Prepared by Dr Simon R Stuart, Clinical Psychologist, on behalf of the Association of Clinical Psychologists www.acpuk.org.uk

Section 1

Introduction

1. This written submission to the Digital, Culture, Media and Sport Committee inquiry into reality television is being made by the Association of Clinical Psychologists (ACP-UK).

Section 2

Executive summary

2. The main points and recommendations arising are that:

• The cultural context of reality television shows in the UK in 2019 is highly complex, with multiple potential psychological impacts upon participants, viewers and society.
• Psychological assessments of potential participants for reality TV shows are not necessarily being carried out by appropriately qualified practitioners. The level of assessment and care, including aftercare, that is required may therefore be misjudged.
• In future it is recommended that appropriately regulated psychologists should have a key role in assessing potential participants, and directing care and aftercare.
• Within this subset of regulated psychologists, Clinical Psychologists are ideally placed to carry out such work.
• A psychologically informed code of practice pertaining to reality TV should be produced by the broadcasting regulator.
• A root-and-branch review of reality TV is recommended, in which psychological awareness is key. By this term we mean cognisance of the multiple individual and contextual factors that motivate people to participate in reality TV; a thorough understanding of the experience of taking part and its consequences for each individual; and the provision of appropriate aftercare informed by this.

Section 3

Background and context

3. The DCMS inquiry into reality TV follows the death of a guest after filming for The Jeremy Kyle Show (now cancelled), and the deaths of two former contestants from the programme Love Island. The inquiry requested submissions considering the psychological support provided to participants in reality TV shows; what might be considered best practice; issues of responsibility; possible psychological pressures on reality TV participants; and the wider context of reality TV and mental wellbeing.

4. It is worth noting at this juncture the existence of the Ofcom Broadcasting Code, produced by the UK’s broadcast regulator (Ofcom, 2019). This contains no mention of psychology, one passing mention of mental health, and minimal consideration of risks of harm to potentially vulnerable people. Reality television is not explicitly considered. It is against this context of what we might term ‘psychological unawareness’ that our submission is made.

5. By way of illustration, the authors are aware that, in the case of Love Island, new aftercare guidelines have been proposed (BBC Newsbeat, 2019). While this is to be welcomed, the use in the BBC report of the phrase “psychological consultant” is a source of considerable concern (see Section 4, below). Further, the apparent assumption by programme-makers that a short course of therapy subsequent to participation will have a palliative effect appears naive, especially when no indication is given as to who will provide this therapy. ACP-UK contends that fundamental issues are being over-simplified; that psychological unawareness is endemic; and that root-and-branch reform is necessary.

6. Generally, there are multiple potential psychological risks to taking part in reality TV. These include, though are not limited to, the potential for psychological abuse during or subsequent to participation; traumatisation (including via events that might not be broadcast); difficulties in adjustment, e.g. to subsequent public attention and loss of normality; changes in relationships; and pressure to remain relevant as a media personality.

7. From a broad psychological perspective, Oates (2019) makes many salient points about the potential harms and risks of reality TV, the lack of guidelines and safeguards, and the positive roles that psychologists might play. ACP-UK commends Professor Oates’s important article to the DCMS committee, and draws attention to the existence of the British Psychological Society (BPS) Media Ethics Advisory Group.

8. ACP-UK seeks to augment this broad psychological perspective with the expert understanding of Clinical Psychologists in particular. Clinical Psychologists are scientist-practitioners trained to doctoral level in the field of human development, cognition, emotion and behaviour; and are qualified mental health practitioners with the competencies to undertake appropriate mental state and risk assessments.

Section 4

Regulation and training of psychologists, especially Clinical Psychologists, in the UK

9. Use of the term “psychologist” in the UK is complex and contentious. In the context of the assessment and aftercare of reality TV participants, this was highlighted in April 2019 by Private Eye magazine (issue 1494). There is no formal regulation of titles such as “TV psychologist”, “behavioural psychologist” or even “consultant psychologist”: while the British Psychological Society has issued guidance about the last of these (BPS, 2017), it is unenforceable. Although the BPS can seek to promote best practice, it has no regulatory function.

