Abstract
This first published history of UK clinical psychology marks the late coming of age of a young profession. The book’s launch in 2016 coincided with the 50th anniversary of the Division of Clinical Psychology’s establishment within the British Psychological Society. Professional successes, failings and rivalries are documented with confidence and humility. Clinical psychology has been overshadowed by the larger and longer-established profession of medicine and as only one of several applied psychology disciplines (albeit the largest) within the learned body of the British Psychological Society. Despite early interdisciplinary roots, clinical psychologists have tended to look inwards to protect and sustain themselves rather more than outwards to connect with others. As hinted in the chapter on inter-professional relationships, there is a mutual fear that in sharing we may lose ground. But well-grounded histories such as this should help us find common cause in trying to make the world a better place.
To declare my interest: as a clinical psychologist, I believe mine is a rigorous and creative profession. Its purpose is to promote psychological health and reduce distress, drawing on complex scientific and humanistic understandings of the human condition and of processes of development and change, and respecting the meanings that people bring to their experiences. We have much to offer. But, as argued in a chapter by Juliet Foster (a professional historian), this can only be realized through partnership with those who want our service, recognizing conflicts of interest and minimizing abuses of power. Efforts to achieve true partnership have yet to gain full traction.
This is largely an insiders’ history, edited by three White men who have lived through the rise of clinical psychology since the establishment of the NHS. They acknowledge their limited editorial composition, noting that the profession is now more attractive to female than male applicants and does not take enough entrants from all populations served, especially in terms of ethnicity, social class and disability. We need to engage better with issues of inclusivity (the Inclusivity Strategy launched in 2016 should help). The book highlights the dedication and passion of key individuals who have promoted the use of psychological knowledge to reduce human suffering and improve the conditions of those who are disadvantaged. In 24 chapters, from 39 contributors (whose names read like a roll call from the profession’s great and good), the book explores contexts, roles, client groups, and national and international perspectives, illuminating the profession’s huge scope. It documents practice foundations with children, and research roots with people with intellectual disabilities, extending into mental health provision for adults and older adults, physical health care, long-term conditions, neuropsychology and forensic services (and beyond). Two chapters acknowledge wider national and international perspectives, challenging the individualistic Anglo-centric psychology that dominates teaching and practice in high-income countries. Chapter 4, on the emergence of clinical psychology in the post-war context, addresses the dark shadows of eugenics and of the UK’s colonial legacy.
Clinical psychology’s history is multi-layered, as befits a profession addressing the human condition. Wide-ranging psychological skills and knowledge, and enormous demands of human suffering, lead to pulls in various directions. There is a particular tension in finding a balance between working at individual levels to ameliorate distress, and working at public health levels to help transform the social determinants of health. Several chapters documented the effort that went into the New Ways of Working in Applied Psychology project from 2004, with the tantalizing prospect of innovation, better pathways to training and greater partnership with medicine, linked with psychiatry’s own progressive plans. This was overtaken in 2007 by the Improving Access to Psychological Therapies (IAPT) initiative. There was enthusiastic engagement in IAPT by many senior clinical psychologists who saw it as a positive political investment in mental health and a route to increased recognition, influence and funding for the profession. Others criticized over-involvement as a retrograde step, narrowing our sights and limiting our potential for greater good, sacrificing principles for pragmatism.
In his chapter on the history of training, Tony Lavender noted that we have not been good at explaining to others who we are and what we do, or achieving government recognition, or harnessing the potential contribution of the many talented psychology graduates who wish to enter the profession but for whom there are insufficient training places. Sometimes, wrongly, clinical psychology is equated with psychotherapy. This book corrects that misunderstanding. It is true (and under-recognized) that much of psychotherapy arises from, and crucially depends on, psychological research. Aspects of clinical psychology practice certainly require therapeutic skills. The complexity of therapeutic traditions is well conveyed in the book. But therapy is only part of what we do. The book documents how clinical psychologists are also trained for broader roles, including as researchers, testers and organization changers.
The book is long, and with its careful documentation of sources it is not designed to be read from cover to cover. But its wealth of detail will be an invaluable resource to help communicate the profession’s complexity and values, and how these have been shaped. It is coherently structured, with good editorial chapters setting the scene within the bigger political and economic picture and identifying key messages for the future. This is an official history – there are other takes on clinical psychology’s struggles for power and influence. It should be followed by alternative accounts, including the voices of those who we try to serve. Meantime, the book (especially Chapter 4 and the final overview) is essential reading for all trainees, and recommended for everyone interested in clinical psychology.
We live in tricky times. Future funding of training is uncertain. Threats abound to all health professions, and to those we seek to serve, as the NHS and the welfare state unravel. We should work together to seek creative adaptations to the changing world, promoting a social order in which people, health and equality are valued more than numbers, money and profit. Clinical psychologists may help to create the conditions for people to flourish. As the editors conclude, only time will tell whether we can succeed.