1. Introduction to the Curriculum
The curriculum is informed by the Standards of Proficiency for Clinical Psychologists set out by the Health & Care Professions Council, and the BPS accreditation criteria for training in Clinical Psychology. Its design is intended to ensure that by the end of training trainees attain the following overarching competencies:
- The skills, knowledge and values to develop working alliances with clients in order to carry out psychological assessment, develop a formulation based on psychological theories, carry out psychological interventions, evaluate their work, and provide reports;
- The skills, knowledge and values to work effectively with systems having an impact on clients;
- The skills, knowledge and values to conduct research that enables the profession to develop its knowledge base and to monitor and improve the effectiveness of its work;
- The ability to understand and evaluate the evidence base relevant to clinical psychology practice;
- The knowledge and professional skills to effectively represent a psychological perspective in their dealings with service users, carers and members of other professions;
- An understanding of fundamental ethical principles and standards and how to ensure these are adhered to in all areas of their work;
- The ability to think about their work in a reflective manner;
- An ability to work in partnership with service users and carers and a recognition of the value of consulting these groups on the design and delivery of services.
In developing these competencies, integration of theory and practice, critical evaluation of psychological evidence and a fostering of the capacity for reflective practice are central to the academic programme and its integration with clinical practice.
2. Guiding Principles
The curriculum is built on the course’s guiding principles and course modules are designed to reflect these:
- To train ‘thinking psychologists’
- Practice that is closely informed by the evidence base
- The close integration of theory and practice
- Emphasis on appraisal skills and critical reflection
These principles reflect the role of the clinical psychologist in the NHS, the required competencies set out in the BPS accreditation criteria and the HPC’s standards. These principles support current government emphasis on evidence-based practice and further represent principles of good teaching practice more generally. The main objectives are applied through a number of learning objectives which include: teaching critical ways of thinking, developing an investigative attitude to clients’ difficulties and psychology in general, and a critical-exploratory approach to assessment and research that pays close attention to the evidence, while being mindful of the limitations thereof.
3. Theoretical Frameworks
A number of overarching frameworks underpin the curriculum and are drawn on to integrate knowledge across different areas. These are:
- A biopsychosocial model
- Developmental Psychopathology
These theoretical frameworks are deemed suitable for clinical psychology training as they can help us understand the complexities of human development. By paying attention to biological, psychological, environmental and social factors, teaching aims to chart the diverse pathways that may contribute to the development of psychological difficulties, or conversely optimal functioning. In going beyond these models, evidence on the role of broader social and cultural factors is emphasised to ensure that trainees understand the role social disadvantage and discrimination may play in the development of psychological difficulties. Furthermore this emphasis aims to encourage trainees to carefully evaluate the relevance and fit of the theories they draw on in the context of a multi-cultural society.
4. Structure of the Programme
In order to facilitate trainees’ broader understanding of the material covered in the teaching programme, the following structural initiatives have been incorporated into the teaching programme:
- Where appropriate, a clear distinction, in terms of teaching delivery, between theory and practice, to maintain coherence and to make the process by which theory and practice are connected more explicit. This is considered a key objective in order to support the development of trainees’ critical thinking skills. In practice, this means explicitly theory-oriented and practice-oriented sessions supplemented by time in the curriculum dedicated to the links between them.
- The structural organization of the teaching programme reflects a coherent developmental process that is designed to facilitate trainees’ thinking and learning.
- An academic framework for teaching that reflects the underlining conceptual framework of academic and professional clinical psychology, rather than one based primarily on specialty, and combines generic and specific teaching.
- A wide range of approaches to teaching and learning, including didactic lectures, small group work, experiential sessions, a range of seminars, masterclasses, conferences and self-directed learning. This combination of approaches is designed to address different learner needs and provide trainees with opportunities to reflect on key theoretical issues in clinical psychology and their application in clinical practice and research.
