Month: October 2014

There is no racism in clinical psychology: Personal reflections from another Black trainee.

This article asks whether the majority ethnic group may have a tendency to dismiss experiences of racism. Considering my lived experience, I reflect on some processes which may become engaged when racism is evoked and propose some potential implications for clinical psychology.

Subjective realities and embodied experiences

When individuals speak about their experiences of racism, they are often challenged about their interpretations and encouraged to consider more ‘objective’ reasons which may account for the behaviours or words that caused offense or hurt. Invariably, as there are multiple ways to interpret events, particularly in the realm of human interactions, experiences of prejudice and of discrimination can easily be discounted. Such dynamics are well documented and I, like other Black and minority ethnic (BME) trainees have encountered them in Training. Navigating a racist society may equip individuals from racialized minorities with the ability to recognize subtle pre-verbal and para-verbal cues of racism.

This embodied apprehension of prejudice may be the result of inner adaptations to the external reality of racism yet, it can easily be dismissed as it may not lead us to easily verbalise our experiences. There have been repeated calls for increased cultural competence within clinical psychology but, trainees continue to be socialised into rhetorics of social and power awareness. Diversity indeed commonly features within our professional discourse. A ‘better than’ position may be adopted whereby racism and discrimination become minimised and eventually envisaged as being ‘out there’ rather than ‘in here’. Being able to remain oblivious to the experiences of those who are racially subjugated and deny responsibility for racism may be the hallmarks of White privilege.

Expectedly, following experiences of racism from a supervisor, I painfully reflected upon my experience before alleging that the supervisor was prejudiced and racially offensive. When my concerns were raised, they were instantly discounted. I was interrupted in my account then coached into considering other possible motives for the conduct. The differential treatment and offending words did not provide ‘evidence’ of discriminatory intentions. Nevertheless, when the same supervisor questioned areas of my competence and intelligence without evidence, an epistemological shift occurred so that the supervisor’s perspective and judgement alone became sufficiently evidential. Meeting a positivist threshold was no longer necessary.

Managing cognitive dissonance

It is well documented that people tend to use prior beliefs to interpret personal experiences. This is the essence of Cognitive Dissonance Theory. Festinger (1957) posited that powerful motives to maintain cognitive consistency often give rise to irrational or unhelpful behaviours and that when excessive dissonance is produced intellectual defences can be triggered. Such defences may manifest in the refusal to accept the discomforting information, or in unduly questioning its validity. Refusing to consider the possibility that racial prejudice may indeed have been involved within the supervisory relationship, may help protect the safety of existing assumptions and truths whilst unabling a reflexive consideration of privilege. More disturbing perhaps, may be the implications that the purported competence/intelligence deficiencies seem to have been accepted in the absence of supporting evidence. Cognitive Dissonance Theory would posit that prior beliefs or worldviews were therefore not disturbed in this instance.

The denial of racism

Behaviours displaying overt prejudice are now relatively rare. They have been replaced by more covert forms of racism. Such behaviours although more subtle have been posited to betray deeply rooted prejudices. When BME trainees have spoken about their experiences of training, experiences of both overt and covert racism have been documented. The latter may be met with more scepticism however, when potentially painful and/or anxiety provoking information is instantly rejected, one may suspect that some level of denial may be at play. Denying racism may indeed serve multiple functions. Institutionally, and it may help avoid liability for potentially unlawful acts. Socially, it may be part of a strategy of positive in-group presentation and demonstrate adherence to social norms and values. Moreover, such self-presentation, may also serve to defend the in-group as a whole or its dominant discourse.

Thus, the failure to fully hear, document and investigate race related concerns may be interpreted as reiteration of the professional consensus and public discourse: ‘there is no racism in clinical psychology’ or ‘we are not racists’. This social denial has been theorised to also fulfil an individual defence. ‘She is not racist’ may therefore mean ‘I am not racist’ whereby staff rather than empathising with the trainee’s distraught come to identify with the supervisor accused of racism. This interaction between the institutional, social, and individual may make accusations of racism highly discomforting. Possibly more so than the potentially discriminatory acts complained of. To discharge such discomfort; counter-accusations are usually made e.g. ‘playing the race card’, ‘having a chip on the shoulder’, ‘being paranoid’, ‘being oversensitive’ or indeed ‘jumping to conclusions’.

Individual and/or institutional racism?

