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UCL DclinPsy Newsletter
DClinPsy: The
post-Rothian era
We wish our long standing joint course director, Professor Tony Roth, a happy retirement (well, semi-retirement)
Clinical &
Research Activity
?? We talk about exciting
initiatives led by staff, trainees and service users happening on the course & on clinical placements.
Supervisor
Workshops
Supervisor workshops, delivered by UCL, UEL & RHUL can be accessed at www.ucl.ac.uk/clinical- psychology- doctorate/events
Jarrod Cabourne (Newsletter Editor)
Senior Clinical Tutor/Service User Involvement Lead Firstly, I would like to welcome all of our trainees, course staff members and associate clinical tutors to the UCL annual newsletter. A warm welcome also goes to our ex-UCL trainees, who are now reading this as qualified clinicians. We look forward to staying in contact with you over the years to come and working alongside you as clinical and research supervisors. As always, I would also like to express the course’s gratitude to all of our regional supervisors, who are involved in supporting trainees with their research or in offering clinical placements. Your collaboration with the course ensures that we continue to provide trainees with the highest quality of training. A huge thank-you also goes to Professor Tony Roth, who at the end of the last academic year in 2018, stepped down from his role as Joint Course Director. Tony has been at the helm of the DClinPsy at UCL for over 20 years and has been a solid source of support and wisdom for many staff members (myself included) and trainees. I personally want to wish Tony all the best for his future and note that his presence on the 4 th^ floor is already sorely missed. To balance this, I am also pleased to announce in the newsletter, for supervisors who may not be aware, that Katrina Scior has taken on the role of Joint Course Director alongside Pasco Fearon and is working hard to ensure we remain a beacon course for clinical psychology. I hope that you enjoy reading the newsletter and hearing about the various projects currently happening. We are very proud here at UCL of the great work that our trainees are involved with in the region alongside their supervisors.
Enjoy, Jarrod
If you wish to contribute to future editions of the newsletter or would like to include an article reporting on any exciting and innovative projects being undertaken in your service by our trainees, please do contact me at jarrod.cabourne@ucl.ac.uk.
Welcome to the 2019 Newsletter
Main Features
3 Three Cheers to Professor Tony Roth
5 Introducing the new UCL DClinPsy Leadership team
6 Updates on the course
7 The International implementation of CST
8 The DClinPsy International Programme
10 The DCP-London Mentoring Scheme
11 Service User Consultation in Trainee research
13 New Staff
14 Trainee Clinical Activity – Developing a Young onset Dementia Pathway
17 Trainee Research – A new model of Self Esteem
19 Supervisor Updates on Placements
In this Issue The UCL Doctorate in Clinical Psychology is the largest professional training course for Clinical Psychologists in the United Kingdom, and welcomes high- calibre candidates from the UK and abroad.