The coherence of the teaching programme is a key principle and target. Its aim is to ensure that trainees develop their skills in line with their progression through placements and increasing skills and experience. Some first year topics are returned to in the third year to allow for further development and refinement of skills and theoretical understanding with increased experience. The curriculum aims to reflect current practice of clinical psychologists in the NHS and is reviewed every year to ensure it remains relevant to current practice. The content of the academic programme reflects a balance between the need to develop generic skills to allow trainees to work across the lifespan in a wide variety of settings, and the need to ensure that areas of specialist expertise are introduced and developed. Most importantly, the academic programme is organized in a way that reflects the conceptual structure of academic clinical psychology and takes a lifespan perspective.
5. Situating the Curriculum within the Wider Context
In linking the content of the academic programme to wider systems within which clinical psychology practices, emphasis is placed on:
- Relevance of what is taught to an NHS context
- Attention to the evidence base
- Attention to the social and cultural context
- The diversity of client experience and needs
- Legal and ethical principles
The curriculum is designed to prepare trainees to work as clinical psychologists within the NHS. The curriculum includes teaching on the various levels of demands placed upon practitioners within the NHS which include: the needs and diversity of the local population, the demands and limitations imposed by the organization in which the individual is placed, and DOH and governmental objectives and targets. Trainees are taught how to access and utilize the evidence base available, how to contribute to an increasing evidence base, and how to apply the evidence base to their actual practice. The interaction between evidence based practice and practice based models of working is emphasized. The legal and ethical considerations in both clinical practice and research are highlighted.
6. Outputs of teaching
The course aims to train clinical psychologists who are:
- Aware of the unique role of clinical psychology, while respectful of the contribution of other disciplines
- Free standing, clear thinking, and independent
- Capable of making decisions
- Thoughtful and sensitive to diverse client needs
- Willing to carry on learning
- Able to function in a wide range of contexts
The curriculum has been designed to ensure that at the end of three years trainees will be well prepared to work with a range of populations and across a diversity of settings. Through an emphasis on developing skills in comprehensive assessment and evaluation, trainees’ capacity to make reasoned and appropriate clinical decisions is gradually harnassed. Through the emphasis on contexts, systems, and multiple levels of influence on practice, trainees will have developed the skills necessary to assist in the development of teams, services, and organizations. The importance of continuing professional development will be emphasized, both with respect to the individual’s personal plans and in relation to assisting others in further developing psychological skills. Thus, through the emphasis in the curriculum on the critical evaluation of theory, evidence and practice, and understanding systems, trainees will be equipped to enter a wide range of areas of work and to use their core transferable skills in combination with a life-long learning philosophy to adapt to professional contexts to which they may have had only limited direct exposure during training.
7. The Modular Structure of the Curriculum
The curriculum is delivered in modules (hereafter referred to as ‘units’) that incorporate the course’s guiding principles and expected outcomes of training as outlined above.
InductionCentral Themes in Clinical Psychology
Assessment and Formulation
Processes, Problems and Disorders
Health and Disability
Conferences & Masterclasses
The central aims and key learning objectives of each unit are outlined below. Details of each unit’s contents are contained within the unit booklets (see course website). One of the challenges in developing this curriculum has been the need to identify generic skills across age groups, specialist populations, specific settings and cultural/lifestyle diversity. The programme incorporates an awareness of the need to tailor teaching to these differences where the teaching of generic models, skills, or treatments is not sufficient. However, given the limitations of teaching time, there will inevitably be some areas which are not covered. It is hoped that through achieving the essential qualities specified in ‘outputs of teaching’ trainees will be able to gain the necessary knowledge and skills as necessary during their career.
The aim of the induction (which lasts for 4 weeks) is to ensure that all trainees have the knowledge and skills required to begin working in their clinical placements. The induction starts with an initial 3-day block which focuses on introducing new trainees to the course, each other and staff, and on orienting them to their new roles as trainees. The next 4 week's teaching draws from several units of the curriculum, and focuses on:
Professional issues – the structure of the NHS, the organisation of clinical psychology in the UK, awareness of professional and ethical codes and of local NHS governance structures and procedures, self-management and personal welfare.
Central themes – an introduction to some of the core concepts underpinning the curriculum, and in particular to developmental psychopathology.
Assessment and formulation – intensive workshops focused on the process and content of interviewing, which include extensive opportunities for supervised and structured roleplay in order to facilitate skills development. Interventions – introductions to the major evidence based therapeutic approaches employed by clinical psychologists, and the start of the teaching on behavioural and cognitive therapies and psychodynamic therapies.
