New Roles In Psychology Paper On The Vision

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Thje vision paper supporting New Ways of Working for Applied Psychologists


<ul><li> 1. New roles in psychology Contributions to a vision of psychology applied to health A written monologue 16th July 2006 Derek Mowbray DRAFT In confidence but for discussion (in other words keep it close to your chest but chat about it to people you can trust) This is a personal reflection of the workshop held on 13th July in Birmingham as part of the work of the new roles working group which is part of New Ways of Working for Applied Psychologists WHERE TO START? We started with Thomas McKeown and his description of influences on health and wellbeing in his book The Role of Medicine (1976).1 In this he identifies genetics, nutrition and behaviour as having significant influences on health and wellbeing. This had a profound influence on my own thinking about the role of psychology in our lives and how aspects of psychological science could be applied to the issues of health. The complexity surrounding defining health is made more difficult by the dominance of the medical interpretation of illness, and the resulting definitions which have been consistently ascribed to classifications. In the end, health is about feeling well or wellbeing. Our own personal levels of tolerance of illness will manifest themselves in ways we describe how we feel. An objective measure may reveal we are, de facto, suffering an illness, but we feel OK about that. Psychological wellbeing may be more difficult to define as it is about the ability the respond positively to events; in effect, to survive. So far, then, we have come up with some influencing features the idea of survival, and acting positively. It is an essential aspect of living that there is a drive to survive. Only when all options for survival have been exhausted do we tend to accept the inevitable and not survive. Up to that point there is a strong driver to survive. BUT is there a strong driver to prosper? In todays society in western Europe it is a question of surviving and prospering. Unlike other societies where the imperative is to survive, we tend to accept that survival is a given, but prospering is something that requires energy. So, our society accepts the basic levels of survival, but we want more. We want people to feel positive, live in harmony, embrace different experiences and cultures, contribute to society at large and specific communities. We expect people to be understanding of different points of view, to become engaged in the growth of communities, to contribute to.anything. The giving of ourselves for no personal gain is altruism. Altruism is rare what we seem to be doing is giving of ourselves for personal gain contributing because something positive will happen to us; this reciprocity of giving and receiving may be a key to unlock the door to prosperity. 1 McKeown, Thomas. The Role of Medicine Dream, Mirage or Nemesis. The Rock Carling Fellowship 1976. NPHT. 1976. 1 </li> <li> 2. Our interpretation of wellbeing is influenced by these matters. Psychological wellbeing will have as the baseline the psychological strength to survive AND prosper. Where prosperity is in doubt we will intervene. Our social interventions start at birth and continue for life. Our health interventions start with birth and continue for life. Our psychological interventions start when someone suggests it may be a good idea to chat to a psychologist. Yet where does all the science about attachment theory, about gender influence in upbringing, about the fascinating issue of available time to learn (instead of listening to family rows and the TV) come from? It comes from psychologists. Another feature is the criterion against which wellbeing is judged. As survival is finite, prosperity is ambiguous. The criterion for judging prosperity comes down to a criterion based on personal expectation. I expect a happy family lifeis ambiguous, but could be made more finite by establishing the expectations of those involved in a systematic manner which reveal their genuine expectations. If their expectations are hovering around the survival level, then we can suggest expectations which imply prosperity. Psychological wellbeing, then, has something to do with moving forward towards something, not simply surviving. On this basis, encouraging people to move forward will provide psychological wellbeing and, by implication, positive health. PSYCHOLOGICAL CULTURE Culture is represented by clustered values, rules, symbols, myths, history, stories and anything else which people find influential in their lives and working lives. Research in this field discovers interesting items such as common language, folk culture represented by songs, dress, behaviour. Some personality assessments, such as the California Personality Inventory (CPI), are based on the idea of folk personalities. A psychological culture might be one which focuses on the individual ability to move forward. The USA culture is psychological the land of the free where you can achieve anything you want. Not bad for a country where all kinds of intolerance is accepted as the norm. A psychological culture might be one which honours and respects the individual. In this context the Chinese culture respects the old, accords them with a special place in the family, and, to a certain extent, revolves their family lives around them. Recent headlines in UK press would suggest that there is little respect for the vulnerable elderly here. A psychological culture might be one which honours and respects differences and absorbs the notion of the whole being greater than the sum of the parts. My own blood family is constituted of English, Scottish, Jamaican and Canadian born. With their interests in world affairs my daughters currently inhabit China and Africa, and their close friends include Chinese, Polish, Indian, French and German born. The mix of experiences and backgrounds contributes immeasurable benefits to their lives and would appear to provide them with a degree of confidence I havent yet discovered. If we are interested in promoting a psychological culture we will need to establish the principles on which a culture will be formed. This will be seen as social control, but it is no more, nor less, than the social control exercised by individuals who invoke the use of national resources through their own actions, thus depriving the rest of society the opportunity of using the same resources for other purposes. Smoking springs to mind. 2 </li> <li> 3. One way into this is to take the determinants of health policy and declare that a psychological culture is being developed around influencing positive outcomes in relation to the critical health issues facing this community today. LANGUAGE We were pondering the relative failure of psychology to make a mark on how health can be improved, in particular, a failure to grasp the sheer power of psychology in influencing wellbeing and health. Two influences were discussed. One was the lack of courage of psychologists to stand out as champions of a science