I know I speak for all the course team and all our colleagues in the health service who have worked with Tony, when I say what an immeasurable debt we owe him. Tony was closely involved in the early days of clinical psychology training as it shifted to a more formal, and commissioned training scheme from the somewhat piece- meal ‘apprenticeship’ models that existed previously. Back in 1994, Tony, with Peter Fonagy, Anne Richardson and Shirley Pearce, set up the UCL Masters in Clinical Psychology (which became a doctorate in 1995), funded by the then Strategic Health Authority. Since then, Tony was instrumental in shaping and innovating what UCL’s training programme became, and UCL has been rightly called a flagship programme by colleagues in other courses around the country, in large part due to Tony’s leadership. The course has always emphasised a pluralistic and evidence-led approach to clinical psychology training, and this is surely a reflection in significant ways of Tony’s non-partisan, open- minded, reflective, logical and grounded way of thinking. Rigorous, meticulous and unflinchingly compassionate to clients, colleagues and trainees alike, Tony is a great example to us all. As if taking a leading role in the DClinPsy, & UK Clinical Psychology as a whole, wasn’t enough, Tony has also been exceptionally influential through his academic work. What Works for Whom , almost certainly the most important book on evidence- based practice for adult mental health so far written, has had a huge impact both within our field and far beyond it. According to Google Scholar, it has been cited more than 3000 times. It’s a perfect example of the Rothian approach – considered, fair and balanced, precise in its formulation, led by the available evidence, and with clients’ best interests at heart. The other enormously influential seam of Tony’s work is his development of competency frameworks for mental health practice. This is an exceptional body of work. So far, Tony and colleagues have completed nine therapy competence frameworks, plus one for supervision of psychological therapies, and a further five for practice in specific clinical contexts. There are more on the way. Each represents a typically comprehensive, detailed and thorough blue-print of the core elements of good practice, and provides crucial information for practitioners, service managers and commissioners in thinking about how you go from ‘high level’ evidence to on-the- ground practice, in a rigorous, safe and effective way. A message from Pasco Fearon (Joint Course Director) With great modesty and diligence, Tony has made a huge contribution to clinical psychology that will be an inspiration to us all for many years to come. You’ll be glad to know that Tony is not disappearing entirely to a life of golfing— unsurprisingly— but is staying on at UCL as Emeritus Professor and continuing his work on competency frameworks with UCL’s Centre for Outcomes Research and Effectiveness (CORE), and no doubt will continue to be a great source of wisdom for many years. So, no goodbyes really, just a big, heartfelt, thank you to a dear colleague. Three Cheers to our Tony!
Introducing the UCL Leadership Team (From left to right As a result of Tony’s departure, there have been numerous changes to the course leadership. Katrina Scior has joined Pasco Fearon as Joint Course Directors. Josh Stott has taken on the role of Clinical Director and Miriam Fornells-Ambrojo the role of Academic Director. Will Mandy continues in his role as Research Director and in January 2019 was joined by John King (not pictured), both now Joint Research Directors. Julia Curl (not pictured) as Senior Administrator completes our leadership team. The new or rather changed team continues to represent diverse clinical and research interests. Pasco’s expertise lies in the area of social and biological processes in children's development. Katrina’s primary interest lies in the field of learning disability and stigma. Josh’s clinical and research interests lie in the older adults field, while Miriam’s lie in the field of psychosis, an area in which she also leads clinical services in ELFT. Will’s research seeks to advance our understanding of how autism spectrum disorders are conceptualised. Finally, John King’s focus is on human memory and the use of techniques such as functional brain imaging and virtual realities with people who are affected by memory impairments. As a team they very much look forward to working with all our stakeholders, above all our trainees, placement supervisors, lecturers and seminar leaders, training commissioners, our local trust Camden & Islington, experts by experience and all others who make the UCL course a vibrant and exciting place to train as a clinical psychologist. Pictured from left to right: Josh Stott, Miriam Fornells-Ambrojo, Pasco Fearon, Will Mandy and Katrina Scior
Congratulations to Professor Aimee Spector The International Implementation of CST Congratulations to our colleague Dr Aimee Spector who is now Professor of Old Age Clinical Psychology. Aimee was recently awarded funding from the Global Alliance for Chronic Diseases for the research programme: ‘Cognitive Stimulation Therapy for people with dementia: International implementation in Brazil, India and Tanzania (CST- International). Aimee speaks about the project in more detail here and further information can be found on the website: https://www.ucl.ac.uk/international-cognitive-stimulation-therapy “The project will last for three years and is jointly funded by the UK Medical Research Council and the Indian Council of Medical Research. Cognitive Stimulation Therapy is a low-cost psychosocial intervention for people with dementia, developed by myself and others at UCL in the late 1990s and demonstrates a strong evidence base for improving cognition and quality of life for people with mild to moderate dementia. It is also cost-effective, recommended by NICE and is now the main non- drug therapy used across the NHS (in around 85% of memory services). Over the next three years, we plan to implement CST for people with dementia in three low and middle income (LMIC) countries: Brazil, India and Tanzania. To do this, we will examine the barriers to and facilitators of successful implementation to formulate an implementation plan, conduct a feasibility trial and engage with policy makers to ensure that CST is provided as part of routine care. Programme Manager Dr Charlotte Stoner was also awarded funding from UCL’s Global Engagement Office to begin a collaboration with academics at the Pontifical Catholic University of Chile to help develop their CST research programme. We hope to submit a further application to expand CST-International to Chile. I am working closely with Hong Kong University for a ‘global partnership in leading non- pharmacological therapies for dementia’. As part of this work, we have also adapted and evaluated CST for Hong Kong Chinese, and recently published a treatment manual”.
