Clinical Psychology… and the global village

  • Ross G. White, Nargis Islam and Rosco Kasujja

  • July 2019

The year 1961 heralded a number of key events. In January of that year, John Fitzgerald Kennedy became the 35th President of the United States or America. Three months later, Yuri Gagarin became the first man in space. That year also saw the publication of a book by Carl Rogers (the American psychologist and founder of humanistic psychology) entitled ‘On Becoming a Person: A Therapist’s View of Psychotherapy’. This book did much to support the development of person-centred forms of support that continue to influence how various forms of psychotherapy and counselling are delivered today. But 1961 is also notable for a development that has profoundly shaped the design and delivery of psychiatric practice across the globe – it was the year that the World Psychiatric Association (WPA) was formally founded. In the 58 years that have passed, the WPA has grown significantly. Described as ‘psychiatry’s global association’ the WPA now represents 140 psychiatric societies in 120 countries serving more than 250,000 psychiatrists. The remit of the organization includes the development of ethical guidelines and the publication of position statements on a range of issues relevant to the psychiatric profession. The WPA’s journal, World Psychiatry, is the number one ranked journal in the field of psychiatry.

Importantly, the WPA also provides important learning and educational opportunities for psychiatrists. A recent example of this is the endorsement that the WPA provided to the recent (February 2019) publication of an edited volume entitled Global Mental Health and Psychotherapy: Adapting Psychotherapy for Low- and Middle-Income Countries. Global Mental Health, as an area of study, research and practice that aims to promote equitable access to mental health services across the world, is clearly a key interest for the WPA. The focus of this particular volume resonates strongly with an academic paper published in 2014 that was written by two prominent psychiatrists Vikram Patel (Harvard University, USA) and Chris Fairburn (University of Oxford, UK) entitled The Global Dissemination of Psychological Treatments: A Road Map for Research and Practice. Psychiatrists, and the WPA as an international network of psychiatrists, are clearly committed to playing an important role in enhancing the availability of treatments for mental health problems in highly populated, but chronically under-resourced parts of the world.

By virtue of their training and expertise, Clinical Psychologists have made, and will continue to make, a vital contribution to the efforts aimed at addressing inequities in health and social care provision. Clinical Psychologists across the globe assess people, formulate cases and deliver interventions to individuals and groups across the life span. Clinical Psychologists work using various treatment models (e.g. CBT, ACT, IPT, Psychodynamic Psychotherapy), and therefore have expertise in a multiplicity of these models. Many Clinical Psychologists are trained to work systemically to address contextual factors that impact on people’s wellbeing at different levels of influence including personal, interpersonal, organizational and societal levels. Clinical Psychologists conduct impactful research that benefits a wide range of populations. As a result of their rich skillset, Clinical Psychologists act effectively in consultancy and supervisory roles. The ability that Clinical Psychologists have to work in multidisciplinary teams augurs well for members of the profession to collaborate effectively with experts in social science, anthropology and psychiatry – all of whom will have important role to play in understanding and supporting mental health and wellbeing across a diverse range of settings.

Although Clinical Psychology training programmes exist across the globe and there are numerous national associations, there is no World Association of Clinical Psychologists. It is reasonable to assume that like their Psychiatry colleagues, Clinical Psychologists would benefit from the formation of such an international network. In the absence of such a network, fruitful and productive collaborations have manged to flourish between Clinical Psychologists in different parts of the world. For example, Graham Powell and colleagues from the UK collaborated closely with colleagues in Bangladesh to support the establishment of the Bangladesh Clinical Psychology Society, the Umoza Trust (established by Clinical Psychologists who graduated from the University of Lancaster programme) has facilitated placement opportunities for trainee placements in Malawi, and Hamish McLeod (University of Glasgow) and colleagues in Scotland have been working with Cesar Hakim (The Guidance and Training Centre for Child and Family, Bethlehem) to establishing the first applied child psychology training programme in Palestine. A further example is provided by the Butabika-East London Link which has facilitated opportunities for mutual learning for Clinical Psychologists and other mental health professionals working in Uganda and the UK. However, these collaborations have relied on the considerable commitment and endeavour of those involved, and unfortunately without a co-ordinated global initiative, opportunities for shared learning across these ventures been limited at best, non-existent at worst. Furthermore, without such a global network, Clinical Psychologists lack supportive structures and a professional ‘voice’ for practice and research issues that transcend geographic, cultural and linguistic boundaries and exceed the scope and remit of national bodies.

So, what might a World Association of Clinical Psychologists offer? Well, potential benefits could include: the creation of a hub for sharing examples of good practice, promoting standardization in  training and improving global mobility of Clinical Psychologists, enhancing equitable exchanges of knowledge from practitioners in the Global South to those in the Global North and vice versa, the production of international guidelines relating to Clinical Psychologists’ areas of expertise (e.g. the formulation of clinical cases, the delivery and supervision of psychological therapies), and improved public understanding about the profession of Clinical Psychology and an associated reduction in stigma associated with mental health care that this might bring. Furthermore, an International network could facilitate dialogue between Clinical Psychologists about how best to adapt working practices for local cultural and service-delivery contexts. At this time of unprecedented global mobility, professional support and advice for those who work across different countries tends to be very limited. Having an international professional network could address such gaps – thus ensuring a safer and more ethical model of best practice. A global professional network for Clinical Psychologists would also provide much needed representation and support to Clinical Psychologists working in countries where national associations are being blocked, or not being granted formal recognition by governments.

Creating a global network for Clinical Psychologists will also present challenges and potential pitfalls that will require careful consideration and negotiation. There will be a need to reflect on the potential impact that dynamics of power and privilege can have on collaborative initiatives. A failure to recognise and mitigate against power dynamics may hamper equitable exchanges of knowledge between those working in different parts of the world. There have been concerns expressed that international collaborations relating to mental health can be akin to neo-colonial ventures or medical imperialism1,2,3. Engagement in international working therefore requires not only an ethical framework to ensure that activities cause no harm, but also a commitment to authentically recognise the range of indigenous psychologies, expertise and skills that can be evident in different cultural contexts, and be open to the possibilities that exist for models of health and social care to evolve to accommodate these4.

Professional groupings, such as the Association of Clinical Psychology UK (ACP-UK), are well placed to play an active role in building the foundations of something akin to a World Association of Clinical Psychologists. It’s time to recognise the important contribution that Clinical Psychology can play in enhancing the mental health and wellbeing of people across the globe, and to appreciate the key role that an international network can play in giving the profession of Clinical Psychology an active voice in key debates and initiatives. If there is a willingness for this to happen, technology can help to facilitate innovative ways of establishing and maintaining global connectivity. At this time when there is so much to be preoccupied by with regard to domestic concerns, it is vitally important that Clinical Psychologists look outward to the opportunities that international collaboration can bring. By invoking a modicum of the sense of hope and endeavour that imbued key events in 1961, Clinical Psychologists can perhaps make some history of their own.

References

  1. Fernando, S. (2010). Mental health, race and culture (3rd ed.). Basingstoke: Palgr