What does Equality, Diversity and Inclusion look like in the new Clinical Associate in Psychology role?

The Clinical Associate in Psychology (CAP) is a new role aimed at filling the gap between assistant psychologists and registered practitioner psychologists by providing high quality, evidence based psychological interventions.

In these interviews by Elise Dyer, a CAP from our PPN South West CAP Community of Practice, a lecturer on a CAP training programme, a supervisor, and an apprentice CAP discuss how the role relates to issues of equality, diversity, and inclusion.

Rebecca Holtom, Clinical Tutor and Lecturer on the CAP Programme

University of Plymouth

Tell us about yourself, and your role on the CAP programme?
I joined the CAP programme 6 months ago. Prior to this, I worked on the Clinical Psychology Doctorate at Plymouth University, as a clinical tutor for about 15 years.

What’s the difference between DClin and CAP programme tutoring?
Apprentice CAPs have a lot more competencies to demonstrate as part of the apprenticeship requirement. DClin trainees rotate through different services during their training, whereas CAPs are based in one service and become part of the service they work in. This is a real bonus for the CAPs, as the services and their clinical educators witness the apprentice CAP’s progression through their training and, potentially are more invested in them, given they are employed by and will work in the service post qualification. In both however, the clinical tutor role is essentially about making sure the apprentice/trainee is getting a good range of work experience, monitoring their progress, providing them pastoral support, as well as being a link for placement educators with the programme.

You were heavily involved in the University of Plymouth Clinical Psychology doctorate Inclusion, Power, and Diversity (IPD) work. How do you think we can all work towards decolonising Psychology?
The IPD work on the doctorate started by listening to our trainees and working together with them as a staff team to change many aspects of the course. They helped us become more aware of how the threads of inclusion, power and diversity were influencing all areas of the training, from selection, how we assess clinical competency to decolonising research and the curriculum. One of the things I learnt is that we all have blind spots, and often we don't know what we don't know, so making all workforces more diverse and paying attention to the influence of power is so important. This links to my work with service user involvement and I noticed that even in huge organisations, we have the power to make changes that make a difference and that systems around us often are more open to change than we imagine.

What can apprentice CAPs and supervisors do to advocate for Diversity, Inclusion and Power and contribute to decolonising Psychology?
Apprentices and supervisors/clinical educators can champion diversity and service-user's voices within their services. We created Behaviour-4 to document this and have add it to the 119 Knowledge, Skills and Behaviours they have to demonstrate in order to qualify as a CAP. To encourage our apprentice CAPs to champion working together with service users and carers, gaining feedback about their clinical practice and to demonstrate that they are sensitive to how power, social inequalities and inclusion may be impacting on how the services work.

You are leading the Patient and Carer Consultation Group, why do think this is important?
Working closely with service user and carer representatives helps me hold in mind what is important to the people who access services (and their loved ones). We can so easily get caught up in the systems we work in and so having fresh eyes to help us see the person and their lived experience is curial, whether it be about the language we use or questioning what is important to research, service user and carer perspectives help shape our professional work and identities. It is so exciting to continue to develop this strand on the CAP programme at Plymouth, which values co-production with all stakeholders, service use and carers being central to this.

Katia Zikidi, Apprentice CAP

University of Plymouth, working in a Primary Care Mental Health Team

What is it like working as an apprentice CAP, how does it differ from the previous roles?
I feel very grateful for working as a CAP. Previously, I worked as a part time Assistant Psychologist (AP) in an inpatient unit. I struggled financially to pay my bills and maintain an everyday life due to all the night shifts being challenging. This role changed my life for the better and provided me with structure. My supervisor and the team have been fantastic in helping me to evolve as a clinician and build on my existing clinical skills. I feel trusted by my clinical supervisor that I can work semi-autonomously, making clinical decisions under clinical supervision. I feel that my clinical opinions are valued and trusted, and I enjoy having this autonomy in my work which feels different compared to previous roles.

I know you are from Europe, and I wonder what your experiences have been like as a European individual working as a CAP?
I do not think it makes a difference. I reckon, if anything, it helps bond with clients who are slightly misplaced or feel unheard due to their diversity. For instance, using English as a second language, I sometimes lose my words, and I tell my clients that I can’t find the right words to express myself right now. They feel that they can relate to me, and this breaks the power structure between ‘therapist and client’. I have one specific client who uses traditional English and gives me a new word every session. Showing my vulnerability helped us build rapport, and we have a strong therapeutic relationship built on mutual trust and transparency. I believe there is too much perfectionism in the Psychology career, and clinicians can be drawn to perfectionism, but I don’t think we need that so much. I aspire to remain human, and showing vulnerability help clients feel at ease that we are equals, they know some things better than I do, and I know a bit more psychological theory than they do.

One of Plymouth University’s values is being mindful of inclusivity, power, and diversity. Is there anything we could do to ensure we deliver our values better?
I do not think you could do any more than you already did. The program and the teaching were fantastic, inclusive, and mindful of the issues of diversity and power. For instance, I felt disappointed that I had to complete ‘English and Maths’ as part of the Functional Skills requirement of the program as a European student even though I completed an MSc in English. I informed the course leader, Dr Peter Keohane, about my disappointment. He responded empathetically and apologised about the structure and systems that sometimes felt unjust. His response made me feel heard, valued, and respected, which made all the difference, and I am grateful for that respectful and warm response.

