CP Forum 235 - with my article

Number 235
July 2012
Clinical Psychology
Forum
ISSN: 1747-5732
Gaining BABCP accreditation
Virtual worlds and learning disabilities
Gastro psychology
Physics and psychotherapy

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News
Clinical Psychology Forum 235 – July 2012 1
More keynote speakers announced for DCP Conference
Three more keynote speakers have been
announced for this year’s DCP Annual Con-
ference, which will be held in Oxford on 5–7
December, in addition to Professor David
Clark, Professor Anke Ehlers and Dr Patricia
Crittenden who were announced previously.
Professor Lorraine Sherr has been
invited to speak by the Division’s Faculty of
HIV & Sexual Health, and Dr Julie
Wetherell and Dr Anne Margaret Pot have
been invited by the Faculty of the Psychology
of Older People. Both Faculties are holding
their annual conference in parallel with the
main Division event.
Lorraine Sherr is Professor in Clinical
Health Psychology at the Royal Free and
University College Medical School, where
she is head of the Health Psychology Unit.
She has been involved in HIV infection and
studying psychological aspects of the disease
since the beginning of the epidemic in the
mid-1980s, and is executive editor of the
international journals AIDS Care and Psychol-
ogy Health and Medicine, and co-editor of Vul-
nerable Children and Youth Studies.
She has published over 140 articles in
peer reviewed journals, and written, edited
or co-written chapters in over 40 books
including HIV in AIDS in Mothers and Babies
(Blackwell), Women, Health and the Mind
(Wiley) AIDS and the Heterosexual Population
(Harwood), AIDS and Adolescents (Harwood),
Grief and AIDS (Wiley), AIDS as a Gender Issue
(Taylor & Francis) and The Psychology of Preg-
nancy and Childbirth (Blackwell).
She has also sat on the Strategic and
Technical Advisory group for the World
Health Organisation HIV section (2004–7);
was appointed a Churchill Fellow for life in
respect of work on HIV and AIDS in Obstet-
rics and Paediatrics; and held numerous
research grants looking into aspects of
health psychology, HIV and AIDS in the UK,
Europe and Africa.
She has chaired the British Psychological
Society Special Group on HIV and AIDS,
and the Special Group on Teaching Psychol-
ogy to Other Professions.
Julie Wetherell holds a position as staff
psychologist in the VA San Diego Health-
care System’s home-based primary care pro-
gramme, which provides comprehensive,
interdisciplinary primary care services in the
homes of older veterans with chronic and
disabling disease. The programme helps vet-
erans in advanced stages of chronic disease,
particularly those at high risk of recurrent
hospitalisation or nursing home placement.
Her research, funded by the National
Institute of Mental Health and the Depart-
ment of Veterans Affairs, involves clinical tri-
als of combined pharmacotherapy and
cognitive behavioural therapy for geriatric
generalised anxiety disorder, and accept-
ance and commitment therapy for chronic
pain. She was recently awarded the David
Shakow Early Career Award from American
Psychological Association’s Society for Clini-
cal Psychology and is on the editorial board
of the Journal of Anxiety Disorders.
Anne Margriet Pot is clinical psychologist
and Professor of Geropsychology in the
Department of Clinical Psychology at the Vrije
Universiteit Amsterdam. She is also head of
the programme on ageing and a member of
the management team of the Netherlands
Institute on Mental Health and Addiction in
Utrecht, and clinician at Parnassia, a mental
health care institute. She is registered as a clin-
ical psychologist and healthcare psychologist,
and has been active in the field of psychology
and ageing for some 25 years – not only in sci-
entific research, but also in academic educa-
tion and clinical practice. Her interest is the
psychological care for frail older people and
their family caregivers.
Dr Pot has published widely in her areas
of interest in scientific and professional jour-
nals and she has served as first editor of the
Handboek ouderenpsychologie [Handbook on
Geropsychology]. She actively stimulates voca-
tional training for geropsychologists in the

2 Clinical Psychology Forum 235 – July 2012
News
Netherlands and is involved in organising
national and international national con-
gresses on mental health and ageing.
You can find all the latest news about the
DCP Annual Conference on its webpages:
www.bps.org/dcp2012.
Special members’ day at this year’s DCP Conference
Theatre in the old psychiatric hospitals
The first day of the DCP Annual Conference
2012 (Wednesday 5 December), will be a
special members’ day. It will see a series of
short, practice-based sessions relevant to the
conference theme of ‘Well-being and dis-
tress: Clinical psychology from cradle to
grave’. Distinguished speakers will talk on
areas such as ‘adults, children and young
people’, ‘older adults’, and ‘health and
learning disabilities’. There will also be a ses-
sion on clinical psychology and the media.
In the evening there will be a public lec-
ture by Robert Whitaker, author of the con-
troversial book Mad in America: Bad Science,
Bad Medicine and the Enduring Mistreatment of
the Mentally Ill.
Division members can register for 5
December only for just £25.
Recession leads to more calls for help
The mental health charity Mind has
reported a surge in demand for its helplines,
with calls to its infoline and legal line up 18
per cent and 28 per cent respectively
between October 2011 and April 2012 com-
pared with the same period in 2010–2011.
Calls to the Mind infoline have increased
steadily since the service opened over 20 years
ago, but since the start of the recession advis-
ers have seen an increase of 100 per cent on
calls on personal finances and employment.
Former DCP chair Professor Peter Kin-
derman, Professor of Clinical Psychology at
the University of Liverpool, says:
‘Social factors are the main determinants
of our mental health and well-being. So peri-
ods of poverty, recession, austerity and social
change are particularly threatening to our
psychological health and well-being. Mental
health professionals and charities predicted
many months ago that this would be a chal-
lenging period. Indeed, Paul Burstow, the
care services minister, assured us that the
Department of Health regarded the protec-
tion of the most vulnerable as a priority as
the country entered economic recession.
‘Unfortunately, we can see our sad pre-
dictions coming true both in the UK and
countries such a Greece. We should also
remember that most commentators tell us
that “the public sector cuts haven’t yet even
begun to bite…”. It is therefore vital that we
follow through on the minister’s promise
and ensure that there is appropriate provi-
sion to protect the mental health and well-
being of citizens in these challenging times.’
Juliet Foster, a social psychologist at the Univer-
sity of Cambridge, has been funded by the Arts
and Humanities Research Council to research
the role of theatre in the old psychiatric hospi-
tals, which closed down in the early 1990s.
She is interested in collecting stories
from people who remember anything about
theatre or drama in these hospitals:
‘It doesn’t matter if these memories are
short or long – there are no right answers.
Perhaps you remember plays being put on, or
pantomimes or other similar entertainment?
I am equally interested in the memories of
patients, members of staff and people who
might have lived in the local communities.’
You can contact Juliet Foster by email at
theatreandpsychiatrichospitalsproject@hot-
mail.co.uk.

A
T THE TIME of writing this I have
only been in post for two weeks as the
new Chair.
As I said in my election statement, we
need to both increase our support to mem-
bers and respond to the new policy and
financial environment in a confident and
strategic way. Given the coalitions’ continu-
ing cuts to services and the return of the
economy to recession, the morale of
applied psychologists on the ground both
within statutory and non-statutory settings
is, unsurprisingly, highly variable. We cur-
rently don’t have an up to date to picture
on the levels of lost posts and downgraded
positions, and we urgently need to pull this
intelligence together as best we can
through the branches and national groups.
Other professions have approached us with
a view to working together to get out into
the public domain an accurate picture of
where the cuts are biting and the impact
they are having.
On the policy front, John Hanna, who
has done a brilliant job as DCP Policy
Director, is standing down in August and I
have been working with him to identify
who will cover key national policy groups
whilst we appoint his successor. These
include the Ministerial Advisory Group for
Mental Health, the Interprofessional Col-
laborative for Mental Health, and a wide
range of other key policy and commission-
ing fora. We are going to be updating the
full and impressive list of policy leads
across all care groups and will circulate this
to members as soon as possible. We need
to maintain our profile and momentum in
all these groups. The English Policy Direc-
tor post will be advertised shortly alongside
the equally important posts for our Mem-
bership Services Unit Director and PR &
Communications Lead. It is crucial that we
fill these positions so if you are interested
in any of these key posts, which all come
with some backfill funding, please get in
touch. Peter Kinderman is still in post as
Past Chair of the Division and the good
news is that he is planning to restart his
popular and informative e-mail newsletter
to all members.
Another pressing priority for me is the
DCP Strategy event in Edinburgh at the
beginning of July. This meeting pulls
together the impressive but daunting
number of our different divisional threads
across the Nations, Branches and Facul-
ties; reports on progress; and resets the
key strategic objectives and set actions
against them. Areas we will be developing
include ‘Workforce Development and
Support’ and ‘Influencing Commission-
ing/Clinical Networks and Senates –
Rethinking our Professional Networks and
Leadership Arrangements’, led by John
Hanna; and ‘DSM-V and formulation’, led
by Peter Kinderman.
Last but by no means least, we need to
give a warm collective vote of many thanks to
Jenny Taylor for having stepped back in as
Acting Chair and keeping the show on the
road over the last few months. She has done
a great job.
It is going to take me a bit of time to get
up to speed and complete my induction
into the role of Chair. I am keen to hear
from members about what they think is
working well and want more of, and any
areas that you want to be given additional
priority.
Richard Pemberton
chair_dcp@bps.org.uk
Notes from the Chair
Richard Pemberton

