In the second of a three-part article, four trainee psychologists, Luisa Eminyan, Louisa Houlton, Fleur Mifsud Bons and Antonella Mizzi, reflect on their experiences gained from a three-week intensive placement in England.
The Leonardo Da Vinci programme offered us the unique opportunity to observe and experience the psychology profession in the UK, more specifically in the context of the psychological services provided by the NHS located in Oxfordshire and Buckinghamshire.
This experience exposed us to innovative ways of applying psychological intervention with various client groups and was an eye-opener on the ways in which the profession of psychology can grow and develop in the Maltese context as well as the pitfalls it may be subject to on the path of its development.
It was refreshing for us to note that within the NHS, psychologists enjoy a formal and well-defined career structure and pathway with a relatively short promotion ladder, designed particularly for the profession. With career advancement, comes an accompanying increase in responsibility, autonomy, authority and decision-making power as well as a parallel rise in the salary scale, ranging from £30,000 to around £75,000. This could have a number of effects on the profession within this particular context: Psychologists can more easily feel recognised, esteemed and at par with other professionals than their Maltese counterparts, who still struggle to strengthen their identity and to be recognised by the larger system.
Another positive aspect of the development of the psychology profession in the UK is the fact that in all the services we observed, psychologists are recognised as professionals in their own right and occupy high supervisory and managerial positions. Indeed, some services are actually led by the psychologists themselves, as in the case of the Eating Disorders Service and the Huntercombe Service for Young Offenders. This contrasts with the profession in the Maltese context where psychologists, unlike psychiatrists and social workers, very rarely occupy posts which enjoy high autonomy, authority and decision-making power. We observed this to have a strong positive impact on the organisational ethos of the service which naturally shapes the service culture and the implementation of the service itself.
This psychology ethos shapes the physical environment of the service which, through its attractive, warm, welcoming and quiet ambience promotes intimacy, in-depth work and self-reflexivity among clients and among psychology professionals working with them.
It also affects the structure of the service itself which always provides the necessary training, group and individual supervision as well as the necessary creative, research and assessment resources needed for the effective provision of psychological therapy. Maltese psychologists are required to work with much fewer resources. We could hypothesise that this is influenced by the fact that they have not yet been given sufficient autonomy and decision-making power to make the desired changes within the environments they work in.
Another positive aspect that belongs to the reality of our profession in the UK is the large variety of training schools of psychotherapy that psychologists and psychotherapists can choose to specialise in. Thus, the same service may contain psychologists and psychotherapists from different schools of thought such as Cognitive-Behaviour Therapy, Cognitive-Analytic Therapy, Psychodrama, Family Therapy and Psychodynamic Psychotherapy, among others. We had the opportunity to observe some clinical meetings and it was interesting to witness the richness created by this variety which, rather than being confusing in its diversity, provided a more comprehensive formulation of the clients' difficulties. Furthermore, therapists in the team could discuss and enjoy the luxury of choosing which therapy would be mostly indicated for which client; while clients enjoyed the benefits of choosing from among the different therapies, the one they themselves preferred to receive.
The services provided by the NHS are under constant evaluation and are monitored for their effectiveness. Strongly influenced by the managed health care revolution, the NHS relies only on therapeutic interventions that are 'evidenced-based', that is, interventions that can be substantiated by research studies, mainly following the Randomised Control Trials (RCT) methodology. Support is given to those therapies which prove beneficial in the least amount of time possible, thus rendering them cost-effective. For this reason, Cognitive Behaviour Therapy has become a widespread psychological intervention within the NHS. However this may not be the therapy of choice for every psychological problem and not all clients may find it helpful or appealing to them. Also, studies indicate that the therapeutic relationship between client and therapist may be more related to therapeutic outcome, than the therapeutic approach used (Horvath, and Symonds, 1991).
Thus, supporting cost-effective treatment methods ensures, on the one hand, that clients are provided with treatments that have been proved to work. On the other hand, if services are too costly, they are cut, sometimes rather abruptly. Working in an environment of constant flux, may have several advantages such as that it increases accountability by keeping workers "on their toes". Through this constant evaluation, a high level of professional effectiveness is encouraged. The disadvantage of working in this high degree of flux is the stress, demotivation and discouragement which could result if this is taken to an extreme.
From our UK professional counterparts we had lot to learn about the ways in which our profession in Malta can develop and establish itself further within the Maltese context, we also learned about the pit-falls that we may need to be careful about on the path of this development.
A group of six trainee psychologists, reading for a Master's degree in Clinical, Counselling and Educational Psychology at the University of Malta, were part of the Community Vocational Training Programme of the Leonardo da Vinci EU-funded programmes through which they carried out an interesting three-week placement in the UK. While two of the trainee educational psychologists visited the Educational Psychology Services in Salford and Warrington, four other trainees from the Clinical and Counselling streams visited a number of psychological services offered within the Oxfordshire and Buckinghamshire Mental Health Partnership NHS Trust.
(To be concluded)