Consider the following scenario: Two women both lost a son in a war. One returns to work immediately and starts volunteering at an organization helping families of fallen soldiers. The other is unable to leave home, spends most of her days crying and sitting in front of her son’s belongings that were left untouched. Who is more resilient? The answer largely depends on how one defines resilience.
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People don’t exist as isolated entities, and social programs, movements, or data analytic methods that assume they do are not aligned with reality—and may be doomed to fail. We all know that providing therapy or tutoring to a child may be less effective than hoped if the child’s parents, peers, school, and neighborhood are not also operating in a way that’s conducive to the child’s growth and well-being.
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Every year in the United States, over 40,000 individuals take their own lives, making suicide the tenth most common cause of death in the country. September, National Suicide Prevention Month, seeks to raise awareness of this problem and—most importantly—help those who might be affected.
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In June 2015, the results of a new study by the Department of Veterans Affairs were released. The study examined more than 170,000 suicides of adult men and women in 23 states between 2000 and 2010, and concluded that female military veterans kill themselves at a rate that is nearly six times higher than their civilian counterparts.
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In 1789, President George Washington said, “The willingness with which our young people are likely to serve in any war, no matter how justified, shall be directly proportional to how they perceive the veterans of earlier wars were treated and appreciated by their nation.” Judging by this standard, we are failing.
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The stigma of mental illness poses a major barrier when it comes to individuals seeking help. As a society, we are much more comfortable admitting physical problems than psychological ones. Nowhere is this more true than in the military, where troops are trained to be tough and not acknowledge any weaknesses.
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According to a new study of nearly 4 million men and women who served in the military between 2001 and 2007, deploying to a war zone doesn’t increase a service member’s risk of suicide. The study was conducted by the military’s National Center for Telehealth and Technology, and its findings would seem to serve the military’s purpose. After all, if no causal connection is found between deployment and suicide, recruitment efforts aren’t affected.
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Fifteen years ago, the suicide rate among patients in a large behavioral care system in Detroit was seven times the national average. Then leaders there decided to tackle the problem. The first question asked was what should be the goal—to cut the rate in half, reduce it to the national level, or more? One employee said even a single suicide was unacceptable if it was your loved one, and that helped set the target: zero.
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By David Murphy
Clinical psychologists help a huge range of people, of all ages, with an increasing number of mental health problems. Here are my top tips for getting into clinical psychology training.
(1) Firstly, and probably most importantly, when you are at University, do your best consistently in your Psychology degree. Relevant experience can always be gained later down the line, but you only have a limited time to work on your degree and then your marks stay with you. Your degree transcript containing your marks from every module is used in selection.
(2) Once your degree is in the bag then you need to get relevant experience. Not just to put on your application form but to make sure that working in this field is really what you want to do. Getting a paid assistant psychologist posts is very competitive; in fact nowadays it is actually more competitive than getting onto a doctoral training course. If you can’t get a traditional assistant psychologist post, there is a wide range of other types of relevant clinical experience; nursing assistant posts and/or some voluntary work are also a useful first step on the ladder.
(3) When you do come to filling in your application form, try and communicate something about yourself, what you have learned, and what skills you have developed through your clinical experience and also in your other activities. Think of ways to set yourself apart from other applicants.
(4) Choose your referees wisely and support them. It’s true that you can’t write the references but you can choose who you ask and help your referee by providing them with information about what the courses are looking for, particularly if they are not used to writing forms for clinical psychology. It’s such a shame when you see a great form accompanied by a clinical reference from someone who has only recently met the applicant or who can’t really comment on their clinical work, or an academic reference from someone who appears to have forgotten all about the applicant. If this information is lacking then it makes it very difficult for a course to know whether or not you meet the selection criteria.
(5) Reflect and review. I’ve heard a lot of people say they were told not to even think about applying for Clinical Psychology training because of how competitive it is. Nevertheless, each year several hundred applicants do get places, so it is certainly possible. You may well not get a place on your first attempt but don’t let that put you off. However, you also need to be realistic and reflect on your progress. It’s true that you generally need to have 1-2 years of relevant experience to maximize your chances but if, after a number of attempts you find you still haven’t been successful, it is probably time to rethink. There are plenty of other ways in which you can apply your psychology degree within healthcare and also within many other fields.
Whatever way it turns out I wish you all the best!
David Murphy is the Joint Course Director of the University of Oxford Clinical Psychology Doctoral Training Programme, and co-editor of What is Clinical Psychology? He trained as a clinical psychologist at the Institute of Psychiatry in London and worked for over 20 years as a full-time clinical psychologist in acute hospital settings within the National Health Service before taking up his current position.