How has the training been for you overall?
It has been very helpful; I learnt a lot, and I became more and more confident as time went on. Initially, I had imposter syndrome, and I was nervous about working as a CAP. However, the course taught us brilliant knowledge and clinical skills that we could apply at work immediately. I learnt not to be afraid of asking questions and was made to feel that I had a voice and was valued. 

What specific resources have been beneficial to you?
Having clinical tutors whom I could approach and ask any questions, having lecturers who delivered lectures like talking to their friends, free from ego and power, made me feel very safe. I could approach the teaching team and tutoring team at any point with any questions, and it was answered promptly. I have completed other studies, and my experience at Plymouth University has been outstandingly positive.

What would be your tips for future apprentice CAPs?
I like this question. I would advise future apprentices not to be scared, to bring their authentic selves to the role, trust and let the process shape them as effective clinicians.

What are your hopes and aspirations for the future of the CAP profession?
I want to see the CAP profession become a core profession and be accredited by the right body. I believe we have a depth of knowledge and skills, having completed robust training. I envision CAPs working as independent clinicians under supervision, utilising all the skills we have learnt, such as providing consultation for third parties, delivering therapies, and supervising others.

Finally, in what ways can apprentice CAPs, especially those from ethnic minorities, be supported in their services?
My service has been fantastic, supporting me, listening to my needs, and helping me build a support network for international staff members within the NHS who can meet monthly to support each other. Initially, I was looking for such a group to help me feel supported and to connect with staff who were in similar situations as I was. There were none. Some groups were only open to specific ethnic minorities, but not others. My manager and supervisor encouraged me to set up one that feels inclusive and open to all clinical and non-clinical staff from all ethnic minority groups where we can come together to support each other. I am very proud of this group, ‘Support Network for International NHS Staff’, now running on the ground successfully.

Kelly, Clinical Psychologist

Long-Term Conditions Pathway in an IAPT service and Plymouth University CAP Programme Supervisor
A pseudonym has been used to protect interviewees’ confidentiality

What is it like supervising apprentice CAPs? Does it differ from supervising other professionals?
I have experience of supervising a range of clinicians, including qualified and trainee clinical psychologists, and trainee and qualified high intensity CBT therapists. Supervising trainee CAPs has been a new experience - it is a new post in our service. Overall, I have enjoyed it, and it’s been rewarding. Linking in with an apprenticeship programme has been new and different and interesting. Regular tri-partite reviews with the apprenticeship lead and the trainees’ CAPs course tutor and monthly CAPs peer supervisor sessions have been useful forums and supportive spaces. I have not had previous experience of using a reflective log like QUIVER – this had its challenges but overall it felt like a useful tool.

How have the apprentice CAPs impacted the services they work in?
The apprentice CAPs have been a real asset to the service. They have each brought different skills and experiences from previous roles into their work in the team. Throughout their training, they have developed into effective clinicians providing individual and group therapy to clients with long term conditions (LTCs) with low mood and anxiety. For example, they have co-facilitated a trans-diagnostic therapy group for clients with Long Term Conditions presenting with complex problems. They facilitate our newly developed Chronic Pain workshop and co-delivered training to community health teams working with clients with LTCs. They have achieved good clinical outcomes in their therapy work and received positive feedback from clients they have worked with.

What has been your approach to understanding the perspectives of CAPs from different backgrounds, were there any challenges you faced?
My approach has been to be inclusive and curious about their different experiences and to be available to explore what they bring into the service from their previous roles.  I have tried to keep cultural issues on the supervision agenda and to create a safe space for these issues to be raised.

What do you think apprentice CAPs can do to advocate for diversity, equality, and inclusion in the services they work in?
The trainee CAPs came into their roles from a variety of backgrounds in terms of their clinical experience and also their personal experiences, and this diversity of experience has been valuable. One of our trainee CAPs is an international student who has lived and worked in Europe, holding various posts in different mental health services.  In supervision, we explored her experience of working for the first time in the NHS. She reflected on her overall positive experiences in her first NHS job, but noticed a gap in peer support for international staff within our service and she initiated the setting up of a bi-monthly peer support meeting for international members of the team through discussion with myself and our Clinical Lead.
Additionally, I attended Cultural Competence training as a supervisor and I disseminated my learning from this training in supervision with the trainee CAPs. This led to further discussions about diversity and inclusion and some helpful reflections on their clinical work with clients from diverse backgrounds.

What are your hopes and aspirations for the future of CAPs as a profession?
I hope the CAP profession develops and CAPs become accredited clinicians. Without this, I think CAPs retention could become a challenge for services but creating an attractive profession people want to engage and stay in, and providing appropriate career progression structures for the qualified CAPs will help with this. The trainee CAPs have received robust training in core foundational skills as a psychologist and a route in to further training as a Clinical Psychologist could also be an exciting development.