Month: November 2014

The impact of difference PART 2: The silent influence of Cultural Capital.

A renewed momentum?

I have made no secret of the fact that clinical psychology training has been fraught with challenges, many unexpected and most related to difference. The Division of Clinical Psychology is currently drafting its first ever Equality & Diversity strategy which emphasises the necessity to increase cultural competence within clinical psychology. It seems quite topical then to further the reflections first laid out (here) within the first part of this article and to start to explore some potential mechanisms which may bear an influence on professional processes. In the next few posts of this series, I will ask the reader to consider more implicit or tacit variables and their potential impact in terms of difference. I start here with cultural capital.

The influence of prior experience

Having 6-12 month relevant experience prior to applying for training is an essential criterion for all clinical psychology courses. In reality however, due to the competitive nature of the recruitment process and for most, the resulting need to apply more than once before obtaining a training place, most successful applicants would have worked a number of years prior to being accepted onto the doctoral course. Forming realistic views of the demands of clinical psychology training and of clinical psychology as a career prior to embarking onto its demanding (and costly) studies is naturally of crucial importance to applicants, recruiters and funders alike.

Nonetheless, some inequalities have been noted in the acquisition of relevant experience. In comparison to their White counterparts for example, BME applicants appear less likely to meet the ‘relevant experience’ requirement. Some evidence also suggests that applicants belonging to minority groups may face some additional difficulties securing assistant psychologists (AP) and research assistant (RA) posts, a key barrier, it seems, in terms of training accessibility for such groups. It still appears that those who have followed more traditional routes in terms of ‘relevant experience’ remain more likely to be accepted onto training.

Although there could be various mediating variables involved (including differences related to reference, degree classification, supervision, previous experience of psychologically informed clinical work etc.), there seems to have been no systematic study scrutinising the impact of past professional experience. I have therefore been curious about the potential influence of less visible, softer but possibly more insidious factors related to the above and, been wondering about the possible impact applicants and trainees ‘prior professional experience may bear upon their professional socialisation and in term of recruitment and assessment outcomes.

Professional socialisation and cultural expectations

Becoming a clinical psychologist necessarily entails the assimilation of in-group worldviews and the adoption of certain ways of thinking, speaking and ultimately being. For applicants and trainees who have held traditional roles, this professional socialisation would have been initiated well before their application for training. On the other hand, those who may have acquired their ‘relevant experience’ outside clinical psychology teams may not have or not have to the same degree, been socialised into presenting, communicating and indeed thinking the way clinical psychologists do (or at the very least as they are expected to).

But, is such socialisation necessary for candidates to successfully complete clinical psychology training or in other words, are there essential attributes that are acquired or believed to be acquired, during this socialisation? Could it contribute to perfectly well qualified applicants being assessed as less suitable for training? Is sufficient attention presently paid to differences in presentation which may be related to past professional socialisation and which may be further complicated by candidates’ cultural and social origins? There is currently no empirical basis upon which to base firm answers to the above questions.

However, there is an extensive body of empirical evidence demonstrating that we are more likely to like, to recruit and to support people who we perceive as being ‘similar to us’. As someone from a ‘different’ cultural and social background and with a relatively unusual professional profile, I have experienced first-hand the violence of normative expectations within training. It has been incredibly difficult to draw a line between such cultural norms and the assessment of some competencies. I have secretly harboured the hope of becoming able to distinguish with certainty the essence of clinical competence from the ‘fluff’ of cultural norms and expectations although; I recurrently question the feasibility of such a task.

Cultural Capital

Bourdieu and Passeron’s concept of cultural capital may be helpful to consider the potential difficulties which may come to light in assessing those who are ‘different’. Cultural Capital refers to the collection of symbolic elements such as tastes, posture, dress sense, mannerisms, etiquette etc. that one acquires through being part of a particular social group. Sharing similar forms of cultural capital with others such as the same taste in music or the same worldview is believed to create a collective identity and a group position in relation to others. Critically, differences in cultural capital are believed to be a major source of inequality in that they can help or hinder one’s social mobility.

This is because some forms of cultural capital are valued over others and in particular the possession of the dominant culture as capital often translates into access to wealth and to structures of power. In that sense, it can be said that the more familiar one is with the dominant culture, the more cultural capital one has. The education system is posited to assume that pupils possess the same cultural capital (as those from upper and middle ‘classes’). This is one of the reasons children from lower socio-demographics backgrounds may face particular disadvantages to succeed in the education system.