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With the British Psychological Society Annual Conference underway, we checked in with Susan Llewelyn, Professor of Clinical Psychology at the University of Oxford, and David Murphy, Joint Course Director for Oxford Doctoral Course in Clinical Psychology. We spoke to the co-editors of What is Clinical Psychology? about psychosis, provision of care, and careers in clinical psychology.
When did you first become interested in clinical psychology?
Sue: When I was an undergraduate studying psychology, I realised clinical psychology was by far the most interesting aspect of psychology. I was particularly interested in psychosis and what “madness” was.
David: Although I covered aspects of mental health in my undergraduate degree, I don’t think I really decided to pursue clinical psychology as a career option until I began working as an assistant psychologist and saw the range of different roles for clinical psychologists in the NHS. I worked for a while in a residential centre for people with epilepsy and became fascinated with the relationship between the brain and behaviour.
What do you think has been the most important development in clinical psychology in the past 100 years?
Sue: Probably the articulation of the cognitive, or information processing model of human behaviour and emotion, to balance the biological or the psychodynamic.
David: Clinical psychology is still such a young discipline that almost all the developments were within the last 100 years and most within the last 50 years. I think the pioneering work in behaviour therapy by Vic Meyer and others, helped open up the notion that psychological therapy could be effective in severe and intractable psychiatric problems like OCD and really changed the role of the clinical psychologist.
What is the most pressing or controversial issue in clinical psychology right now?
Sue: How we can deliver high quality clinical psychology services to meet all the so far unmet need.
David: I agree with Sue, we know from epidemiological surveys that there are large numbers of people with mental health problems who don’t or cant access services. We need to be better at using the resources to provide the most effective and responsive services we can; this often means trying to intervene early.
How might your current research have an impact on the wider world?
Sue: I am not sure I can be that grandiose! But our work tries to show how psychologically grounded ideas can make a big difference in people’s lives, and how taking the psychological realm seriously can improve the nature of the health care that can be offered to people in distress.
David: I agree with Sue; hopefully reading about the applications of psychology in practice across a diverse range of settings might inspire the next generation of clinical psychologists to pursue what is quite a long and challenging path into the profession.
Which famous psychologist has been most influential to you?
Sue: My friend and colleague Professor Glenys Parry in Sheffield has helped me to understand two important areas of psychological functioning: first how broad social and political influences shape the psychological (particularly how social and political gender issues become internalised and intimately lived by individuals), and second, how both the insights of psychodynamic, interpersonal therapies and CBT therapies can be effective combined to maximise how much we can help people.
David: That’s a really tough one! I’ve been lucky enough to work with a number of really inspirational psychologists through my career to date and, of course, many psychologists I haven’t met have influenced me through their work. One person who stands out on a personal level to me is Padmal De Silva who was my clinical tutor during training in London. Padmal was an internationally renowned expert in an array of areas; obsessive compulsive disorder, sexual and marital therapy, post-traumatic stress and Buddhist psychology. One of the most intelligent people I have ever met, he was also one of the most kind and humble. He always seemed to have time for people, even us trainees, and was genuinely interested in what they had to say. I feel very privileged that now in Oxford I have responsibility for training the clinical psychologists of the future and I am fortunate to have Padmal and others as role-models to aspire to.
What advice would you give to someone wanting to specialize in your field?
Sue: Try to be open minded about ideas: you can gain insights about the human condition from so many places including the newspapers, politics, art and literature, and conversations with friends, as well as psychology textbooks.
David: Read my OUPblog post “Five top tips to getting into Clinical Psychology” tomorrow!
What do you see as being the future of research in your field in the next decade?
Sue: We may be able to track more carefully what are the important components of our interventions, so that we can tailor what we offer more precisely to our clients
David: Wow, there are no easy questions, are there! I think research in psychological therapies, at least, will need to be not only carried out with larger sample sizes with longer follow ups but also with very detailed analysis of individual factors and therapy process factors to really enable us to answer the question “what works for whom”.
If you weren’t teaching clinical psychology, what would you be doing?
Sue: Reading really beautifully written literature, and also walking with friends and family in the mountains
David: Learning about clinical psychology! I’ve always found teaching to be just a natural extension of learning and practicing, if I can pass on what I’ve learned to trainees then hopefully I will hopefully have contributed in some way to them going out and generating more knowledge and innovative practice. I do have a life outside Psychology though, and in that life I enjoy playing football (even though I’m still not very good at it) and travelling to new places with my family.
Susan Llewelyn is Professor of Clinical Psychology at Oxford University, and Senior Research Fellow, Harris Manchester College, Oxford. David Murphy is the Joint Course Director of the University of Oxford Clinical Psychology Doctoral Training Programme. They are co-editors of the new edition of What is Clinical Psychology?
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