A very unpalatable soup?
Having read David Pilgrim's article (Ethics
Column, CPF 233), I have realised that I
must never again deliver therapy. I identify
as a gay man, so I can't see male clients, but
I am sometimes attracted to women, so I
can’t see women either. I'm not safe with
anybody. And I can't think of any way of
finding out beyond all doubt whether any
of my clients are 100 per cent gay or
straight and, who knows, some of them may
even be bisexual, so there are no clients
who are safe to be seen by anyone, either.
We will all have to give up. This is not
‘grasping the nettle about sexual orienta-
tion’: it is throwing the nettle in a pan of
hot water and discovering that it makes a
very unpalatable soup.
Dr Paul Withers
Consultant Clinical Psychologist, Head of Psycho-
logical Treatment Services, Calderstones Partner-
ship NHS Foundation Trust
Response from David Pilgrim (author of
original article):
My point about sexual orientation was not
to attack the existence of anyone, straight,
gay or bi-sexual but raise an empirical point
that we evade at our peril. This is that a risk
factor in abuse during therapy is the sexual
interest a therapist might take in their
client group.
That interest is less likely to arise if the
therapist’s orientation is not towards that
client group’s sex on an a priori basis. That is
a fact: working through the implications of
that fact might be difficult but the status quo
is difficult when we know that sexual orien-
tation is a factor to consider where abuse
arises, whether not it is reported and proven
(there is a prevalence iceberg effect here).
An acknowledgement
Thank you for publishing our article Online
Support for people with prospective memory prob-
lems in CPF 223. We were really pleased with
how the article came out and with the posi-
tive response that we received from psychol-
ogists around the country. Unfortunately,
re-reading the article, we later realised that
we had somehow neglected to include an
‘acknowledgements’ section in the main
paper. Certainly, we would like to thank the
service user himself for giving us permission
to write his case study up for publication, as
well as all of the staff of Rebuild’s Brain
Injury Unit. However, we would most like to
thank our specialist occupational therapy
colleague, Nicola Venning for kindly shar-
ing her prospective memory assessment that
we included as the main outcome measure
in the case study. Thank you to everyone
who helped with this project, which we hope
was of interest and benefit to readers of Clin-
ical Psychology Forum.
Dr Graham Simpson-Adkins
Assistant Clinical Psychologist, North Stafford-
shire NHS Trust
Paul Skirrow
Consultant Clinical Psychologist, Mossley Hill
Hospital, Mersey Care NHS Trust
We want to hear
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Please send all letters for publication
in Clinical Psychology Forum to:
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(e-mail correspondence preferred)
Correspondence

T
HE perceived dominance of CBT hits
the pages of Clinical Psychology Forum
once again. Pieter Nel argues that CBT
has had a negative impact on the recent
development of clinical psychology and
draws parallels with various accounts of
developments within theoretical physics and
their domination by single theories or
approaches. It might be worth stressing,
however, that IAPT is not synonymous with
CBT as Pieter suggests and that considerable
efforts have been put into extending the
scope of IAPT-available evidence based ther-
apies around the four additional modalities
including IPT, brief psychodynamic, coun-
selling and couples therapeutic approaches.
Interestingly, another current article by
Jonathan Hutchins places some of this
debate into context. Jonathan describes how
some recent clinical psychology graduates
should be able to gain BABCP accreditation
as CBT therapists. What is particularly
important about Jonathan’s article is that he
argues that this is achievable without privi-
leging CBT above and beyond all other
approaches and, hence, for clinical psychol-
ogy to preserve its unique and diverse range
of approaches and roles. This article
reminds me of joint meetings between the
DCP and BABCP some years ago when I was
DCP Chair, and we worked with Rod Hol-
land trying to come up with accreditation
case studies. Unfortunately the work was
never completed but Jonathan has now
kindly obliged. I am also grateful to Amanda
Cole and Shirley Reynolds from BABCP who
have constructively commented on
Jonathan’s article. As Amanda also states,
there are a number of ongoing projects
looking at BABCP course accreditation for
clinical psychology programmes and we
would be more than happy to publish arti-
cles in Clinical Psychology Forum reflecting on
this new venture.
There are several highly innovative articles
this issue including the Suzanne Conboy-Hill
and colleagues’ use of virtual worlds for assess-
ing people with learning disabilities. Charlie
Tyack’s article also presents an engaging
piece about using sales techniques to motivate
and involve people with the choice of thera-
pies available within IAPT stepped care serv-
ices. Clearly psychotherapy is FAB! I was also
intrigued by the title of Phillip Simpson and
Richard Dearden’s piece on ‘gastro psychol-
ogy’. However, I was disappointed to learn
that actually it was a rather informative survey
of referral patterns to services rather than psy-
chology’s answer to a gastro-pub. I had visions
of nicely polished tables, modern sofas and a
menu of psychological interventions. Stephen
Kellett and colleagues also present a thought-
ful and clinically useful review of morbid jeal-
ously: we would like to promote more
authoritative reviews of clinical conditions
that perhaps are unfamiliar or covered less
comprehensively in the literature.
Rob Flynn and Lynne Howey present a
timely article around measuring clinical out-
comes within CAMHS teams which might
help inform the additional investment and
developments around children and young
people IAPT services (tinyurl.com/iaptcyp)
that are currently taking place.
Sleep and its disorders are clinical phe-
nomena which I fear psychologists do not
pay sufficient attention to in their routine
work. Joseph Judge and colleagues present a
fascinating pilot study of sleep on a medium
secure in-patient setting. They report
counter-intuitively that the residents actually
report more rather than less time sleeping,
in addition to greater levels of fatigue. The
authors discuss the impact of medication
and the lack of meaningful activities during
the day; observations that John Wing made
over fifty years ago about patients’ experi-
ences within the old psychiatric institutions.
From the Editor’s chair
Graham Turpin

From the Editor’s chair
The sobering thought that for some of
our clients not much may have changed
during the last sixty years or so is also
echoed in Gemma Gray’s report from the
Faculty for Learning Disabilities published
in ‘DCP Update’ and reviewing the impact
of the enquiries into Winterbourne View. I
found Gemma’s piece particularly informa-
tive and it is helpful to be able to appreciate
the key issues happening in clinical areas
outside of one’s own but still hugely rele-
vant across the board.
The theme of challenge is picked up
by our new DCP Chair – Richard Pember-
ton; well done Richard, and a plea for
people to come forward for nominations
for the various key DCP vacancies that
have been advertised.
Finally, we have as ever a timely and
thoughtful Ethics Column from Tony Wain-
wright around regulation.
Graham Turpin
Co-ordinating editor
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W
ELCOME to this update on
behalf of the Faculty for Learn-
ing Disabilities. I thought it may
help to provide a brief context for those
who are less familiar with this particular
Faculty.
There are currently 460 members
across the UK, a number that continues to
increase year-on-year. The committee
meets four times per year usually at the
Society’s London office. In addition to the
main committee roles we have a represen-
tative from each of the four nations. One
of the four meetings is an annual review
meeting in December to which a represen-
tative from each of the regional groups is
invited to ensure good communication
from the different regional groups and
consult on the strategy of the Faculty and
its resources in the forthcoming year.
There are currently 15 regional groups –
do contact us if you would like to be put in
touch with your local one. As boundaries
change sometimes new groups appear and
others merge or cease to exist. Do keep us
notified of changes so that we don’t lose
touch with your group. We also publish a
quarterly journal for our members – Clini-
cal Psychology and People with Learning Dis-
abilities.
As is certainly the case with many facul-
ties, we are involved in lots of different activ-
ities, responding to consultations, writing
practice guidance for its members, organis-
ing CPD, etc. Rather than repeat all of these
in detail (all of which can be found in our
annual reports) I felt it might be of greater
interest to focus upon some of the major ini-
tiatives that we are involved with in more
detail. At the end I have summarised our
plans for the coming year.
1. Payment by Results for Learning
Disability services
Payment by Results is being extended to
health services for adults with learning dis-
abilities in England. The initial emphasis is
upon developing a reliable tool that will be
able to allocate people to clusters of need, as
distinct from diagnosis. There is a consensus
between local authority and health commis-
sioners that they want to know what they are
paying for irrespective of whether the lan-
guage used is strongly health/medical. This
work is clearly rooted in the Department of
Health (DH) and the current version of the
proposed clustering tool does not appear to
reflect some of the work that is carried out
by Community Learning Disability teams in
local authority or other settings.
Since this initiative is an extension of the
mental health clustering, the DH has set out
a requirement that the Mental Health Clus-
tering Tool is to be the basis of the Learning
Disability Tool, but that additional domains
can be added onto this to capture the wider
range of needs that are catered for by Learn-
ing Disability teams. As the Health of the
Nation Outcome Scales (HONOS) forms
the basis of the mental health tool, we are
expected to use this rather than the Health
of the Nation Outcome Scales for People
with Learning Disabilities (HONOS-LD).
Proposed clustering tool
There are a number of variations of draft
clustering tools in different consortia across
England. The tool that is currently being
developed across the Northern and York-
shire & Humber regions consists of 27
domains (18 that reflect the person’s behav-
iour over the past two weeks and nine histor-
ical ratings). Each domain is rated on a 0–4
DCP Update
Faculty for Learning Disabilities
Gemma Gray

