Although there are many methods of providing mental health services, England is primarily based on an individualized western approach. As they do not consider psycho-social and psychological factors in emotional distress, psychiatric diagnosis is often criticized. This essay will answer the question whether Community Psychology principles can be applied to Psychiatry-led Psychiatry services. It will also address the challenges that Clinical Psychologist (CPs) may face in doing so. My essay will focus on the question of whether the traditional therapy model that provides 1:1 intervention is better for working with individuals who are often underrepresented in talking therapies and may have difficulty accessing services. It will address three major areas: working with clients, systemically, and developing the CP profession.
Psychotherapy and psychology are primarily concerned with improving wellbeing. Research has shown that both external and internal factors play a role in mental health issues. Stephen Joseph (2007), a psychologist, has criticized the current practice of psychotherapy and psychology as being too focused on biological and psychological factors. He argued that it has unwittingly become a tool for social control. Stephen Joseph believes that psychologists perpetuate social injustices by exacerbating the biological and psychological aspects and neglecting the social-environmental. Martin Baro (1994), Liberation Psychologists, called on psychology to examine itself in order to be able support people’s wellbeing. Gillian Proctor, a psychologist and clinical psychiatrist, criticised the current approach. Harper (2016) commented further about Harper’s individualistic perspective, arguing that CPs have remained largely individualistic and prevented them from maximizing their abilities. The individualist approach has made it difficult for CPs to offer individual therapy. This is only for those who have experienced distress (Norcross & Karpiak (2012)). Mainstream individual therapy tends not to address the causes of distress in the environment but rather within the person. This allows therapists to conduct interventions, and individuals are more likely to view themselves as problematic than recognize the contributing factors that arise from their problematic environment (Smail 2005). Further, it has been suggested that psychology, due to its individualistic approach, has failed to recognize the importance of social context in distress experience (Humphreys 1996, p. 193). Martin-Baro suggested that the problem in psychology lies in the fact that socially-produced psychological problems can be solved by attempting to alter individual behavior. The social order must also be maintained, which would strengthen the discussion of what causes and where the problems lie. Martin-Baro adopted the term “conscientization”, which he used to describe the process of individuals developing a greater capacity for reflection, interpretation, and action in order to promote positive change.
Community Psychology seems to be an alternative to the Clinical Psychology Profession. Jim Orford (2008) stated that community psychology’s central idea is to understand people’s functioning and their health by understanding the social contexts in which they live. Because it emphasizes intervention and analysis beyond the individual and their immediate interpersonal contexts, it is called “community psychology”. The ecology of human development was the foundation of community psychology (e.g. Bronfenbrenner (1979), but he later used a variety of theories and models, including one that relates to empowerment (e.g. Rappaport (87), and liberation psychological (e.g. Montero, 1998). It uses a multi-layered perspective (Nelson & Prilleltensky 2010), and analyzes micro-systems such as. A family, social network, and mesosystems. There are links between macro-systems and micro-systems like relationships between home, school, and home. Social norms, economic policies, and other systems. This multi-level approach allows for the identification of different influences that might be exerted at different times on individuals. The community psychology approach is similar to that of public health. It promotes healthy lifestyles, environments, and was inspired by dissatisfaction about clinical psychologists’ tendency to find mental health problems within people.
Community psychologists adhere by the following principles: Considering the social context of people and avoiding blaming them. They also consider the wider ecological systems with which they interact, including the political, cultural and economic influences. Community psychology recognizes the importance of power, empowerment, as well as disempowerment, because individuals with less power can have a greater impact on their health (Jim Orford, 2008). This power refers to how society controls and arranges resources, such as wealth, gender, and membership. Community psychology attempts to increase awareness of the various levels of power and how these are used. It is also possible to work with people who are marginalized or disempowered through community psychology. This is often done by going beyond the power dynamics and seeking out ways to resist oppression and inequity. Community psychology works in this way by encouraging respect for differences and working towards equal power distribution (Jim Orford, 2008). Community Psychology believes in a variety of research methods and actions. This is why it engages in action-oriented research to create, implement and evaluate programs. There are many debates in the psychology world about whether it’s possible to practice fully in accordance to the Community Psychology principles. These clinical examples highlight the best practices, as well as some of the challenges.
How can CPs utilize Community Psychology Principles for therapeutic work with clients
The mental health system has long struggled to meet the needs of marginalized populations. Often viewed as the most difficult to reach, yet often the most vulnerable, people of color and minorities are more likely to seek out nonvoluntary services. These include in-patient care in section and voluntary access to talking therapies. The literature identified common barriers as language barriers, familiarity and awareness with talking therapies, stigma surrounding mainstream services and the perceived relevance of therapy. These barriers have had an impact on the use Narrative Therapeutic and Community Psychology in interventions. Because Narrative Therapy gives meaning to the individual’s past and identity, it can be seen as a ‘good match’ for Community Psychology’s principles. It recognizes issues such as power and oppression. The literature supports the claim that Narrative Therapy is a ‘good fit’ with Community Psychology principles. “Despite overwhelming evidence showing that social inequalities (such as poverty) fundamentally create, maintain, and perpetuate psychological and physical ill-health, most mainstream psychology therapies continue to promote internalized but de-contextualized theories
“In contrast, narration therapy highlights the importance o ideologic power in human despair, emphasizing how dominant discourses throughout society in relation race, gender, or “mental illness” may impact negatively clients’ wellbeing.” (Kelly & Maloney, 2006). The Trailblazers Project offers a valuable insight into how CPs might work with clients according to the Community Psychology principles. In 2009, The Trailblazer Project began to help Black men with mental disorders. It was funded by the National Delivering Race Equality programme and facilitated in part by Dr Angela Byrne (NHS BME Access Service). The project aimed to increase referrals to psychotherapy. It also investigated whether CP’s have to be sensitive to cultural differences when delivering therapy approaches such as Cognitive Behaviour Therapy. 11 African and Caribbean men took part in the programme. They attended five sessions to learn about The tree, a framework, model, and tool for narrative therapy. This was created by Ncube (2006). Participants had positive experiences, better understanding of talking therapies, and the project demonstrated that CP’s are able to support Community Psychology principles and still work with psychiatry-led service providers. The project’s co-production was successful despite being in a system that primarily delivered 1:1 intervention and within an enhanced Cognitive Behaviour Framework. This helped to ensure the positive outcomes of the project and countered the power discourse within services. Following the program, interventions were made with the Vietnamese and Turkish communities.