10. An essential point that we would exhort the inquiry to bear in mind is the difference between basic registration with a professional body (such as the BPS or the British Association for Counselling and Psychotherapy), and more rigorous regulation by a statutory organisation that sets, monitors and maintains standards of practice, such as the Health & Care Professions Council (HCPC). Nine practitioner psychologist titles are regulated by the HCPC and therefore protected in law.

11. Clinical Psychologist is one of these, as are Counselling Psychologist, Educational Psychologist and, potentially confusingly, Registered Psychologist. It is regrettable if this last term gives rise to ambiguity between a Registered Psychologist (bound by the HCPC code of practice) and a psychologist who simply describes themselves as registered with another professional body. Anyone in any doubt can check a psychologist’s status with the HCPC’s online register.

12. While psychologists regulated by the HCPC are beholden to strict standards of proficiency, the governance of non-HCPC-regulated psychologists is less clear. It is possible for someone with minimal qualifications and no professional oversight to offer their services as “a psychologist”, applying any unregulated adjective to suit.

13. Clinical Psychologists, by contrast, are highly qualified. A practising Clinical Psychologist will have completed at least six years of advanced higher education – including three years of postgraduate study at doctoral level – plus considerable other supervised experience. Such is the competition for doctoral training places, Clinical Psychologists will usually have around a decade’s academic and professional education, including supervised clinical practice and research, by the time they qualify. More information about doctoral training can be found in the accreditation standards document (BPS, 2019).

14. Once qualified, in order to maintain HCPC registration, Clinical Psychologists are required to engage in comprehensive Continuing Professional Development (CPD), ensuring skills and knowledge are up to date and that they can practise safely.

15. Clinical Psychologists are therefore robustly trained and regulated professionals, who are required to work within their competencies and professional-practice guidelines. They have expertise in human psychology across the lifespan, including biological, neuropsychological, relational and social aspects, as well as mental health and wellbeing. They are highly skilled in assessment, formulation and appropriate intervention. Many go on to further complex study, and conduct research to advance understanding in the field.

16. None of this is to denigrate other psychologists. It is to clarify that there are multiple factors that must be taken into account when the proficiency of anyone using the term “psychologist” is considered, and to highlight the skills of Clinical Psychologists in particular.

Section 5

A Clinical Psychological perspective on reality television in the UK, incorporating a brief review of literature

17. Reality television can be defined as a genre, increasingly popular since the beginning of the 21st century, in which real people are portrayed living out events for the entertainment of viewers (Nabi et al., 2003). It is a broad category, including studio-based, confrontational programmes such as the now-cancelled Jeremy Kyle Show; competition-based shows such as The X Factor; and more contrived, scenario-based programmes such as Love Island. While there remains academic debate about the appeal of such shows (e.g. Hershman Shitrit & Cohen, 2018), they are nevertheless an established aspect of global programming. A concomitant cultural impact can be assumed, even if its ramifications remain unclear (Skeggs & Wood, 2012).

18. A core factor of reality TV is the expectation that participants will provide a high level of self-disclosure, for instance about their emotions and behaviours, distinct from everyday interaction (Tal-Or & Hershman Shitrit, 2015). Such disclosure may be expected – and encouraged – to be intense, dramatic or controversial.

19. In the UK, reality TV shows have recurrently been criticised in popular media for their potential impact on participants’ mental health (e.g. Cadwalladr, 2008; Wilson & Ollerenshaw, 2018). The recent tragic deaths in the context of The Jeremy Kyle Show and Love Island have intensified such criticism (e.g. Waterson, 2019), a frequent conclusion being that better assessment and aftercare procedures are required (e.g. Reynolds, 2019).

