On clinical psychology and stagnation

January is always a struggle. It’s freezing, it’s wet, and any festive joy you may have been channelling has evaporated, leaving only your expanded waistline as evidence that it ever existed. Even if you hate Christmas, I don’t know anyone who loves January. Its only redeeming feature is that the days finally begin to get longer. 

My January was notable because I started two new jobs. What that meant in reality was that, in addition to all my actual clinical work, I also had to spend huge amounts of time trying to get ID badges and security passes and printing tokens (since when do you need a SWIPE CARD to print a letter, by the way?) and IT access and clinical notes access and remembering the names of five thousand different colleagues. 

Tiring, reader, does not even begin to cover it. Though I suppose world events *may* have something to do with that. But anyway. I’ll have no shortage of opportunities to write about the nightmare of global politics over the coming months, more’s the pity, so I am going to write something less dystopia-focused. 

My new-job-excitement was subject to an interlude because I went to Liverpool. Basically, the main clinical psychology conference was occurring there and a motley crew of colleagues  and co-conspirators had thought it might be good craic to simultaneously have a fringe festival bringing together mental health and the arts, as well as reprising Beyond the Therapy Room, which was first held in London in 2015, and which is very close to my heart. So I was always going to spend a few days in Liverpool, but I wasn’t too fussed about the big conference. 

I then got a very kind offer from the inestimable Anne Cooke, who was organising a panel debate on the future of the profession. Many of the biggest names in U.K. clinical psychology were on the panel, and I agreed, though I confess I wondered from the beginning what I could say that would be useful or interesting. I have no pretensions about my contribution to my profession – it is, as you would imagine, tiny. But anyway, I said yes. 

The week of the conference rolled around and several of the panellists emailed synopses of their points. I had no idea what I was going to say so kept quiet. The day before the conference rolled around. I hared off for a half-day at work before trotting to Euston for a train and spent the journey stuffing my face and looking out of the window, still unsure what I was going to say. 

That night I met up with some friends who were also involved in the Fringe and we spent the evening escorting acts to venues and so on. I had by this time some half-formed ideas for what I was going to say, but no more. 

On the day of the conference I still wasn’t sure what was going to come out of my mouth (not unusual, given that I rarely plan a talk thoroughly, but this was vague, even for me) but I knew it would have something to do with the privilege of clinal psychology training and the passport it gives you to a better kind of existence (the debate was recorded and once I’ve a link I’ll post it here). But as I got onto the stage (a stage so flimsy that I genuinely thought my right foot was going to go through it at one point) and took my seat I suddenly realised something. 

I was at the flagship clinical psychology event in the U.K., at a debate on the future of the profession. And all I could see around me were white faces, mainly – and I do hope they’ll forgive me for saying so – of a certain age. Now there were exceptions, of course. A few ethnics, some younger folk. But there were a lot of old people in suits. And even though I had been around these people – all decent people, I’m sure; some of whom I know, and none of whom I wish to denigrate – all day, it wasn’t until I saw them as a group that I realised how homogenous they appeared to be. And so I began to wonder why this might be. 

There are 12 000 clinical psychologists in the U.K., but only around 2-300 attend the conference. And, from the few I have attended, it’s often the great and the good who come; those who are established and respected and whatever else. I went because I was speaking, but otherwise I wouldn’t have (I’m not a huge fan of 3-day conferences, for many reasons and in any case, the sheer cost of it was prohibitive). But many of the clinical psychologists I know couldn’t give two hoots about it and that, I think, is concerning. 

Put bluntly, we had a debate about the future of the profession attended primarily by people who may well not even be practising in ten years’ time. Those people may know their stuff; they may have built careers and won awards and got tenure and have a publication list as long as your arm, but they are not the future. People who are barely-qualified are the future. People struggling to get onto training are the future. And the people who use our services are the future, because they know what our profession needs to do differently. And whilst there were one or two explicitly ‘service user’ voices, they were drowned out by the rest of us with our doctorates and our academic posts and our reputations and our egos. 

And as the panel stopped talking and the audience began to contribute I knew that nothing that anyone had said would make any difference in the real world and that many of the conceptual debates will go on for years to come and that although we might have clapped and patted each other on the back we need to start having radically different conversations with radically different people if we are ever to make any progress. 