“In 2015, I entered the UCL DClinPsy training course at UCL as an international trainee, 3 years after the first international trainees had been recruited. When speaking with course staff it was clear that one of the clear advantages of introducing the international programme was the increase in diversity within the cohort. In parallel, as a profession, the DCP began developing an inclusivity strategy in 2014 that sought to increase access to the profession, develop research / practice led by more diverse knowledge, and ultimately highlighted the need to widen the demographic pool of the profession. This very much fit with UCL as a reputable institution with a global outlook. There is a general consensus that the goal to increase representation and diversity within the profession would have a positive impact on service users we work with. In the following piece I hope to share my experiences of being an international trainee on the course, some of the adjustments made and how we have addressed these as international trainees and course staff. The experience of training I have been appreciative of the opportunity to gain a multitude of experiences across the NHS, an opportunity I could have only dreamed of a few years prior to learning about the course. This is particularly pertinent as I come from Bahrain, a country, situated within a region where mental health services are less developed, and opportunities for training and working in these services are fairly limited. The lessons I have learned from peers, colleagues, and course staff have been invaluable in shaping the way I practice and hope to continue to practice in my future. Alongside these exciting opportunities have come some challenges of being on the course and working in the NHS as an international trainee. Firstly, there was an inevitably steep learning curve to understanding a new healthcare system altogether – from knowing what a GP is to understanding the paths of training to become a clinical psychologist in the UK. Having worked in mainly private and small services, the concepts of referral pathways and levels of care were foreign to me. Alongside this, there was of course the learning demands on all new trainees in covering a large amount of psychological theory, all before getting to our first day of placement. There are also practical aspects of being an international trainee that can make the experience somewhat different to that of a home fee trainee, notably the financial implications of not being a salaried employee. Aside from the annual tuition, commuting in London can be expensive and for international trainees to access to the varied learning opportunities available within the various NHS trusts across the North Thames region, this can increase monthly outgoings. Continued on Page 9 The UCL International Training Programme With the DClinPsy now having an international programme established for 6 years, and the first cohort of trainees qualifying in 2015, Summer Fakhro (a 2018 graduate) talks about how we are continuing to develop this branch of our training programme and the lessons learned. For supervisors less familiar with this aspect of the training programme, international trainees are recruited under the same process as UK/EU trainees but are non-EU applicants who may be funded by an external sponsor e.g. their national government or who may be self-funding. All requirements that form part of the course remain the same for international trainees, including coursework, exams, clinical placements and the major research project.
DCP-London Mentoring Scheme for Black and Asian Aspiring Psychologists: A Call for Mentors
The DCP-London BAME Mentoring Scheme aims to provide support,
encouragement and direct contact with both trainee and qualified
clinical psychologists for Black or Asian aspiring psychologists.
Kat Alcock (Mentoring scheme founder and lead), talks about the
scheme and we hear from a small number of mentees.
What do mentees receive?
1. Six evening workshops, led by trainees from across the six London
courses. Workshops are exercise based, focusing on reflection as a skill,
including Burnham’s social GGRRAAACCEEESSS. The 2018 - 2019
workshops are now complete.
2. 1:1 mentoring with a trainee clinical psychologist of any ethnic
background – a minimum of three to four contacts (face-to-face, email,
phone SKYPE etc.) over a 6-12 month period. Mentoring generally focuses
on advice relating to application forms, job and DClinPsy interviews,
theory-practice links and guidance relating to relevant experience.
