. The book concludes with a brief consideration of
some continuing debates in British clinical psychology that we
expect to shape the attitudes and work of its members as we
progress through its sixth decade. We suggest that the most radical
shift in orientation may come from the growing influence of the
Positive Psychology movement that champions the active promo-
tion of psychological well-being in contrast with the exclusive focus
on pathology, disorder and distress, which has traditionally charac-
terised our work. If this shift occurs it may, at least in the short term,
increase the gap between clinical psychology and other professions
in the psy complex.
We hope that our readers find this book both informative and
stimulating. Clinical psychology is still a very young profession but
it is no longer in its infancy and we offer this contribution to debates
about its nature and function in the belief that critical self-awareness
is a sign of maturity within both individuals and organisations.
PREFACE
vii
CHESHIRE_&_PILGRIM-PRELIMS.QXD 3/12/04 3:54 PM Page vii
ACKNOWLEDGEMENTS
We would like to thank colleagues from the Fife Area Clinical
Psychology Department, Stratheden Hospital, Cupar, Fife for their
contributions to the following sections of Chapter 4:
Dr Steven Hughes: Children and young people
Dr Frances Baty: Older adults
Mr Bob Walley: People with intellectual disabilities
Ms Kate McGarva: Clinical psychology in physical health care
Mr Andy Peters: Adults with substance misuse problems
Dr Alan Harper: Clinical neuropsychology
CHESHIRE_&_PILGRIM-PRELIMS.QXD 3/12/04 3:54 PM Page viii
1
THE SOCIAL AND HISTORICAL CONTEXT
OF THE PROFESSION
Like all professions, clinical psychology has both features that it
shares with other professions and characteristics that are peculiar to
itself. In this introductory chapter we will first examine the nature
of professions, drawing heavily on their sociology. This summary of
sociological approaches to professional life should assist the reader
to understand how clinical psychology reflects and reproduces gen-
eral features of what came to be known during the twentieth century
as the ‘new middle class’ (Carchedi, 1977). After this general socio-
logical introduction we will identify one aspect of the particular
character of British clinical psychology: its history. This history
reflects the contested knowledge base of the profession – a subject we
will return to in Chapter 2. In Chapter 6 we revisit this discussion
by examining the ways in which this knowledge is expressed in
British clinical psychology, both organisationally and rhetorically, as
a form of clinical expertise. Our final chapter incorporates further
discussion of the profession’s internal dynamics and socio-political
context and suggests how these factors are shaping its future.
What are professions?
The reader of this book, and of others in the series, can appraise the
socio-political character of particular professions on a continuum
from hostile scepticism to naïve trust. The former can be sum-
marised in George Bernard Shaw’s suggestion that ‘the professions
are a conspiracy against the laity’. This expression of outright dis-
trust of self-serving professionals is also found in the sociology of the
professions, as is its opposite: the view that professions are benign,
altruistic and productive contributors to modern societies. In order
to make sense of this range of views, and their potential applicabil-
ity to clinical psychology, we will provide a summary of some socio-
logical work about the mental health professions.
The mental health focus may seem overly restrictive, given that
today clinical psychologists work in a variety of settings. However,
Cheshire-Ch-01.qxd 3/12/04 3:55 PM Page 1