The induction ends with a day dedicated to ‘placement preparation’.
7.2 Central Themes in Clinical Psychology
The aim of this unit is to provide some fundamental conceptual background to training as a clinical psychologist, which is relevant to all specialties, populations and stages of the lifespan. This unit provides introductory teaching on the major theoretical frameworks in current use by clinical psychologists working in the field and central conceptual issues related to the development and causation of psychological difficulties and distress. Each of these issues is covered relatively briefly highlighting critical epistemological assumptions, broad explanatory frameworks, the evidence base of key tenets of the major perspectives and the investigative and clinical methods that are associated with these points of view. These critical lectures are designed to provide a framework for trainees’ thinking about clinical psychology science and practice throughout the course.
7.3 Assessment and Formulation
The aim of this module is to understand the role of clinical formulations in treatment planning and enable trainees to perform a wide range of psychological assessments. The module is concerned with ensuring that trainees can psychologically assess and formulate across a wide range of clinical settings and client groups. At the end of the module trainees will have knowledge pertaining to the assumptions, uses and limitations of different assessment methods and how these relate to the development and evaluation of clinical formulations. They will also have ample opportunity to practice these skills. A key aim of this unit is to integrate teaching of theory and skills required to competently undertake psychological assessment and develop formulations.
The interventions module is delivered according to the four leading models guiding clinical psychology practice in the NHS. For each model the theoretical rationale is introduced, the basic skills and techniques described, and the evidence base for efficacy and effectiveness examined. Their application for different problems, populations and stages of the lifespan is considered.
7.4.1 Behaviour Therapy
The aim of this module is to develop a behavioural understanding of psychological problems so that behavioural methods and procedures can be applied skilfully to a wide range of clients. The module provides the knowledge and skills for developing behavioural conceptualizations to psychological distress found across the life span and across diverse areas of psychological services.
7.4.2 Cognitive Behaviour Therapy
The aim of this module is to familiarise trainees with the fundamental philosophy of cognitive therapy and enable them to draw on a cognitive model to understand individuals’ distress and its aetiology. From this base, the module teaches trainees the skills to develop and deliver evidence based cognitive behavioural interventions. The unit also outlines major psychological disorders and difficulties, where the current evidence suggests that these are best understood from a cognitive behavioural perspective (such as anxiety, obsessive compulsive disorder and post traumatic stress disorder). The module makes ample use of role plays, videos and discussion of clinical material to achieve its aims.
7.4.3 Psychoanalytic Psychotherapy
This unit aims to provide an introduction to psychoanalytic ways of thinking about emotional problems and work with individuals presenting with mental health problems. It is not aimed at teaching psychotherapy, but rather at introducing the core concepts that underlie psychoanalytic theory from which to extend clinical practice with adults, children and families. The Unit introduces core concepts from Freud’s writing and goes on to examine in more detail ideas about psychic development and functioning. It examines more closely psychoanalytic models of assessment, transference and counter-transference, the language of action as opposed to thinking, and the importance of endings. These areas are richly illustrated with clinical material.
7.4.4 Systemic Therapy
This unit aims to provide trainees with an understanding of the main concepts and practices in systems theory and therapy. Theoretical developments and clinical applications of systems theory over the past 30 years are tracked. Systemic approaches, methods and techniques pertaining to several ‘schools’ of systemic therapy are covered. Trainees learn basic systemic skills and techniques via reading, video material and role plays. The focus is on a variety of contexts for individual work, family work and systemic consultation.
7.5 Processes, Problems and Disorders
The aim of this unit is to outline the major psychological disorders and difficulties, critically examine theories relating to their aetiology and outline the conceptualisation of mechanisms of development, maintenance and change. The unit covers major problems areas (depression, psychosis, personality disorders, eating disorders, neuropsychological impairment) and examines key sources of influence from a developmental psychopathology perspective: biological factors (genetics, psychophysiology, neuropsychology), personal factors (cognitive processes, emotion-regulation, defences and coping mechanisms, personality), interpersonal processes (attachment, social support, marital harmony, relational violence) and contextual factors (social disadvantage, cultural influences, prejudice). The unit also aims to encourage a critical stance when considering causal models of psychological problems and appreciation of the empirical status of such models and their clinical applications. Moreover, the kinds of psychosocial environments that promote both maladaptive and adaptive behaviour will be stressed, insuring that social-cultural and community factors are integrated into the larger picture.