The relevance of cultural capital

Bourdieu has at times been criticised for the lack of precision of some of his concepts, nonetheless, his emphasis on the non-material/economic resources possessed by socially privileged groups is noteworthy and has generated much theoretical and empirical literature within education and occupational fields. I am not aware that the framework has formed the basis of any empirical studies within professional psychology nonetheless; differences in cultural capital may be important to reflect upon in relation to current inequalities of access to the profession.

The concept invites selectors and assessors to be on the look out for ways in which dominant capital (here White and middleclass) may become normalised at systems level and therefore expected during recruitment and assessment. The framework is not only useful to consider the ways non-traditional applicants may be disadvantaged through not having acquired the expected (professional) cultural capital on their pathway to training, it also encourages us to consider the tacit knowledge which may escape those who diverge from the typical White English middle class clinical psychologist (who also tends to be female, heterosexual, and able bodied).

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

All work published on Race Reflections is the intellectual property of its writers. Please do not reproduce, republish or repost any content from this site without express written permission from Race Reflections.  If you wish to repost this article, please see the contact section for further details.

Want to learn more?

Please see…

Bourdieu, P. & Passeron, J. C.(1990). Reproduction in Education, Society and Culture. London: Sage Publications.

Division of Clinical Psychology (2014). The Alternative Handbook for Postgraduate Training Courses in Clinical Psychology: 2014 Entry. Leicester: British Psychological Society.

Hemmings, R., & Simpson, J. (2008). Investigating the predictive validity of the Lancaster DClinPsy written shortlisting test on subsequent trainee performance: Final Report to the Clearing House. Doctorate in Clinical Psychology: Lancaster University.

Phillips, A., Hatton, C., & Gray, I. (2004). Factors predicting the short-listing and selection of trainee clinical psychologists: A prospective national cohort study. Clinical Psychology and Psychotherapy, 11, 111–125.

Scior, K., Bradley, C. E., Potts, H. W. W., Woolf, K. and Williams, A. C. (2014). What predicts performance during clinical psychology training?. British Journal of Clinical Psychology, 53: 194–212.

On being one of them: Embracing our vulnerability.

The therapist role and its contradictions

It’s a funny thing being a therapist. On the one hand we speak about the importance of challenging stigma and discrimination in the lives of those affected by mental health distress and write at length about inclusion, on the other, many of us fear being open about our own mental health distress, use discourses and/or behave in ways that can perpetuate stigma and the fallacious distinction between service users and mental health professionals. Service users are often constructed as though they were a discrete, separate group of human beings. For example, we invite service users to speak to ‘us’ so that we can learn from ‘them’. We argue with much passion that ‘they’ are vulnerable, voiceless and/or oppressed as opposed to ‘us’ who have power on our side. We firmly hold onto professional boundaries in part because we do not want to confuse ‘them’ about ‘us’, about who we are and about our role.

Those service users who get into the realm of the profession are often referred to as ‘service user researchers’, ‘service user consultants’ or as ‘experts by experience’. Equally, those professionals who have gone public and disclosed their use of mental health services are also set apart from the rest of us in various ways. Many view them with adulation, a few with disdain but, whether we agree with their choice to go public or not is immaterial. The point is, one aspect of their history or experience (their use of mental health services) seems to often become an all-encompassing dimension of their being in the manner that we relate to ‘them’ in the same way that past use of mental health services or experience of mental health distress seem to become the key part of the job tittle, role or identity of those constructed as service users.

In my sense these processes; which of course may well be helpful in some respects, can also be problematic. They arguably allow us to distance ourselves from those we view as service users but most importantly, they may also serve to distance ourselves from ourselves within the safety of a ‘them and us’ separation (for some evidence on the pervasiveness of stigma within mental health professions, click here). Of course there is no ‘them and us’. They are us and we are them. Disclosed or not, it is clear that mental health professionals as a group, have/have had their share of mental health distress. There are no official figures (that I am aware of) about the rates of mental health distress amongst clinical psychologists. However, a number of studies have evidenced the higher than expected rates of diagnosable mental ‘disorders’ within mental health professional groups including; that of trainee clinical psychologists.

