Bridging which gap? Reflections on Clinical Psychology Forum 261

This month’s CP forum special (PDF version at this link) has been quite evocative for me. It looks at the ongoing discussions about differences between clinical psychology and psychiatry.  I shall outline my thoughts about the special issue below.

The gap is left relatively undefined, and different authors approach it in different ways.  Simon Mudie talks about getting “boxed in”, and ways to avoid this. Lauren Evans uses tectonic metaphors to explore the rift that might exist between clinical psychology and psychiatry. Tanya Byron highlights differences in relation to the professions’ apparent willingness to air their concerns about issues that might impact services, especially in the media. In fact, her article motivated me to set this blog up! Other writers wrote about ideological differences, which can lead to conflict, and Dr Philip Thomas suggests it is crucial that psychiatry engages constructively with its critics.

There is a sense throughout that the gap is mainly a negative phenomenon, but in a field where our clients’ concerns are so complex and resistant to simple definition, perhaps there is real value in the gap: it is a reflection of the uncertainty that faces all clients and clinicians, and one hopes that we can work together to maintain a safe uncertainty. It is natural to want to close the gap, to resolve our differences, but the gap can be a space for discussion, as the Forum demonstrates. Sami Timimi poignantly describes how change is not merely an option: lack of change might perpetuate ongoing harm to the people we intend to help. Perhaps representatives of different groups are averse to the conflict they imagine might arise if differences in beliefs are raised and discussed. Almost all the articles end with an exhortation to “come together”, “open a dialogue across professions and with service users”, “respectful discussions must be had about …. differences and how they can be resolved”, “find more effective ways of talking together” and so on.

The concept of the gap brought to mind Sharif’s seminal Robbers Cave Study, in which boys were arbitrarily split into two groups, and conflict ensued, especially when competition was intensified. Perhaps clinical psychologists and psychiatrists sense interprofessional competition, and this magnifies the perceived gap. Perhaps the known disparities in pay and sometimes relative hierarchical positions also play a role. Since the last stage of the Sharif study aimed to defuse the inter-group conflict, perhaps we need to think about ways we can do this, to allow more harmonious work and discussions of differences. Gordon Milson‘s piece highlights the similarities between the professions, some of which was novel information for me: perhaps this information could help. The study used a limited supply of water to unite the groups: perhaps the current climate of limited funding could be a useful spur to encourage our groups to collaborate.

Ways to improve the situation are discussed in the Forum, and it seems that the contributors are largely in agreement that meeting more to discuss things would be helpful. This includes professionals and their clients: as time passes, more collaborative ways of working are becoming standard practice, and this seems to be especially helpful for the people we work for: our clients. Perhaps adopting an approach that frames all of us as being together, united in our efforts to help, would cut the chance of people splitting along lines determined by professional, diagnostic, or other labels, and lead to better outcomes, and more pleasant clinical environments. Ways to make this happen might be more meetings of different groups: both professionals and their clients. Less formal, more social events might encourage people to take part more, and break down the sometimes entrenched hierarchical power-projecting structures people find themselves in.  Interaction through Twitter is easy, and more democratic. It might feel like a less safe and certain space, but then perhaps that is a positive, as freer discussions might ensue.

In conclusion, I really enjoyed this issue: it explored the concept of the gap from a range of perspectives, and offered a range of possible ways forwards. Perhaps in future, this could become a regular feature of the Forum, either as a monthly column, or via more special issues. Most poignantly, it left me with a feeling of greater hope for the future, which I hope was the prevailing sense it left more widely.