DCP Update
Likert scale, which has clear definitions for
each rating. It has been subjected to small
scale reliability checks.
Potential learning disabilities clusters
A number of consortia have been trying to
draft potential clusters in advance of the
development of a clustering tool. Not surpris-
ingly the resultant clusters tend to reflect the
local referral patterns, interests and prefer-
ences of the clinicians who are devising them.
There is currently no agreement about the
clusters of need, but in addition to the 20
mental health clusters they generally include
all or some of the following groupings:
n Cluster 9 – autistic spectrum disorders
n Psychological:
l Complex and multiple needs
l Challenging behaviours
l Vulnerable with poor coping skills
l Offending behaviour (but this might
be included in new forensic clusters)
n Physical:
l Epilepsy
l Dysphasia
l Profound Intellectual and
multiple disabilities
As yet the proposed clusters do not reflect the
sort of gradations of severity that is differenti-
ated in the mental health clusters (e.g. low
severity, moderate severity, severe, very
severe). It is likely that once the clustering tool
has been developed, needs such as challeng-
ing behaviours will be similarly differentiated.
Currently over 20 services are involved in
a pilot project to develop an evidence base
for the revised clustering tool and potential
clusters using the tool devised in the North-
ern and Yorkshire & Humber regions. There
is a need to have 1000 cases as a minimum
across all sites. The data collection element
of the pilot runs from February to August
2012, followed by a period of data analysis by
Bangor University.
2. Learning disability clinical senate
Over the past few years members of the Fac-
ulty for Learning Disabilities have been work-
ing closely with the other professions that
provide assessment and support to people
who have learning disabilities. We recognise
that service improvements will only come
about through collaborative approaches. We
have co-hosted a biannual conference with
the Royal College of Psychiatrists and have co-
authored guidance documents about demen-
tia (BPS & RCPsych, 2009) and challenging
behaviour (RCPsych, BPS & RCS&LT, 2007)
with colleagues from other professions.
The clinical professions have not had a
formal link with policy makers at DH and
so have difficulty shaping policy through
formal routes.
One of the NHS reforms has proposed
the development of clinical networks or
‘senates’ in England. The Learning Disabil-
ity Faculty has taken a leading role in estab-
lishing a clinical senate to advise on
Learning Disability policy. This network
includes representatives of Royal College of
Psychiatrists, Royal College of General Prac-
titioners, Royal College of Nursing, College
of Occupational Therapists, Royal College
of Speech & Language Therapists, Char-
tered Society of Physiotherapy, National
Valuing Families Forum, National Forum
(self advocates). The main activities being
addressed by the senate include:
n Providing advice to the Department of
Health’s Learning Disability Programme
Board. Alick Bush will be representing
the health professions as the current
chair of the clinical senate.
n Promoting effective joint working and
the development of shared practice
guidelines across the professions.
n Coordinating the response of the
clinical professions to the Department of
Health’s review of Winterbourne View.
n Developing commissioning guidance for
the emerging Clinical Commissioning
Groups in England to improve the
health and well-being of people with
learning disabilities.
3. Winterbourne View
Following the abuse at Winterbourne View
that was uncovered in the BBC Panorama
programme in May 2011, the Learning Dis-
ability Faculty has been involved with a
number of other organisations to look at

DCP Update
the lessons that need to be learnt and what
can be done to prevent similar situations in
the future. Over the years there have been
many such investigations into abusive prac-
tice (Ely, Normansfield, Cornwall, Sutton &
Merton to name but a few) and every time
we say that this mustn’t happen again.
Sadly we have short organisational memo-
ries and too often the root cause of the
scandals is not properly identified or does
not get fully addressed. Psychological mod-
els are important tools in helping us formu-
late the issues. Clinical psychologists are in
important leadership positions to try to
address the shortcomings.
In recent months a lot of the target of
recriminations has been upon the manage-
ment and governance within that particular
provider organisation. However, the role of
the local Community Learning Disability
Teams (CLDT), local Provider Services and
the lack of strategic commissioning for peo-
ple with complex behaviours must also be
considered. People would be less likely to be
referred into distant Assessment and Treat-
ment Units if local commissioners ensured
that there are appropriately skilled local
providers and the CLDTs have effective
pathways for managing risky behaviours,
focusing on prevention and support. Cur-
rent estimates are that there are 1521 in-
patient beds in England for adults who have
learning disabilities, but only 300–400 would
be required if appropriate local services
were developed (Mencap, 2012).
The Care Quality Commission (CQC)
has carried out a programme of unan-
nounced visits of Assessment and Treatment
Units across the NHS and the voluntary and
private sector (150 services). They focused
their attention upon two quality outcomes –
the care and welfare of people who use serv-
ices, and safeguarding people who use serv-
ices from abuse. CQC has completed all of
their visits and a national report is due in
spring 2012. Greater details of the individual
service reports can be found at
www.cqc.org.uk/LDReports5.
The Department of Health has under-
taken a review of the findings from the Win-
terbourne View enquiries. Members of the
Faculty have contributed to the process.
Although the report will not be published
until the criminal prosecutions have been
concluded, it is likely that the report will
raise a number of questions where the mem-
bers of the Faculty can make a significant
contribution to the ‘solution’ to the short-
comings identified. The action plan will
identify many areas for improvement, but
some of the most relevant ones for clinical
psychologists are likely to include:
n How should services provide training
and support to direct care staff who are
often on minimum wages and are
required to support people who have
complex needs and display very
challenging behaviours?
n How do psychologists ensure that
people are effectively supported close to
home so that there is reduced need for
them to be placed at times of crisis in
distant provision?
n How do psychologists build up a
relevant evidence-base (Jackson 2011)
and help to design-in best practice?
n How do clinicians in local CLDTs work
in partnership with Assessment and
Treatment Units such that an in-patient
spell is part of a continuous pathway
and there is effective planning for the
person to return to their original area?
All this is happening at a time when budget
cuts are threatening the functioning of
many psychology teams which should be tak-
ing a strong leadership role in implement-
ing many of the required improvements.
These roles were outlined in the Learning
Disability Faculty’s guidance to commission-
ers (see box-out at end of article).
4. CPD
Provision of CPD events has been a key fea-
ture of the Faculty for Learning Difficulties
since its inception many years ago. Each
year we host a three-day CPD event, rotat-
ing its location across the four nations. Last
year was slightly different in that in Septem-
ber we hosted a highly successful European
Congress attended by 350 delegates from
across Europe. As a result, we have not run

DCP Update
the usual spring CPD event; instead we are
putting on two one-day events on Payment
by Results/outcomes and neuropsychology.
Such events are run at cost to members of
the Faculty. At the end of March 2012 we
co-hosted a conference with the Royal Col-
lege of Psychiatrists focusing upon the
topic of offending.
For several years the faculty has made
available to each of its regional groups a bur-
sary £250 to host regional CPD events. With
increasing financial constraints within local
services it is recognised that there is benefit
to the membership in delivering high qual-
ity CPD events at low cost. Due to robust
financial planning we have been able to
increase this figure to £500 for each group
for 2012 and are currently considering
whether this can be further extended to
benefit the members for more years.
5. Plans for the coming year
In recent years we have published profes-
sional guidance that is specifically relevant
to clinicians working with people with learn-
ing disabilities (Dementia & People with Learn-
ing Disabilities, 2009) and Good Practice
Guidance for Clinical Psychologists When Assess-
ing Parents with Learning Disabilities (2011) –
both of which are available from the Soci-
ety). We have plans to develop/revise the
following guidance:
n Definitions & Contexts (review and
update the 2000 guidance);
n Psychological Therapies Guidance Paper;
n Challenging behaviour: A Unified approach
(to update the 2007 guidance with
RCPsych and other professional groups);
n Good Practice Guidelines for UK Clinical
Psychology Training Providers for the
Training and Consolidation of Clinical
Practice in Relation to Adults with
Learning Disabilities (revision of the
2005 guidance).
The faculty has also agreed to pilot the cen-
tralised funding of e-learning for 10 faculty
members on the topic of Positive Behavioural
Support. Hopefully, this article will have
given you a brief insight into some of the
many and varied activities of the Faculty for
Learning Disabilities committee and its
members. If you work with people with
learning disabilities and aren’t a member,
do consider joining us – you can find details
on the Society’s website (http://dcp-
ld.bps.org.uk).
Dr Gemma Gray
Chair, Faculty for Learning Disabilities
Do you have any thoughts or opinions the Health Professionals Council?
The DCP wishes to ensure that members’ concerns are appropriately represented in
relation to the HPC.
Whether you work for the NHS, in independent practice or elsewhere, we would like to
know what you think, whether positive or negative, so that we can take informed feedback
to the Society’s regular meetings with the Health Professionals Council.
Since the last meeting we have heard that the HPC will be raising the threshold for
complaints about members, so your comments can make a difference.
Catherine Dooley, Professional Standards Unit Director
What do you think of the HPC?
Please send your comments to Helen Barnett (helen.barnett@bps.org.uk