Facing our vulnerability

The current prevalence of ‘stress related’ or ‘stress induced’ absenteeism within the NHS also seems consistent with the above. Further, career choices and interests are not coincidental and, personal motivations to work and indeed to be with mental health distress can be quite complex. Rarely are they simply academically or financially driven. Jung theorized that as psychotherapists we may be compelled to ‘treat’ patients because we are wounded so that the helping role also enables us to heal our own wounds. The idea of the ‘wounded healer’ appears to have some empirical support as some evidence suggests that a range of traumatic experiences (including mental health crises) influence ‘helping professionals’ decision to train.

There are of course potential safety gains in maintaining some relational distance from the people we see within services particularly when their stories and experiences are very similar to our own. A strategy often employed by therapists to develop empathy for their clients is to find life experiences of their own that evoke the feelings described by the client‘s material. In the context of shared ‘wounds’ such strategies can give rise to over-identification. Over-identification carries risks for both the therapist and the client including: the occurrence of significant blind spots which may adversely affect clinical decisions; re-traumatisation and/or unhelpful tranferencial processes. From this perspective the ‘them and us’ illusion may well have a protective value and be ethically desirable.

Terror management and splitting?

Nonetheless, things are rarely that simple…Indeed, many a times when we are busy constructing service users, we are not acting in a clinical or therapeutic capacity and the above distancing may not be warranted. I have found Terror Management Theory (TMT) a useful framework to make sense of this distancing. In essence TMT posits that as human beings we are motivated and indeed built to defend against the awareness of our vulnerability. To do so, we create belief systems that allow us to escape, if only momentarily; the inevitability of our ultimate vulnerability: our mortality. Of course TMT focuses on our terror of death and I am not aware that the concept has been used to consider our relationship with madness but, it seems to me that the fear of madness or that of going mad are also exclusively human.

Not only do they appears as deeply rooted as the fear of death, interestingly, they often seem to go hand in hand with it. Isn’t it the case that those who are in the process of mourning commonly question their sanity and fear losing their minds? It follows, from a TMT perspective, that separating ourselves from service users may also have the function of managing anxieties we may harbour in relation to our own mental health. Refusing to accept that no qualitative difference exists between ourselves and the people we serve may therefore also help to defend against the fear of our own vulnerability when it comes to insanity. Such distancing may psychoanalytically be conceptualized as ‘splitting’.

A possible inability to integrate our vulnerable mental health and indeed our potential insanity into a cohesive, realistic whole which include both the identity of the service user and that of the therapist. In this sense, having service users that are different from us makes it possible to disown these potentially unacceptable parts of ourselves and to locate them inside them. Can we fully support others to accept all aspects of their experiences and identity without doing so ourselves? I am not sure but, I know from experience that it is often our vulnerability that allows the people we see to connect and engage with us and; for movement to take place within therapy.

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

All work published on Race Reflections is the intellectual property of its writers. Please do not reproduce, republish or repost any content from this site without express written permission from Race Reflections.  If you wish to repost this article, please see the contact section for further details.

Want to learn more?

Please see…

Barr, A. (2006). An Investigation into the extent to which Psychological Wounds inspire Counsellors and Psychotherapists to become Wounded Healers, the significance of these Wounds on their Career Choice, the causes of these Wounds and the overall significance of Demographic Factors. The Green Rooms. Retrieved 06 November 2014.

Cushway, D. (1992). Stress in clinical psychology trainees. British Journal of Clinical Psychology, 31, 169-179.

Hubble, M. L., Duncan, B. L., & Miller, S. D. (1999). The heart & soul of change: What Works in Therapy. Washington, DC: American Psychological Association.

Jung, C. G.(1951). Fundamental Questions of Psychotherapy in Read, M., F.; Adler,G. and McGuire, M.(1951). The Collected Work of C.G. Jung, Vol. 16. Ed. Princeton: Princeton UP, 116-25.

Kuyken, W., Peters, E., Power, M.J. and Lavender, T. (2003). Trainee Clinical Psychologists’ Adaptation and Professional Functioning: A Longitudinal Study. Clinical Psychology and Psychotherapy, 10: 41 – 54.

Solomon, S., Greenberg, J. & Pyszczynski, T. (1991). A terror management theory of social behavior: The psychological functions of self-esteem and cultural worldviews. Advances in experimental social psychology, 24(93): 159.

For a personal account of the lived experience of training in clinical psychology when in mental health distress, please see: On being a trainee psychologist with mental health problems, an inspiring and saddening blogpost from a fellow trainee.