What is it like to work with Clinical Associates in Psychology?

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 this third edition of interviews by Elise Dyer, a CAP from our PPN South West CAP Community of Practice, a primary care liaison team manager talks about the implementation of the role, and a service user discusses the support she received from a CAP.

Holly, a service user who was supported by a CAP through a Community Mental Health Service

Pseudonyms have been used to protect interviewees’ confidentiality

Please tell us about yourself and what brought you to services.
I am not sure what you need to know, but I can tell you I am under the care of the community mental health team because I have bipolar type 1, which is the most severe form of bipolar. After having a depressive episode at the beginning of the year, my medication kept increasing. Still, nothing seemed to be helping, so my psychiatrist recommended that I go for therapy, and that's how I ended up seeing a CAP within CMHT service.

What was it like working with an apprentice CAP?
I was a bit dubious at the beginning, so I was like, “oh no, I'm not sure about receiving help from an apprentice.” I hold an MSc in Psychology myself, and I was not sure whether I would be more qualified than an apprentice, but she is so great, and she's so lovely. I'm really pleased that I have been able to have these sessions with her. My apprentice is knowledgeable and helped me a great deal. It has been really, really useful. She's amazing and she really understands where I'm coming from, which is great, especially for someone so young she is brilliant.

What aspects of the help you received from an apprentice CAP have benefited you?
I think being able to explore the narrative of my life has been really beneficial and, making links between the experiences I've had in the past and what I experienced on a day-to-day basis has been really useful to identify my feelings and emotions. I can now link between past experiences and current experiences. It's just been really useful to talk about that with an impartial person. I mean, I've said things to my CAP that I haven't said to anyone else which means that obviously I trust her enough to do so. Like I said, identifying emotions and things from the past memories that influenced my behaviour and emotions, and present helped me to make sense of what is going on for me.

Were there any challenges in receiving help from an apprentice CAP?
This has nothing to do with the CAP personally, but recently our work is challenging because we've now moved on to an area of my life which I really haven't discussed with anyone else and my last therapy session, I was actually dreading going because I was just like, “I don't wanna talk about this.” I know I should, but I don't want to. However, my CAP was really encouraging. She was like, “you know, you don't have to, but I think it would be good for you to do so,” and it was. It was an emotional, challenging session facing my past and some aspects of my past but in in a good way. I am pleased I have done it.

What would you say to family and friends about CAPs within services?
I think that it would be amazing if it was made available more widely, and more people were offered these services from CAPs in their local GP’s and NHS mental health services. As I said, I was at the end of my tether and I was not responding to medication anymore. And since having started my work with my CAP I haven't need it to increase my dose, I've actually gone down in medication, not up. It is certainly beneficial, and it would be highly beneficial to a lot of people. I think my CAP in particular, I don't know anyone else, but she does such an amazing job, and she needs to be praised for that because her support has been hugely beneficial to my wellbeing.

Alex Driver, Team Manager

Primary Care Liaison Service, Avon and Wiltshire Mental Health Partnership NHS Trust

What is it like to have apprentice CAPs in your service?  Are there any challenges?
We currently have two apprentice CAPs in our service. It has been beneficial to have them; it has been brilliant to get that psychological input from apprentice CAPs. We are capturing and offering a service to people who are not eligible for other services, and apprentice CAPs are providing brief interventions. We are now able to offer more to the local community. Apprentice CAPs are filling the gap in the service, providing psychological expertise for our multidisciplinary team.

The challenge has been that, like any new initiative, communication has been a little limited as CAPs are supervised by their Clinical Supervisor and attend their training. I do not hear from the Clinical Supervisor for months. I am left out of the loop, unaware of who oversees what aspects of their training. They are psychological practitioners, and I imagine if the manager is unaware of the Psychological Profession and its remits, they might be unable to utilise CAPs in their service. Luckily, I have worked in multidisciplinary teams, and I know how psychology can contribute to teams and enrich team discussions.

How does it differ from having other professions in your team?
The apprentice CAPs add something different; they bring the biopsychosocial approach to the team discussions. The multidisciplinary team discussions become richer with their input, and our discussions are now broader. People are asking questions and trying to find out more about psychological input. As a team, we appreciate multimodal working. My background is in social work, we have nurse colleagues, and the apprentice CAPs help the service with their psychological expertise. We pull together to provide a good service that works using integrative models and appreciates differing perspectives.

What resources have been beneficial to you as a manager who has new team members training in your service?
As a manager, I felt that there was a lack of communication, and it would be good to receive some more input from their Clinical Supervisor and to be involved in some of the discussions. I can’t mould somebody into the service they are working into if I do not know what their professional remits are. I am still not sure who to go to if there is an issue with an apprentice CAP. As a manager, I do not have time to go chase people or identify issues, it would be better if we were a bit involved and work across together helping apprentices develop.

How have the apprentice CAPs impacted the services they work in?
CAPs are helping to improve services and their offer of psychological support, and creating opportunities for people with mental health difficulties that would otherwise not have been picked up to be seen. For instance, people with emotion regulation difficulties, and people with a diagnosis of emotionally unstable personality disorder are sliding through the gaps. They are not well supported by community mental health services nor Improving Access to Psychological Therapies (IAPT) services. We are now offering them support via our apprentice CAPs. I view CAPs as working at Step 3.5 level. The pandemic created a higher need, and everything shifted upward, there is a massive gap. CAPs are filling some of this gap by providing brief interventions for people who risk falling through the gaps in services. Having CAPs is very beneficial for the services.

What are your hopes or aspirations for the future of CAPs?
I hope they get to retain their psychological identity and that element of their job, and are not pulled into working as generic clinicians. Nationally there is a lack of nursing or practitioner level staff, and it might seem easy to shift CAPs into these roles. If they are placed into more generic roles, it would be a real shame as they are signed up and trained for being a clinical associate psychologist, not a generic clinician.