W
HEN I was nearing the completion
of my clinical psychology training
at the University of Hertfordshire,
which ran from 2008 to 2011, I applied for a
few posts within local Improving Access to
Psychological Therapies (IAPT) services.
Following one of my applications I was told
by the clinical psychologist in the team that
I would not have the cognitive behavioural
psychotherapy (CBT) competencies
required to do the job and that I would not
be able to get British Association of the
Behavioural and Cognitive Psychotherapies
(BABCP) accreditation. I recall arguing with
her at the time that our CBT skills would be
the equivalent to High Intensity Worker
training but she disagreed and refused to
select me for interview. Subsequently, I
applied for another job in IAPT and got it
because they believed that I could gain
BABCP accreditation, which was one of the
job requirements. I therefore set about
matching my clinical psychology training to
the BABCP accreditation standards.
The process
The BABCP accreditation process takes
place in two stages. The first is gaining
provisional accreditation, which requires
the applicant to demonstrate their CBT
teaching, skills practice and experience,
which is the emphasis of this article. The
second is gaining full accreditation where
you apply a year after gaining provisional
accreditation doing 30 hours of CBT
related CPD and providing logs of CBT
supervised practice.
I knew that this would be a challenging
task so I began by investigating the stan-
dards for accreditation and by contacting
the BABCP to establish the level of evi-
dence required. They stated that they
would need copies of my course timeta-
bles, module handbooks and summary
clinical log, which would all demonstrate
my CBT training and practice. I therefore
reviewed three years worth of lecture
timetables, emphasised where the lecture
was CBT related and either added CBT
into the title or put CBT in brackets under
the lecture, as it was CBT dominated. I
knew this would help the accreditation
officers to see exactly where I had gained
CBT training. For example, where a lec-
ture was titled chronic pain and the
emphasis was on chronic pain manage-
ment using CBT, I entitled the lecture CBT
for chronic pain, as this accurately
reflected the CBT aspect of the teaching. I
also emphasised the CBT in the modules
of teaching that were directly related. For
example, I argued that the adult mental
health, older people, people with learning
disabilities, clinical health psychology,
forensic, clinical skills, problem based
learning, small group discussions and long
term mental health conditions modules
were all CBT related.
Getting CBT accreditation with the BABCP
as a newly qualified clinical psychologist…
and how we can retain our identity as
clinical psychologists
Jonathan Hutchins
This article demonstrates how the author, a newly qualified clinical psychologist, gained accreditation as
a cognitive behavioural psychotherapist with the British Association of the Behavioural and Cognitive Psy-
chotherapies. Systemic implications for the profession and clinical psychology training are discussed.

Jonathan Hutchins
To demonstrate my clinical practice and
academic competence in CBT, I gathered
the relevant sections of the course hand-
book on clinical placements as well as my
summary clinical log, signed off by all my
clinical supervisors, where I had emphasised
all the CBT hours that I had done on each
placement. Finally, to support the applica-
tion I co-wrote a letter with my course direc-
tor supporting the relevant documentation
and my application. Gathering this informa-
tion was time-consuming, but well worth it as
the BABCP fully accepted the relevant docu-
mentation and my application.
I based my application on the formal
teaching I received at the University of Hert-
fordshire, which was the same as that of the
rest of my cohort. I did not try to optimise my
CBT experiences or teaching, but I empha-
sised the CBT related studies and clinical
practice that I had completed as part of my
clinical psychology training. I would argue
that because of the British Psychological
Society’s standards on what clinical psychol-
ogy courses have to encompass (BPS, 2010)
in terms of CBT related teaching and clinical
practice, we may all meet the accreditation
criteria for the BABCP.
I submitted my application for provi-
sional accreditation in November 2011 and
the BABCP granted me provisional accredi-
tation in January 2012. The only recommen-
dation they sought was for me to provide
more details in the supervision log part of
the application form when I complete my
full accreditation application. I will now
explicitly highlight the criteria for accredita-
tion with the BABCP (BABCP, 2010) and
how I matched it.
The BABCP accreditation criteria and
how I successfully argued that my
clinical psychology training met these
standards
The British Association for the Behavioural
and Cognitive Psychotherapies accreditation
criteria (BABCP, 2010) is as follows:
1. 450 hours of formal CBT teaching and
skills practice, including:
(a)100 hours of formal face-to-face
tutor time on CBT theory;
(b)100 hours CBT skills practice;
(c) 250 hours of prescribed self-directed
academic study.
2. 200 hours of supervised CBT
practice where:
(a)supervisees need to have their
competency formally assessed by
their supervisors either using the
Cognitive Therapy Rating Scale
(CTS-R) or equivalent;
(b)the trainees’ supervisors need to be
BABCP accredited or trained and
experienced to an equivalent standard.
3. Four academic case reports of between
2000 and 4000 words in length based on
at least three different problem types.
1. 450 hours of formal CBT teaching
and skills practice
(a) 100 hours face-to-face tutor time on
CBT theory
I successfully argued that based on the
modules I had taken (Adult Mental Health,
Older People, CBT, Personal Construct
Psychotherapy [PCP], Clinical Skills, Clini-
cal Health Psychology, Forensic Psychol-
ogy, Long-term Mental Health Needs,
Learning Disabilities, and Child and Ado-
lescent Psychology) as well as tutor time in
problem-based learning and small group
discussions, I had received 321 hours of for-
mal face-to-face tutor time on CBT related
teaching during my three years of clinical
psychology training.
(b) 100 hours of CBT skills practice
I successfully argued that in a majority of our
teaching we had to practice clinical skills
and in addition a total of 337 hours across
the three years of clinical training on clinical
placements comprising of 222 hours of skills
practice through formal teaching/role-
play/group, pair and triad work and 115
hours of skills practice.
(c) 250 hours of prescribed self-directed
academic study
Throughout the three years of clinical train-
ing trainees were formally required to have
four hours per week of placement related
study time (for 48 weeks) equating to a total

Getting CBT accreditation with the BABCP as a newly qualified clinical psychologist
of 576 hours over the three years. In addi-
tion to this, I successfully argued that we
have one-and-a-half hours of prescribed aca-
demic study time per week and, when the
university was closed, we had two days of aca-
demic study equating to a total of 756 hours
over the three years. Furthermore, we were
also allocated research study time for our
major research and small scale research
projects coming to a total of 280 hours.
Therefore, I successfully argued that we had
a total 1612 hours prescribed self-directed
academic study.
To evidence these hours I used my
course timetables, module handbook and
the letter from my course director.
2. 200 hours of supervised
CBT practice
The British Psychological Society requires
that in all of our clinical placements that
we need to draw on at least two models of
therapy where one must be CBT (BPS,
2010). Therefore, I successfully argued
that a vast majority of my clinical work used
CBT, either directly or indirectly with staff
teams – as was the case in my learning dis-
abilities placement. Therefore, the total
hours of clinical practice for the three
years in my adult, older people, learning
disabilities, CAMHS and my specialist
placement in Early Intervention in Psy-
chosis came to 336 hours.
I also successfully argued that all my
supervisors were CBT practitioners and
that they would meet the requirements for
BABCP accreditation should they apply as
they were equivalent to the BABCP’s stan-
dards. None of my supervisors during my
clinical psychology training were BABCP
accredited. Furthermore, I also argued that
my placement supervisors used a variety of
measures to assess my competency through
direct observation and listening to therapy
tapes, and that they used course measures
of my therapeutic competency similar to
the CTS-R.
To support my arguments, I provided a
copy of my summary clinical log with the
signatures of my supervisors supporting
my CBT practice. I also supplied the rele-
vant sections of my course handbook on
clinical placements, specifically where
CBT must be one of the models used in all
the placements throughout the training
programme.
3. Four academic case reports of between
2000 and 4000 words in length
On the clinical training course at Hert-
fordshire we were required to submit four
5000 word case reports on the following
subjects: a therapy case, a neuropsychol-
ogy assessment, an indirect piece of work,
and work with a family. Two of these case
reports were CBT relevant – my therapy
case report (where I used CBT for a client
with low self-esteem) and my indirect
piece of work (where I drew on a behav-
ioural approach for working with someone
with a learning disability). In addition to
this, I successfully argued that my clinical
commentaries for my six pieces of clinical
work (one for every placement) also
counted, as each required me to put down
an assessment, formulation and interven-
tion plan which often drew on CBT and
were between 1000 and 2000 words in
length. I should note that I also drew on
other models of understanding when com-
pleting my case reports and clinical com-
mentaries, but I emphasised the CBT
aspects to the BABCP. The BABCP
accepted the combination of the case
reports and my clinical commentaries to
match their requirement of four academic
case reports. To evidence this, I provided
the section of the handbook on assess-
ments of clinical competency as well as the
letter from my course director.
Systemic implications for clinical
psychology
There has been a growing debate in the
profession over clinical psychologists’
competence in CBT (CPF 221 and CPF
223). I would argue that this article puts
that issue to rest because if I can get CBT
accreditation as a newly qualified clinical
psychologist, I would argue that we all can,
should we wish to pursue it. As part of all
clinical psychology training courses we are

Jonathan Hutchins
required to have competency in delivering
CBT interventions with client groups
across the lifespan (BPS, 2010). What this
article emphasises is how this standard is
comparable with the BABCP accreditation
standards, arguably meaning that we are
all CBT competent. It is important to state
that I do not believe we should all become
CBT therapists; it is more that we can
demonstrate this competency and we
should focus more on our added value as
clinical psychologists. For example, it
could be argued that we can provide com-
petent CBT and in addition provide ther-
apy using systemic and psychodynamic
models. Furthermore, our skills in manag-
ing risk, neuropsychology, indirect work-
ing, reflective practice, consultation and
psychological leadership are some of the
important added values that we can offer
to clients groups and services across the
lifespan.
This has several possible systemic impli-
cations: on the plus side it could grant us
all more legitimacy and protection from
potential job cuts as we can demonstrate
how we can deliver NICE directed CBT.
Furthermore, it may reduce a possible
threat from CBT therapists as we can
demonstrate that we match their level of
competency – which could be used to
acquire more funding for clinical psycholo-
gist posts in the NHS. On the minus side,
there is a risk that we may be deemed as
expensive CBT therapists if we do not
emphasise our added value to employers.
This has implications for clinical psy-
chology training, as I would argue that
there is currently enough CBT teaching on
courses in order that all trainees come out
eligible for accreditation. This is provided
that trainees consider how much of the
standard course curriculum for clinical psy-
chology training courses is CBT related,
and how it is a requirement that we must
use CBT in our clinical placements –
according to Society guidelines (BPS,
2010) – which needs to be emphasised to
the BABCP. I base this view on the fact that
my training course at the University of Hert-
fordshire is one of the least CBT orientated
training programmes – where the course
philosophy is constructivist and social con-
structionist – and that most other training
courses would have more CBT teaching in
them. Therefore, I would argue that it is
important for us to retain our identity by
retaining the wide variety of therapeutic
models that we are taught currently (as we
do not need to give up any more teaching
time to CBT).
Recommendations
1. That clinical psychology training
courses do not devote any more time to
teaching CBT and that they retain their
course curricula on a wide variety of
therapeutic models, approaches and
client groups, as this gives us added
value on top of our CBT skills.
2. That we, as professionals, should feel
more confident in our professional
competency to deliver CBT for clients
across the lifespan. Furthermore, we can
offer more than IAPT trained CBT
therapists as, arguably, they are trained
to work with working age adults, where
as we are trained to work across the
lifespan using CBT requiring advanced
skills to adapting the model to a wide
range of neuropsychological,
behavioural and cognitive presentations.
3. That we emphasise our CBT
competency to employers to
demonstrate how we can match BABCP
accredited CBT therapists, rather than
undermining our professional strengths
in this area.
4. That we acknowledge that we can do
competent CBT and provide so many
more additional skills, including our
ability to draw on multiple therapeutic
models (systemic, psychodynamic, etc.).
5. That training courses formalise, in
standardised letter form, how much of
CBT theory/skills practice related
training trainees have completed,
which I would argue includes adult,
older people, child and adolescent,
people with learning disabilities,
forensic, and clinical health psychology
modules. Furthermore, that CBT skills