In the mist of scepticism and cognitive ‘reframing’ attempts, my distress became invisible. I was left with little support. Engaging with the pain might have shifted ‘the gaze’. Perhaps I was being punished unconsciously. Trainees, who challenge racism may be at risk of being ostracised, dismissed or penalised. The McPherson enquiry uncovered institutional racism within the police force which it defined as:

‘The collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture or ethnic origin. It can be seen or detected in processes, attitudes and behaviour which amount to discrimination through unwitting prejudice, ignorance, thoughtlessness and racial stereotyping’. (McPherson, 1999, 6.34)

Although this definition is not without problems, it does offer a framework to reflect on how systemic and unintentional discrimination may become manifest within institutions. The independent enquiry into the death of David Bennett found institutional racism within the psychiatric system, including persisting race inequalities, the widespread use of stereotypes and of particular relevance here, failures to take allegations of racism seriously. Its recommendations led to the ‘Delivering Race Equality in Mental Health’ programme. The action plan came to an end in 2010 thus; race inequalities may have fallen down the political agenda. However, they remain. In this context of suffering and alienation, BME service users’ experiences of racism continue to receive little empirical and clinical attention. Perhaps parallels may be drawn.

Final Reflections

Although multiple versions of events and reality can and do co-exist, the most privileged amongst us may have vested interests in maintaining oppressive biases which locate truth where power is and assure that only those with power can define reality. The inter-connection between agency and systemic structures may mean trainees from racialized minorities are at risk of being silenced and dismissed in their experiences. It was to help ensure that they have a voice that I created ‘The Minorities in clinical psychology Training Group’. Indeed, in the context of continuing challenges in recruiting a more representative workforce and enduring difficulties in adequately serving BME communities; a failure to pay close attention to such voices may not only deprive the profession of opportunities to better understand and meet the needs of service users from traditionally marginalised groups, it may leave clinical psychology vulnerable to accusations of institutional racism.

Thank you for reading. If you have found this article helpful or interesting, please share it with others.

Want to learn more?

Please see…

Adetimole, F., Afuape, T., & Vara, V. (2005). The impact of racism on the experience of training on a clinical psychology course: Reflections from three Black trainees. Clinical Psychology Forum, 48, 11-15. 6.

Care Quality Commission and National Mental Health Development Unit (2010). ‘Count Me In 2009 – Results of the 2009 national census of inpatients and patients on supervised community treatment in mental health and learning disability services in England and Wales’. Care Quality Commission: London.

Constantine, M. G., & Sue, D. W. (2007). Perceptions of Racial Micro aggressions among Black Supervisees in Cross-Racial Dyads. Journal of Counselling Psychology, 54(2), 142-153.

Department of Health (2005). Delivering Race Equality in Mental Health Care, Department of Health: London.

Fanon, F. (1967). Black Skin, White Masks. London: Pluto Press.

Festinger, L. (1957). A Theory of Cognitive Dissonance. Stanford, CA: Stanford University Press.

Hardy, K, V. (2001). Family therapy: Exploring the fields past, present and possible futures. Adelaide: Dulwich Centre Publication.

Hook, D. (2006). ‘Pre-discursive’ racism. Journal of Community and Applied Social Psychology. 16, 207-232.

Patel, N., Bennett, E., Dennis, M., Dosanjh, N., Mahtani, A., Miller, A., et al. (2000). Clinical Psychology, Race and Culture: A Resource Pack for Trainers. Leicester: BPS Books.

Patel, N. (2004). Difference and Power in Supervision: The case of culture and racism. In Fleming, I. & Steen, L. (Eds.), Supervision and Clinical Psychology: Theory, Practice and Perspectives. Hove: Brunner-Routledge.

Macpherson, W. (1999). The Stephen Lawrence Inquiry: report of an inquiry by Sir William Macpherson of Cluny. London. Home Office Cm 4262-I.

NSCSHA (2003). Independent Inquiry into the death of David Bennett. An Independent Inquiry set up under HSG (94)27. Norfolk, Suffolk and Cambridgeshire Strategic Health Authority: Cambridge.

Tan, R., & Campion, G. (2007). Losing yourself in the moment: The socialisation process of clinical psychology training. Clinical Psychology Forum (180), 13-16.

Van Dijk, T. A. (1992). Elite Discourse and Racism. Discourse and Society 3(1): 87-118.

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Unspoken challenges of clinical psychology training? A view from inside. PART 1

Becoming a clinical psychologist has been likened to a process by which a new identity is incorporated into an existing sense of self whereby unique physical and mental experience, attributes, and a position within social roles, relationships and discourses is transformed. This process, although rewarding in the main, is not experienced without challenges and pain. What one might struggle with on the professional pathway is to some degree personal and idiosyncratic nevertheless, some processes may become engaged and/or significant for many. Further, often it is the things we do not expect to find difficult that come and pose the most challenges. This post aims to present some of the processes and dynamics which can become challenging for trainees within the professional socialization process. Those who are aspiring clinical psychologists or new trainees may find reflecting on some of the issues it highlights helpful. Hopefully too, it will be of some use to those with supervision responsibilities.