My own experience as a CP in adult psychiatry gave me insight into the challenges that CP’s face when trying uphold community psychology principles. As an Assistant Psychologist in The Tower Hamlets BME Access I was responsible for delivering interventions to increase the acceptance and accessibility of talking therapies for Bangladeshi Muslims. The project, “Faith in Recovery”, was delivered in secondary care mental hospitals. This community has a large Bangladeshi community (32%) and the highest number of Muslim residents in England (35%) respectively. The intervention lasts for 8 weeks. Ten participants participated in the session design. Participants requested an imam to be invited to discuss their religious beliefs about mental distress. Through a focus-group, participants expressed interest in having other groups run in similar ways. Members spoke out about the importance and contribution of peer support to the success and design of the group.
Despite the success of the project and the clear commitment to ethnic equality made by the National Service Framework (Department of Health 2005), the service failed to retain my Assistant psychologist to continue the work. The lead psychologist was left with a contract to continue the work. This is a common problem for Community Psychologists. With this in mind, we implemented the intervention in accordance with the community engagement approach (Fountain et.al. 2007). This model seeks collaboration with volunteers to ensure that both parties can share expertise and are able continue to deliver interventions well after CP involvement. Critics of Community Psychology also attack community-run projects. They claim they pose a risk of being unintentionally controlled by the government policy, which essentially makes them a provider of healthcare services (Parker 2007. Others have tried to overcome these problems by strategically partnering with charities. Charlie Alcock’s Music and Change was founded to assist the often marginalized young people who live in socially deprived neighborhoods. They use innovative methods to connect them with talking therapy. For example, they offer’street therapy’, which focuses more on developing trust and rapport with youth in informal settings. These projects have the ongoing challenge of finding funding. They can be costly and take more time to fund.
Sue Holland, a feminist therapist and psychotherapist, created the social action psychotherapy model. She was working with women living on London’s White City Estate. This approach started with individual psychotherapy, moved to groups, and then finally to collective action. This allowed mental health to be reframed. Instead of being treated as a private issue, in primarily biomedical terms it was considered more societal (Holland, 1988). Her work with the Caribbean and African communities highlighted the strength of community in overcoming racism. Her work is frequently cited as an influence by British community psychologists. Her work also influenced Dr. Angela Byrne’s own work with HIV-positive women who are refugees and asylum seekers. Sue Holland (1992) suggested three levels of engagement for Assure women’s projects. They offer individual therapy, group counseling and opportunities for participants to develop strategies together. The project also encourages women to have critical views on psychology and support them in service delivery and design.
CPs can use a lot of their therapy skills to work with community psychologists. Clinical Psychologists can provide group interventions. These interventions are designed and implemented in partnership with voluntary sector organizations. With the goal of continuing work, the community workers can benefit from the expertise of clinical psychologists. A CP is also capable of supporting therapy on a personal basis. This allows clients to talk about their concerns and offer support to others.
Many of the examples above are more ameliorative-oriented than they are transformative. Nelson and Prilleltensky, (2005) made a distinction between the two. While both promoting well-being is a priority, transformative interventions are focused on the transformation of power relations and fighting oppression. Nelson and Prilleltensky (2006) state that most forms or community psychology are beneficial. However, they recommend that more attention be paid to a transformative approach to social justice and creating long-lasting, sustainable changes (Kagan et. al. 2011, 2011). The next topic will discuss how psychologists can use research to share knowledge and create awareness to effect transformative change. How can CP’S employ Community Psychology principles in their research? An important aspect of a CP’s role encompasses the scientist-practitioner commitment to conducting research
How can CPs integrate Community psychology principles into their systemic work?
Beyond the therapy rooms
Psychologists against austerity
Framework for power threat
Festival of community psychology
DCP – Community Psychology Section
Psychologists against austerity
Investigation
Social Action Psychotherapy
The Church of Jesus Christ of Latter-day Saints is a religious organization.
Contextual and discourse maps
Conversation
Being a politician
Community-based interventions are possible if you’re able.
Language use
Sensitivity raising is important
Social action commitment – Influencing public policy
Be the change we desire to see
The tree of Life provides an emotional and physical safe place to explore and share each other’s stories and ‘narratives’. It is a visual metaphor, spanning past and current. Its use in narrative therapy has its greatest value because it focuses on the individual, not symptoms or illness (Margaret Calin 2009).