which could make a difference to many. The other was the simple, but complex issues of language. Simple because language is a subject most people understand its what distinguishes us from other species, and helps to create cohesion. It is complicated because psychological discourse can be in simple and complex language. The simple language makes psychology seem like common sense, and can support the idea that everyone is a fully developed psychologist. Semi-complex language (the kind of stuff one of my close friends records and berates me with when we meet like direction of travel or pro-active or psychodynamic). This is seen by my friend, at least, as psychobabble and instantly dismissed as words from a lesser being. Hes a lawyer and has no legs to stand on, but when has that stopped a lawyer? The complex language can exclude others from understanding, and can sometimes (often?) create the hilarious situation where someone is speaking complicated psychology to an audience that hasnt a clue what she is talking about. And that could be in a court room. What we need is a psychological language to go along with the psychological culture. To me the language needs to be robust and not fluffy; it should be strongly identified with moving forward, overcoming things, producing personal satisfaction, peace of mind, providing confidence an assertive type language, but not macho; a language of depth, not superficial; a language of warmth, not distancing; a language of encouragement. Somehow it has to be distinctive from the language of the clergy. AWARENESS OF PSYCHOLOGY The idea that everyone is a psychologist is true, but there are limitations placed on the untrained and uneducated psychologist about which the general public is probably unaware. Put bluntly, a medic can chop out something and the patient goes home OK and grateful. A psychologist cannot do this in quite the same way, although there are plenty of illustrations of the public being grateful for the services of psychologists; it doesnt seem as immediate. Although CBT is now gaining stardom status, and there are interesting media depictions of psychologists as profilers and being forensic, there is a need to raise the awareness of the public of the benefits and contributions which the science of psychology makes to the wellbeing of society and the understanding of events. Over the recent past there has been a drive for scientists in general to communicate effectively with the public. This must be equally important for psychologists and social scientists. The public is influenced by the media; the media controls the publics agenda. This is a specialist area, and could become a new role. HOW DOES PSYCHOLOGY INTERVENE? 3 </li> <li> 4. I developed the model of strategic purpose about 12 years ago in Ireland. I was doing the makeover of Cork Regional Hospital and its services at the time, and trying to engage as many senior staff as possible in deciding what the hospital and its services should do. There were many and varied outcomes from that two year piece of work, but the most obvious was the change of name to reflect the purpose of the hospital as a teaching and research institution. The model has been used regularly since, by many people around the world, and has stood the test of many applications. There is a huge role in prevention. If Thomas McKeowen is to be believed then behaviour has a significant influence on the wellbeing and health of the population. By intervening early in the processes of personal development, wellbeing and health, there is a prospect that behaviour patterns will follow those which lead to health and wellbeing. As mentioned earlier social care can intervene at birth; the same with medicine, yet psychology isnt there seeking to ensure the psychological wellbeing of mother, father and child, together with providing the support needed to start a life in a direction leading to health and wellbeing. As school age approaches, the role of psychology in interaction, learning, behaviour, assessment for potential as well as for developmental factors, diagnosis, and general family support is well established but not widely available. On a wider scale, the inter-relationship between systems, organizations and policies have a direct impact on the potential of the individual to survive, thrive and prosper. The link between employment and wellbeing is now established; the link between family integration and wellbeing is, also, reasonably clear; the link between poverty, employment and wellbeing has been established for over twenty years. A role for psychology in this mix of tensions is to provide the coping ability to transform a reaction of helplessness to one of survival and prosperity. As children move through adolescence we know there are particular risk situations. Apart from the lifestyle issues of sex and booze, there are the complex issues of adolescent boy suicides, and girl anorexia. Logic suggests that some kind of trigger exists for these two painful experiences, for which psychology should have some kind of answer or at least hint from which active intervention at some stage might be possible. The empty nest syndrome can plummet people into depression. Just as mothers might be considering a return to employment they are plunged into a sense of helplessness, both in terms of being equipped to work once more, and in emotional terms having entered into a bereavement process because of their children leaving home. The impact of this on the economy may be known to others, but with the rise in the numbers attending universities, and the shrinking of the employable population size, with the increasing numbers of dependants on the State, the performance capability of mothers at this stage in their lives becomes an issue for psychologists. The idea of preventing deterioration comes from the notion that once anyone is in contact with a professional service, that service would have the purpose of preventing any deterioration in the condition or reason for being in contact. The antithesis of this is for people in need to be in contact with a service and then be placed in a queue to be supported at some later stage. There is little point of being in contact with a service only to have to wait a further period for attention. If someone acted in this way in a shop, the customer would probably cry with frustration or leave and go elsewhere. In health terms this delay can be fatal. If I hadnt insisted that my wife go to her GP, and he hadnt had a dermatological house job in his career, and if the Frenchay team hadnt operated within a week, that nasty melanoma might have taken its toll. As it was it was five years of absolute misery. But she didnt deteriorate. She got better and returned to being a mother and eventually work, and her actuarial insurance assessment is now better than mine. 4 </li> <li> 5. Preventing deterioration should be a significant purpose for psychologists. Does it matter that those in need wait? For some physical conditions it may not. There are some orthopaedic conditions which can wait, but...</li></ul>


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