7.6 Lifespan Development
The aim of this module is to provide the conceptual basis for considering the development of adaptive and maladaptive behaviour across the lifespan. First, key principles and theoretical frameworks are presented, providing trainees with robust models for understanding mental health adjustment from childhood through to older age. These frameworks include developmental psychopathology and attachment theory, as well key cognitive, interpersonal and social processes that shape development throughout life. Following on from earlier teaching on specific mental health problems, the module concentrates on specific disorders and clinical problems that appear during childhood and adolescence, as well as those specific to older age. Finally, teaching in this module will address key stage-salient tasks (e.g., developing intimate relationships) and life-span transitions (e.g., transition to parenthood) that can influence mental health adjustment across developmental periods. In doing so, the unit will encourage the trainee to look at mental health adjustment as a process that occurs over time, involving an interaction of individual differences, developmental factors and socio-cultural contexts.
7.7 Health and Disability
This module considers psychological models of disability and ill-health in two separate yet linked units:
7.7.1 Learning Disability
The unit is designed to provide an introduction to the diverse roles of clinical psychologists in learning disabilities services and to familiarise trainees with current ‘good practice’ in this area. The unit introduces trainees to the diverse nature of ‘learning disability’ and the very diverse needs of individuals with learning disabilities. Service values and philosophies and how these translate into service delivery are considered. Teaching then provides trainees with an understanding of different psychological approaches to assessment and intervention with this client group in addressing a range of ‘typical’ difficulties presented by individuals with learning disabilities.
7.7.2 Health Psychology
This unit is designed to introduce trainees to health psychology, including its theoretical models, evidence base and applications. The unit aims to educate trainees about psychological processes in the experience of, and response to, health and illness. It provides an overview of the main theories, concepts and issues in health psychology and from there develops trainees’ knowledge about how to work with individuals, groups and systems in addressing health related problems. The role of health psychology in preventing ill health and disability, promoting and maintaining health and working with health care systems in reducing illness, disability and its consequences is elucidated. It has a strong academic base and seeks to ensure its applications are evidence and theory based.
7.8 Active Learning
The module aims to equip trainees with the fundamental knowledge and skills required as competent clinical psychologists in the NHS. It does so by engaging trainees in a range of activities where they have a very active role in their own learning. The unit is designed to achieve these aims through the following modalities:
7.8.1 Academic Seminars
These consist of small group discussions of theory and research driven published work, facilitated by an academic member of staff. Their aim is to develop trainees’ ability to critically examine the evidence by paying close attention to the results of published research and examine the validity and reliability of conclusions drawn. Prior to each seminar trainees are required to read two key articles or chapters that reflect an important area for debate within academic clinical psychology, with a particular emphasis on the interface between theory and practice. These sessions provide a unique environment for trainees to lead discussions and engage in academic debate in a discursive manner, with the guidance of members of the academic team. Trainees are encouraged to sharpen their critical and debating skills and to participate in peer-led discussion of central issues in clinical psychology.
7.8.2 Clinical Seminars
Clinical seminars offer a regular forum for trainees to present, discuss and reflect on the clinical work they are undertaking on placement. The aim is to encourage discussion of this material from a clinical and a professional perspective. The remit is broad, and topic areas include: the development of theory-practice links (identifying the ways in which psychological models and theories can help to understand the clinical material); the generation of hypotheses about the presentation and of potential formulations which could help to guide plans for intervention; consideration of the social contexts and systems in which the client’s presentation, referral and difficulties are located; consideration of the broader professional contexts within which casework takes place, and the impact of this on the presentation and the ways in which the intervention has progressed; consideration of the acceptability of the intervention for service users and whether the service context itself might influence the ways in which clients present and respond to treatment; consideration of any professional and ethical issues raised by the casework, cross-referring to the HPC and BPS codes of conduct and ethical practice. While not all these topics will be considered in every seminar, the seminar group should hold them in mind and ensure that where pertinent to the case they are discussed in appropriate depth.