3. 1:1 mentoring with a qualified clinical psychologist of any ethnic
background - a minimum of three to four contacts (face-to-face, email,
phone SKYPE etc.) over a 6-12 month period. Mentoring generally focuses
on the bigger career picture: experience, ambitions and interests;
possible pathways into clinical psychology; gaps in experience; various
roles of a clinical psychologist; current issues in the NHS and for the
profession; navigating the application process, form and interview;
support with linking theory and practice and understanding different
models of mental health; discussion of alternative career paths where
relevant. Some mentors are able to offer shadowing/attendance at
meetings/clinical and/or research experience where there is capacity.
This is not a requirement.
We are currently recruiting
qualified clinical
psychologists based in the
London region, to provide
1:1 mentoring to a Black or
Asian aspiring psychologist,
as there is evidence that
Black and Asian applicants
have fewer opportunities
for such contact than their
white counterparts. This is
likely to be a significant
contributor to the marked
and consistent
underrepresentation of
BME trainee and qualified
clinical psychologists.
“Thank you for the mentoring scheme, I’ve got fantastic mentors and through them I’m looking forward to starting an honorary assistant psychologist role” “I was fortunate enough to get a place into training this year! I was a part of the scheme last year and found it extremely helpful” “I have a place on a course and will be starting the Doctorate this September. I found the BME scheme really helpful. I made some really good contacts and got to be part of great research opportunities”
My thesis is aiming to explore conceptualisations of care in the inpatient setting from the perspectives of service users and staff, with a focus on experiences of restrictive practices. Ensuring that the study design was acceptable to service users was key and my supervisors, Vyv Huddy and Claire Williams and I wanted to ensure that service user involvement was incorporated within the process of designing and implementing the project. Consultations were arranged with 5 members of the UCL service user and carer reference group, which were easy and straightforward to arrange. After months of preparing the NHS ethics application, collaborating with the consultants brought the project back to life for me. The feedback I received was thoughtful, insightful and creative, leading to some beneficial changes being made to the research, such as proposing evening as well as daytime visits for the field work component of the research and reflecting on the language used in the research documents. Knowing that individuals with lived experience felt the project was acceptable and relevant also gave me confidence going in to the NHS ethics review and the contribution of the consultants was well received by the ethics committee. It was clear to me that the consultants gave up their time due to a passion to improving research in this field and many offered ongoing support with the project, should there be opportunities for further input. I would highly recommend engaging with the service user and carer reference group as an opportunity to meaningfully collaborate with individuals who are experts by experience, and who can bring ideas and wisdom to trainee clinical psychologists’ research.
On Page 12…..
A member of the UCL Service User & Carer Committee speaks about the experience of consulting with Caroline on her research. Service User Consultation in Research
The UCL DClinPsy Service User and Carer committee have been working steadily at increasing
the representation of service users in all areas of the doctorate programme. The last 3 years
have seen an increase in involvement in selection and teaching and this year we are focusing
specifically on research, for example involving service users in the early stages of research (e.g.
study design). Members of committee at UCL have recently been invited to act as consultants to
some trainees in developing their research for the major research project. Caroline Bendall, one
of our current trainees who is preparing her thesis for submission in May 2019, speaks about her
experience of this initiative. We also hear from the member of the service user and carer
committee who acted in a consultative role to the project. Trainees wishing to speak with our
service user and carer committee regarding research should make contact with me directly at
jarrod.cabourne@ucl.ac.uk.