So, conference duties over, my attention returned to the Fringe. I attended events on both the Thursday and Friday nights, scampering across the city to try to cram in as many acts as possible. Inevitably, there were too many late nights and too many detours to the nearest fried chicken shop.  But it was joyful and energising in a way that most conferences, I think, fail to be. And on the Friday – the last night that most of us were in the city – we once again trundled off somewhere for crisps and conviviality. And I looked around the table and I saw perhaps 18 or 20 people – performers, their friends and partners; psychologists and their friends and partners – many of whom barely knew each other; some of whom were good friends, discussing mental health and art and politics and something and nothing and it was joyous. And that is my psychology – a psychology in which I can have a drink and share some crisps with someone and get to know them. And that, I think, is the psychology that many people – qualified or otherwise, because our shared humanity is what’s important here – believe in. 

I don’t think the current model can survive, not if we want a profession that is going continue to be relevant in the decades to come. Academic publishing is in crisis – hell, academia is in crisis. The NHS is in crisis. Mental health services have never not been in crisis. Taking three days off and paying the better part of £500 to stay in the cheapest hotel you can find and go to a conference which obviously isn’t attracting the people who will be ‘doing psychology’ for the next thirty or forty years? It’s not sustainable. It can’t be. 

What I want is to go to a clinical psychology event that actually represents people. At the moment, we don’t. We know that clinical psychologists are too white, too cisgendered, too rich, too able-bodied, too straight. Apparently we’re also too female, though it’s still men who get the most senior jobs so my sympathy is limited, frankly. But also we have this absurd division between ourselves and the people who use our services and although we might talk about ‘no us and them’ I don’t get that sense of democracy in action. There’s always a service user stream at conferences, of course, but it does feel rather like crumbs from the rich man’s table. 

I suppose my vision is of events which bring people together – irrespective of your background or training – and which allow them to think of ways to make our systems and practices better. That’s not radical – better people than me have been saying it since forever. We talk about making services accessible to all, but we haven’t managed it with our training pathway and we certainly don’t manage it with our professional events. It’s hardly surprising, then, that so many of us have such complex feelings about the way we earn our livings. 

I don’t know how this magically happens. There are obviously people doing this work all over the place, and maybe those people aren’t attracted to fancy conferences and that’s fair. But there is very evidently a real problem if huge swathes of people feel disconnected from and unrepresented by their professional body. And of course you have to be part of something to be able to change it. But you also – as many of us know – have to be given the opportunity to actually create real change. And maybe that’s something we need to work on. 


  1. Given increasing representation of clinical psychologists that are not ‘too white, too cisgendered, too rich, too able-bodied, too straight’ is obviously important, it is curious that you don’t feel the same when it comes to increasing the representation of people who identify as men within the profession. Your use of the term ‘frankly’ is particularly unfortunate given males are over represented in some areas when it comes to service users.

    (Long time reader and general lover of your work).

    1. I appreciate that male mental health is an area we have not focused on enough. My remark relates to ‘minority’ identities within the profession, and particularly that, even though there are far fewer male clinical psychologists than female, men tend to lead services and influence policy much more. I think that’s also worthy of conversation, and I don’t think we do talk about it properly, or meaningfully, or with a will to do something about it, anywhere near enough (though there are doubtless structural forces at play here too). I think that’s slightly separate to the issue of how we improve male mental health in a broader sense.

  2. Dear Masuma,

    Thank you for leaving your views. I wonder if we need a new models of helping relationships to inspire the change you want. I too was at the conference. I believe we need to use the power and responsibility we have to each other to begin to change.

    1. Dear Andrew

      Many thanks for reading. Yes, I think you’re right – perhaps we need to led and taught much more by the people who use our services. And I suspect we need to become less in thrall to our models and much more focused on ‘stories’.

  3. The day that psychologists can truly be themselves, and not only those who are well respected and “famous” (and usually very well-established/nearing the end of their career), and truly stand across the them and is divide will be the day that clinical psychology comes into its own. “Service user representation” and the various guises this comes under still feels tokenistic. There’s still an undercurrent of not being able to be fully open, at least not without fear. One cannot apparently be an excellent clinical psychologist AND a current service user. Why not? This is the rhetoric that has always troubled me and continues to trouble me. I wonder if I am left feeling like this over “them and us” (being a them and an us), then how do all the other “thems” feel and when are we going to find a way of actually talking about this “for real”?

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