ABSTRACT
Clinical psychology is a popular career route for psychology graduates, who gain their professional qualification by following a 3-year postgraduate course which covers clinical, academic and research skills. The majority work in Adult Mental Health, in a variety of settings such as wards, clinics and community teams. Clinical psychologists are perhaps most strongly associated with individual therapy, especially cognitive behavioural therapy (CBT). However, they also work with families and groups, offer supervision to individuals, teams and, organisations, carry out research and evaluation into services, and, increasingly, take on consultancy and leadership roles now that other professions may be able to offer psychological therapy more cheaply. Here I explore clinical psychology’s dilemma about how to position itself in relation to psy-
chiatry. Of course, whether or not this is seen as an ethical issue depends on one’s views about the nature and purpose of psychiatry (see also Chapters 2 and 3). Biomedical models of mental distress are not necessarily problematic if psychiatry is seen as sound in its basic principles, working steadily towards more effective ‘treatments’ for those who are unfortunately stricken by ‘mental illness’. If this is accepted, disputes will mainly arise about the most effective or efficient ways of achieving this worthy aim. In the words of one psychologist, ‘There have never been any anti-oncologists, anti-cardiologists, (or) anti-gastroenterologists’ (p xiv).1 In psychiatry this is not the case; fundamental disagreements about the validity, nature and purpose of traditional psychiatry date back to its origins in the early nineteenth century and have continued ever since, surfacing most powerfully in the so-called ‘anti-psychiatry’ movement of the1960s and in today’s service user/survivor movement. The issues have also been extensively debated within the profession of clinical psychology. Clinical psychologists who accept these critiques are faced with unavoidable ethical dilem-
mas about their role and work. The key question becomes not ‘How can we best use our scientific expertise to help the sick?’ but ‘How ought we to help the most disadvantaged members of our society when they are emotionally distressed?’ This quickly leads to other questions:
• How do we understand the reasons for people’s distress? • What role ought we to play in alleviating these causes? • What are our professional and moral obligations as members of a society in which this
kind of suffering occurs?
