Changing NHS commissions: What can UK DClinPsy programmes take from a US model?

Leicester staff member Jerry Burgess reflects on going back to his US training institution

When a clinical psychologist moves from one country, and thus one training model and healthcare delivery system, to another there is much to learn and adjust to. I know this, or feel it to be true, as I made such a transition myself. I was trained as a mental health counsellor, then a clinical psychologist in the U.S.A., then moved to England in 2003 where I have since worked as a clinical psychologist in two NHS Trusts, and two British higher education institutions as a trainer of clinical psychologists, and which coincidently is my current role at the University of Leicester. In April 2016 I returned for 11 days to my postgraduate training institution, James Madison University (JMU) in Virginia, U.S.A. with three Leicester trainee clinical psychologists, and collectively we made several observations and comparisons of similarities and differences between the U.S.A. and U.K. systems.

In the context of a shifting tide of NHS-commissioned training places, and thus the possibly for clinical psychology training programmes to be in a position to have to reorganise themselves, my attention shifted to whether something of use and value from my native American system may be transferred or adapted here in the U.K.? JMU, the training institution itself, funds and graduates a cohort of six trainee clinical psychologists per year. Trainees graduate from JMU with an APA-accredited doctorate in clinical psychology with relatively very little in the way of debt or student loans, and having gained a wealth of knowledge and various experiences along the way.

Ways in which the U.S.A. and U.K. are fundamentally different has to initially be acknowledged, namely that the U.S.A. does have a higher education system in which universities may be reasonably cash rich from multiple sources, including research, state, and alma mater charitable sources of income, of which JMU is a successful university in this matter. Also, the U.S.A. healthcare system of private, and third party insurance payments tends to support and sustain options that make psychological assessment and therapy available at a reasonable cost. This therefore is a concept that joins mental health service delivery to the public symbiotically with the needs of a training institution – treating people in the community at low cost whilst providing trainees with ‘real’ clients who present with a range of concerns. These trainees are then supervised by clinician academics, faculty of the university. University-based psychology clinics are common in the U.S.A., and have served their local communities, and contributed prolifically to psychotherapy outcome research in the process. Further experiences are gained by American trainees by serving their university student population as well, for example by doing supervised placements conducting individual and group psychotherapy/counselling at the JMU Student Counselling and Development Centre (SCDC), and by conducting the university’s learning difficulties (e.g. dyslexia) assessments.

We observed as well that every faculty member at JMU had a core research, scholarly, and/or theory development agenda or programme, that trainees spent at least their first year in the role of ‘trainee research assistant’ in the area of that faculty member’s research and development. Then this work commonly served as the initial basis or groundwork for the trainee’s thesis (i.e. doctoral dissertation), supervised by the faculty member whose area of research it was. These trainees’ second and/or third year saw them as lecturers in foundation undergraduate psychology classes, experimental psychology, and/or statistics for the social sciences.

I ‘re-discovered’ but I think all four of us who went to the U.S.A. found how the trainees were provided ample opportunities to obtain or practice relevant competencies. JMU is on a ‘semester’ term system, in which the curriculum is planned out and controlled, meeting weekly with the same professor for 12 lectures/workshops in the same content area. This provided a consistent and well-managed curriculum, but also opportunities for the trainees to take some control of their own learning, as for example they became responsible in this system to deliver some of the teaching to their cohort, and other small group, cooperative learning activities. We who are teachers or presenters know there is nothing quite like ‘knowing’ or coming to know a topic as when you are responsible to teach it.

Those of us who went to JMU also gained an appreciation for our U.K. system, what it has to offer that the American trainees did not experience, like how our teachers are full-time clinicians who work in the service (the NHS) that will be the employment organisation of the trainees upon graduation, and a multitude of perspectives and experiences are shared by people whose ‘day job’ is clinical. Furthermore, U.K. trainees are generally assessed more academically, whereas at JMU trainees are evaluated on their clinical work and dissertation only, providing U.K trainees greater opportunity for learning content on their own, critiquing research, and carrying out small-scale service evaluations, and such like.

In conclusion, in an NHS that is ever-changing, it may be useful to think of options of how clinical psychology doctoral training can be sustained. The American system may have aspects of useful models of sustainability that may be helpful to us. Essentially trainees ‘giving back’ to their universities is an interesting concept to consider, and in America led to sustained research agendas having a constant workforce, some university undergraduate teaching covered, and the university and local community population having accessible psychological assessment and therapy made available to them, symbiotically through the needs and resources supplied by a higher education training institution.

The photo accompanying this post is of a bust of James Madison on the JMU campus.

Jerry Burgess, November 2016

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