Getting CBT accreditation with the BABCP as a newly qualified clinical psychologist
practice and experience is added to
this letter to facilitate more clinical
psychologists achieving BABCP
accreditation should they wish to.
Courses will have to document the
number of hours of CBT and
experience in relation to specific
cohorts as there may have been an
increase in the number of CBT
training hours provided due to British
Psychological Society guidelines
published in 2010 (BPS, 2010).
6. That the BPS/DCP continue formal
discussions with the BABCP with a view
to making the whole of clinical
psychology accreditable in CBT should
individuals wish to pursue BABCP
accreditation.
Acknowledgements
I would like to thank Professor David Win-
ter, Steve Davies, Tim Sharp and Dr Emma
Berry for their support with the application.
Affiliation
Jonathan Hutchins CPsychol, BABCP
accred.: Clinical Psychologist/High Intensity
Worker, The Newtown Centre, Huntingdon.
Address
Dr Jonathan Hutchins, Clinical Psycholo-
gist/High Intensity Worker, Improving
Access to Psychological Therapies Hunting-
don, The Newtown Centre, Huntingdon
PE29 3RJ; jonathan.hutchins@cpft.nhs.uk.
References
British Association for the Behavioural and Cogni-
tive Psychotherapies (2010). Criteria and Guide-
lines for Provisional Accreditation as a Behavioural
and/or Cognitive Psychotherapist. Bury: Author.
British Psychological Society (2010). Accreditation
through partnership handbook: Guidance for Clinical
Psychology Programmes. Leicester: Author.
Kinderman, P. (2011). Notes from the Chair. Clinical
Psychology Forum, 221.
Westbrook, D. (2011). Clinical psychologists and
expertise in CBT [Letter to the editor]. Clinical
Psychology Forum, 223.
DCP CPD Workshops
EVENT DATE
Where do we go from here? History, theory and values in learning
disability services
Jenny Webb CPsychol
18 July
Clinicians leading services or teams: Using your clinical skills to improve your
leadership management
Jacqui Saradjian CPsychol & Des McVey
23 July
An experiential introduction to Mindfulness
Dr Cecilia d'Felice Cpsychol
2 October
Updates in CBT to work with OCD
Dr Heather Sequeria CPsychol AFBPsS
8 October
Best practice in Expert Witness work and independent psychological services
Dr Stephen Roundhill CPsychol
15 November
www.bps.org.uk/ﬁndcpd
The British
Psychological Society
Learning Centre

I
VERY MUCH welcome the opportunity to
comment on Jonathan Hutchins article
‘Getting CBT Accreditation with the
BABCP’. He has clearly put considerable
effort into making sense of the accreditation
criteria, and aligning them with his experi-
ence on the University of Hertfordshire clin-
ical psychology training. He has assisted the
accreditation team – two independent
accreditors managed by an Accreditation
Liaison Officer – in clearly describing which
hours of his theory, skills development and
clinical experience were specifically in CBT,
and providing the correct forms of evidence.
I believe he also demonstrates well the flexi-
bility of the accreditation process by provid-
ing examples of alternative forms of
evidence to those specified (e.g. six clinical
commentaries equating to two of the 4 x 2 –
4000 word case reports) which were
accepted by the accreditors.
Jonathan has been advised that in order
to meet the requirements for Full Accredi-
tation, he would need to ‘provide more
details’ in his next supervision log. This is
intended to provide accreditors with infor-
mation they need to evaluate Jonathan’s
ongoing commitment and development as
a CBT Practitioner. The supervisor’s report
will provide evidence of the specifically
CBT nature of his clinical work, and should
include evidence of a required live element
within supervision. It is highly recom-
mended that CBT competency measures
are used as part of this live assessment for
all applicants.
As to the wider implications of
Jonathan’s article, it is timely that 5 Clinical
Psychology programmes across the country
have put themselves forward to be accred-
ited by the BABCP Course Accreditation
process. In due course, this will provide evi-
dence as to the equivalence or not of pro-
grammes in meeting CBT Practitioner
standards (Level 2) or partially meeting
them (Level 1). I am pleased that the editor
has offered space in CPF in the near future
to debate this matter and consider early out-
comes from the courses which have been
through the process.
Congratulations to Jonathan on his Pro-
visional Accreditation, and thank you for
contributing to making the process more
accessible for clinical psychologists.
Amanda Cole
Chair, CBT Practitioner Accreditation, BABCP
Commentary on ‘Getting CBT
accreditation with the BABCP as a newly
qualified clinical psychologist’
Amanda Cole
Missed DCP Annual Conference 2011?
Catch up with PowerPoint presentations at
tinyurl.com/dcp-conf

I was delighted to read Jonathan’s account
of his successful application for Practitioner
Accreditation with the BABCP. As a profes-
sion, we assert that our graduates will have
competence in CBT so this should not come
as an enormous surprise. As Co-Director of a
clinical psychology training programme I
was aware of other successful applications
from our trainees and it is very helpful to
have this knowledge and experience more
widely disseminated. What is particularly
important in Jonathan’s account is that he
has reached the standard for BABCP accred-
itation from a programme which, as he
observes, is not identified as a specifically
CBT orientated. Jonathan has also helpfully
outlined the steps which trainees should
take to ensure that they can provide evi-
dence of training and supervised CBT prac-
tice. Luckily for current and recent trainees,
there is plenty of opportunity for them to
record their experiences. For those of us
who trained many years ago, providing this
evidence is much more challenging.
The discussion about the role of CBT
within clinical psychology is important and
timely. But as a professional group we must
take care not to let the tail wag the dog.
CBT is one of many models of psychother-
apy to which clinical psychology has made
a significant contribution. We have helped
to demonstrate that CBT is effective and
cost effective in a wide range of settings,
and with many different people and pre-
senting difficulties. However, we can and
should be working just as hard and just as
enthusiastically with other modes of psy-
chology intervention to evaluate and high-
light their contribution to improving
health and well-being.
Shirley Reynolds
Professor of Clinical Psychology; Past President
BABCP (until June 2012)
Commentary on ‘Getting CBT
accreditation with the BABCP as a newly
qualified clinical psychologist’
Shirley Reynolds
to advertise in
The Psychologist
Please contact:
Ben Nelmes
020 7880 6244
ben.nelmes@redactive.co.uk

I
HAVE STOPPED reading books and
papers to do with mainstream clinical psy-
chology, at least temporarily. Instead, I
am reading about physics, trying to develop
a better understanding of the different mod-
els of science and how they have developed
over time. I am particularly interested in
quantum physics and the great debate
between the two giants of physics in the 20th
century, Albert Einstein and Neils Bohr,
about the nature of reality. Some would no
doubt frown upon this venture, questioning
whether it had any value to the everyday life
of a clinical psychologist. Others may at least
concede that I am fulfilling one criteria of
what makes a ‘good’ clinical psychologist: a
curiosity and interest in a broad range of
topics. But if I’m honest my motivation is as
much driven by a restless intellectual curios-
ity as it is by the lack of interesting and stim-
ulating material appearing in print in
mainstream clinical psychology over the last
few years.
Whilst reading about quantum physics I
came across a book by the theoretical physicist
Lee Smolin entitled The Trouble with Physics. In
the book Smolin (2006) reviews the state of
modern physics. Much of his account focuses
on providing a history of string theory and
then a critique of the assumptions underlying
this theory. Given my limited knowledge of
mathematics I struggled to comprehend
much of Smolin’s (2006) explanation of
string theory and his rather technical critique.
However, in the final part of the book he pro-
vides a fascinating account of how string the-
ory, despite a lack of evidence, has dominated
modern physics for the last 30 years. Smolin
(2006) is troubled by how this domination of
string theory has almost certainly stifled scien-
tific progress in the field of physics, rather
than enabled it. In the rest of this paper I will
argue that like string theory in physics, the
growing dominance of cognitive-behavioural
therapy (CBT) in clinical psychology is almost
certainly stifling our scientific progress, rather
than enabling it. This, in my view, is the trou-
ble with clinical psychology today.
Towards a monolithic community
When I started teaching clinical psychology
trainees about ten years ago there was
already an emphasis on cognitive behav-
ioural informed therapies, but there was cer-
tainly more room for different approaches
than there is now. With the introduction of
the IAPT project (and the money that came
with it) some in our profession strongly
argued that for clinical psychologists not to
be left behind, training programmes should
be adapted to produce more CBT-orien-
tated clinical psychologists. Although
opposed by some, a decision was taken to
raise the already high profile of CBT in
training. It became a requirement for all
programmes to teach ‘CBT and at least one
other’ therapeutic approach, signalling a
significant shift from the previous (more
pluralistic) position to teach ‘at least two
therapeutic approaches’.
The trouble with clinical psychology
Pieter W. Nel
The growing dominance of one psychotherapeutic approach in clinical psychology is troubling. Instead of
enabling scientific progress in clinical psychology, this development could actually be slowing it down. In
order to overcome this trouble we need to encourage more independent thinking at all levels of our profession.
‘As long as men [sic!] are free to ask what they must, free to say what they think, free to think what
they will, freedom can never be lost and science can never regress.’
– Marcel Proust