20. Less attention seems to have been paid in popular media to the wider context in which people watch such shows, or to existing academic research about them. In terms of viewing, it has been suggested that habit and escapism play a fundamental part (Papacharissi & Mendelson, 2007). However, there will be individual differences between viewers, and voyeurism, wishful identification and self-importance may play a part (Baruh, 2010; Bond & Drogos, 2014; Reiss & Wiltz, 2004), as might more prosocial factors such as social affiliation (Hall, 2009, Lundy et al., 2008).

21. More perniciously, it has been demonstrated that reality TV programmes contain high levels of verbal and relational aggression – that they “seem to bring out the meanness in all types of people” (Coyne et al., 2010) – and that adolescents who frequently watch socially aggressive reality TV display higher levels of social aggression (Ward & Carlson, 2013). The authors of the latter study suggest that there may be a causal direction: i.e. that consumption of socially aggressive television heightens social aggression.

22. In a study of 147 women, Mazzeo et al. (2007) found that cosmetic-makeover reality programmes may contribute to eating-disordered attitudes and behaviours. It might further be noted that a large-scale study of attachment style in young Americans – broadly, how securely and supportively they relate to other people and by extension to themselves – found that the percentage with secure attachment styles had decreased between 1988 and 2011 (Konrath et al., 2014). The percentage with insecure (especially dismissive) attachment styles had increased over the same timescale; furthermore, positive views of others had decreased. The authors suggest a link with the voyeuristic and competitive nature of reality TV, which became popular during that timeframe, and note – per Young & Pinsky (2006) – complex personality traits that may be factors in terms of who participates in reality TV.

23. Research into reality TV contestants remains minimal, and the majority of our understanding of the impact of participation comes from the popular press. Nevertheless, based on all of the above it might be assumed that potential participants are drawn to apply for reality TV shows for multiple and potentially complex reasons; that wish fulfilment might be a key aspect; and that it is not clear in what depth such psychological factors are considered by programme-makers. It is similarly unclear to what extent producers consider possible impacts on participants (see paragraph 6). All of this requires to be considered in light of potential participants’ previous experiences, personality and coping styles: an assessment that requires considerable skill to conduct.

24. In this light, the comment from one young participant reported by Wilson & Ollerenshaw (2018) – that despite a history of anxiety and depression she had “not been honest” during psychological testing because of her desire to appear on a show – is of particular concern. ACP-UK suggests that a Clinical Psychologist carrying out truly in-depth assessment, including the application of reliable, validated psychometric measures, would have been able to identify these issues and explore them.

25. On certain shows – for example The Jeremy Kyle Show and Love Island – the complex context has been further aggravated by the use of so-called “lie detectors” (Sweney, 2019). Concerns about the validity of lie-detection techniques are not new (Kleinmuntz & Szucko, 1982), and considerable research effort has been expended in attempting to advance the science of understanding deception. The meta-analysis by Hartwig & Bond (2014) makes clear that this is an extremely complicated field in which issues including motivation and context must be carefully considered. ACP-UK suggests that a comprehensively trained and appropriately regulated psychologist has an ethical duty to challenge inappropriate application of such approaches.

26. In summary, the context of contemporary reality television is an enormously complex one in which there is considerable potential for psychological harm to participants, viewers and society. Regulation of such programming is scant, with no clear governance or oversight. Again, there is a psychological unawareness. ACP-UK contends that this situation must change.

Section 6

Roles for psychologists, and Clinical Psychologists, with regards to reality TV in the UK

27. It is unknown to what extent each psychologist currently involved in assessment, aftercare and other processes pertaining to reality TV is considering these complexities, theoretically or practically. What is known – and what we will reiterate – is that unregulated psychological practitioners can be involved in decision-making which may have a profound impact upon individuals, viewers and society.

28. In light of the evidence above, ACP-UK would contend that any assessment of a person’s suitability to participate in a reality television show requires a comprehensive understanding of the impact of that individual’s particular developmental experiences upon their motivation, personality, cognitive capacity, mental wellbeing and coping style. This in turn should inform any and all further decisions, including comprehensive discussion about different options, always with the best interests of the individual at heart. ACP-UK strongly disagrees with blanket assumptions such as “those taking part know exactly what they’re signing up for” (see e.g. Newman, 2019).