Feeling deskilled

Feeling deskilled at the start of training or learning journeys is a common experience. However, in the context of clinical psychology training such feelings may well become amplified. The demand for clinical psychology training places has always outstripped the supply. The possible difficulties trainees may have faced to gain places due to the inherently competitive nature of the recruitment process may bear an influence on the professional socialisation process. Trainees may feel pressured to ‘prove’ that they are deserving of a training place or that they are good enough. Unsurprisingly, many will come to experience self-doubt, some loss of confidence and even ‘impostor syndrome’ during the training journey.

The Conscious Competence Ladder model (Burch, 1972) may provide a helpful framework to better understand and reflect on how trainees may respond to learning processes and activities. This model essentially posits that two factors: consciousness and competence, affect our thinking and emotions as we acquire a new skill. According to the model, we move through four different levels or phases as we build competence. The initial level: ‘unconsciously unskilled’, occurs when we do not know that we are not competent. We then move onto the ‘consciously unskilled’ phase as we realise the limitation of our competence.

Thirdly, it is posited that we become ‘consciously skilled’ when we are aware that we have acquired the skills/ competence required (though conscious effort is still required). Finally, the ‘unconsciously skilled’ level is reached when the said skills and competence have become so assimilated that they demand little or no conscious awareness to be practiced. This model is not linear and we may for instance after having become unconsciously skilled, revert to feeling consciously unskilled for instance because we fail an assignment. Of particular relevance, training wise, may be the fact that trainees are required to complete placements in different specialized areas and thus may recurrently find themselves in the consciously unskilled phase, the most emotionally demanding position; as they develop their competencies.

Managing power imbalances

We all have peculiar relationships with power and authority based on various factors including: our personal history, our cultural and social backgrounds and to some degree our social positioning. In addition, how we may deal with potential feelings of disempowerement and powerlessness can also be related to professional experiences and in particular, the level of past autonomy, responsibilities and/or organisational cultures accustomed to prior to starting training. Whilst for most ‘traditional’ applicants gaining a training place will entail an increase in status and with it an improvement in terms of employment and work conditions, for those who held relatively senior posts and worked autonomously before starting training, the training environment and trainee role may take some adjusting to and indeed involve a decrease in status and in autonomy.

Trainees can often (though mostly tacitly) be positioned as naïve, dependent and/or passive. Such implicit infantilisation can occasionally become explicit. On one occasion, for example, the positive feedback from a placement review I received included ‘doing as I am told’. Clearly, the supervisory relationship is not an equal one as clinical supervisors hold evaluation and marking responsibilities and thus have actual power (to pass or to fail) over the trainee. An unusual dynamic may be created when trainees because of their past experiences/responsibilities, qualifications and/or behaviours may not meet some supervisors’ potential expectations of dependency. Whilst actual power may not be disrupted, for some, perceived power may well be.

Power dynamics are of course further complicated when trainees belong to minority and/or marginalised groups. Their presence in the training arena alone can challenge or evoke social/personal expectations and stereotyped notions. Self-fulfilling hyper-vigilance may thus become an issue for such trainees who may become anxious about the (real) possibility of being discriminated against or of facing prejudicial attitudes. On the other hand, difference may also impact on some supervisors who may not have prior experience of working with ‘non-traditional’ trainees and who may be unsure about how and whether or not to raise issues of difference within the supervisory relationship and/or be unduly preoccupied with the (also real) eventuality of being perceived or experienced as prejudiced.

The challenge of adopting a questioning attitude

Clinical psychology trainees hold dual statuses as trainees thus, employees of specific NHS trusts which usually provide an employment contract, associated terms and conditions and the placements within which practical skills are developed and; as students within universities which host the courses, deliver the academic components of the training programme and thus the student identity. With the professionalization of the discipline, the adoption of the trainee role over that of the student one seems to have been preferred. Such preference would appear to give higher status to the trainee role.

However, the exclusion or reduction of the student identity may set particular dynamics and impact on how trainees see themselves, their learning and how they are perceived. Whilst students may be actively encouraged to be questioning and irreverent toward prior practices, theories and of taken for granted wisdom, such a stance may not be specifically sought after or strongly emphasized within the trainee role, arguably necessarily so. Indeed training is, by definition, centred on applying and demonstrating practical competence often by copying or mirroring others.

Given the unbalanced power distribution and the potential high risks of getting into conflict with those who hold a responsibility for assessing you, it is perhaps unsurprising that trainees often simply decide to ‘go along’ with theories and models of working that are experienced as oppressive, are incongruent/incompatible with their worldviews or appear to lack empirical support. Additionally, people in cohesive groups typically experience greater pressure to conform than those in non-cohesive groups. Consequently, homogeneity and conformity may not only present challenges for trainees, they may problematize innovation and creativity within the profession (more on that in due course).

Thank you for reading, If you have found this article useful or interesting, please spread the word.

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