Of course, the issue is not whether CBT
should be taught on training programmes
or practised by clinical psychologists, but
why CBT, in spite of a lack of evidence (see
for example, Lynch et al., 2010), is monopo-
lising the resources (including training
resources) available to advance clinical psy-
chology, thus choking off equally promising
alternative approaches which may advance
our profession. Clinical psychologists need
to be competent in different psychothera-
peutic approaches in order to effectively
address the different kinds of problems that
our clients present with. In the world of psy-
chological problems one size does not fit all.
No therapeutic model has all the answers.
As it achieves more power over clinical
psychology we can see the obvious benefit for
CBT: it gains a legitimacy that would not be
afforded by a similar conquest of any other
profession (such as nursing). But what about
clinical psychology – what do we gain? Not
much, in my view. Instead, we stand to lose a
great deal as our carefully developed and
much valued pluralistic identity dissipates.
CBT trumps all
I find the absolute confidence in CBT
amongst certain clinical psychologists and pol-
icy makers perplexing (Nel, 2009). This confi-
dence in CBT leads to it being aggressively
promoted (e.g. through NICE guidelines, by
NHS commissioners, etc.) as the primary
pathway for treating people who are psycho-
logically distressed. As a result there is a grow-
ing disregard for alternative approaches to
the psychological problems that CBT claims
to solve. I am worried that a new generation of
clinical psychologists will become disinter-
ested in, or even ignorant of anything that is
not labelled ‘CBT’ and thereby contribute to
a growing perception that CBT is the only
approach yielding successful results when
treating psychological problems.
Optimistic interpretation of evidence
It is no secret that there isn’t any scientist,
not even Newton or Einstein, who wasn’t
wrong on a significant number of issues that
they had strong views about. However,
throughout the history of science there has
always been a tendency amongst scientists to
read their ‘evidence’ in the most optimistic
way possible. Those clinical psychologists
who study the effectiveness of CBT (or
indeed any other model of psychotherapy)
are no exception.
Although NICE guidelines usually
acknowledge the incompleteness of the evi-
dence base for psychological therapies, they
are often used by proponents of CBT as pro-
viding conclusive evidence that this
approach is superior to any other approach,
or worse, the only approach that can be
used for a particular psychological problem.
But there is a more fundamental problem
with the evidence for CBT in the NICE
guidelines. According to Heisenberg
(1958), a winner of the Nobel Prize for
Physics, there can be little doubt that psy-
chological experiments based on Newton-
ian mechanics (on which most, if not all of
the evidence for CBT in these guidelines
are based) cannot be sufficient to describe
psychic phenomena. He cautions us that
‘for an understanding of psychic phenom-
ena we should start from the fact that the
human mind enters as object and subject
into the scientific process of psychology’
(Heisenberg, 1958, p.63). When it comes to
judging the scientific evidence for CBT (as
with anything else), we should perhaps take
heed of the words of another Nobel Prize
winner in physics, Richard Feynman (1969)
who concluded in one of his lectures: ‘Sci-
ence is the organised scepticism in the reli-
ability of expert opinion.’
It is all about power
So if it is not all about wisdom (evidence),
what is it about? It is about power: who has
it, and how they use it. As in many other
fields of science, it is often the older and
more powerful clinical psychologists who
enforce direction on younger ones. A good
example here is clinical psychology training
where trainers and supervisors (both clinical
and research) are able to exert an enormous
amount of power over the direction that
their trainees take. In training one has to
acquire knowledge and skills to successfully
complete things in certain ways to pass. But

Pieter W. Nel
this is where it becomes tricky: which things
do you need to know about and which skills
do you need to be proficient in to be able to
qualify as a clinical psychologist? And, per-
haps more importantly, who has the power
to decide what these things are? The answer
is clear: it is those who are in powerful posi-
tions like programme directors, heads of
service, clinical and research supervisors,
and so on. For a good example of how this
operates in practice, look no further than
recent attempts to establish a norm and
enforce a consensus about what a compe-
tent clinical psychologist should look like.
Slowing scientific progress
What will happen if all clinical psychologists
can be forced to believe in the ultimate
superiority of CBT? In my view such a delib-
erate narrowing of clinical psychology will
not just be deplorable in principle, but it will
almost certainly lead to slowing scientific
progress down in our profession. Many
potentially important ideas that do not fit
with CBT orthodoxy will simply go unex-
plored. For clinical psychology science to
progress, plurality and disagreement, rather
than singularity and agreement, is essential.
According to the philosopher of science
Feyerabend (2010), history shows us that sci-
ence advances fastest when there are compet-
ing theories. There is, of course, an older,
naive view that one should put forward one
theory at a time and test it against the data. A
much more productive scientific context, how-
ever, is one where different psychological the-
ories are allowed to compete to explain the
same evidence. Feyerabend (2010) argued
that even in cases where there is a widely
accepted theory that agrees with all the evi-
dence, it is still necessary to invent competing
theories in order for science to progress. He
concludes: ‘Proliferation of theories is benefi-
cial for science, while uniformity impairs its
critical power’ (Feyerabend, 2010, p.17).
What can be done?
My aim here is not to criticise clinical psy-
chologists who exclusively use CBT or
indeed CBT itself. When we look back at this
period in years to come we may well con-
clude that CBT was part of the truth, part of
a more comprehensive or unifying approach
in clinical psychology. The issue, therefore,
is not so much whether we are currently
spending too much energy on developing
CBT, but ‘Why we are not expending nearly
enough on alternative approaches?’
So, what can be done to restore the
balance so that the science of clinical psy-
chology can progress more rapidly? Or
should we simply heed the words of the
Borg, to Captain Picard, in Star Trek: The
Next Generation: ‘Resistance is futile. You
will be assimilated.’
Selection
We should select people who have the abil-
ity to think for themselves, who can tolerate
the uncertainty inherent in all science, and
who are able to be critical of, or even ignore
the established ideas of powerful clinical
psychologists in the field. We should be cau-
tious to award training places to those who
want to take the easy way into the profes-
sion, who simply want to sign up with the
team that seems to be winning at the pres-
ent time rather than showing a genuine
desire to try and understand all psychologi-
cal problems afresh and from multiple per-
spectives. Moreover, if we, like the Italian
physicist Carlo Rovelli, believe that science
is a continuous process of exploring novel
possible views of the world, and that this
exploration happens via a ‘learned rebel-
lion’ where one always builds and relies on
previous knowledge but at the same time
continuously questions aspects of this
received knowledge, we urgently need to
welcome more learned rebels and trouble-
makers onto clinical training.
Training
We should continue to encourage trainees
to work in different therapeutic approaches
and try to learn from each what they can, so
that they are equipped to choose for them-
selves the most promising approach for each
individual client they might encounter in
their career. We should push trainees to
think independently, be critical and dis-
agree as much as the evidence permits. If we

don’t do this, we are letting the science of
clinical psychology down. Trainees should
be told that when one joins a scientific com-
munity like clinical psychology, one needs to
give up the childish desire to feel that one is
right all the time and in possession of the
absolute truth. Moreover, to combat any
escalating tribal tendency in clinical psychol-
ogy training (the you-are-either-with-us-or-
against-us attitude), leading trainers should
de-emphasise boundaries between CBT and
other therapeutic approaches and resist cat-
egorising programmes by whether or not
they display loyalty to CBT or not.
Clinical practice
Increasingly, advertisements for clinical psy-
chology jobs state that applicants should be
proficient in the science and practice of
CBT. We need to be cautious in adopting
such a pragmatic, aggressive approach that
aims to give us a standard model of what a
clinical psychologist is, or should be. To
keep clinical psychology vibrant we need to
hire and promote young clinical psycholo-
gists on the basis of their ability, creativity
and independence, without regard to
whether they subscribe to CBT or any other
established therapeutic model. Moreover, it
is essential that all practicing clinical psy-
chologists should have the intellectual free-
dom and professional responsibility to use
the psychotherapeutic approach or
approaches they judge most promising for
each client with whom they work.
Research
Increasingly, funding for clinical psycholo-
gists who want to research is only available to
investigate the effectiveness of one model of
psychotherapeutic treatment using a single
method of science. In my view, we need to
recognise that a diversity of research pro-
grammes, exploring different psychothera-
peutic models and using a diversity of
research methods to generate evidence
(APA, 2006) for treatments, is necessary for
our continued health as scientist-practition-
ers. Therefore, wherever possible, we should
try to limit the proportion of support given
to the research of any one particular psy-
chotherapeutic approach or research
method to, say, a third of total funding avail-
able. Also, we should encourage researchers
in our profession to think for themselves
and not pay too much attention to the estab-
lished research agendas of powerful senior
clinical psychologists. Finally, where the
publically available research evidence (e.g.
NICE guidelines) does not succeed in bring-
ing people of good faith in our profession to
agreement on an issue, we should allow and
even actively encourage people to draw dif-
ferent conclusions, rather than to close
down any scientific debate.
Service users
We should encourage the public in gen-
eral, and service users in particular, to be
critical of what we do, rather than to simply
accept any particular view that may domi-
nate in our profession at any given time.
When a clinical psychologist tells a service
user that there is only one approach that
can work for their particular problem, they
should not accept this at face value. They
should ask for evidence and also do their
own research to find out what alternative
approaches there are that might work bet-
ter for them, taking into account their par-
ticular circumstances.
Conclusion
I want to conclude by returning to Smolin
(2006), who had this to say: ‘…if you let
other people do your thinking for you (even
if they are senior and powerful), then you
are not living up to your ethical obligations
of a scientific community. Your doctorate is
a license for you to hold your own views and
make your own judgements. But it is more
than that; it obliges you to think critically
and independently about everything in your
domain of competence’ (p.354).
Affiliation
Pieter W. Nel, University of Hertfordshire.
Address
Pieter W. Nel, DClinPsy Programme, Univer-
sity of Hertfordshire, College Lane Campus,
Hatfield AL10 9AB; p.w.nel@herts.ac.uk.