Marc worked as a psychophysicist and experimental psychologist for over ten years, studying visual processing in psychiatric, neurodevelopmental and neurological conditions such as Schizophrenia, Autism and Migraine. Marc qualified as a Clinical Psychologist in 2017, and has worked at the Brandon Centre and Great Ormond Street. Marc has a number of research interests, but most recently has been studying the social and economic predictors of psychological symptoms. Marc is also interested to explore the impact of such contextual factors in young people’s mental health, with a particular focus on the role of digital technology and social media use. Michelle trained at UCL and since qualifying, she has worked in a variety of health settings including plastic and reconstructive surgery, chronic wound care, and specialist weight management (adult obesity) services, as well as CAMHS Eating Disorders. Michelle has a keen interest in stigma and implicit attitudes, obesity, appearance concerns, as well as compassion focused therapy, acceptance and commitment therapy and trainee experiences of clinical psychology training and placements. Since jointly organises the health unit with Amanda Williams. She is currently involved in an ongoing project exploring trainee experiences of clinical placements whilst on training. Liam completed his PhD in cognitive neuroscience at the University of Manchester in 2012, and then his clinical training at the Institute of Psychiatry, Psychology & Neuroscience. Since qualifying as a Clinical Psychologist in 2015, he has been working in a National & Specialist service providing CBT for psychosis and bipolar disorder. Liam's research focuses on mood instability and risk-taking, combining mood tracking using smartphones with neuroimaging. He is also interested in how psychological therapies change the brain. Vaughan’s research and clinical work largely focuses on psychosis and the people affected by it. He currently works in a psychological interventions clinic for people with psychosis where he specialises in seeing people with psychosis alongside neurological or neurodevelopmental difficulties. His research largely focuses on the same, using experimental and epidemiological methods. New Staff Marc Tibber Lecturer Michelle Wilson Clinical Tutor Liam Mason Lecturer Vaughan Bell Associate Professor
Trainee Placement Activity In addition to delivering therapeutic interventions, the doctorate programme provides trainees with opportunities to develop their knowledge and skills in relation to other roles of the clinical psychologist, including leadership and service development. Itamar Cohen is a third year trainee and here he talks about his involvement in developing a new care pathway for Young Onset Dementia (YOD) during his placement at Newham Memory Service in East London. “It is estimated that there are 42,325 people in the UK who have been diagnosed with young onset dementia (YOD) and represent around 5% of the 850,000 people living with dementia across the UK (Ref Dementia UK, 2nd edition 2014, Alzheimer’s Society). The main aim of the new care pathway is to provide a new therapeutic framework addressing the unique needs of people who have been diagnosed with YOD, i.e. where symptom onset is before 65 years of age. The new care pathway is a shared project of three organisations: Newham Memory Clinic, The Alzheimer Society and ELFT’s People Participation stream. Although younger people experience similar symptoms in YOD to older people with dementia, the impact on their lives can be very different. Younger people are more likely to still be working when they are diagnosed and many may still have significant personal and financial commitments (e.g. a mortgage, dependent children, or have their own carer responsibilities for living parents). It is estimated that there are 42,325 people in the UK who have been diagnosed with young onset dementia (YOD) and represent around 5% of the 850,000 people living with dementia across the UK (Ref Dementia UK, 2nd edition 2014, Alzheimer’s Society). The main aim of the new care pathway is to provide a new therapeutic framework addressing the unique needs of people who have been diagnosed with YOD, i.e. where symptom onset is before 65 years of age. The new care pathway is a shared project of three organisations: Newham Memory Clinic, The Alzheimer Society and ELFT’s People Participation stream. Although younger people experience similar symptoms in YOD to older people with dementia, the impact on their lives can be very different. Younger people are more likely to still be working when they are diagnosed and many may still have significant personal and financial commitments (e.g. a mortgage, dependent children, or have their own carer responsibilities for living parents). The New Pathway The new YOD care pathway aims to fulfil a gap within current service provision where the needs of younger clients are met via educational and psychosocial interventions. Continued on page 15 Developing a Young Onset Dementia Pathway Itamar Cohen