29. ACP-UK proposes that only psychologists regulated by an independent statutory body (in this case the HCPC: see paragraph 10) should be carrying out such assessment and/or directing decisions about psychological care for participants. Governance and accountability are absolutely key: only regulation can guarantee these.

30. Further, ACP-UK respectfully suggests that, of the groups of highly expert practitioner psychologists who meet the exacting standards required by HCPC regulation, Clinical Psychologists are best qualified to carry out such work. Clinical Psychologists are doctorally trained and skilled in assessment, formulation and appropriate intervention; in the fundaments of neuropsychology; in the analysis of behaviour in context; in multiple complex aspects of mental health and wellbeing; in multiple therapeutic models; and in risk assessment. Practising Clinical Psychologists hone further specific skills, for example working with complex systems to bring about positive change. As reflective scientist-practitioners they are trained critically to evaluate ever-emerging knowledge bases – and biases – including in the contexts in which they work. This has already been reflected in examples of best practice in reality TV through the work of Professor Tanya Byron, a Clinical Psychologist (and some-time presenter) renowned for her work on the highly regarded shows Little Angels and The House Of Tiny Tearaways.

31. In summary, ACP-UK contends that vital decisions are not necessarily being made by the right people, with the right training, accountability or governance, in the right context. A weak and poorly informed culture of regulation around psychology and reality television is a cause for considerable concern.

Section 7

Recommendations

32. Based on the considerations outlined above, ACP-UK proposes the following:

• That only appropriately regulated psychologists should assess individuals for, and direct psychological care related to, participation in reality television programming in the UK.
• That, of the subset of appropriately regulated psychologists, Clinical Psychologists are best placed to take this role.
• That assessment of participants for reality TV, by at least one regulated psychologist, involves an individual formulation of the person in the context of their developmental history, their cognitive capacity, their personality and their coping style, always with the person’s best interests at heart.
• That appropriate aftercare is provided for reality TV participants, not on a one-size-fits-all model but guided by the needs of the individual in context.
• That a more rigorous and appropriate code of practice pertaining to reality TV must be constructed by the broadcasting regulator. This should incorporate a comprehensive, evidence-based understanding of multiple psychological factors and their impact upon participants, upon viewers and upon wider society.
• That the current DCMS inquiry is the first step towards a root-and-branch review of reality TV programming in the UK, in which psychological awareness is key. Again, this means understanding the multiple complex factors that impact upon people’s motivation to participate; their experience of participation; and their subsequent experiences.

Section 8

Conclusion and final observations

33. This submission by ACP-UK uses the expertise of Clinical Psychologists to consider the nature of assessment and support; best practice; responsibility; psychological pressures; and the wider context of reality TV and mental health and wellbeing. We have further made recommendations for what we would like to see happen as a result of the DCMS inquiry.

34. One area not addressed here is the current direction of broadcasting, which is moving away from traditional models towards a larger number of smaller-scale producers – including, at a micro level, individuals broadcasting on services such as YouTube. The potential psychological harms here are vast; regulation is even more vexed. That this is not considered here is a matter of context and space: it is not to say that it does not matter. It does, and – again – a psychologically informed and aware perspective remains vital.

35. Finally, we would like to acknowledge the risk that a psychologically informed perspective becomes skewed by inattention to other perspectives. Clinical Psychology in the UK is predominantly a white, middle-class profession. As reflective practitioners, we might try to be aware of this and respond accordingly. Brown (2019) observes that, exploitative and theatrical though The Jeremy Kyle show was, it was also “a corner of television to hear people’s real problems in their own words”.

36. This must not be lost: already-dismissed voices must not be silenced in the desire to improve. Clinical Psychology is increasingly entwined with the emerging science of compassion. Per Gilbert (2019), we might all ask ourselves how we can reciprocally stimulate this in every domain of life, including how we consume and construct reality TV.