Pieter W. Nel
APA Presidential Task Force on Evidence-Based
Practice (2006). Evidence-based practice in psy-
chology. American Psychologist, 61, 271–285.
Feyerabend, P. (2010). Against Method. London:
Verso.
Feynman, R. (1969). What is Science? The Physics
Teacher, 7(6), 313–320. [Originally presented at
the fifteenth annual meeting of the National Sci-
ence Teachers Association, 1966 in New York
City].
Heisenberg, W. (1958). Physics and Philosophy. Lon-
don: Penguin Books.
Lynch, D., Laws, K.R., & McKenna, P.J. (2010). Cog-
nitive Behavioural Therapy for major psychiatric
disorder: does it really work? A meta-analytical
review of well-controlled studies. Psychological
Medicine, 40, 9–24.
Nel, P.W. (2009) ‘Improving’ access to psychological
therapies: It’s the end of the world as we know it
(and I feel fine). Clinical Psychology Forum, 194,
7–11.
Smolin, L. (2006). The Trouble with Physics. London:
Penguin Books.
References
You can find book reviews on the Clinical Psychology Forum web pages, including
Janie Applebee’s review of Early intervention and autism: Real-life questions, real-
life answers, by James Ball (Future Horizons, Inc., 2008).
This book is specifically aimed at helping parents on their journey from an early
diagnosis of autism through providing the information they need to understand
autism, laying the foundations for future good behaviour; and then problem solving.
Interested in reviewing a book for
Clinical Psychology Forum?
The site also contains the list of books available for review. Please contact Sue
Maskrey (s.j.maskrey@sheffield.ac.uk) for further details.
www.bps.org.uk/cpfbooks
Books Reviews on the Web

O
NE PREREQUISITE for capacity to
consent (Mental Capacity Act, 2005)
is fully accessible information about
any proposed procedure. In Brighton &
Hove learning disability psychology service,
we have promoted the use of graphical
information to supplement literature given
out by clinicians. Carers assist the person to
work through personalised leaflets as often
as possible to enhance their likelihood of
recalling vital information when consent is
required. We also built in a cognitive inter-
view (CI), modified to extract meaning and
understanding (CImodC), to evaluate
capacity. The outcome allows us to advise cli-
nicians of the capacity and likely communi-
cation prospects of the individual on the
day. This process seems, anecdotally, to lead
to better outcomes, and has been described
in full elsewhere (Conboy-Hill, 2006).
Nevertheless, engagement with litera-
ture, however simply and colourfully
expressed, is passive and, where simplifica-
tion is extensive, may not carry sufficient
information to support capacity. We saw the
need for something more active, self-
directed and comprising the ‘lean forward’
experience that enables learning by active
participation (Nielson, 2008).
Serious games
‘Serious games’ describes the development of
public service products underpinned by gam-
ing technologies (e.g. Zyda, 2005). Online
and video games are structured to motivate
users by manipulating the reward schedule
(Chatfield, 2010). With the growth in popu-
larity of gaming across demographics, this
seems a promising way of delivering health-
related information. We chose Second Life
(SL), a free, socially-based virtual world (VW)
in which the ‘residents’ operate freely and do
not work towards levels of achievement.
Second Life, avatars and ‘presence’
SL is a three dimensional interactive environ-
ment or VW, accessed via a computer. Within
it, a participant is represented by a digital char-
acter or avatar, which can be moved around
the environment, interacting in real time with
objects and other avatars, via a device such as a
keyboard, joystick or trackball.
The social nature of VWs is derived from
the principle of ‘presence’ and ‘co-pres-
ence’, by which the sense of being with
another person is generated by the behav-
iour of the participant’s own and other
avatars. Presence and co-presence enhance a
sense of involvement with the environment
(Bailenson, Beall & Blascovich, 2002).
Preparation
We interviewed four volunteers from a day
service (The Grace Eyre Foundation [GE])
who had experienced a hospital admission,
asking what they wanted from hospitals, doc-
tors and nurses. Interviews were individual
and took place on site. They were videoed
using a Flip video camera operated by a
carer, thereby giving control to a familiar
person. The volunteers were shown clips of
their video before leaving, and also had
Virtual worlds, people with learning
disabilities, and capacity to consent: A
feasibility study
Suzanne Conboy-Hill, Val Hall & Dave Taylor
Using a 3D simulation of Brighton, we tested the feasibility of delivering highly interactive healthcare infor-
mation to adults with learning disabilities via virtual world technology. Participants showed engagement
and enjoyment, recalled details at interview, and in many cases asked to return.

copies stored for them on site. The inter-
views took between ten and thirty minutes.
We used the interviews as public consultation
material, and as a demonstration of the
CImodC for the purposes of our application.
Three interviewees were judged able to
consent to their videos being used and one
was not. However, he had enjoyed the session
greatly, performing enthusiastically to cam-
era. His family felt that any possible harms
arising from using his material were limited by
the purpose (i.e. the videos would be seen
only by key researchers) and were outweighed
by the upset he would feel if his film were not
used, and so it was included with the others.
Key statements from our interviewees
were in reference to communication. People
mentioned clinicians talking to ‘my carers, not
me’, and wanted information they could
understand ‘so you wouldn’t be frightened’.
P: Well, they’d have to show them some pictures or
something to help them along.
Author: They would have to show them some pic-
tures, yes, that’s a really good idea.
P: Because if they couldn’t read they’d have to
have pictures or, or something to show them, or
show them on their body what was happening to
them or something if they didn’t know.
Author: How do you, how does it work when peo-
ple are telling you, like the doctor is telling you
what’s going to happen?
D: They never do, they tell the other person
Author: What do you think about that?
D: I think it’s horrible cos they’re not the person [not
audible] cos recently I really wanted this operation
to straighten my back and they gave the, and made
the, and the people that were with me made the deci-
sion for me.
Designing an interactive information-
giving experience
The users’ views convinced us that there was
a need to develop an interactive experience,
and so we (Dave Taylor [DT] with Robin
Winter [RW]) built a simulation of Brighton
in a private area of SL, leased by Imperial
College from Linden Lab. The hospital fea-
ture was designed to match the external
appearance of the Royal Sussex County Hos-
pital (RSCH), while inside, there was a ‘race-
track’ tour of waiting room, assessment
room, anaesthetic room, operating theatre
and recovery area. To enhance familiarity
for participants, we included Brighton
seafront, the pier, the Sea Life Centre, and
GE’s reception and Angel Café. We hoped
this would provide anchoring in an other-
wise unfamiliar context, and encourage
learning by play, allowing people to become
more skilled at manoeuvring their avatar via
the keyboard before needing to negotiate
the hospital.
Assessing accessibility needs
During the building process, we asked another
small group of service users to try out SL, and
comment on its physical and social accessibil-
ity. Our volunteers were supported by GE staff,
two members of the research team (VH and
SCH), and David Matthews (DM) who man-
aged the IT suite. Over two hours, we assisted
and then observed our volunteers operating
off-the-peg avatars in an area of SL previously
determined to be quiet and non-contentious.
One person was particularly keen on finding
clickable content, and less interested in the
social features. Another found the keyboard
skills difficult to master but persisted in trying
to operate her avatar. A third viewed the con-
text as entirely social, and tried to make
friends with ‘passers-by’. The fourth also found
the keyboard difficult to manage, but persisted
and took over again each time she was assisted
in moving her avatar along.
All the participants stayed for the whole
session and described and demonstrated
interest, engagement and persistence. Some
asked when they could repeat the experience.
Working in partnership
We were keen to engage the GE staff group
because they were collaborators on the study
but also because our use of the IT suite
would inevitably cause them some inconven-
ience. At a time suitable to GE, we (SCH and
VH, with DT online) gave a full demonstra-
tion of the Brighton simulation. This cre-
ated much good will and made easier our
‘adoption’ into the GE community during
the study. This ultimately helped with
recruitment and retention of participants.