pTrainee Research Self-esteem is one of the most studied topics in the social sciences. Researchers have repeatedly found associations between low self-esteem and a number of unfavourable outcomes including poor interpersonal relationships, criminal behaviour, substance abuse and various mental health conditions. In contrast, high self- esteem has been associated with greater autonomy and ability to cope with life stresses, happiness and psychological wellbeing. Traditionally, self-esteem has been described as a global concept, which is relatively stable across time and situations. However, self-esteem has also been conceptualised as multidimensional or domain- specific, which refers to an individual’s self-appraisals within more circumscribed domains, for example, intellectualism, athleticism and appearance. However, despite support in the literature for the multidimensional nature of self- esteem, there is currently a lack of interventions targeting domain specific self-esteem. In response, a new cognitive- behavioural model of domain- specific self-esteem was proposed by Jack Hollingdale, a former UCL trainee who qualified from the programme in 2017. The model (next page) suggests that an individual’s early life experiences influence how much value or importance they place on different domains. The model also suggests that these life experiences influence the development of attributional styles, which determine how the person will perceive and interpret events in various domains. Attributional styles refer to a general tendency to make internal (versus external), stable (versus temporary), and global (versus specific) attributions for positive and negative events (Abramson et al., 1978). The model challenges the traditional view that self-esteem can be identified as having arbitrary thresholds of ‘low’ and ‘high’. Instead it views self-esteem as being on a continuum, which, at times, can become unsatisfactory for our needs within a specific domain, situation or period of life. Based on the unsatisfactory self- esteem model, a four-session CBT group intervention was developed (Hollingdale, 2015). The content of the intervention included psychoeducation about the model, development of a domain specific self-esteem profile and formulation, positive data logs, thought challenging and behavioural experiments. As part of our doctoral theses, we, Emily Dixon and Ciping Goh, conducted a pilot study of the intervention. We hoped to determine if the intervention would lead to improvements in global and domain-specific self-esteem, depression, anxiety and psychological wellbeing. We were also interested in whether the intervention would lead to changes in individual attributional styles. In the winter edition of the 2016 UCL newsletter, Jack Hollingdale (a former trainee who qualified in 2017), wrote about the development of a new domain- specific model of self-esteem (access to this article can be found under the Course Newsletter tab on the website). Since then, the clinical effectiveness of the model, using a group intervention, has been investigated as part of a DClinPsy major research project. Emilie Dixon, a 2018 UCL graduate, reports on the findings of this project. Emily Dixon 2018 UCL Graduate Continued on Page 17
Researching a new model of Self Esteem The Study METHOD We tested the group intervention on 51 students at UCL, using a pretest-posttest design. Participants were asked to complete questionnaires at pre- treatment, post-treatment and one-month follow up. RESULTS We analysed the results using mixed-model analyses and post- hoc comparisons which revealed significant differences between pre-treatment and post- treatment on measures of domain-specific self-esteem, global self-esteem, depression and psychological wellbeing. At post-treatment the effect sizes for global self-esteem, depression and anxiety were found to be in the moderate range. All these changes appeared to be maintained at the one-month follow up. However, we did not find any significant differences between time periods on measures of anxiety. The analyses also revealed significant differences between pre-treatment and post- treatment on a measure of attributional styles for negative events, which again was maintained at follow-up. This suggests that, following the intervention, participants showed a shift towards more external, unstable and specific styles. However, no significant differences were found between time points on measures of attributional style for positive events. CONCLUSIONS The unsatisfactory self-esteem model and group intervention are the first of their kind specifically to target domain specific self-esteem. Thus, we were gratified that the results suggest that the intervention is promising for improving domain- specific self-esteem, global self- esteem, depression and psychological wellbeing, as well as resulting in changes in an individuals’ attributional styles towards negative events. The domain specific self-esteem model allows individuals to identify specific domains of self- esteem that might be considered unsatisfactory for their needs, or indeed to highlight areas of satisfactory self-esteem. This can be valuable for planning specific treatment goals in comparison to the broader self-esteem goals employed by traditional self- esteem approaches. Although these results appear promising we hope in the future we will be able to compare the intervention with a control group, using a randomised controlled trial (RCT), so we can start to make inferences about causality.