The overarching aim of clinical seminars is to support trainees in their capacity to think deeply about clinical work. However, the intent is to complement but not to substitute for or conflict with, the supervision offered to the trainee on their placement. The seminars also give trainees an opportunity to practise formal clinical presentations and to develop their capacity to communicate complex clinical material in a clear and concise manner.
7.8.3 Cross-Speciality Workshops
These have been designed to bring together clinicians across areas of specialty to address issues relevant to several fields of clinical psychology. The purpose is to help integrate thinking about important theoretical issues and their translation into clinical work as they apply across different client groups (such as consent & capacity, bereavement, abuse of vulnerable adults).
7.8.4 Reflective Practice Seminars
These aim to emphasise the importance of reflective practice as an integral
part of the curriculum and the role of a clinical psychologist. In small groups trainees reflect on a specific issue in relation to clinical scenarios from their
placement (such as establishing & maintaining boundaries, trainees’ & client’s relationship to help). The seminars are part of a much broader approach to supporting trainees’ personal and professional development through all aspects of training and are informed by Johns’ (2004) model of reflective practice which identifies different layers of reflection from ‘doing reflection’ to ‘reflection as a way of being’. The seminars are initially facilitated by course staff and as trainees progress through their training are increasingly trainee-led.
7.8.5 CBT Supervision Groups
Learning to apply techniques in practice is often challenging, and in order to consolidate theory-practice links, and to enhance practical skills learned on placement, trainees attend specialist CBT supervision groups during the first and second years of training. These groups arise from a recognition that trainees’ exposure to expert CBT on placement can be variable and to ensure that all trainees are competent in CBT by the end of their training.
Trainees bring clinical material that is discussed in their small groups under the supervision of clinical psychologist expert in CBT. The overarching aim is to support trainees in developing their understanding of CBT theory and their capacity to apply this in clinical practice. The intent is to complement but not to substitute for or conflict with, the supervision offered to the trainee on their placement.
7.8.6 Psychodynamic and Systemic Seminars
In their second year trainees have a choice of attending either psychodynamic or systemic seminars. Their overarching aim is to support trainees in developing their understanding of fundamental concepts in psychodynamic/ systemic therapy and their capacity to translate these into clinical work. Trainees read key papers or chapters in preparation for each seminar. Seminars are facilitated by experts in the respective approach, all of whom are also active clinicians in the NHS. Discussion aims to develop trainees’ understanding of the key concepts and ideas addressed in the reading and how these can be translated into clinical work. Systemic seminars also take a “learning through doing” approach and use systemic techniques to critically appraise the reading material and trainees’ responses to this.
7.8.7 Transitional Workshops
These workshops consider major transition points within training (such as the shift from novice to more experienced trainee, and from trainee to life post-qualification). The first of these workshops aims to increase trainees’ awareness of expectations of themselves and supervisors, and to allow them to feel more confident in asserting themselves within supervision. It explores elements of good supervision and what to do when supervision is not good enough. The second workshop considers the personal and professional challenges involved in qualifying, how life as a qualified psychologists differs from that of a trainee, and the skills needed to operate as an effective and reflective practitioner when the structure of a training course is no longer present.
7.9 Professional Issues
This unit aims to develop trainees’ understanding of the organisational context of clinical psychology practice in the UK, to foster personal awareness of the ethical and legal basis of professional practice and to educate trainees about national service priorities influencing clinical practice. There are two broad strands to the professional issues unit. The first focuses on the various professional and ethical issues which a psychologist needs to know and to understand, and aims to foster understanding of the professional and organisational context within which clinical psychologists practice in the UK, with particular reference to the NHS and community care system. The second strand reflects the fact that, in practice, working as a professional involves the development of personal skills, without which effective ethical and reflective practice is hard to achieve. Over all three years of the course there is teaching related to the ethical and legal bases of professional practice, the BPS and the HPC’s standards of conduct, performance and ethics and the organisational context of psychology practice in the UK, and (in a separate sub-unit) difference and diversity. The initial induction block in the first year contains an introduction to these themes, which are developed over the course of the three years (not only within the professional issues teaching, but in other units, where thinking about professional and/or ethical issues is pertinent to the topic). Further sessions focus more directly on helping trainees to develop as reflective practitioners, able to think and reflect on their development as professionals.