Virtual worlds, people with learning disabilities, and capacity to consent
Research assistants
Our pilot showed that we would need
support for participants from people adept
at keyboard use. We recruited a team of four
volunteer psychology graduates and two clin-
ical trainees on placement as assistants. They
were given an induction protocol and then
supported (SCH & DM) in signing up to SL
and familiarising themselves with the virtual
world, their avatars, and the Brighton simula-
tion. Our aim was not for the assistants to be
SL experts, but for them to have confidence
to manage common in-world difficulties.
Following this, an exposure protocol was
developed describing the assistants’ roles
and giving short scripts for particular points
in the session. They would work in pairs,
each performing one of two functions – SL
Facilitator or Room Manager (the latter to
minimise interruptions and deal with extra-
neous problems). These were alternated to
maximise their experience.
Participants
The participants were twenty volunteers who
attended the GE service and had responded
to a poster asking for research participants.
GE staff then gave them the information
about the study and asked if they would like
to take part. If they agreed, we found a con-
venient time for them during one of the
allocated exposure sessions. GE staff took
them through the consent process on the
day and they brought their completed form
to be displayed on camera.
The group was aged between 20 and 80
years, comprised 11 men and 9 women, and
was not selected on the basis of computer
literacy. Post-session estimates of intellec-
tual functioning showed that all but one
had a significant to severe learning disabil-
ity. The one who did not, had an autistic
spectrum disorder.
Exposure
Participants were exposed to the virtual rep-
resentation of Brighton, which they were
encouraged to navigate using a keyboard
interface. They were supported by an assis-
tant and, if they wished, a familiar carer. The
gender of the avatar was matched to that of
the participant and an attempt was also
made to match ethnicity. The starting point
of the session was Brighton seafront, by the
pier, to encourage identification with loca-
tion. The second location within the simula-
tion was the GE Centre, and the third was
the RSCH. We anticipated spending 10 to 20
minutes in each of the first two locations for
familiarisation, keyboard skill development,
and anchoring, before moving to the RSCH.
Participants were encouraged to play with
the environment, explore and move their
avatar as they wished to gain confidence.
Once familiarised, participants were
encouraged to tour the RSCH. They were met
in reception by a robot nurse avatar, invited to
activate a blood pressure machine in the
assessment room, explore the operating the-
atre and approach the ‘patient’ in recovery. At
the end of the tour, they were guided back to
a preferred location, such as the seafront.
Data capture
We used synchronised front and rear video
cameras to capture participant face and on-
task activity. Screen capture recorded partic-
ipant activity within SL. Separate audio
recording captured vocal responses to the
session. This technology was installed and
monitored by Richard Griffiths and Heloise
Candella from the University of Brighton,
who also harvested the data. This material
was transferred on site to SD cards and
removed to secure storage.
Participants were interviewed between one
and two weeks later (SCH) using the CImodC
to see how much detail of the exposure they
recalled. At a subsequent session, they com-
pleted two psychometric screening tests to
provide contextual information. The data
were aggregated using NVivo software (VH).
Outcomes
Our intent was to explore the feasibility of vir-
tual world technology as an information deliv-
ery environment for people with learning
disabilities. We found that everyone persisted,
with very little assistance, for between twenty
minutes and an hour. Not everyone com-
pleted the hospital tour, often because they
had managed to move to another simulation,

including a space station. The facilitator’s
style was important: assertive management
succeeded in ensuring all three elements were
explored, but seemed to hamper engage-
ment, while a more hands-off approach
encouraged engagement, but not necessarily
full exposure to the three key elements.
We also looked for identification with the
avatar as a way of indicating presence. One
person quickly began referring to her avatar
as ‘I’. Others made reference to the avatar’s
environment (for example, ‘It’s cold out here!’
as the avatar fell out of a window into the
water) or to specific features (‘We’d better get
out of here before the sharks get us!’, referring to
being under the sea with some dolphins
[The participant was laughing at his joke]).
Some made contextual remarks that implied
relationship: ‘She’d better watch herself
crossing the road’. While others remarked
on the environment as a whole, asking ‘Where
are the shops?’, ‘I want to go shopping now’, and
‘There should be some clubs here’.
Participants who were the most inde-
pendently interactive also made the most
positive statements about the experience
and showed the most pleasure. Those who
were least interactive, showed the fewest
indications of pleasure. This is consistent
with ‘lean forward/lean back’ notions of
engagement. No one showed any distress.
At interview, most people recalled some-
thing of the exposure session, but were more
likely to confabulate when offered visual
prompts (screen-shots of key SL scenes). Some
had not visited certain areas but still attempted
to ‘recall’, elaborating on the prompts and
their own experience. Significantly, both dur-
ing the session and at interview, people drew
on existing knowledge of hospital or medical
experiences (e.g.‘That’s where the doctor puts his
pictures’ [the X-ray viewer] or ‘I had my leg plas-
tered on there’ [the operating table]). This sug-
gests that the process accesses memory hooks,
to which new information may be attached in
preparation for a new procedure. We did not
formally measure recall or compare the
CImodC with any other interview at this stage.
Further details are presented elsewhere (Con-
boy-Hill, Taylor & Hall, 2011; Hall, Taylor &
Conboy-Hill, 2011).
Conclusions
Our study showed how people with signifi-
cant cognitive impairments were able to
engage with, and make use of, a VW via an
ordinary keyboard. They were able to sus-
pend disbelief in order to enter a 3D envi-
ronment, and to interact with it as if it were
real, but without fear or risk. In particular,
they were able to tour a sterile unit, touch
equipment, and ‘have their blood pressure
taken’ by a virtual nurse, without travelling
or compromising the routines of a real
world hospital. Their later recall, and the
triggering of existing knowledge, shows
where conversations about new procedures
may be built.
Our aims now are to extend this research
towards product development, whereby spe-
cific, targeted information will be delivered
to prospective patients with learning disabil-
ities, and other cognitive vulnerabilities, via
a range of media and devices. We also hope
to conduct trials of the CImodC in assessing
capacity, thereby closing the information
delivery/capacity assessment loop.
Acknowledgements
This article presents independent research
commissioned by the National Institute for
Health Research (NIHR) under the i4i pro-
gramme award number II-FS-0908-10011. The
views expressed in this article are those of the
authors and not necessarily those of the NHS,
the NIHR or the Department of Health.
Affiliations
Suzanne Conboy-Hill: Consultant Psycholo-
gist, Sussex Partnership NHS Foundation
Trust; Visiting Clinical Research Fellow, Uni-
versity of Brighton.
Val Hall: Head of Centre for Health
Research/Director NIHR Research Design
Service South East, University of Brighton.
Dave Taylor: Programme Lead for Virtual
Worlds & Medical Media, Imperial College
London.
Address
Suzanne Conboy-Hill, Sussex Education
Centre, Mill View, Hove BN3 7HZ; s.p.con-
boy-hill@brighton.ac.uk.

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References
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T
HE CAMHS Outcomes Research Con-
sortium (CORC) is a collaboration
between child and adolescent mental
health services (CAMHS) across the UK, with
the aim of instituting a common model of
routine outcome evaluation. CORC started in
2002 as a joint initiative between five found-
ing services (Bedfordshire & Luton; Leeds;
Enfield, Barnet & Haringey; Tavistock & Port-
man; and Hertfordshire), and was from the
outset a collaboration between front line cli-
nicians, managers and administrative leads in
member services. CORC then opened to
wider membership in April 2004 (CAMHS
Outcome Research Consortium, 2011).
CORC aims to foster the effective and
routine use of outcome measures in work
with children and young people (and their
families and carers) who experience mental
health and emotional well-being difficulties.
It aims to do this through collaboration with
its members, academic consultants, and
learning partners; sharing ideas and good
practice. The Tees, Esk & Wear Valley
(TEWV) NHS Foundation Trust is one such
member involved in the CORC project and
uses several outcome measures within its own
service (one such measures being the CHI-
ESQ questionnaire which provides service
user feedback). As part of the TEWV CORC
project, two aspects were highlighted with
regards to CHI-ESQ: firstly how to improve
the amount of service user feedback by
obtaining higher return rates, and secondly,
to ensure that this feedback was meaningful.
This would allow more data, which could be
used to improve service user experience.
The purpose of this article is to explain
and share techniques used by the TEWV
CORC team in order to improve the use of
the questionnaire within the trust. The article
will explain five strategies used to improve
data collection of the questionnaire, and will
also discuss some of the issues and challenges
experienced along the way. The five strate-
gies implemented by the CORC team were: to
increase access to measures (CHI-ESQ Ques-
tionnaire) for service users/parents, to have
reminders around the team premises for staff
members to remember to give out the ques-
tionnaire, to create some feedback (based on
the returned CHI-ESQ questionnaires) to
give to CAMHS teams, to establish a process
for when a team receives negative feedback,
and finally, to create a presentation for staff
about understanding outcome measures.
Before each strategy is described in more
detail, it is important to get an understanding
of what the CHI-ESQ Questionnaire is.
The CHI Experience of Service Question-
naire is completed by parents, carers and
young people aged 9 to 18, and is intended to
be used for all children seen by a CAMHS
service (Attride-Stirling, J., 2002). It provides a
means of estimating the level of satisfaction
with the service, and uses forms for parents,
older children and young children. It should
be completed at six months or case closure,
but not given at assessment stage. The CHI-
ESQ was originally used as an anonymous
measure for one-off audits of service delivery
but CORC recommended it be used routinely
in conjunction with other core measures, so
that a family’s experiences with the service can
Improving the use of CHI-ESQ (CORC
outcome measure) in CAMHS services
across an NHS trust area
Rob Flynn & Lynne Howey
This article discusses some of the issues and challenges of using CHI-ESQ in an NHS trust and
ways used to improve its use.

CP Forum 235 - with my article

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