7.9.1 Difference and Diversity
This unit is part of the broader professional issues unit. Its key aims are to attune trainees to the influence of cultural and social diversity on psychological health and difficulties. The unit also aims to equip them with the knowledge and skills to function as clinicians who are sensitive to disadvantage and discrimination, mindful of the potential impact of social stressors on the success of psychological interventions and flexible and critical in the application of psychological approaches to very diverse clients and communities. The unit also considers equity of access to NHS and clinical psychology services and the role clinical psychologists can play to maximise the accessibility and suitability of services.
The aim of this module is to equip trainees with the knowledge, skills and confidence to carry out research, evaluation, and audit studies. Teaching is delivered across three sub-units:
7.10.1 Research Methods
The research methods sub-unit aims to help trainees become both better producers and consumers of clinical psychology research, in becoming competent scientists as well as practitioners. It teaches the fundamental concepts, methods and skills that trainees need to carry out their own research and for understanding and evaluating other people’s research. In addition to teaching the tools of the trade, the sub-unit aims to instil an enthusiasm for research in trainees and convince them undertaking research can be stimulating, challenging and enjoyable. The teaching is structured around a practical description of the research process, following the steps involved in executing a project: groundwork, measurement, design, analysis, interpretation and dissemination. In addition to the technical aspects of research, attention is given to the socio-political context, taking into account that clinical research is often conducted in working service settings. Although the focus is mostly practical, the philosophical issues raised by different methodological approaches are addressed in taking a “methodological pluralist” stance. Both quantitative and qualitative approaches to clinical research are examined.
7.10.2 Project Support
The project support subunit aims to guide trainees through the various stages involved in carrying out the major research project, from the choice of topic at the start, through to submitting the finished thesis at the end (and hopefully going on to disseminate the findings). This sub-unit provides the back-up required to get trainees successfully through this substantial undertaking, and hope that the experience of carrying out the major research project will both enthuse them for the subject matter and equip them to carry out further research in their future careers.
The statistics sub-unit aims to give trainees the conceptual and practical skills needed to carry out the major research project and to design, interpret and evaluate clinical research. It aims to provide essential statistical training that will be an important part of the skills required of a scientist- practitioner. The sub-unit aims to give trainees a sound understanding of fundamental statistical concepts, the main principles underpinning the most common statistical methods, how to implement these using SPSS and how to interpret and report them appropriately. Teaching is closely tied to the implementation and evaluation of research in clinical settings. It emphasises the importance of theory, methodology and clinical expertise in the appropriate use of statistics in clinical research and is organised around a set of common practical research issues.
7.11 Elective Teaching
Elective teaching is designed to reflects the course’s expectation that trainees should take an active role in their own learning, develop increasing levels of autonomy and towards the end of their training should possess the knowledge and skills to plan and organise their own continuing learning needs. This teaching takes place towards the end of the third year and the topics are chosen by the trainee group in consultation with the academic director and course management. The topics covered will usually reflect knowledge and skills relevant to specialist client populations or settings or offer advanced teaching on topics covered at an earlier point in the academic programme. Trainees then approach speakers and organise the timetable.
7.12 Masterclasses & Conferences
Because of limitations on teaching space, year groups attend college on different days. However, on the last day of each term trainees across all year groups come together for a formal case presentation and a DClinPsy conference. Masterclasses take as their starting point an in-depth presentation of a clinical ‘case’ provided by a final year trainee. Experts representing a range of theoretical models or professional disciplines then discuss the case in terms of their formulation and possible interventions. Where masterclasses are delivered to trainees within the broader research department, in particular educational psychology trainees, they aim to enhance inter-professional learning and ensure that members of both professions are alert to the skills and knowledge unique to each professional group.
Conferences are attended by all trainees and are also open to regional supervisors. They aim to showcase up-to-the minute topics, evidence and its translation into clinical work and go beyond what is taught as part of the academic programme.
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